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San Francisco Chronicle Examines Emergency Department HIV Testing Program

HIV/AIDS Advocates Express Concern About Obama's Continuation of Needle-Exchange Funding Ban

Early Initiation of Antiretroviral Therapy Improves HIV Survival Rates, Study Says

Using Social Networks Effective Strategy To Reach Populations at Risk of HIV/AIDS, Study Finds 

More In the News

Delaying HAART Might Prevent Complete Immune System Recuperation, Study Says

Groundbreaking HIV/AIDS study investigates dangers of "down low" label

Awareness Campaign On HIV/AIDS Begins

Hamilton Spectator Examines Debate Over Criminalizing HIV Transmission

PBS Program Features Discussion of HIV/AIDS

Shocking study on Black teen STD rates raises troubling HIV questions as well

Illinois House Rejects Legislation That Would Have Repealed Act Requiring Students To Report Their HIV Status

Faith-Based Organizations Express Support for Needle-Exchange Programs

Illinois Lottery Launches Game To Fund HIV/AIDS Awareness, Prevention

Los Angeles Times Examines Aging Among Long-Term HIV Survivors in U.S.

HIV/AIDS Experts, Doctors Voice Concerns About Health Problems Seen Among Long-Term HIV/AIDS Survivors

Recently Homeless Youth More Likely To Engage in Risky Sex, Increasing Risk of HIV, Other STIs

One Youth's Story

New Book Encouraging Christians To Join Fight Against HIV/AIDS Pandemic

New Rules for HIV-Positive People Visiting U.S. More Restrictive Than Old Regulations, Critics Say

House Democrats Send Letter to Homeland Security Secretary Chertoff Objecting to New Rules for HIV-Positive People Visiting U.S.

Black MSM Twice as Likely as White MSM To Be Living With HIV

Groups Launch AIDSVote.org

"Powerful Link" Between Housing and HIV Transmission Adherence

Antiretroviral Treatment Linked to Health Literacy

MAC AIDS Fund Survey of People in Nine Countries Finds Misconceptions, Stigma

More Than 30 States Have Laws Hindering Physicians From Implementing Routine HIV Testing

Concurrent Sexual Relationships Contribute to Spread of HIV

GRACE Study Involves Record Number of Women, Minorities

Some HIV-Positive People Taking Longer To Initiate Treatment

Black Ministers are Proving the Church Can Lead the AIDS Fight

Socioeconomic Position Associated with Effectiveness of HIV Drugs

CDC Awards $35 Million to Support HIV Testing and Increase Early Diagnosis of HIV among African Americans

HIV-Positive Women Who Become Pregnant Less Likely To Develop AIDS, Die of AIDS-Related Causes

POZ Examines How Stigma, Violence Fuel HIV/AIDS Epidemic in Jamaica

Stop AIDS in Prison Bill Passes 

San Francisco Chronicle Examines Emergency Department HIV Testing Program

Henry J. Kaiser Family Foundation
May 12, 2009     

The San Francisco Chronicle on Monday examined an HIV testing program at San Francisco General Hospital's emergency department, which is part of a nationwide CDC program that offers routine testing to all ED patients. CDC officials say the program has identified more cases of HIV in the U.S. and helps explain a recent rise in the number of new cases. "I can't say that it's all due to emergency room testing, but it's certainly suggestive that that's what's occurring," Bernard Branson, an associate director with CDC's Division of HIV/AIDS Prevention, said, adding, "We're beginning to work down the backlog of these cases and in the process identify not only more people but identify them earlier, so with effective therapy and treatment they can have a normal life expectancy." Branson also explained that patients must verbally consent to receiving an HIV test.

Health officials targeted emergency departments for the program because of the variety of populations they serve, including the uninsured and others who use EDs as their primary health care facility. San Francisco General Hospital has seen an increase in the number of patients tested, from about 150 monthly to 500, while HIV cases have been recorded among patients from a variety of demographics, Beth Kaplan, who oversees the program, said.

The article also profiled an ED testing effort in Fort Worth, Texas. According to the Chronicle, the number of HIV-positive diagnoses made at the JPS Health Network hospital in Forth Worth increased by four times the amount of diagnoses before the hospital increased testing in 2006, up from 17 in 2005 to 98 in 2008. Glenn Raup, the former senior executive director of emergency and trauma services at the hospital, said the testing effort was made in conjunction with hospital-sponsored HIV/AIDS awareness programs. Raup said community awareness has increased and that there is less stigma associated with HIV testing (Berton, San Francisco Chronicle, 5/11).   

Henry J. Kaiser Family Foundation
May 11, 2009     

Although President Obama previously has expressed support for needle-exchange programs as part of HIV/AIDS prevention efforts, advocates recently expressed concern that the administration's 2009-2010 budget proposal intends to continue a funding ban for such programs that dates back to the 1980s, the San Francisco Chronicle reports. Jeffrey Crowley, director of the White House Office of National AIDS Policy, on Friday released a statement saying that the Obama administration "is committed to moving forward to address the federal ban on syringe-exchange programs as a part of a national HIV/AIDS strategy." However, Crowley did not provide an explanation for why the budget continued the funding prohibition for such programs.

According to the Chronicle, Obama's approach to funding needle exchanges "may reflect the political controversy" over such programs, which opponents claim promote illegal drug use. Advocates of the programs assert that research supports their claim that needle exchanges are an effective means of preventing HIV/AIDS and other diseases among injection drug users. Laura Thomas, head of the Drug Policy Alliance Network in San Francisco, said it is "ridiculous that at this point in the epidemic, we're not looking to science in determining what we're funding." She added that state, local and private funding for needle-exchange programs do not provide sufficient resources to reach all IDUs. "Without the federal funding, we're missing people that we could reach," Thomas said. According to Paola Barahona of Physicians for Human Rights, supporters of needle-exchange programs "hoped that the president would seize the first opportunity for lifting federal restrictions." Barahona added, "Denying people at risk for HIV a proven prevention intervention is a denial of their basic human rights."

Soon after Obama took office, the White House Web site featured a statement asserting that the president "supports lifting the federal ban on needle exchange, which could dramatically reduce rates" of HIV/AIDS and other illnesses among IDUs, the Chronicle reports. Although this comment was removed from the site recently, Bill Piper, national affairs director for DPA, said the removal likely was part of a "housecleaning of statements from the transition period rather than a signal of a policy shift," according to the Chronicle. Piper noted that Gil Kerlikowske, director of the White House Office of National Drug Control Policy, supported needle-exchange programs during his confirmation hearings and also while working as police chief in Seattle. In addition, Margaret Hamburg, Obama's nominee to run FDA, sponsored New York City's first needle-exchange program as health commissioner in the 1990s. According to Piper, Obama "wants to repeal the syringe ban," and administration officials have "show[n] moral leadership on the issue, but they really need to show political leadership" (Egelko, San Francisco Chronicle, 5/11).  

Early Initiation of Antiretroviral Therapy Improves HIV Survival Rates, Study Says

Henry J. Kaiser Family Foundation
April 30, 2009     

The New York Times on Thursday examined a study that found asymptomatic HIV-positive people who delayed antiretroviral treatment until their disease reached an advanced stage faced higher mortality rates than those who initiated treatment earlier. According to the Times, current national guidelines recommend starting HIV-positive people on antiretroviral treatment when CD4+ T cell counts fall below 350; however, the recent study suggests that initiating treatment earlier could reduce the risk of death. The study, as well as a related editorial, appeared online in the New England Journal of Medicine earlier this month and both will appear in the April 30 edition of the journal. In addition, a separate study published online earlier this month in the journal Lancet developed similar conclusions about the benefits of earlier antiretroviral therapy initiation, the Times reports.

For the NEJM study, researchers led by Mari Kitahata, director of clinical epidemiology at the Center for AIDS and Sexually Transmitted Infections at the University of Washington, tracked survival rates for 17,517 asymptomatic HIV-positive people in the U.S. and Canada who received care from 1996 to 2005 and who had never previously taken antiretroviral therapy. For their first analysis, the researchers examined a group of 8,362 patients, 2,084 of whom started therapy when CD4+ counts were between 351 and 500. They also examined 6,278 participants with similar CD4+ counts who delayed therapy until their counts declined below 350. According to the study, the patients who delayed treatment had a 69% higher risk of death compared with those who initiated treatment earlier. For the researchers' second analysis, they examined 9,155 HIV-positive people with CD4+ counts of more than 500. Of those, 2,220 started therapy within six months, while 6,935 delayed therapy. Among those who postponed treatment, 3,881 experienced a decline in CD4+ levels and 539 started antiretroviral treatment within six months of having a CD4+ count of 500 or less. In addition, the researchers found that those who deferred therapy had a 94% greater mortality risk than those who initiated treatment earlier.

According to Kitahata, the study examined "one of the most important questions in the last decade: what the optimal timing is for starting therapy." She added that the recent research "provides evidence that patients would live longer if antiretroviral treatment was begun when their CD4+ count was above 500." According to the Times, the study is "not the final word on the matter" (Rabin, New York Times, 4/30).

The study is available online.

Related Editorials
Two related editorials also appeared in the April 30 edition of NEJM. Summaries appear below."When To Start Antiretroviral Therapy: Ready When You Are?:" Although the results of Kitahata's study are "striking," they "cannot be considered definitive evidence that everyone with HIV should start receiving antiretroviral therapy," Paul Sax and Lindsey Baden of the Division of Infectious Diseases at Brigham and Women's Hospital write. They continue that despite the researchers' "relatively large" sample size and use of "advanced statistical methods," their study was not a "randomized trial, and the patients who chose to begin therapy early might have differed in other important ways from those who chose to defer therapy -- ways that improved survival but were not measured." Sax and Baden add that "a conclusion would require data from a randomized, prospective clinical trial, and at least three such studies are either ongoing or planned." They conclude that despite the study's "limitations," evidence supporting the benefits of earlier antiretroviral therapy "continues to increase, making strategies to identify patients with HIV infection before the onset of substantial immunodeficiency all the more compelling" (Sax/Baden, New England Journal of Medicine, 4/30).

"Rationing Antiretroviral Therapy in Africa: Treating Too Few, Too Late:" Although the international health community has achieved "striking advances" in increasing access to antiretroviral treatment in Africa, "too few people are receiving treatment" and health workers "are waiting until people are symptomatic" before administering antiretroviral therapy, Nathan Ford -- head of the medical unit of Medicines Sans Frontieres in Cape Town, South Africa, and research associate at the School of Public Health and Family Medicine at the University of Cape Town -- and colleagues write. They continue that although "delaying therapy may mean saving money on drugs," the "long-term cost of such delays is increased substantially by the need for more intensive clinical care, decreased income and likely regimen switches." In addition, later antiretroviral initiation "encourages the spread of tuberculosis" and could increase the risk of HIV transmission "by allowing patients to remain viremic longer," the authors write. They conclude, "The battle to start providing antiretroviral therapy in the developing world has been won. The battle to provide the best care we can is just beginning" (Ford et al., New England Journal of Medicine, 4/30). 

Using Social Networks Effective Strategy To Reach Populations at Risk of HIV/AIDS, Study Finds 

Henry J. Kaiser Family Foundation
April 30, 2009     

Using HIV-positive people's social network is "an efficient, high-yield" method of contacting their partners who are at high-risk for the virus and providing them with testing and other HIV-related services, CDC researchers said in a recently published study, Reuters Health reports.

For the study, which appears online in the American Journal of Public Health, researchers led by Lisa Kimbrough documented the results of a social networks project that took place between October 2003 and December 2005. For the project, nine community-based organizations in seven cities signed up 422 recruiters. The initial recruiters were HIV-positive, and later recruiters could be HIV-negative but at a high-risk for HIV. The most commonly self-reported behavioral risk factor was having had high-risk heterosexual sex at 46%. The average age of the recruiters was 41.7, and 60% were HIV-positive. Sixty-three percent were men, and 61% were black.

Recruiters referred peers, known as network associates, into the study. On average, the number of network associates referred and tested per recruiter was 7.4. The report found that of the 3,172 network associates referred, 177, or 5.6%, tested HIV-positive and two-thirds were connected to HIV care and services. According to the study, the HIV prevalence among those tested as a result of the project was about five times greater than the prevalence found in other CDC-funded counseling, testing and referral projects.

The researchers said that this was a "significant public health achievement, because persons who learn that they are HIV-positive tend to reduce their high-risk behaviors to avoid infecting others and have the opportunity to access medical care and other services to improve their personal health." They added that the social networking strategy was more effective and a better use of staff time at contacting undiagnosed HIV-positive people, compared with the common approach of partner counseling and referral services (Reuters Health, 4/29).

An abstract of the study is available online.

People living with HIV who do not start highly active antiretroviral treatment until their CD4+ T cell counts drop below 200 might not be able to reach a normal CD4 cell count, even after 10 years of otherwise effective treatment, according to a study in the March 15 issue of Clinical Infectious Diseases, Reuters reports. According to Reuters, an HIV-positive person is considered to have a normalized immune status after CD4 counts are maintained above 500.

For the study, researchers examined 366 HIV-positive people who had maintained plasma HIV RNA levels of no more than 1,000 copies per milliliter of blood for at least four years after starting therapy. About 25% of the study's participants were followed for more than 10 years, with a median follow-up of 7.5 years. Reuters reports that 95% of the participants who started therapy with a CD4 cell count of at least 300 were able to reach a normalized CD4 cell count of at least 500. The researchers reported that 44% of participants who began treatment with a CD4 cell count of less than 100 -- as well as 25% who began treatment with a CD4 cell count of between 100 and 200 -- were not able to reach a CD4 cell count higher than 500.

Lead author Steven Deeks of the University of California-San Francisco and colleagues wrote that a "persistently low CD4 cell count during treatment is associated with increased risk of both AIDS and non-AIDS related events," such as liver disease, cardiovascular disease and cancer. They added that "novel immune-based therapeutic approaches may be necessary to restore immunocompetence in these individuals." In a related editorial, Boris Julg and Bruce Walker, both of Massachusetts General Hospital, wrote that major treatment guidelines recommend beginning antiretroviral therapy when CD4 cell counts drop below 350, adding that it can be difficult for developing and low-income countries to follow such advice. Julg and Walker wrote that "adequate early therapy, leading to more-complete immune reconstitution, may save resources because of the resulting lower incidence of opportunistic infections and reduced need for medical care" (Reuters, 4/7).

An abstract of the study is available online. An abstract of the accompanying editorial also is available online.

U.S. to Spend $45 Million Over 5 Years

By Darryl Fears
Washington Post Staff Writer
Wednesday, April 8, 2009; Page A03

The Obama administration began a five-year, $45 million media blitz yesterday to spark awareness about HIV infection and AIDS, saying that Americans have grown complacent about the deadly illness even though it represents "a serious threat to the health of our nation." The campaign, Act Against AIDS, will include public service announcements, advertising on trains, buses and other modes of public transportation, text messages and a Web site, http://NineAndaHalfMinutes.org, a reference to the frequency with which people are infected.

"There is a complacency . . . a false sense of security and a false sense of calm," said Kevin Fenton, director of the national center for HIV/AIDS at the Centers for Disease Control and Prevention. "Every 9 1/2 minutes, someone's mother, someone's daughter, someone's father, someone's friend is infected."

Fenton said the aim of campaign, at a cost of $9 million a year, "is to put the HIV epidemic back on the front burner, on the radar screen." But the program is being criticized as inadequate by a leading HIV/AIDS nonprofit group.

Read the full article here.

Hamilton Spectator Examines Debate Over Criminalizing HIV Transmission

Henry J. Kaiser Family Foundation
Apr 07, 2009 

The Hamilton Spectator on Monday examined debate among some legal experts and HIV/AIDS advocates over criminalizing HIV transmission for those who know they are living with the virus. The Spectator examined the case of Johnson Aziga, an HIV-positive Canadian resident who on Saturday was convicted of murder for not informing sexual partners of his HIV status and knowingly spreading the virus. One of Aziga's sexual partners who became contracted the virus died. According to the Spectator, although some people believe that knowingly spreading HIV should be considered a criminal act, many HIV/AIDS advocates contend that such actions are unreasonable and counterproductive. Edwin Bernard, a freelance writer and editor who specializes in HIV/AIDS-related issues, said Aziga's trial is particularly significant because it is the first case worldwide to consider whether intentional HIV transmission can constitute homicide. Bernard added that Aziga's case "raises all kinds of moral and legal questions about responsibility and blame."

Winifred Holland, a former University of Western Ontario law professor, said she believes most HIV-positive people are responsible, get tested and disclose their status. However, she added that the law should intervene when public health measures do not work. According to Holland, criminal sanctions "protect the public from behavior that people see as potentially damaging and threatening to society." She said that such criminalization would protect the public from "a minority who are hell-bent on either deliberately or recklessly infecting other people" with HIV. She added, "To me, it's just a no-brainer to criminalize" reckless HIV transmission. Holland also said that such a measure only would "be used in these pretty extreme cases," adding, "If the measure isn't required, it won't be used."

However, many HIV/AIDS advocates assert that criminalizing HIV transmission "in any circumstance risks demonizing all people with HIV." According to the Spectator, these advocates argue that it would be unreasonable to compel people to disclose their HIV status under the law, particularly because some people are unaware that they carry the virus. In addition, criminalizing HIV transmission could worsen the discrimination and stigma associated with the virus, some advocates say. Alison Symington, senior policy analyst with the Canadian HIV/AIDS Legal Network, said, "The majority of coverage in the media about HIV is focused on the few people who are facing criminal charges, and the risk with that is that it puts the idea in the minds of the general public that all people living with HIV are potential criminals." Moreover, criminalizing transmission could discourage people from seeking HIV testing, prevention and treatment services, according to some advocates. Bernard said, " If this means that even one person who has HIV but doesn't know it is then put off from testing or treatment, subsequently goes on to unwittingly infect others and eventually, needlessly dies, then this trial has done more harm than good" (Hemsworth, Hamilton Spectator, 4/6).  

Groundbreaking HIV/AIDS study investigates dangers of "down low" label 

PrideSource
Originally printed 4/2/2009 (Issue 1714 - Between The Lines News) 

PHILADELPHIA - Researchers at Public Health Management Corporation published a study in the American Journal of Public Health showing that black men who have sex with men and women and identify themselves as on the "down low" engage in the same level of risk with women as behaviorally bisexual men who do not identify themselves as "down low." PHMC senior researcher Dr. Lisa Bond explains, "The findings of our research underscore the importance of focusing on behavior and not subjective labels like 'down low.'" Bond explains, "Our research shows that not all bisexually active men who refer to themselves as 'DL' are having sex with women, while a significant number of bisexually active men who do not call themselves 'DL' are having sex with women." 

Funded by the Centers for Disease Control and Prevention, the PHMC study is the largest of its kind to investigate the link between the DL and HIV infection. Based on interviews with over 1,100 Black gay, bisexual and straight-identified MSM, the study focuses on residents from Philadelphia and New York City, including 361 men who considered themselves DL. 

According to Dr. Darrell Wheeler, an Associate Dean and Professor at the Hunter College School of Social Work in New York and one of the lead investigators of this study, "Men on the down low have been characterized by the media as black men who are pretending to be straight, while secretly engaging in sex with men and possibly spreading HIV to unsuspecting female partners. This is an oversimplification of a socially constructed label that does not have a singular meaning." 

Henry J. Kaiser Family Foundation
Dec 18, 2008

A new study has found that HIV appears to attack normal, healthy genital tissue in women and does not require breaks in the skin to infiltrate cells, offering new perspectives on how the virus is spread, researchers said on Tuesday, Reuters reports. Thomas Hope, a study author from Northwestern University's Feinberg School of Medicine, said that scientists have had little detailed understanding of how HIV is transmitted sexually in women and that it was "previously thought there had to be a break in [genital tissue] somehow" for women to contract the virus. He added that the study's findings show that "normal skin is vulnerable."

For the study, researchers in a partnership between Northwestern and Tulane University introduced HIV -- which carried fluorescent, light-activated tracers, a new method developed to better see how the virus worked -- to newly removed vaginal tissue taken from hysterectomy surgeries. A microscope was used to observe the virus as it penetrated the outer lining of the female genital tract -- also called the squamous epithelium -- and found that HIV was able to move quickly past the skin barrier to reach immune cells. The process also was observed in nonhuman primates, according to Reuters. In addition, the results of the study suggest that HIV focuses on areas of the genital tissue where skin cells recently had been shed, Hope said (Steenhuysen, Reuters, 12/16). Hope said the results are "an important and unexpected result -- we have a new understanding of how HIV can invade the female vaginal tract." He added, "We urgently need new prevention strategies or therapeutics to block the entry of HIV through a woman's genital skin" (BBC News, 12/17).

According to Reuters, researchers in the past have assumed that HIV sought out breaks in the skin -- like a herpes sore -- to gain access to immune system cells deeper in tissue, and some thought the normal lining of the vaginal tract could work as a barrier to transmission during sexual intercourse. Reuters reports that the study "casts doubt" on the theory that HIV transmission requires a break in the skin or that the virus gains access through the cervical canal's single layer of skin cells. The findings also "might explain why some prevention efforts" -- such as diaphragms or herpes treatment -- have "failed," Reuters reports (Reuters, 12/16).

Lisa Power from the Terrence Higgins Trust in the United Kingdom said the results are an "important finding" but "sadly, not surprising" because it has been "long known that it is easier for a man to transmit HIV sexually to a woman than for a woman to transmit it to a man." She added that the study "helps us understand why" and "will help in developing better prevention mechanisms -- but until then, it's more clear than ever that a condom is a vital part of safer sex." The British not-for-profit organization AVERT said that the study "serves to strengthen" the argument for condom use during heterosexual intercourse and "will hopefully give weight to the need for safer heterosexual sex to be advocated further by governments and practitioners worldwide" (BBC News, 12/17). According to Hope, the findings emphasize the importance of methods to prevent transmission, such as a vaccine and condom use. He said, "People need to remember that they are vulnerable. The sad part is if people just used a condom, we wouldn't have this problem" (Reuters, 12/16).

Henry J. Kaiser Family Foundation
Aug 05, 2008 

A panel of the International AIDS Society-USA in the Aug. 6 issue of the Journal of the American Medical Association issued new recommendations for when doctors should begin antiretroviral treatment for patients with HIV, AFP/Google.com reports. The recommendations also were presented Sunday at the opening of the XVII International AIDS Conference in Mexico City (AFP/Google.com, 8/3).

Under previous recommendations, doctors delayed antiretroviral treatment until CD4+ T cells were nearly depleted and the body could no longer fight off infection from other illnesses because physicians wanted to keep the virus from developing resistance to treatment (Lauerman/Pettypiece, Bloomberg, 8/3). Usually doctors would begin treatment when CD4+ T cell counts reached fewer than 200 to 250 cells per milliliter of blood. Those recommendations were issued 12 years ago, when antiretrovirals were first introduced, treatment failure was common and there were few available treatments (AFP/Google.com, 8/3).

IAS-USA said those recommendations should be overhauled because there are now a greater number of more effective, less toxic drugs. The authors, led by Scott Hammer, an AIDS researcher at Columbia University, wrote, "The substantial toxicity and inconvenience of early regimens dampened enthusiasm for starting therapy at higher CD4 counts." They added, "However, newer regimens are potent, durable and less toxic."

IAS-USA recommended that doctors begin antiretroviral treatment when CD4+ T cell counts reach 350 copies per millileter of blood, though patients with heart, liver or kidney disease might require earlier treatment (Bloomberg, 8/3).

According to the researchers, benefits of earlier treatment of HIV include lower incidence of lung, anal, head and neck cancers; cardiovascular disease; and kidney and liver dysfunction (AFP/Google.com, 8/3). The organization's recommendations were based on a trial of more than 5,000 patients that ended last year that showed the advantages of starting treatment before the virus progresses (Bloomberg, 8/3).

The IAS-USA recommendations also could prompt doctors to combine recently approved drugs, including raltegravir, maraviroc and etravirine, with combination with older treatments to keep down viral levels and boost CD4 counts, AFP/Google.com reports.

According to AFP/Google.com, the IAS-USA recommendations are intended for high-income countries and "selected" middle-income countries where good diagnostic infrastructure and multiple drug options make it relatively easy for physicians to treat HIV-positive people.

In addition to less funding, low-income countries often have a smaller range of treatment options and lack the means to determine if a patient is responding to drugs. However, the researchers said the "core principles" of the IAS-USA guidelines are applicable to developing nations and provide ways to make treatment and patient monitoring simpler and less costly. "Progress with antiretroviral roll-out in the developing world is encouraging, but recent advances in the highly resourced world need to be adapted and translated to the developing world to realize these benefits," the researchers added (AFP/Google.com, 8/3).

The recommendations are available online.

Tuberculosis Drug Interferes With HIV Treatment, JAMA Study Says 

Henry J. Kaiser Family Foundation
Aug 05, 2008 

The antiretroviral drug nevirapine is less effective in people with HIV/tuberculosis coinfection who begin taking nevirapine at the same time as the TB treatment rifampicin, according to a study published in Wednesday's HIV/AIDS-themed issue of the Journal of the American Medical Association and released at the XVII International AIDS Conference in Mexico City, BBC News reports.

For the study, Andrew Boulle of the University of Cape Town in South Africa and colleagues analyzed outcomes from approximately 4,000 people who began antiretroviral therapy between 2001 and 2006 (BBC News, 8/4). The researchers assigned 2,035 people to begin HIV treatment with the antiretroviral efavirenz, 1,074 of whom had TB. The researchers assigned nevirapine to 1,935 people, 209 of whom also had TB. All of the study participants with TB received rifampicin.

Among people receiving nevirapine who also had TB, 16.3% were about twice as likely to have increased HIV viral loads after six months, compared with 8.3% among HIV-positive people taking nevirapine who did not have TB. In addition, patients with HIV/TB coinfection were more than twice as likely to develop treatment failure at a faster rate as those without TB. However, after 18 months, 80% of people with HIV/TB coinfection taking nevirapine had reduced HIV viral loads (AFP/Melbourne Herald Sun, 8/4). Nevirapine also was found to be effective among patients who started taking it before beginning TB treatment. The researchers found no difference in the effectiveness of efavirenz among people who took it alone and those who took it in combination with rifampicin (BBC News, 8/4).

According to AFP/Herald Sun, the study's findings are important because approximately one-third of people living with HIV/AIDS also have TB, and the death rate among people with HIV/TB coinfection is five times greater than among those with only TB (AFP/Melbourne Herald Sun, 8/4). The findings also are important because physicians in developing countries often initiate antiretroviral therapy in TB clinics because TB is common among people living with HIV/AIDS, BBC News reports. In addition, nevirapine is commonly used as a first-line antiretroviral in developing countries because it is inexpensive and safe for pregnant women (BBC News, 8/4).

According to Boulle, it is unclear why rifampicin has an impact on nevirapine, but it is possible that the drugs have a shared toxicity when used in combination or that rifampicin induces a drug reaction when patients begin antiretroviral treatment (AFP/Melbourne Herald Sun, 8/4). Boulle said that further research on the interaction between nevirapine and rifampicin is needed given Africa's reliance on nevirapine-based therapies and the importance of treating TB in people with HIV/TB coinfection. Boulle added that a "striking" aspect of the study is that 40% of HIV-positive individuals starting antiretroviral treatment have concurrent TB, which "underscore[es] the public health importance of improving affordable treatment options" for patients with HIV/TB coinfection.

John Howson, associate director of the International HIV/AIDS Alliance, said that the study demonstrated that antiretroviral therapy may "compromise" TB treatment but added that "this needs more research" (BBC News, 8/4).

An abstract of the study is available online.

HIV risk from heterosexual intercourse may be underestimated 

Agence France Presse
August 5, 2008 

MEXICO CITY (AFP) — The standard method for assessing the risk of HIV infection through heterosexual intercourse could be badly wrong, according to a study to be presented at the International AIDS Conference here on Tuesday.

The paper, published online late Monday by the journal The Lancet Infectious Diseases, takes issue with a yardstick widely used by epidemiologists and says it may have helped fuel misperceptions that HIV is hard to catch for heterosexuals.

This yardstick suggests that transmission of the HIV virus occurs on average once with every 1,000 acts of heterosexual intercourse between someone who is infected and another who is uninfected.But the measurement is based on stable couples where there is a low prevalence of risk factors, according to an overview of the published evidence, led by Kimberly Powers of the University of North Carolina.

In other scenarios, these risk factors can multiply the chances of transmission by a factor of between several times and several hundred times, it suggested.

Powers' team found zero transmission after more than 100 acts of penile-vaginal intercourse among a study group of so-called serodiscordant couples -- couples in which one partner has the human immunodeficiency virus (HIV) while the other does not.

At the other end of the range, infection occurred for every 3.1 acts of heterosexual anal intercourse, the investigators found.

These risks could be amplified by other factors, such as men who were not circumcised -- circumcision has been found to provide some protection against infection -- or if a partner had genital ulcers, or was at the early or late stage of HIV infection, when virus levels are higher.

"The use of a single, one-size-fits-all' value for the heterosexual infectivity of HIV-1 obscures important differences associated with transmission cofactors," the study said.

The measurement of one infection per 1,000 acts of intercourse "seems to represent a lower bound. As such, this value substantially underestimates the infectivity of HIV-1 in many heterosexual contexts," it said.

The study says there remain many blanks in the knowledge about heterosexual infectivity, such as the area of oral sex.

The 17th International AIDS Conference opened on Sunday in the Mexican capital, drawing 22,000 doctors, field workers, scientists and policymakers from around the world. It runs until Friday.

Henry J. Kaiser Family Foundation
Aug 04, 2008  

The percentage of U.S. high school students engaging in sexual behaviors that can spread HIV and other sexually transmitted infections declined between 1991 and 2007, according to a study published Friday in CDC's Morbidity and Mortality Weekly Report, Reuters Health reports.

For the study, researchers analyzed data from several Youth Risk Behavior Surveys conducted during the study period and found that the percentage of high school students who were sexually experienced decreased by 12%. The researchers also found that the percentage of students who had multiple sexual partners decreased by 20% and that the percentage who were currently sexually active decreased by 7%. During the study period, the percentage of students who used a condom increased by 33% (Reuters Health, 7/31).

Between 1995 and 2007, the prevalence of injection-drug use among high school students remained below 4%. The study did find a significant increase in injection-drug among black and Hispanic students (MMWR, "Trends in HIV- and STD-Related Risk Behaviors Among High School Students-United States, 1991-2007," 8/1).

According to the report's findings, risky behaviors among black, Hispanic and male students did not decrease to the same extent as observed in the overall study group. In addition, from 2005 to 2007, the researchers found no significant changes in the prevalence of risky behaviors, according to Reuters Health.

In a related report, CDC researchers found that most U.S. secondary schools include HIV prevention education as part of their health curricula. Of the states surveyed, New York had the highest percentage of schools that taught HIV prevention at 99.3%, and Arizona had the lowest percentage at 35.6%. The researchers also found that only a few of the school surveyed provide information on all 11 prevention topics listed on the study questionnaire. According to the authors, schools "should increase efforts to teach all HIV prevention topics" to help reduce HIV-related risk behaviors (Reuters Health, 7/31).

Henry J. Kaiser Family Foundation
Aug 04, 2008 

CDC on Saturday ahead of the XVII International AIDS Conference, which opened Sunday in Mexico City, released updated national estimates of the annual number of new HIV infections that occur in the U.S., the Washington Post reports (Brown, Washington Post, 8/3). The new data were published Sunday in a special HIV/AIDS issue of the Journal of the American Medical Association, which was released at the AIDS conference (CDC release, 8/3).

The new analysis found there were about 56,300 new HIV infections in 2006, the most recent year for which data are available, about 40% higher than CDC's long-standing estimate of 40,000 for each of the last several years (Washington Post, 8/3). According to CDC, the number of new infections likely was never as low as the previous estimate of 40,000 and has been relatively stable overall since the late 1990s (CDC release, 8/3). According to the Post, the estimate is based on data from a new advanced testing method, which enabled researchers to detect recent HIV infections (Washington Post, 8/3). The study did not calculate the total number of U.S. residents living with HIV/AIDS, although such estimates are expected soon. Earlier projections estimated that about 1.2 million people in the U.S. are HIV-positive, and CDC is updating that number, the Boston Globe reports (Smith, Boston Globe, 8/3).

Among sub-groups, the report found that:

Men who have sex with men accounted for 53% of all new infections;

Non-Hispanic blacks accounted for 45% of new infections (Sternberg, USA Today, 8/2);

People in their 30s had the highest number of new HIV infections, while people younger than age 30 accounted for 34% of all new infections;

73% of new infections were recorded among men (Washington Post, 8/3);

Injection drug users accounted for 12% of infections; and

Heterosexuals made up 31% of new infections.

Although the report indicates general stability in new infections nationally, as well as reductions in new infections among both IDUs and heterosexuals over time, it also shows increases among MSM (CDC release, 8/3).

HIV incidence in 2006 among blacks was 83.7 infections per 100,000 people, seven times as high as the rate of 11.5 per 100,000 among whites and three times as high as the 29.3 infections per 100,000 people among Hispanics (Altman, New York Times, 8/3). According to the data, although new infections among blacks are higher than among any other racial or ethnic group, the number has been relatively stable since the early 1990s (CDC release, 8/3).

Historical Analysis
According to the analysis, new HIV infections peaked at about 130,000 annually in the mid-1980s and decreased to a low of about 50,000 annually in the early 1990s. The number of new infections increased in the late 1990s and has been relatively stable since then, with estimates of between 55,000 and 58,500 new infections annually in the three most recent time periods that were analyzed, according to the study (New York Times, 8/3).  Prevention, Funding
According to the Post, CDC spends about $750 million each year on prevention efforts. About half of CDC's HIV prevention budget targets blacks, Kevin Fenton -- director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention -- said. However, he added that the increasing incidence in MSM -- particularly in young black MSM -- is evidence that prevention campaigns have "not reached all those who need it" (Washington Post, 8/3).

According to Fenton, the recent relative stability in incidence is somewhat good news because the overall number of people living with HIV who could potentially pass the virus on to others is increasing as HIV-positive people are able to live longer due to antiretroviral drugs. That suggests those people are taking steps to prevent spreading the virus, the San Francisco Chronicle reports (Stannard, San Francisco Chronicle, 8/3). "Over 95% of people living with HIV are not transmitting to someone else in a given year," David Holtgrave of the Bloomberg School of Public Health at Johns Hopkins University said, adding, "What that says is the transmission rate has been kept very low by prevention efforts" (Washington Post, 8/3).

An analysis last year by Holtgrave and Jennifer Kates, a Kaiser Family Foundation vice president and director of HIV policy at the foundation, showed a correlation between the amount of funds spent on prevention and HIV incidence. "You get what you pay for," Holtgrave said, adding, "I think the new statistics are the most important AIDS story in the U.S. since the advent of the new treatments" (USA Today, 8/3).  

Comments
According to the Globe, the fact that more people than previously thought might have contracted HIV since the late 1990s will have "profound consequences" for physicians, policymakers and HIV/AIDS advocacy groups (Boston Globe, 8/3).

CDC Director Julie Gerberding said that the new data likely will influence decisions about efforts to control the epidemic. She added that although HIV incidence is "certainly too high," it is "stable." According to Gerberding, a "stable number of new infections in a world that has got more and more people with HIV and people with AIDS living in it suggests that we are keeping up with that pressure for transmission" (New York Times, 8/3).

Several HIV advocates expressed anger at CDC's delay in releasing the data, which were available in October 2007 when the agency completed the study, the Wall Street Journal reports. UNAIDS Director Peter Piot said that "timely information is important for prevention." Kate Krauss, a spokesperson for Physicians for Human Rights, said, "Science-based AIDS prevention means having access to accurate data about how many people are becoming infected," adding, "Without it we are shooting in the dark" (Chase, Wall Street Journal, 8/4).

The agency's delay in releasing the data also has fueled criticism that the Bush administration has not done enough to fight HIV/AIDS in the U.S., according to the Times. Rep. Henry Waxman (D-Calif.) said HIV prevention efforts have been "underfunded and too often hindered by politics and ideology," adding that, when adjusted for inflation, the administration's domestic spending on HIV/AIDS has decreased by 19% since 2002. Waxman also said he plans to hold congressional hearings on why CDC has had "less and less money to actually get [HIV prevention] programs to the communities that need them."

Gerberding responded to the criticism, saying that the data have "been scrutinized by some of the best statisticians in the country and is much better now than when we started this process" (New York Times, 8/3). Gerberding added that the new data represent the "most reliable estimate" since the "beginning of the epidemic" (Stobbe, AP/San Francisco Chronicle, 8/3).

Fenton said, "It's important to note that the new estimate does not represent an actual increase in the number of new infections but reflects [CDC's] ability to more precisely measure HIV incidence and secure a better understanding of the epidemic" (CDC release, 8/3). However, Fenton added that the "fact remains that there are far too many people becoming infected in the United States every year. Therefore, these findings should be a wake-up call ... that the epidemic in the United States is far from over" (San Francisco Chronicle, 8/3).
An abstract of the study is available online.

More information on the new estimates are available online from the CDC.

Henry J. Kaiser Family Foundation
July 14, 2008

Henry J. Kaiser Family Foundation
Jun 30, 2008

The pending reauthorization of the U.S. President's Emergency Plan for AIDS Relief, commonly called PEPFAR, is a clear challenge for our government to demonstrate its commitment to human dignity and life.

PEPFAR would be expanded dramatically by legislation, S 2731, now before the Senate and already passed by the U.S. House of Representatives (and with the long name of "The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, H.R. 5501").

Funding would be tripled to $50 billion over the next five years. While the increased funding is a tremendous step forward, the House version also contains ideological restrictions that will prevent the funds from most effectively containing the spread of HIV by blocking the participation of family planning programs.

The Religious Coalition for Reproductive Choice and our partners in the interfaith community are urging the Senate to hear the voices of people of faith on the issue of AIDS relief. These are people from diverse traditions who share common principles of justice and compassion and the belief that we have a moral responsibility to help the vulnerable and the sick to the full extent of our ability.

Simply put, we want PEPFAR to be reauthorized and we welcome the increased funds -- but we want language restricting the participation of family planning organizations to be removed.

This language requires that organizations must comply with the global gag rule -- the requirement that foreign organizations receiving U.S. funding must not provide abortion counseling or services or conduct advocacy on abortion policy. We believe that an ethical policy will support the best and most flexible approaches possible to contain the spread of HIV. Experience shows that involving family planning organizations will ensure the greatest level of access to information and services for women and girls.

We also are concerned by an onerous reporting provision in the bill that would require Congress to be informed when countries with generalized epidemics fall below 50 percent of funds spent on abstinence and fidelity programs. Instead of promoting programs that allow for flexibility and are tailored to the needs of individual communities, the new reporting policy will restrict delivery of comprehensive and integrated information.

Those involved in our community response on PEPFAR include 26 Protestant, Catholic, Jewish, Unitarian Universalist, ecumenical and interfaith agencies and bodies. We are actively reaching out to our constituencies to underscore that this issue involves our faith commitments, including our commitment to action for social justice.

HIV and AIDS have had devastating consequences throughout the developing world - consequences that can be prevented by empowering the most vulnerable populations with proven prevention strategies.

The United States launched PEPFAR in 2003 as the largest investment ever made by any nation to combat a single disease. PEPFAR has successfully brought AIDS treatment, care and HIV prevention to millions of people who would not otherwise have had services. But constraints on prevention and care are contrary to the authentic moral concerns of the American public for those suffering from HIV/AIDS. The religious and religiously affiliated organizations opposing these constraints have pointed out that they directly affect women, youth, and socially marginalized groups - those who increasingly bear the greatest burden of this pandemic and who often receive medical care mainly or only from family planning organizations.

It is our moral duty to challenge our government to adopt the most effective, humane and just policy to contain the HIV/AIDS pandemic, without ideological restrictions and constraints.

What is a Woman Worth? The Feminization of AIDS

Marcy Bloom
June 9, 2008
On The Issues Magazine

What is a woman worth?

HIV infections among women and girls have risen in every part of the world in recent years. The numbers point to a fundamental and startling reality -- the HIV/AIDS pandemic is inextricably linked to the brutal effects of sexism and gender inequality, most pronounced in Africa.

Consider these statistics: The latest reports from the UNAIDS (Dec. 2007) show 33.2 million people are living with HIV throughout the world. Sub-Saharan Africa has more than two-thirds (22.6 million) of the total number of HIV infections. Sixty-two per cent (14 million) of those infected are women and adolescent girls. Seventy-five per cent of all HIV-positive women in the world are African.

Why are we allowing women and girls to die from this preventable and treatable disease? What is a woman worth in our world today?

"The toll on women and girls presents Africa and the world with a practical and moral challenge, which places gender at the center of the human condition. The practice of ignoring gender analysis has turned out to be lethal…what has happened to women is …a gross and palpable violation of human rights," said Stephen Lewis, former UN Secretary-General's Envoy to Africa, at the International AIDS Conference in Barcelona, Spain in 2002.

Many forms of violence against African women contribute to, and worsen, the devastation of women and girls from the HIV/AIDS virus. Women and girls are often ill informed about sexual and reproductive matters and are more likely than men and boys to be uneducated and illiterate. Physiologically, women are two to four times more likely than men to become infected with HIV, but they lack social power to insist on safer sex or to reject sexual advances.

Gender-based violence and harmful traditional practices are some of the major risks for contracting the HIV virus. These include sexual violence, marital rape, domestic violence, early child marriage of young girls to older men, forced marriage, wife inheritance, widow cleansing, polygamy, and female genital mutilation.

Poverty forces many women into subsistence sex work or transactional relationships that preclude negotiating condom use. For economic reasons, women are often unable to leave a relationship, even if they know that their partner has been infected or exposed to HIV. In many African countries, women are designated as minors, lack their own earning power, are unable to obtain credit and cannot own or inherit property.

The oppressive economic dependency of women on men is a core aspect of gender relations in this region. This critical issue must be taken on with real solutions and basic societal changes by governments, AIDS programs, non-profit groups, and, most importantly, the women themselves.

Thoraya Obaid, the executive director of the United Nations Population Fund (UNFPA), said in 2006: "Women and girls are vulnerable to AIDS not because of their individual behavior, but because of the discrimination and violence they face, the unequal power relations. Even being married is a risk factor for women … Female HIV infections are on the rise in Asia, Eastern Europe, and Latin America, as well as in Africa. And AIDS is the leading cause of death for 25-34-year-old African-American women in the United States … only by addressing the needs and human rights of women and ensuring their full participation will we change the course of this disease."

Link to the full article.

Verizon Wireless Continues Support of National HIV Testing Awareness Campaign

ALPHARETTA, Ga.,
June 23
PRNewswire

The message about the importance of HIV testing is getting out to the general public, thanks to the innovative use of wireless communications. Verizon Wireless, the company with the nation's most reliable wireless voice and data network, announced today its continued effort to draw awareness to the importance of HIV testing and encourage everyone to know their status. In honor of National HIV Testing Day on June 27, an annual event organized by the National Association of People with AIDS (NAPWA), Personal Public Service Announcements (PPSAs) -- created from "man on the street" interviews captured in Atlanta using wireless video phones and technology -- will be broadcast via a variety of channels on the Web, television and through the Verizon Wireless network.

In partnership with the University of Georgia's New Media Institute and with the support of the Centers for Disease Control and Prevention (CDC), Verizon Wireless participated in events in Atlanta and Philadelphia over the past year, making wireless phones a new medium in the fight against HIV/AIDS. The use of the PPSAs created at the Atlanta event for National HIV Testing Day is the culmination of those efforts.

"It's exciting to see how wireless equipment and our network can capture and make available critical health messages to the public at large," said Jeff Mango, president of the Georgia/Alabama region for Verizon Wireless. "Wireless technology no longer is just a one-to-one communication tool. It serves a much broader social networking role in our individual lives and in our communities. It's critical that we all continue to harness the power and reach of wireless technology for the greater good."

In both Philadelphia in 2007 and Atlanta in 2008, public service announcement videos were created by college students and delivered on personal mobile media devices. Using Verizon Wireless phones and data equipment, student teams from Emory University, the University of South Carolina, Clark Atlanta University, Georgia State University, Georgia Institute of Technology, Temple University, Chapman University, and the University of North Texas collaborated during each event with health experts from the CDC, as well as professional producers and editors from around the country, to shoot, edit, produce, and premiere short video PPSAs encouraging HIV testing. These PPSAs will be distributed ahead of June 27 to increase the awareness of the upcoming National HIV Testing Day.

The videos will be distributed in a variety of ways including e-cards, podcasting on key Internet sites, e-mail distribution, YouTube, MySpace, Verizon Wireless' V CAST network, Verizon Communications FiOS network, and more.

"Delivering health messages to young people today can be frustrating," said Dr. Scott Shamp, director of the New Media Institute and professor of telecommunications at UGA's Grady College of Journalism and Mass Communication. "A whole generation isn't using their parents' media, so we have to find new ways to reach them. Mobile media has powerful potential for reaching young people with information to help them stay healthy and protect others."

National HIV Testing Day is an opportunity for people nationwide to learn their HIV status and to gain knowledge to take control of their health and their lives. According to the CDC, more than a quarter million people are estimated to be living with HIV and are unaware of their infection. Often those infected exhibit no visible symptoms and are more likely to pass the virus to others. Knowing infection status can lengthen life expectancy dramatically as patients are able to start treatment earlier.

The New Media Institute is an interdisciplinary unit of the University of Georgia's Grady College of Journalism and Mass Communication. The institute explores the creative, critical and commercial dimensions of innovative digital communication technology. For more information, visit www.nmi.uga.edu.

AIDS Failure at Merck Elevates Burton Vaccine for 2 Million

By John Lauerman
June 20, 2008
Bloomberg

(Excerpted from full article)

On a sunny March afternoon, Dennis Burton draws his office blinds, blocking a view of the 10th tee at La Jolla's Torrey Pines South Course and Southern California's Pacific surf.

Instead, he turns to a handful of twisted, translucent yellow models, each smaller than a bar of soap. This set of what look like dog chew toys holds the key to Burton's mission to halt the spread of AIDS, the pandemic that has killed 25 million people in a quarter century and threatens 33 million more today.

``Six or seven years ago, I decided that this was what I would be doing the rest of my life,'' says Burton, 56, seated at a coffee table in his office at the Scripps Research Institute, the world's largest private, nonprofit research organization.

Burton, a British-born biochemist who's now a professor of immunology at Scripps, leads a small cadre of AIDS scientists who are exploring a mysterious region of the body's immune system.

His models represent the proteins he says can stop strains of the virus from infecting cells, sparking optimism for a vaccine that would wipe out one of the planet's most baffling and drug-resistant infections.

Betting on a vaccine puts Burton at the center of hope -- and controversy -- in research to counter AIDS, or acquired immune deficiency syndrome. That role has intensified since last September, when pharmaceutical giant Merck & Co. suddenly terminated a vaccine trial after inoculated volunteers appeared more likely to contract HIV, or the human immunodeficiency virus that causes AIDS, than those who got placebo injections.

Now, even after spending billions of dollars since 1984, when U.S. and French researchers announced the discovery of HIV, scientists say it may be at least 10 more years before another such promising vaccine candidate emerges from testing.

Burton, who has toiled out of the headlines, is trying to shorten the time by understanding the immune response to HIV. He then plans to attack the virus with proteins he's studied from the rare patients who can fight off HIV, neutralizing the devastating effects.

The Bill & Melinda Gates Foundation, the world's richest charity, is spending more than $160 million on similar efforts in addition to bankrolling some of Burton's major funders. The U.S. government's National Institute of Allergy and Infectious Diseases -- along with private donors -- is also backing Burton's approach as the best way to stop AIDS dead in its tracks.

``We know the overall strategy works and that this is just a very difficult case,'' Burton says. ``Science works very well, and we should just stick with it. It always pays off.''

Not everyone sees the payoff. Pfizer Inc., the world's biggest drugmaker, and other companies with billion-dollar budgets aren't racing to create HIV vaccines.

The development costs are high, the chance of failure greater and the return relatively low compared with vaccines such as Merck's Zostavax. That vaccine, which helps prevent the painful viral skin rash called shingles, costs $200 a dose.

Merck would be lucky to get a fraction of that for an HIV vaccine in southern Africa, where two-thirds of the world's AIDS patients live. The World Bank estimates the average annual income in Zimbabwe is about $340.

Companies already have spent millions of dollars only to hit dead ends making vaccines for malaria, tuberculosis and other diseases that ravage poorer countries. And once-promising efforts, such as Merck's, can turn to dust overnight.

``We have to admit to ourselves that we don't know how to make an HIV vaccine right now,'' Beatrice Hahn, an AIDS researcher at the University of Alabama at Birmingham, said in a March meeting in Washington.

Michael Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation, is among those who are agitating for vaccine research money to go to groups such as his that provide drug treatments. Or the funds should pay for prevention and protection, including vaginal creams called microbicides, he says.

``We've been doing trials for years that we knew would not be successful,'' Weinstein says. ``An AIDS vaccine will be an emperor that has no clothes.''

Anthony Fauci, director of the NIAID in Bethesda, Maryland, says that while treatments are effective, they aren't a cure. So they can't solve the problem of AIDS, which infects more than 2.5 million people each year.

``We can't treat our way out of the epidemic,'' he says. ``For every person in the developing world that we put on antiviral treatment, at least three more are infected. To really get our arms around this epidemic and put a stop to it, we need a vaccine.''

While treatment advocates and scientists butt heads over drugs versus a vaccine, AIDS doctors are battling a growing scourge. At least 40,000 people are infected annually in the U.S., according to the Centers for Disease Control and Prevention.

And because AIDS makes patients vulnerable to microbes that the body can normally defeat, it's fueling secondary illnesses. Drug-resistant strains of tuberculosis are striking 400,000 people each year, stoked in part by AIDS's immune-damping effects.

AIDS also makes patients more vulnerable to malaria, which kills about 1 million people each year, most of them African children.

Burton wants to design the first vaccine to get the human body to mount a protective immune response that it doesn't normally create. He says that by studying patients who make immune proteins that disable the virus, he can finally bring the disease to heel -- and perhaps also show how tuberculosis and malaria might be averted.

``Making a vaccine is all about taking control of the proteins involved and getting them to do what we want them to do when we put them into people,'' says Burton, who shows his competitive streak outside the lab in pickup soccer matches at Torrey Hills Neighborhood Park, where his steady voice directs the defense.

Burton is hanging his research on two relatively new discoveries. First, he's studying the blood of the few lucky patients who can shut down HIV on their own. He's finding the vulnerable nooks, crannies and handles on the virus that the immune system can recognize, along with the human proteins that can attack them.

Second, he's applying to HIV the insights gained from scientists working in X-ray crystallography, a technique for analyzing protein structure in minute detail.

Link to the full article.

Why do some people infected with HIV do well for years while others experience rapid declines in health? A growing body of research suggests mental health and other psychosocial factors provide part of the answer.

A special issue of Psychosomatic Medicine published this month provides a detailed picture of how depression, stress, lifetime history of trauma, maladaptive coping and other psychosocial factors are translated into physiological effects on the immune system, adherence to medication regimens, and health behaviors that can exacerbate viral transmission and progression. Conversely, positive psychosocial factors such as effective coping appear to improve chances for better health.

Better understanding of the complex mechanisms by which psychosocial and behavioral processes can affect the immune system and the body’s response to HIV and its treatment have also led to the development and testing of more effective prevention and treatment strategies.

“There is compelling evidence that psychosocial factors can affect disease progression and adherence to medications,” said Jane Leserman, PhD, a professor of psychiatry and medicine at the University of North Carolina at Chapel Hill.

“I think the contribution of behavioral and psychosocial variables to disease progression has really been underestimated in the biomedical field,” said Lydia R. Temoshok, PhD, a professor of medicine at the University of Maryland. “In studies conducted over a short timespan, the contribution of these variables might be small, she noted. “But when you repeat those behaviors every single day, that adds up to a potentially strong effect on the immune system, and hence, on the control or activation of HIV, over and above the effects of antiretroviral medication.”

Leserman and Temoshok served as guest editors for the special issue of the peer-reviewed journal Psychosomatic Medicine, which is available for free on the web at www.psychosomaticmedicine.org . In this issue, internationally respected HIV experts review the current evidence for the impact of psychosocial factors, behaviors, and interventions and suggest strategies for addressing the HIV/AIDS epidemic. The target audience for the special issue is physicians and other health-care providers who treat people with HIV infection or AIDS.

“I think it’s important that health-care professionals know that depression, stressful life events and trauma, such as sexual and physical abuse and childhood neglect, are highly prevalent in the lives of HIV-infected patients,” Leserman said. “It is important for them to know who their patients are, in addition to knowing their CD4 levels and viral loads, and that they know the potential effects that depression and stressful experiences can have on increased risk of medication nonadherence, risky behaviors and poor health outcome. Without proper adherence to medication, we see the development of resistant infections and worse prognosis.”

The advent of highly active antiretroviral therapies in 1996 transformed HIV/AIDS from a fatal disease into more of a chronic illness for many. Despite this, there is still great variability in the course of HIV infection. In one article in the issue, Leserman reviews studies that examined the role of depression, stressful life events, and trauma in HIV disease course. Some of the largest recent studies show that chronic depression and trauma have been associated with about twice the risk of AIDS-related mortality. These findings remained even when controlling for the use of highly active antiretroviral therapy, and baseline CD4, viral load, and HIV-related symptoms.

Psychosocial factors such as depression and anxiety can affect prognosis through biological factors, such as changes in the sympathetic nervous system, the hypothalamic-pituitary-adrenal axis, and the immune system, as well as through changes in such behaviors as levels of adherence to medications and risky sexual activity. Two articles in the issue review recent studies providing evidence that maladaptive or positive coping may have direct effects on immune mechanisms linked to HIV progression.

“By integrating psychological and behavioral information with some of the latest findings from the biomedical sciences, we can generate the strongest intervention and prevention strategies,” Temoshok said. “If you know that someone has multiple partners, you can discuss the risk of acquiring a reinfection with a different HIV strain,” Temoshok said. Antiretroviral medicines may have been effective against the initial infection, but the next strain—acquired from a different partner--may be drug-resistant.

Temoshok said that if health-care professionals are aware of the specific psychosocial risks their patients are facing, they can tailor treatment and advice accordingly. If, for example, psychological assessment reveals that someone has high levels of stress, depression, or poor coping, a physician could ensure that expert psychologists or psychiatrists specializing in HIV are involved in working with those patients to develop more effective coping strategies. “Ideally, this would involve a multidisciplinary team approach, not just referring patients to a mental health specialist,” Temoshok said.

Psychosomatic Medicine, founded in 1939, is the official peer-reviewed journal of the American Psychosomatic Society. It publishes experimental and clinical studies of relationships among social, psychological, behavioral, and biological factors in humans and animals. It is an international, interdisciplinary journal devoted to experimental and clinical research in behavioral biology, psychiatry, psychology, physiology, and clinical medicine.

www.HealthNewsDigest.com

NPR's "News & Notes" on Thursday included two discussions about the spread of HIV in prisons and efforts to promote condom distribution to inmates.

In the first segment, Keith DeBlasio, a former inmate who contracted HIV in prison, and Lovisa Stannow, executive director of Stop Prisoner Rape, discussed the spread of HIV through rape and consensual sex in prisons. Stannow, whose group supports the distribution of condoms in prisons, said, "It's a public health issue, and it's also a human right issue," adding that "incarceration simply should not lead to serious illness and premature death."

Stannow also discussed the federal Prison Rape Elimination Act, which was passed in 2003, "News & Notes" reports. She said, "It may not have trickled down yet to the actual facility level, but we certainly see a much more serious discussion among corrections administrators and lawmakers and policymakers, that even five years ago you would still hear wardens and prison managers claim that sexual abuse was not really a problem. And we don't hear that any more." She added, "The question is now, how do we address the problem?" (Chideya [1], "News & Notes," NPR, 5/15).

In the second segment, the Rev. Dorris Green, director of community affairs for the AIDS Foundation of Chicago, discussed the group's support of HIV screening and condom distribution in Illinois prisons. According to "News & Notes," the "state of Illinois has been resistant" to the proposals.

Green said the group is working on "educating our legislators about HIV" and sex in prisons, adding, "We have a hard time here in this state convincing our legislators that people are actually having sex in prison." The group also is developing a demonstration project that could include condom distribution in a state prison, she said (Chideya [2], "News & Notes," NPR, 5/15).

  
Effectiveness of Antiretroviral Therapy Causing 'Complacency' Among High-Risk Groups, Opinion Piece Says

Henry J. Kaiser Family Foundation
May 16, 2008 

HIV/AIDS clinicians and scientists have been "witness to a transformation in disease management that is virtually unprecedented in the history of medicine," Mark Wainberg, director of McGill University's AIDS Centre at Jewish General Hospital, and Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS, write in a National Post opinion piece. According to the authors, antiretroviral drugs "now enable HIV-[positive] individuals to survive indefinitely with good quality life." However, an "unintended consequence" of the development of antiretrovirals has been to "convince thousands of members of vulnerable populations that an [HIV-positive] status may not be harmful," they add.

According to Wainberg and Montaner, numbers of AIDS-related deaths have "drastically dropped" since the introduction of the first successful antiretroviral regimens in the mid-1990s. Yet it "now appears as though these successes may be responsible for growing numbers" of new HIV cases among injection drug users, men who have sex with men and other vulnerable groups, they note.

The authors write that HIV/AIDS experts should "confront the reality" that achievements in antiretroviral therapy have led to "complacency in regard to high-risk sexual behavior that, in turn, has resulted in steep rises in numbers of new cases." They add, "Clearly, we have to do a much better job in regard to public health, if we are to have any chance at limiting the spread of HIV."

In addition, some "physicians now often proclaim that HIV disease has been converted into a chronic manageable condition and that the use of [antiretrovirals] to prolong life is akin to the use of insulin by diabetics or anti-hypertension medications by people at risk of coronary disease or stroke," according to the authors.

According to Wainberg and Montaner, one way to address this issue is to "make sure that vulnerable individuals understand" that antiretrovirals might not "work as well as we would like them to." Although the drugs are effective at blocking replication of the virus, there is "growing evidence" that HIV-positive people are more susceptible to a number of cancers and other conditions that are "rare in the general population," they write.

Wainberg and Montaner add that the "most likely explanation" for this evidence is that the virus causes "irreparable damage to the immune system, weakening natural surveillance systems that defend against cancer." They conclude, "Perhaps it is fear of cancer and not HIV itself that will encourage people at risk to desist from high-risk sexual behavior and lead over time to reductions in numbers of new cases of HIV transmission" (Wainberg/Montaner, National Post, 5/15).   

Chicago Tribune Magazine Examines HIV/AIDS Among Children, Adolescents in U.S.

Henry J. Kaiser Family Foundation
May 13, 2008 

The Chicago Tribune Magazine on Sunday examined HIV/AIDS among children and adolescents in the U.S. According to the Tribune, there are about 6,000 children and young adults living with HIV/AIDS in the country.

The development of antiretroviral drugs in the 1990s has improved the lives of children living with HIV/AIDS and reduced the number of infants born with the virus from about 1,700 annually in the 1990s to about 150 annually today. Ram Yogev, founder of the HIV program at Children's Memorial Hospital in Chicago, said it is "unbelievable" that children with HIV now live into adulthood, adding that HIV-positive children had a life expectancy of three to four years in the late 1980s and eight or nine years in 1990.

Although the life expectancies and health of HIV-positive children have improved, children living with the virus "often are left to handle their HIV on their own and carry around this unseen burden that most people don't know about," Linda Walsh, a nurse practitioner at the infectious diseases clinic at the University of Chicago Medical Center, said. Kenneth Boyer, chair of pediatrics at Rush University Medical Center, added that HIV is a "constant and a very tough burden" for children living with the virus.

According to John Marcinak, medical director of the Adolescent HIV program at the University of Chicago, HIV-positive children "have more complications" than adults living with the virus "because they have been on medicine a much longer time." He added that the virus "can develop resistance to the medication" and that some children "can't use some of the new" antiretrovirals.

Robert Garofalo, director of adolescent HIV services at CMH, said that children living with HIV/AIDS are "a forgotten group" because the "sense of community" for other groups "does not exist" for them. "The youth who are born with HIV have very different issues with their family, parents and mothers," Garofalo said, adding, "But like all adolescents, they are still struggling to establish autonomy from their parents, to understand their emerging sexuality."

Lori Wiener, coordinator of the National Cancer Institute's Pediatric HIV Psychosocial Support Program, added that the "stress is tremendous" for children living with HIV. "The stress of HIV appears to increase beginning with adolescence," Wiener said, adding that HIV-positive adolescents "fear social rejection more than many of them fear dying" of AIDS-related causes. Children and adolescents living with HIV/AIDS "who have done the best psychologically are those who have people in their lives that they share their diagnosis with and can talk to openly" about HIV/AIDS, Wiener said (Breu, Chicago Tribune Magazine, 5/11).

Henry J. Kaiser Family Foundation
May 14, 2008 

An increasing amount of evidence is finding that exercise can improve the health of HIV-positive people and reduce the risk of AIDS-related illnesses by increasing muscle mass and improving heart and lung endurance, the Sacramento Bee reports. Many people living with HIV/AIDS have begun or resumed exercise regimens since the development of antiretroviral drugs in the 1990s, according to the Bee.

Archana Maniar, an infectious disease specialist and assistant professor at the University of California-Davis, said that HIV-positive people need regular exercise just like HIV-negative people. HIV-positive people are living longer and developing diseases such as diabetes, hypertension, cardiovascular disease and strokes, Maniar said. "From that standpoint, exercise promotes their general wellness and increases their chances of avoiding those things," Maniar added.

A 2006 Massachusetts General Hospital study found that exercise helps manage the symptoms of metabolic syndrome, which some studies indicate as many as 45% of HIV-positive people have. Metabolic syndrome increases the risk of heart disease and diabetes. In addition, a 2005 Columbia University study found that moderate exercise in combination with antiretroviral treatment leads to improved nervous system function and circulation among people living with HIV/AIDS. Many HIV-positive people also say they exercise for psychological benefits. "For me, the effects are more psychological than biochemical," Bob Katz -- a member of the Positive Pedalers, a cycling group with HIV-positive members in California -- said, adding, "Having a sense of self-worth, feeling comfortable in your body, is something exercising will do" (McManis, Sacramento Bee, 5/13).

New Fact Sheets released on the Impact of HIV/AIDS Among African-Americans and Women

May 12, 2008

• HIV-related deaths and HIV death rates are highest among Blacks. Blacks accounted for 56% of deaths due to HIV in 20043 and their survival time after an AIDS diagnosis is lower on average than it is for most other racial/ethnic groups.  In 2004, Black men had the highest HIV death rate per 100,000 men aged 25–44 at 39.9; it was 5.5 for white men. The HIV death rate among Black women aged 25–44 was 23.1 compared to 1.3 for white women.
  
• The share of AIDS diagnoses accounted for by Blacks has risen over time, rising from 25% of cases diagnosed in 1985 to 49% in 2006; in recent years, this share has remained relatively stable.
  
• Black women are most likely to have been infected through heterosexual transmission, the most common transmission route for women overall. White women are somewhat more likely to have been infected through injection drug use than Black women.
  
• The HIV Cost and Services Utilization Study (HCSUS), the only nationally representative study of people with HIV/AIDS receiving regular or ongoing medical care for HIV infection, found that Blacks fared more poorly on several important measures of access and quality than whites; these differences diminished over time but were not completely eliminated.  HCSUS also found that Blacks were more likely to report postponing medical care because they lacked transportation, were too sick to go to the doctor, or had other competing needs.
  
• Women have been affected by HIV/AIDS since the beginning of the epidemic, but the impact on women has grown over time.  Women of color, particularly Black women, have been especially hard hit and represent the majority of new HIV and AIDS cases among women, and the majority of women living with the disease.  Many women with HIV/AIDS are low-income and most have important family responsibilities, potentially complicating the management of their illness. Research suggests that women with HIV face limited access to care and experience disparities in access, relative to men. 
  
• The AIDS case rate per 100,000 illustrates the severe impact on women of color. In 2006, the case rate for Black women was 40.4 per 100,000, or 21 times the rate for white women.  The case rate for Latinas of 9.5 was 5 times the rate for white women. The case rate was 3.6 for American Indian/Alaska Native women and 1.6 for Asian/Pacific Islander women.
  
• Mother-to-child transmission of HIV in the U.S. has decreased dramatically since its peak in 1992 due to the use of antiretroviral therapy (ART), which significantly reduces the risk of transmission from a woman to her baby (to less than 2%). Still, perinatal infections continue to occur each year, the majority of which are among Black Americans.
  
• Among those who are HIV positive, 35% of women were tested for HIV late in their illness—that is, diagnosed with AIDS within one year of testing positive (in those states/areas with HIV name reporting); by comparison, 39% of men were tested late.

Henry J. Kaiser Family Foundation
May 12, 2008 

CDC Director Julie Gerberding on Friday at a forum in Oakland, Calif., said that more money is needed to fight HIV/AIDS in the black community, particularly among black men who have sex with men, the San Francisco Chronicle reports.

"We have not succeeded in our prevention efforts," Gerberding said at the meeting, which was hosted by Rep. Barbara Lee (D-Calif.). She added, "You have to scale the money to the scope of the problem. The pie is only so big right now. What we need is a bigger pie."

Although 13% of the U.S. population is black, the group makes up about 50% of people living with HIV, the Chronicle reports. Among young people newly diagnosed between 2001 and 2005, 61% were black, and 48% of cases among black men were linked to sex with other men. HIV/AIDS rates among black men were seven times higher than those among white men in 2005, according to CDC.

The Bush administration has proposed reducing CDC's budget request for HIV prevention and surveillance funding by $1 million to $691 million in the upcoming fiscal year. According to the Chronicle, Gerberding often testified before Congress that she wanted more money for CDC than was requested by her superiors in the administration. She requested $7.2 billion for the agency last year, but the budget was reduced to $5.9 billion.

In response to HIV/AIDS in the black community, Lee said that she is again calling on the federal government to declare a "national public health emergency." She added, "We need to make sure not only that resources are increased, but are targeted to where they are needed most."

George Lemp, director of the Universitywide AIDS Research Program at the University of California, said studies from the early 1990s repeatedly found that HIV was spreading twice as fast among black MSM than among white MSM but that prevention programs were not reaching young black men. "Our interventions are targeting the wrong people, in the wrong places and at the wrong time of day," he said (Russell, San Francisco Chronicle, 5/10).

Henry J. Kaiser Family Foundation
May 07, 2008 

HIV/AIDS rates among blacks and Hispanics in the U.S. have reached alarming levels, and the U.S. urgently needs to establish new initiatives to address the spread of the disease among the groups, Beny Primm, executive director of Brooklyn, N.Y.-based Addiction Research and Treatment, said at an event in Connecticut on Sunday, the Hartford Courant reports. Primm, who was a federal health official under President George H.W. Bush, spoke at the Greater Hartford chapter of The Links, a professional black women's group, where he was recognized for his work related to substance abuse, domestic violence and HIV/AIDS.

Primm said, "It's not on the radar screen. There are not enough voices being raised." Primm said the spread of HIV among black women in particular has not received the same media attention as other groups. He said HIV/AIDS cases among blacks and Hispanics "are skyrocketing," while cases "are at emergency numbers" in black women.

Primm's work has focused, in part, on the connection between the spread of HIV infection through injection drug use. He recently represented the U.S. at World Health Organization meetings and at an international conference on AIDS prevention in London, according to the Courant.

Sharon Steinle, a Links member and chair of the event, said, "Globally, underserved communities are being ravaged by this disease, and the effects on women have been particularly devastating." She added, "As a volunteer-based organization focused on the betterment of women and the community, we feel it is our duty to educate others about HIV/AIDS and its prevention" (Jones, Hartford Courant, 5/5).

Henry J. Kaiser Family Foundation
Apr 23, 2008

The U.S. correctional system is missing valuable opportunities to provide HIV testing, educating and prevention to its more than two million state, federal and local inmates, panelists said at a recent briefing on HIV/AIDS in correctional settings, CQ HealthBeat reports. According to new information from the American Foundation for AIDS Research, prisoners are three times more likely to be HIV-positive than the general population.

The panel said the reasons that HIV rates are higher in prisons include needle sharing for tattoos or drugs among inmates, as well as unprotected sex with multiple partners at high-risk of HIV before and during incarceration. According to CQ HealthBeat, more than 90% of prisoners are eventually released, which leaves communities to deal with "the public health burden of having a high number of HIV-positive people."

Josiah Rich, professor of medicine and community health at Brown University, said that other than prisons and jails in Rhode Island -- the only state that mandates HIV testing for all inmates -- most correctional facilities nationwide do not require HIV testing as part of the entry process. Barry Zack, a correctional health programs consultant, said prisons should provide condoms to inmates -- a practice advocated by the World Health Organization and UNAIDS but implemented in only a few states. However, evidence indicates that even when condoms are available in prisons, inmates rarely use them, according to an amfAR issue brief about HIV prevention and treatment in prisons.

Zack added that prisons should establish needle-exchange programs to stem the spread of HIV. In addition, Zack said that it is crucial to reform the country's prison release system to include providing inmates with access to health care, mental health care, affordable housing and job programs. Panelists said that prisoners preparing for release should be provided with copies of their prison medical records and information about how to access HIV/AIDS treatment (Walker, CQ HealthBeat, 4/22).

A Webcast of the event is available online at kaisernetwork.org.

Some black religious leaders and public health officials in North Carolina are urging prison officials to require routine HIV testing of inmates and treatment for those who test positive, the Raleigh News & Observer reports. The officials who are lobbying for mandatory testing maintain that "prisoners are impeding the state's effort to end the spread of HIV." North Carolina does not require HIV testing for inmates but recommends the test to new prisoners who admit to high-risk behaviors such as intravenous drug use or intercourse with a sex worker. Twenty-two states -- including the majority of Southern states, which have high numbers of new HIV cases -- require HIV tests for inmates.

There is little demand for the test under the current voluntary policy, the News & Observer reports. David Rosen, a medical and doctoral student at the University of North Carolina-Chapel Hill, found that about 25% of men not previously diagnosed with HIV requested testing upon arrival at one of the state's six prisons. Blacks were less likely than other inmates to ask for the test, Rosen found. At the two prisons housing the youngest men, ages 18 to 25, fewer than 5% of inmates requested testing. Some public health officials contend that the statistics show the prison system is missing the most at-risk population.

According to the News & Observer, "Some religious leaders blame prisons for the toll HIV has taken on the black community." In 2007, several black religious leaders lobbied for a bill that would require inmates to be tested upon release, but the bill never made it to a vote. Legislators said they will review the bill in May. "This is destroying our community," Larry Williams, a pastor who led the lobbying effort, said, adding, "Our women are sharing men who've gotten HIV. It's swirling around us. We cannot pretend it's not happening and can't ignore a chance to try and fix it." While 21% of the state's population is black, black women represented more than 80% of new HIV cases among women in 2006, the News & Observer reports, adding that a recent study found that most HIV-positive women reported that their last three sexual partners had been in prison the previous year.  

Costs, Other Efforts
State prison officials said that they are not opposed to a screening mandate but that the cost of testing every inmate would exceed available funding. According to prison estimates, screening and treating HIV-positive inmates would cost $21 million annually. However, according to the News & Observer, the estimate is based on a 10% infection rate, which is much higher than any state has reported. An estimated 1.8% of North Carolina's prison population, about 700 inmates, has HIV or AIDS (Locke, Raleigh News & Observer, 4/13). This summer, researchers at UNC plan to begin a new study that will examine over several years the reasons why so few inmates are volunteering for HIV tests (Associated Press, 4/14).

Henry J. Kaiser Family Foundation
Apr 03, 2008 

The House on Wednesday voted 308 to 116 to approve a bill (HR 5501) that would reauthorize the President's Emergency Plan for AIDS Relief, the Washington Post reports (Brown, Washington Post, 4/3). The measure, which was approved in February by the House Foreign Affairs Committee, would allocate $50 billion for PEPFAR over the next five years. President Bush had called on Congress to authorize a $30 billion, five-year extension of PEPFAR (Kaiser Daily HIV/AIDS Report, 4/2). The House on Wednesday rejected an amendment to the bill that would have reduced funding to the $30 billion Bush initially requested (Graham-Silverman, CQ Today, 4/2).

The bill also would remove a requirement that at least one-third of HIV prevention funds that focus countries receive through PEPFAR be used for abstinence-until-marriage programs. It would require "balanced funding" for abstinence, fidelity and condom programs based on evidence in each PEPFAR focus country. In addition, the bill would retain the requirement that PEPFAR recipients pledge opposition to commercial sex work. The bill would allow groups to use PEPFAR funding for HIV testing and education in family planning clinics but not for contraception or abortion services. The bill also would require reports to Congress if abstinence and fidelity programs compose less than half of country-level spending on programs aimed at preventing sexual transmission of the virus.

Of the $50 billion allocated in the bill, $9 billion would be allocated to fight tuberculosis and malaria, which often affect HIV-positive people in Africa. That amount also would underwrite food supplements for people living with HIV/AIDS. The bill would provide loans to women widowed by the disease or ostracized because of their HIV-positive status. The measure also would add Lesotho, Malawi and Swaziland as PEPFAR focus countries; include clean water programs; encourage countries to work with historically black colleges to improve their health infrastructures; and expand inspector general authority (Kaiser Daily HIV/AIDS Report, 4/2). In addition, the bill would add 14 Caribbean countries to the program (Dunham, Reuters, 4/2). The bill strengthens a "conscience clause" that would allow groups to not endorse prevention methods that they find religiously or morally objectionable (CQ Today, 4/2).

Of the $41 billion specifically allocated for HIV/AIDS under the measure, up to $2 billion would be included annually for the Global Fund To Fight AIDS, Tuberculosis and Malaria, the AP/International Herald Tribune reports. The bill limits U.S. contributions to the Global Fund to one-third of total contributions, according to the AP/Herald Tribune (AP/International Herald Tribune, 4/3).

The measure aims to shift PEPFAR from an emergency response program toward a long-term, sustainable plan, CQ Today reports. It would provide training for 140,000 new health care workers, target vulnerable groups such as women and girls, and add nutrition and other secondary services to PEPFAR. It aims to double the number of people receiving antiretroviral drugs to three million, prevent 12 million new HIV cases and provide care for 12 million people (CQ Today, 4/2).

Henry K. Kaiser Family Foundation
Apr 02, 2008 

HIV-positive women in the U.S. face stigma associated with the virus, according to the results of an online survey released Monday by the American Foundation for AIDS Research, CNS/Atlanta Journal-Constitution reports (Krouse, CNS/Atlanta Journal-Constitution, 3/31).

The survey was conducted online between March 22 and April 17, 2007, by Harris Interactive among 4,831 U.S. residents ages 18 to 44 who were willing to disclose their race. According to an amfAR release, one-fifth of the respondents said they would be somewhat or not at all comfortable having a close friend who is HIV-positive, and 59% said they would be somewhat or not at all comfortable with an HIV-positive woman caring for their children. Among the respondents, 68% and 57%, respectively, said they would be somewhat or not at all comfortable having an HIV-positive female dentist or physician. Only 14% of respondents said they believe HIV-positive women should have children, despite antiretroviral drugs that can prevent mother-to-child HIV transmission.

Black and Hispanic respondents were more likely to have an HIV-positive family member at 34% and 32%, respectively, compared with 13% of white respondents. About 40% of the respondents said they were sure they had not been tested for HIV. Eighty percent of these respondents said it was unnecessary for them to receive an HIV test because they "knew" they were not HIV-positive or did not believe they should be tested.

Most respondents supported expanded HIV testing, with 65% saying HIV testing should be part of routine health care. Sixty-seven percent of respondents incorrectly assumed they are screened for HIV during screenings for other sexually transmitted infections, and half of respondents believed pregnant women are automatically tested for the virus as a part of prenatal care.

The survey was funded by Broadway Cares/Equity Fights AIDS and the MAC AIDS Fund (amfAR release, 3/31).  

Reaction, Recommendations
Fears associated with contracting HIV, the belief that HIV is the result of promiscuity or moral failures and the severity of the disease all contribute to the associated stigma, according to participants at a conference on Monday in Washington, D.C., to release the survey (CNS/Atlanta Journal-Constitution, 3/31). Susan Blumenthal, senior policy and medical adviser for amfAR, said that "[c]omplacency has obscured the changing face of" HIV and the "dramatic" increase in HIV infections among women in the past 25 years (amfAR release, 3/31).

A panel of HIV/AIDS advocates and experts at the conference said policymakers should increase efforts to improve HIV/AIDS education in an effort to reduce stigma (CNS/Atlanta Journal-Constitution, 3/31). The survey's results "should serve as a wake-up call for action across all sectors of society," Blumenthal said, adding, "We need to intensify efforts for science-based education and policy to shatter the stigma that has surrounded this disease for all too long" (amfAR release, 3/31).

Regan Hofmann, editor-in-chief of POZ Magazine, said the government should increase comprehensive sex education to ensure people understand how HIV is transmitted and how to prevent the spread of the virus. Hofmann also discussed the importance of promoting safer-sex practices and discussing HIV with future partners. "Women are the ones living in secret," Hofmann said, adding, "Women are terrified, women of all colors, of all socio-economic statuses" (CNS/Atlanta Journal-Constitution, 3/31).

By David Brown
The Washington Post
updated 2:05 a.m. CT, Fri., March. 21, 2008

The two-decade search for an AIDS vaccine is in crisis after two field tests of the most promising contender not only did not protect people from the virus but may actually have put them at increased risk of becoming infected. 

The results of the trials, which enrolled volunteers on four continents, have spurred intense scientific inquiry and unprecedented soul-searching as researchers try to make sense of what happened and assess whether they should have seen it coming. 

Both field tests were halted last September, and seven other trials of similarly designed AIDS vaccines have either been stopped or put off indefinitely. Some may be modified and others canceled outright. 

Numerous experts are questioning both the scientific premises and the overall strategy of the nearly $500 million in AIDS vaccine research funded annually by the U.S. government.

Catastrophe
"This is on the same level of catastrophe as the Challenger disaster" that destroyed a NASA space shuttle, said Robert Gallo, co-discoverer of the human immunodeficiency virus (HIV), which causes AIDS, and head of the Institute for Human Virology in Baltimore. 

The recently closed studies, STEP and Phambili, used the same vaccine -- made from a common respiratory virus called adenovirus type 5 that had been crippled and then loaded with fragments of HIV.

Both studies were halted when it became clear the STEP study was futile and possibly harmful. The results of the Phambili vaccine trial, which was conducted in South Africa, were revealed last month and only worsened the gloom. Although the number of new HIV infections in that study was far smaller than in STEP -- and too few to draw firm conclusions from -- those results, too, hinted at a trend toward harm among vaccine recipients. 

Many researchers are questioning the scientific premises on which all those studies were based and are wondering, along with AIDS activists, what effect this near-worst-case scenario might have on tests of future vaccines. 

The working hypothesis for what went wrong is that the vaccine somehow primed the immune system to be more susceptible to HIV infection -- a scenario neither foreseen nor suggested by previous studies. 

The National Institutes of Health, which funded the STEP and Phambili trials, is convening a meeting next week to reassess its AIDS vaccine program. But some respected scientists have already reached a verdict. 

"None of the products currently in the pipeline has any reasonable chance of being effective in field trials," Ronald C. Desrosiers, a molecular geneticist at Harvard University, declared last month at an AIDS conference in Boston. "We simply do not know at the present time how to design a vaccine that will be effective against HIV."He told a rapt audience that he has reluctantly concluded that the NIH has "lost its way in the vaccine arena" and that he thinks it should redirect its AIDS vaccine funds to basic research and away from human trials. 

In this fiscal year, the NIH's budget for AIDS vaccine research is $497 million. The STEP and Phambili trials were each expected to cost about $32 million. Pharmaceutical giant Merck & Co. has spent an undisclosed amount developing the vaccine and helping to manage the studies.

Stop and reassess
"We can't afford to have any more trials like this," said Mark Harrington, head of the activist Treatment Action Group and a longtime observer of AIDS research. "We have to stop and reassess and recommit to basic science, or people will begin to lose faith.

"At the moment, only two things are certain. The first is that the vaccine, developed by Merck, could not have caused HIV infection because it contains only three proteins from HIV, not the entire virus. The second is that there are no obvious villains. 

"I do not think that what happened in this trial is an example of scientists blindly rushing into dangerous things," said John P. Moore, an AIDS virologist at Weill Cornell Medical College, who has criticized vaccine trials he considered futile. "In the general HIV-research community, I didn't know anyone who said this was going to happen." 

Both trials recruited people who were at high risk of HIV infection through sexual activity. The STEP subjects included many male homosexuals; the Phambili volunteers were male and female heterosexuals. Half the people in each trial were randomly assigned to get three shots of vaccine, and half to get three shots of a harmless liquid containing no adenovirus or HIV proteins. 

Each trial was to have 3,000 participants. STEP had finished enrolling subjects in North and South America, the Caribbean and Australia. Phambili (which means "moving forward" in the Xhosa language of South Africa) had signed up 801 by the time it was shut down. 

While scientists hoped the Merck vaccine might prevent some infections, its chief purpose was to stimulate "cell-mediated" immunity to produce a less severe illness. Specifically, the vaccine was expected to lower the "viral load" of HIV in the bloodstream, which in turn would both prolong survival and lessen the chance the person would infect others. 

Many experts are questioning the wisdom of that strategy, even if it had worked perfectly. Urging millions of people to take an AIDS vaccine that probably would not protect them from the virus, they say, would be a hard and confusing task, even in places where the epidemic still rages. For the moment, that is an academic question. The vaccine failed to achieve any of its goals.

How did it happen?
In both studies, people who got vaccine were more likely -- not less -- to become infected, with trends suggesting roughly a twofold risk. In the STEP study, which has many more cases to evaluate, nearly all that added risk was in people who had high levels of antibodies to adenovirus type 5 before they got their first shot -- evidence they had been previously infected with that strain. Uncircumcised men in that group had the highest risk. 

So how could this have happened?
The leading theory is that activation of the immune system, a cascade of events that occurs naturally when a person is infected with a virus or bacterium or gets a vaccine against one of them, in some way increased the risk of HIV infection. Activation causes cells called CD4 T-lymphocytes (among many other things) to proliferate. CD4 cells are the targets of choice for HIV. In their activated state, they are coated with molecules called CCR5 co-receptors, which HIV needs to attach itself to a cell. 

The hypothesis is that people who received the vaccine had greater-than-normal activation and consequently produced more and fatter cellular targets for HIV. That then increased their chances of becoming infected should they encounter the virus in unprotected intercourse.

Two things undercut this idea. People have been suffering immune-activating infections and getting vaccines for years, and there has never been evidence that those events increased a person's risk of acquiring HIV. These vaccine trials would be odd places to first notice such a thing. Furthermore, people in the STEP study who got the vaccine did not have more activated CD4 cells than people who got placebo -- something that Merck vaccine executive Mark B. Feinberg called "kind of an interesting and unexplained observation." 

Something very, very peculiar
"There is something very, very peculiar" going on in the vaccine trials, said Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases, which sponsored them.

The multiple surprises have reminded researchers how much they still do not know about HIV's biology. It has also focused attention on questions they never asked. For example, none of the monkey experiments with the Merck vaccine subjected animals to the kind of sexual exposure that people in the trial had -- namely, repeated encounters with low doses of HIV, with no single exposure being especially high-risk.  Why not? The researchers did not have any reason to believe the vaccine might be harmful (although they acknowledged it might not be effective), and in any case such a study would have required quite a large number of monkeys, which are expensive to acquire and maintain for research. 

Instead, researchers vaccinated a relatively small number of monkeys with the Merck vaccine and then injected them with the monkey equivalent of HIV in a manner that guaranteed they would become infected. Those animals did much better over the long run than infected but unvaccinated ones. 

That was once enough to move a vaccine into human trials. But it probably never will be again.

Henry J. Kaiser Family Foundation
Friday, March 21, 2008

The "national silence" on issues such as sexual behavior, race and poverty has contributed to the high rate of HIV and other sexually transmitted infections among teenagers in the U.S., Robert Fullilove, associate dean at Columbia University's Mailman School of Public Health, Adaora Adimora, associate professor of medicine at the University of North Carolina-Chapel Hill, and Peter Leone of the North Carolina Division of Public Health write in a Washington Post opinion piece.

According to the authors, a CDC study released earlier this month that found that about 25% of U.S. girls and young women ages 14 to 19 have at least one of four common STIs is "already old" news for people who work in public health. They add that public health workers "fear this latest study will have its 15 minutes in the spotlight and also fade from view," just like a similar study released 10 years ago by the Institute of Medicine did. The "taboo" of talking about sexual behavior, poverty and race is one "obvious reason" that rates of STIs remain high, the authors write, adding, another is "that the incidence of [STIs], particularly HIV, is concentrated in poor, segregated neighborhoods that are characterized by high rates of incarceration." The "shift" in marriage and courtship patterns that results from men being incarcerated, as well as an increase in the number of "multiple concurrent sexual partnerships," also are contributing to the problem, according to the authors.

HIV/AIDS and other STIs cost the U.S. "tens of billions of dollars" annually, "but with the exception of HIV infection, [STIs] remain the elephant in the room when it comes to the national conversation about health and health care," the authors write. They add, "We can no longer have effective [STI] prevention campaigns in poor communities of color if they treat one person at a time or ignore social conditions underpinning high rates of HIV and other" STIs. "Simply put, we will never rid the U.S. of HIV and other [STIs] if our only weapon is medical treatment," the authors write, concluding, "And if we are unable to engage in a national dialogue about the sexual health of our youths and the social dynamics that drive [STIs], this epidemic will go largely ignored, and many more lives will be lost" (Fullilove et al., Washington Post, 3/21).

National AIDS Housing Coalition Press Release
Baltimore, MD March 6, 2008 

On the second day of the National Housing and HIV/AIDS Research Summit, investigators from two major multi-year studies released preliminary data showing that providing housing for homeless people living with HIV/AIDS improves health outcomes and saves millions in medical costs. The National Housing and HIV/AIDS Research Summit is convened by the National AIDS Housing Coalition in collaboration with the Johns Hopkins Bloomberg School of Public Health. 

The four-year Chicago Housing for Health Partnership (CHHP) study, the subject of an article in today's Wall Street Journal followed 407 chronically ill homeless people, more than a third of whom had HIV. Half of the study participants were placed in housing with case management, while the other half relied on Chicago's existing network of services. The group that received case management and housing assistance spent significantly less time in hospitals, emergency rooms and nursing homes and experienced improved health. 

After 18 months, 55 percent of CHHP-assisted participants with HIV had "intact immune systems" compared to only 34 percent of people in "usual care." Researchers estimate that the improved medical outcomes for all study participants saved approximately $1.5 million in emergency room, hospital and nursing home costs, after taking into account the costs of the housing and case management. 

The other major study presented today came from researchers who worked on the five-year HUD- Centers for Disease Control and Prevention (CDC) Housing and Health Study, which followed 630 unstably housed people living with HIV/AIDS. Half of the participants received enhanced housing and medical assistance while the other half depended on usual AIDS services networks. 

Preliminary data showed that receipt of a housing voucher enabled 82 percent of participants to secure and maintain stable housing. Housing participants who secured housing had significantly fewer overnight hospitalizations, emergency room visits and opportunistic infections, and significant improvements in medication adherence and mental health. The study also showed a 40 percent reduction in the number of people who traded sex for shelter--a significant prevention problem among homeless people living with HIV. 

The CDC study also showed some of the unexpected challenges of trying to conduct research on homelessness and HIV. For example, some participants were unable to use housing vouchers to get stable housing because of a lack of affordable housing in their communities. 

"The results of the CHHP and CDC studies as well as the numerous other studies presented at the conference this week are inspiring," said David Holtgrave, PhD, chair of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School, who worked on the CDC study. "Not only do these studies show that there is a really good scientific basis to the argument that housing is health care, they show that we can save lives and save money at the same time by providing people with housing." 

More than 200 researchers, service providers and people living with HIV from all over the world are in Baltimore from March 5 to 7 for the Third National Housing and HIV/AIDS ResearchSummit sponsored by the National AIDS Housing Coalition (NAHC). Researchers presented groundbreaking research on housing and HIV. Highlights included: 

• A study from India that showed that sex workers "housed" in brothels were able to form support networks that led to widespread condom use versus so-called "flying" or un-housed sex workers.
• Homeless youth are four to five times more likely to engage in high-risk drug use than youth in housing with some adult supervision and over twice as likely to engage in high risk sex.
• Among poor women, there is a strong connection between housing instability, HIV risk and violence. 

The past two National Housing and HIV/AIDS Research Summits provided the basis for the development of the NAHC Policy Tool Kit.  Summit Series convening researchers also worked closely with the NAHC on a special "Housing and HIV" issue of the journal AIDS and Behavior released last fall (Volume 11, Supplement 2/November, 2007). 

The National AIDS Housing Coalition (NAHC), founded in 1994, believes that persons living with HIV/AIDS have a fundamental right to decent, safe, affordable housing and supportive services. NAHC's mission includes educating legislators and public policy makers about the need for housing programs that assist persons living with HIV/AIDS and encouraging new initiatives and better coordination between federal agencies.

___________________

About National AIDS Housing Coalition: The National AIDS Housing Coalition (NAHC) is a 501(c)(3) organization founded in February 1994. NAHC believes that persons living with HIV/AIDS have a fundamental right to decent, safe, affordable housing and supportive services that are responsive and appropriate to their self-determined needs. The purpose of the NAHC is to ensure that the diverse voices of those infected and affected by HIV are heard and their needs are met.

http://www.nationalaidshousing.org
Contact: Latoya Thomas
email: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
phone: 202-347-0333

From the AIDS Foundation of Chicago website 

The Chicago Housing for Health Partnership (CHHP) research study is the first in the nation to evaluate whether providing stable housing and intensive case management services to chronically medically ill homeless individuals improves their health and health service utilization. Initial study findings presented March 6, 2008 at the National Housing and HIV/AIDS Summit in Baltimore, revealed improved health outcomes for housed participants and cost-savings for taxpayers. 

CHHP is a “hospital-to-housing” effort that identifies chronically ill homeless individuals at hospitals, moves them to permanent supportive housing, and provides them with intensive case management services so that they can maintain their health and secure long-term housing stability.  

In the summer of 2007, CHHP evolved from a four-year research and demonstration project (2003-2007) to a permanent citywide collaboration between 15 healthcare, housing, and social service agencies. Led by the AIDS Foundation of Chicago, CHHP currently provides 230 permanent housing subsidies for homeless individuals who are discharged from three area hospitals. 

You can access the preliminary findings from this research here.

Congressional Quarterly
March 13, 2008 – 1:07 p.m.  

The Senate Foreign Relations Committee on Thursday approved a five-year, $50 billion reauthorization of a global AIDS plan after members agreed to hold amendments until floor consideration.

 The panel approved the bill 18-3, with the “no” votes coming from Republicans who objected to its price tag.  Jim DeMint , R-S.C., said the money outstripped the need and the ability of receiving countries to absorb it.  “We’re just pushing the gas pedal when it’s already floored,” he said after the markup.Most of the committee, however, praised the bill’s bipartisan spirit.  

“We wanted to get this up and out, as the quicker we get this moving the more lives we’re going to be saving,” said sponsor and Chairman Joseph R. Biden Jr. , D-Del. 

U.S. Global AIDS Coordinator Mark Dybul praised the panel’s “fantastic bipartisan support” after the vote.

A 2003 law authorized $15 billion for the program’s first five years; Congress ended up providing almost $19 billion, including $6 billion in fiscal 2008. President Bush had called for a $30 billion reauthorization, though he signed on to the $50 billion level after returning from a weeklong trip to Africa last month.

The House is pursuing a similar approach that is expected to see floor action the first week in April. Though Senate floor time is uncertain, members hope to arm President Bush with a new law so that he can seek commitments from other countries at the Group of Eight summit in Japan beginning July 7.

BlackAIDS.ORG
March 13, 2008 

Federal health researchers said this week that a whopping half of African American teenage girls have a sexually transmitted infection. That fact is troubling enough, but it's all the more so when you consider its implications for the Black AIDS epidemic.  

The Centers for Disease Control and Prevention released the study, which is the first of its kind, on March 11 at its annual STD prevention conference. Researchers culled through 2003-2004 data in an ongoing, annual health survey of American households. As part of that survey, 838 14- to 19-year- old girls were tested for a handful of common sexually transmitted infections -- chlamydia, herpes, trichomoniasis and human papilloma virus, or HPV. More than a quarter of the girls had at least one of the infections, as did 48 percent of Black girls. Twenty percent of both white and Mexican American girls (the only Latino group CDC broke down the numbers on) had one of the infections.  

The study is the latest to show higher prevalence of STDs and STIs among Black youth. Syphilis rates, for instance, are holding steady or declining among other youth groups, but are increasing among African American teens -- and skyrocketing among Black males. Already, we know that Blacks account for 69 percent of new HIV/AIDS cases among American teens every year. And this week's study suggests that number will get worse before it gets better.  

While there are many unanswered questions about HIV's ongoing spread, one thing is clear: Untreated STDs make it happen a lot easier. If you have an untreated STD or STI and have unprotected sex with someone who is HIV positive, you are as much as five times more likely to contract the virus. If half of all Black teen girls had an STI in 2003-2004, the potential growth in the AIDS epidemic is breathtaking. But ultimately, the research done by the CDC and others on youth sexuality leaves too many questions unanswered. It's important to note, for instance, that other CDC studies have found that sexually active Black teens are not taking greater risks than their peers, and that in many ways they are in fact more responsible in their sex lives.  

Federal and state health officials survey high school students about sex every two years. They've found that black youth do in fact report more active sex lives than their peers -- they're more likely to have ever had sex, to start by age 13, and to have multiple sex partners in their lifetime. But among all students who report having sex, black youth are more likely to use condoms, far more likely to be sober when they have sex, and far more likely to get HIV tests.  

So we need far more research exploring the seeming gap between sexual risk and sexual disease among Black youth. We've established there's a problem. Now it's time to pay substantial attention to what's causing it. We also need to break down the unnatural wall between STD research and prevention and HIV-specific efforts. The two are inextricably linked in the real world, and they should be in our public health efforts as well.  

But it's also time for Black youth and their families to become more active participants in their sexual health. If people of any age are having sex, they must also pay attention to their sexual health. Sexually active people should not only be regularly tested for HIV, they must be regularly tested for the range of sexually transmitted infections that can help it spread.  

And that means we've all first got to be able to honestly discuss the fact that, whether adults approve or disapprove, young people are having sex -- and they need support in getting the medical care necessary to reduce the likelihood that their sex lives lead to HIV infections. We must honestly discuss sex in our family rooms. We must honestly discuss it in our schools, and demand that any sexual education program be evaluated not for its ideological purity but for how well it works in keeping kids safe. And we must make youth sexual health a permanent and ongoing part of our communal dialogue and political organizing. Turning a blind eye to youth sexuality won't make it go away, it means only that young people are left to sort it out on their own.


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Henry J Kaiser Family Foundation
Mar 06, 2008

The Illinois House on Tuesday voted 62-43 to reject a bill (HB 4314) that would have repealed a state act requiring students to report their HIV-positive status to school principals, the Springfield State Journal Register reports. Under the act, called the Communicable Disease Prevention Act, principals are permitted to disclose the identities of HIV-positive students to school nurses and the students' teachers. In addition, principals can disclose students' identities to people who, under federal or state law, are required to determine the students' placement or education program.

"As a parent, I want the school officials to have every bit of information that they can have in order to ensure public safety for all the kids," Rep. David Reis (R), who voted against the bill, said, adding, "If we want to do some bills to help to promote HIV testing, then let's do that. If my son is playing on the basketball court with another boy (who is HIV-positive) who has a bloody nose, we want to be able to in a polite way make sure the other kids don't get infected with HIV. We're talking about a lifelong virus that could be preventable if that principal knew that the child was HIV-positive."

Ann Hilton Fisher, executive director of the AIDS Legal Council of Chicago, said that lawmakers should make efforts to improve their awareness about HIV/AIDS. "HIV is not spread through playground accidents or bloody noses," Fisher said, "It just does not happen that way. Other diseases like hepatitis can be spread that way. Schools have been required since 1995 to use universal precautions in all such accidents."

Rep. Sara Feigenholtz (D), who sponsored the bill, said that she will try to revive the bill and provide lawmakers with education about the importance of repealing the act. "I don't think people have a full understanding of what youth is faced with and the stigma that still remains around HIV and the need to protect people's privacy around health issues," Feigenholtz said (Sexton, Springfield State Journal Register, 3/5).

Faith-based organizations on Monday during an event voiced support for needle-exchange programs as a means of preventing the spread of HIV among injection drug users and their partners, CQ HealthBeat reports. The meeting -- sponsored by the Interfaith Drug Policy Initiative and the Drug Policy Alliance -- brought faith-based groups together to discuss ways to advance exchange programs and repeal a ban on federal funding for such programs (Mattingly, CQ HealthBeat, 3/4).

The meeting comes after President Bush in December 2007 signed a $555 billion fiscal year 2008 omnibus spending bill (HR 2764) that effectively lifted a ban on city funding for needle-exchange programs in Washington, D.C. Since 1999, the district has been the only U.S. city barred by federal law from using local funds for needle-exchange programs. A report released in November 2007 by district health officials found that injection drug use was the second most common cause of HIV transmission in the city (Kaiser Daily HIV/AIDS Report, 1/3). According to the North American Syringe Exchange Network, there are more than 200 needle-exchange programs operating throughout the country, mostly on the local and regional levels.

Charles Thomas, executive director of IDPI, said organizations that voiced support for needle-exchange programs include the Unitarian Church, the Episcopal Church, the Union for Reform Judaism and some Baptists. Mary Jo Iozzio, a board member of the Society of Christian Ethics, said, "Some would say this is a little left leaning for [SCE], and they would be right," adding, "But to do anything less is to fail to act to save human lives." William Martin, a senior fellow for Religion and Public Policy at Rice University, said that among conservatives, "there is a great deal of resistance on drug policy reform." He added, "But there are a lot of loose bricks on the wall."

According to CQ HealthBeat, any chance of lifting the ban on federal funds for needle-exchange programs "faces a difficult partisan battle" in Congress. Bill McColl, political director for AIDS Action, said, "I consider this a nonpartisan issue, but the change in administration will certainly help" lift the ban. Democratic presidential candidates Sens. Hillary Rodham Clinton (N.Y.) and Barack Obama (Ill.) both have said they support using federal funds for needle-exchange programs. Republican presidential candidate Sen. John McCain (Ariz.) has not given an official position on the issue, CQ HealthBeat reports. However, McColl said he has not dismissed the possibility that McCain would support efforts to repeal the ban (CQ HealthBeat, 3/4).

Henry J Kaiser Family Foundation
Feb 22, 2008 

The Illinois Lottery on Friday launched a game that will raise money for HIV/AIDS prevention and education programs in the state, the St. Louis Post-Dispatch reports. The game, called Red Ribbon Cash, will sell two-dollar tickets and have four top prizes of $20,000.

A spokesperson for the Illinois Department of Revenue on Tuesday said the lottery hopes ticket sales will raise $3 million annually, which is the amount a ticket benefiting breast cancer research raised in 2006. According to the Post-Dispatch, all the proceeds will go to support HIV/AIDS programs in the state. Grants will be distributed by the Illinois Department of Public Health. It is not known when enough money will be generated to start awarding grants, the Post-Dispatch reports.

Angele Barnes -- executive director of Bethany Place, a not-for-profit HIV/AIDS education and treatment facility in Belleville, Ill. -- said the group will apply for a grant when the funds become available. Barnes said the money likely will go toward education materials and prevention programs, such as no-cost HIV tests. According to the Post-Dispatch, Illinois ranks sixth among states with the number of AIDS cases recorded since 1981. Last year, 1,906 HIV cases and 814 AIDS cases were reported in the state, the Post-Dispatch reports (Haughney, St. Louis Post-Dispatch, 2/20).

"With so many Illinoisans afflicted with this terrible disease, we must continue to create opportunities that raise awareness and to fund prevention and treatment options," Gov. Rod Blagojevich (D) said, adding, "The dollars raised from this ticket will provide grants for HIV/AIDS prevention and education in communities across the state, especially in the communities that have been hardest hit with the disease." According to a Blagojevich release, all grants funded by the program will be reviewed and approved by a special advisory board called the Quality of Life Board (Blagojevich release, 2/11).

From the Washington PostTuesday
January 8, 2008 

Carl, a 19-year old Prince George’s County resident, spoke with reporter Susan Levine about finding out that he was HIV-positive – and about his life after the diagnosis.  Excerpts from that conversation: 

I’ve now been diagnosed for two years.  Well, not two years, going on two years.  January 13^th.  I found out on January 13^th, 2006.  It was Friday the 13^th.  I never forget, Friday the 13^th, what a horrible day to find out… 

I do not know when or where I was infected… All I can give is a time period, an estimated time period anywhere between the ages of 15 and 16. 

If you are what they call an at-risk person, the average teen, you kind of know, you’ve got to know, you have a feeling, look, I’m doing certain things, I’m living a certain lifestyle that can be damaging in the future. 

So kind of by the age of 17, I started thinking, you know, all my friends kept saying, we’re all gonna go get tested, and we should all get tested together, but I lived with a certain fear because, a fear of knowing.  You know, I kind of said to myself, I think I might have it, but I’m not sure.

To me, at the time, at the time not knowing was waaaay better than knowing.  Because if I didn’t know, I did not have to deal with the pressures or, for lack of understanding at the time, you know, ending my life.  You know, it was like a death thing, what I thought at the time.

I was very uneducated about the subject.  You know, when things came up on TV about AIDS or HIV, when they talked about it in school, I kind of ran away from it.  You know, cut the channel, cover my eyes, ‘cause I was scared of, I was scared of the facts, I didn’t want to know the facts, I wanted to stay ignorant to the subject… because as long as I was ignorant to the subject, I thought, Okay, I’m fine. That kept me sane.  I’m thinking, If I don’t know anything about it, I’m fine.  But if I knew what was going on, it made me feel more and more guilty about the things I was doing as a teenager.

I was afraid my mom was going to throw me out, she was going to disown me as her child… I did not know what the outcomes could be, you know.  We didn’t grow up with the best of relationships, so I didn’t know how she was going to feel if I was positive.

The bad part about it is that my mom was just as ignorant on the subject as I was.  So when we got home, it was a circus, you know.  She made me eat off of paper plates, eat from paper products.  You know, I couldn’t, like I said, I had three other brothers and sisters.  I couldn’t share any, any, you know, knives, forks, spoons that they shared.  I drank from paper cups, paper knives, ate off of paper plates.  Everything was separate.

It really hurt me, it really hurt me.

Like I really pushed myself away from the family. Over the past two years, I’ve grown a lot.  I’ve become educated, I’ve become educated on the subject through my doctors, my social workers…. I’ve really become one with who I am, and I’ve embraced being HIV-positive.  Sometimes I even forget I have it.  I live a normal life.  Like I say, I’m a college student.  I have normal bills, normal student loans… I live a life of a teenager. Teenagers start rumors.  So I had rumors from everywhere:  I was starving my soul.  I was bulimic.  And then the big thing came out.  Everyone said Carl had AIDS.  The big rumor came out about Carl having AIDS.

I used to have pity parties for myself.  You know, that was the hardest part.  I would have a weekly pity party, where I would go and I would sob and it would be sob, play the blame game, feel sorry for myself.  I don’t have those anymore.

I’ve changed my sexual patterns and my sexual behavior, um, where at first I was afraid to ask for condoms. I use them. I’m not afraid to use them.

To me, it’s a part of you.  It’s like anything that’s a part of you, from a scar on your hand… it’s something you have to live with.  It’s something you have to say to yourself: “Am I gonna let this scar on my face control who I am as a person?  Am I gonna let cancer dictate my life?” As I said to myself, “Am I gonna let HIV define who I am as a person?” And I said to myself, “No, no, I’m not.”

Yes, I’ve seen people die of HIV, and I’ve heard the stories of people dying at a young age.  But I’ve also heard the stories of healthy people who live long, healthy lives, who lived into their 40s or even into their 50s or late 30s, who took care of their selves and accomplished everything they wanted in life, you know.

Teens should know that HIV is real.  And I think, you know, no matter how many commercials you put, how many billboards you put up, how many posters, how many people come to your school and talk, they need to know that it’s real and it’s out there. 

A lot of teens are naïve to certain things.  I know I was naïve… It’s like… it’s not gonna happen to me.  And finally, when it happens, it’s reality.

Let me tell you:  The closest thing I got to HIV education in school, I don’t even remember talking about HIV in health class… A little segment in health class on what they called at the time STDs, that’s about it.  We didn’t focus on HIV and AIDS in school, which to me is sad.

My parents and adults, they didn’t think HIV is real in teenagers.  It’s like teenagers don’t think HIV is real in the adults, parents don’t want to believe that HIV is real in teenagers.

The way I was living, it took me getting HIV to turn my life around. I think my main message to another teenager, one who would be at risk or not at risk:  HIV is alive, is real.  If it can happen to me, it can happen to you or can happen to your friend, your BFF, your boyfriend, your girlfriend.  It’s alive.

Carl spoke with The Post on condition that his last name not be used.

Henry J. Kaiser Family Foundation
Jan 09, 2008  

Youth who recently have become homeless are more likely than other youth to engage in risky sexual behavior that can lead to the transmission of HIV and other sexually transmitted infections, according to a study published in the Jan. 3 online edition of the Journal of Adolescent Health, ANI/Daily India reports.

For the study, researchers at the University of California-Los Angeles AIDS Institute -- led by M. Rosa Solorio, assistant professor of family medicine at the David Geffen School of Medicine at UCLA -- identified 261 youth ages 12 to 20 in Los Angeles County. The youth had been homeless for a period of one day to six months, and the researchers tracked them for two years. The youth were interviewed at the beginning of the study and at three, six, 12, 18 and 24 months after the study began about symptoms of depression, substance abuse, living arrangements, number of sexual partners and condom use.

According to the study, 77% of the youth were sexually active at the beginning of the study, compared with 85% at the end of the study. According to the study, female participants were less likely to use condoms if they were living in nonfamily situations or abused drugs. Drug abuse was found to be the primary indicator of risky sexual behavior among female participants, and male participants who lived without their family members or who abused drugs were more likely to have multiple sex partners, the study found. The study also found that U.S. or foreign-born Hispanic female participants were less likely to have multiple sex partners than female participants of other groups.

"While gender and some racial/ethnic differences in predictors of sexual risk were found in this study, living with nonfamily members and drug use appear to be the most salient in explaining sexual risk," according to the authors. The authors added that "interventions aimed at reducing sexual risk behaviors, and thereby reducing [STIs] and HIV among newly homeless youth, need to help youth find housing associated with supervision and social support ... as well as aim to reduce drug use." Solorio said that the study's findings are "important" because previous interventions "have focused on addressing individual risk behavior and not on addressing structural factors, such as living situations that might have an impact" on risky sexual behavior (ANI/Daily India, 1/7).

The AP/Carroll County Times on Friday profiled the new book "Dangerous Surrender" -- written by Kay Warren, wife of Saddleback Church pastor Rick Warren -- which encourages Christians to help fight the HIV/AIDS pandemic. In the book, Warren recounts traveling to Mozambique, Cambodia, the Philippines, Rwanda and other countries; meeting AIDS orphans and women living with the virus; and learning about the vulnerability of child sex workers.

Warren said she hopes to break down barriers that have prevented conservative Christians from becoming involved in HIV/AIDS issues, the AP/Times reports. "I hope this book is disturbing to people," Warren said. She added, "There are situations in the world that I cannot tolerate for one more second. I think there are some people who won't get past the first few chapters.&