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Kaiser Daily HIV/AIDS Report [Aug 06, 2008]
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Governments Overlook Behavior Change in HIV Strategies, Experts Say at AIDS Conference
When formulating their HIV strategies, governments worldwide overlook research showing the importance of behavior change in HIV prevention, several experts said Tuesday at the XVII International AIDS Conference in Mexico City, the New York Times reports.
Experts discussed a variety of behavior modifications, including promoting safer sex practices, decreasing injection drug use, providing needle-exchange programs and promoting male circumcision. Although "none of the measures alone offer a simple solution to preventing infection with HIV," combining interventions and making their use more widespread is crucial to fighting HIV/AIDS, the experts said, the Times reports. They added that there is an increasing need to combine prevention and treatment efforts. Myron Cohen of University of North Carolina said researchers in the respective fields "need to get married," adding, "we need to be one community."
The Global HIV Prevention Working Group, a panel convened by the Bill & Melinda Gates Foundation and the Kaiser Family Foundation, on Tuesday released a report calling for a greater focus on behavior change. According to the Times, the report addressed misconceptions about behavior change interventions, including: "misplaced pessimism about the effectiveness of HIV prevention strategies," confusion between "the difficulty in changing human behavior" and the ability to accomplish that, and "misperception that because it is inherently difficult to measure prevention success, those efforts have no impact" (Altman, New York Times, 8/6).
Also on Tuesday, the Lancet released a series produced in collaboration with UNAIDS that examines how global efforts to control HIV/AIDS cannot succeed without a comprehensive prevention package. The series includes six papers - which focus on combination prevention, decreasing the infectiousness of HIV-positive people, reducing risky behaviors, structural factors, targeting resources effectively, and the social and scientific movement needed to implement combination prevention - as well as two commentaries (Lancet release, 8/5). In one of the articles, to be published Saturday, Thomas Coates of the University of California-Los Angeles, wrote, "Behavioral strategies need to become more sophisticated." He also called on governments to ensure that they have put in place "the right programs" to prevent HIV.
Jorge Saavedra, director of Mexico's HIV/AIDS program, said political leaders worldwide need to follow epidemiological and scientific evidence when planning HIV strategies and must involve more men who have sex with men in planning how to reach groups at high risk of HIV. Saavedra added that the world "will lose the fight against HIV" if governments do not follow the epidemiological and scientific evidence (New York Times, 8/6).
The Global HIV Prevention Working Group report is available online.
Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference. Related webcasts from Tuesday include:
• A plenary session featuring Saavedra and Cohen.
• A briefing to release the working group report.
• A briefing on the series from the Lancet.
• A video roundup featuring the day's highlights from the conference, with a focus on prevention.
Former African Leaders Launch Regional Campaign To Pressure Politicians on HIV/AIDS
Former leaders of Botswana, Mozambique, Tanzania and Zambia, as well as other well-known African figures, launched an initiative Tuesday at the XVII International AIDS Conference in Mexico City to put pressure on politicians whom they believe have not done enough to fight HIV/AIDS, Reuters reports (Rosenberg, Reuters, 8/6). The campaign is called "Champions for an HIV-Free Generation." Its founding members include former Botswanan President Festus Mogae; Joaquim Chissano, former president of Mozambique; former Zambian president Kenneth Kaunda; South African Archbishop and Nobel peace laureate Desmond Tutu; and Miriam Were, head of the Kenyan National AIDS Control Council (Ingham, AFP/Khaleej Times, 8/6). The initiative calls for more government actions and public education campaigns to prevent new HIV cases in countries where up to one in four people are living with HIV/AIDS (Reuters, 8/6). Mogae also said the campaign's members would aim to launch "a dialogue" with governments about changing behavior, unsafe sex, stigma and discrimination against women. He added that the campaign would be open to prominent leaders all over Africa, as well as people "from all walks of life" (AFP/Khaleej Times, 8/6).
Mogae said, "The fact that we are prominent individuals from all parts of Africa, if we strongly disagree with someone, I think we can mobilize shame against that person," adding, "Some countries appeared to ignore the problem" (Reuters, 8/6). He added that the initiative hopes to reach a consensus with current political leaders, "but even if it doesn't emerge, we will advocate things we believe (in)" (AFP/Khaleej Times, 8/6). Mogae also said he would set up a small technical office in Botswana to develop HIV/AIDS prevention programs that will be funded by the World Bank, the U.S. and other organizations.
Were said, "Not everyone might be comfortable with it, but we need to talk about HIV, about stigma, about our behavior, because silence and inaction are fatal."
Stephen Lewis, a former UN special envoy for AIDS in Africa, said, "This will be interesting. Former presidents can wield a lot of influence" (AFP/Khaleej Times, 8/6).
Edwin Cameron, a prominent South African HIV-positive judge who is supporting the initiative, said, "What we have lacked is sufficient visibility of leadership. Just as my own country was mired in ghastly nightmare of President Mbeki's AIDS denialism, President Mogae in Botswana was rolling out very scientific responses."
Reuters reports that during Mogae's 10 years as president, Botswana reduced mother-to-child HIV transmission from 40% to 4%. In addition, of the 300,000 people in the country living with HIV/AIDS, about 100,000 are receiving antiretrovirals. The United Nations said that despite government education campaigns in the country, misconceptions about the disease remain. Nearly one-third of people surveyed in 2004 said they thought HIV can be acquired through supernatural means, and more than half said it can be transmitted through mosquitoes (Reuters, 8/6).
Advocates Discuss Travel Restrictions Around the World for People Living With HIV/AIDS
HIV/AIDS advocates on Tuesday at the XVII International AIDS Conference in Mexico City discussed travel restrictions around the world for people living with HIV/AIDS, the AP/Los Angeles Times reports.
Developed countries say such restrictions help them avoid the cost of caring for HIV-positive people from other nations, but advocates say research shows that countries without restrictions have not had to do so on a significant scale. According to the European AIDS Treatment Group, seven nations - Brunei, Oman, Qatar, Sudan, South Korea, United Arab Emirates and Yemen - deny entry for people living with HIV and 30 countries deport foreigners reported to have HIV. In addition, more than 65 nations enforce some degree of travel restriction for HIV-positive individuals.
Australia currently allows people living with HIV to enter the country but requires testing for those intending to work in the medical field and for sub-Saharan Africans seeking to study (Watson, AP/Los Angeles Times, 8/5). Australian Prime Minister John Howard in a radio interview last year said that his initial reaction was to oppose the immigration of HIV-positive people but added that he needed "more counsel" on the issue (Kaiser Daily HIV/AIDS Report, 4/13/07).
The bill (HR 5501) signed into law last week by President Bush that reauthorizes the President's Emergency Plan for AIDS Relief through 2013 also includes a provision that eases U.S. HIV/AIDS travel restrictions. However, it is not clear whether HHS plans to address the restrictions in the near future. HHS in 1987 placed HIV on a list of diseases barring entry into the U.S. Although that prohibition is separate from the congressionally imposed travel restrictions eased in the PEPFAR bill, federal health officials are no longer bound by law to keep HIV on the list.
Neither HHS nor CDC - which is under the jurisdiction of HHS and would make recommendations about the travel restrictions - commented on the provision last week, though advocates expressed hope that the ban would be repealed (Kaiser Daily HIV/AIDS Report, 7/31).
According to Craig McClure, executive director of the International AIDS Society, China plans to lift its HIV/AIDS travel restrictions at a later date, and countries such as Russia and the United Arab Emirates are revising their policies. "The U.S. always sets the tone," McClure said, adding, "This is huge not only for the people who have not been able to enter the U.S., but finally these laws might be overturned throughout the world" (AP/Los Angeles Times, 8/5).
In China, government "agencies, including the Ministry of Health and the General Administration of Quality Supervision, Inspection and Quarantine, have reached consensus on the issue," Hao Yang, deputy director of the ministry's disease control and prevention bureau, said. After performing the necessary administrative and legal procedures, "the HIV/AIDS restrictions will be lifted in 2009", he added (Shan, China Daily, 8/6).
In his opening address at the conference, United Nations Secretary General Ban Ki-moon said the travel restrictions on people living with HIV "should fill us with shame." Ron MacInnis, policy director for IAS, said travel restrictions "imped[e] our ability to control HIV and AIDS" and compel HIV-positive people to conceal their status. He added that it is "blatantly discriminatory to single out people with HIV." UNAIDS Executive Director Peter Piot said there is no public health justification for the travel restrictions, adding that they undermine efforts to control HIV/AIDS by implying that the disease can be curbed with tight border restrictions (AP/Los Angeles Times, 8/5).
IAVI Releases Blueprint for HIV/AIDS Vaccine Research
The International AIDS Vaccine Initiative on Tuesday at the XVII International AIDS Conference released a set of guidelines aimed at developing a safe and effective HIV/AIDS vaccine, Reuters reports. According to the guidelines, researchers should concentrate on smaller, more focused vaccine trials and abandon any candidates that do not show strong promise. "Developing an AIDS vaccine may take more time and innovation than we might have once imagined, but we are confident that science will prevail," IAVI President and CEO Seth Berkley said, adding, "The necessary direction for the field is clear." According to Berkley, the cancellation of a Merck vaccine trial last year does not mean that researchers should give up on developing vaccines.
It is not unusual for it to take decades for a vaccine to be developed, Berkley said, adding that he believes vaccine research efforts will be successful. "We have got to create this new mechanism to be able to turn the AIDS vaccine into a normal product development initiative so that every time there is a failure, it doesn't raise the question of whether this is the end of the line," Berkley said.
According to Berkley, if money is diverted from testing vaccines only to see if they work - which is an expensive effort - additional resources would be available to examine more difficult scientific questions. The blueprint calls for solving the scientific challenges associated with developing a vaccine, such as discovering a method of activating the two arms of the human immune system against HIV. "Before vaccines go into efficacy trials, they need to go through a set of screenings to look at evidence they are significantly better," Berkley said. He added that it could be possible to bolster a vaccine's efficacy by implementing things such as another type of virus to carry the vaccine into the body. "We are pushing a whole new generation of vectors," Berkley said, adding, "We have got candidates coming down the pipeline on that."
The approach outlined in the blueprint is similar to one being taken by NIH's National Institute of Allergy and Infectious Diseases to direct funding to increased laboratory work and animal tests rather than large-scale, human vaccine trials. "Strong scientific evidence in both humans and animal models suggests that developing an AIDS vaccine is possible," Wayne Koff of IAVI said.
IAVI is helping to test five vaccines with NIH, academic research institutions and companies, such as Targeted Genetics, Therion Biologics, Crucell and GlaxoSmithKline Biologicals (Fox, Reuters, 8/5).
Rising Food Prices Could Affect Those With HIV/AIDS, Increase Number of Women Entering Commercial Sex Trade, U.N. Officials Say
United Nations officials on Monday at the XVII International AIDS Conference in Mexico City discussed how rising food prices could affect HIV/AIDS, Reuters reports. The United Nations said that climbing food prices - due to increased use of biofuels, a growing demand for grains to feed large populations in Asia, droughts and market speculation - caused 50 million more people to go hungry in 2007 compared with 2006.
The rising food prices could force low-income women to participate in commercial sex work for basic goods and thus increase new HIV/AIDS cases, officials said.
According to Stuart Gillespie of the International Food Policy Research Institute, recent studies in Botswana, Malawi, Swaziland, Tanzania and Zambia have found links between food shortages and sex work among low-income women. "Food is such a basic need that you can see people really going to great lengths," Fadzai Mukonoweshuro of the Food and Agriculture Organization in southern Africa said.
Experts at the conference also said malnutrition can affect the health of HIV-positive people. Antiretroviral drugs can upset the stomach if not taken with food, and people living with HIV/AIDS, as well as tuberculosis, require more nutrients and calories, Martin Bloem, chief nutritionist at the World Food Program, said.
Kevin De Cock, director of the World Health Organization's HIV/AIDS Department, said, "We really need to watch this very carefully. We are in a situation of rising oil prices, rising food prices and at the same time the cost of AIDS is going up along with new infections." (Rosenberg, Reuters, 8/4).
Risk of HIV Transmission From Heterosexual Intercourse Could Be Underestimated, Study Finds
The standard method for assessing risk of HIV transmission through heterosexual intercourse could be flawed, according to a study published in the Lancet Infectious Diseases and presented at the XVII International AIDS Conference on Tuesday, AFP/iAfrica.com reports.
According to the study, a "yardstick" widely used by epidemiologists to determine HIV risk could have helped "fuel misperceptions" that HIV risk is lower for heterosexuals, AFP/iAfrica.com reports. The yardstick suggests that transmission of HIV occurs on average once per 1,000 acts of heterosexual intercourse by couples where only one individual is HIV-positive. However, the study said that the measurement is based on "stable couples" with few risk factors and that in other scenarios, risk factors can increase the chance of transmission by between several times and several hundred times, AFP/iAfrica.com reports.
The study, led by Kimberly Powers of the University of North Carolina, conducted a systematic review of estimated of heterosexual infectivity and found a wide range of results, ranging from zero transmission of HIV after more than 100 acts of heterosexual vaginal intercourse in one study to a rate of HIV transmission of once out of every 3.1 acts of heterosexual anal intercourse.
The study said HIV risks could be amplified by other factors, such as men who are not circumcised, partners who have genital ulcers or if a partner is at the early or late stage of HIV, when viral loads are higher. In addition, researchers do not know the risks of HIV transmission for certain sexual behaviors, including oral sex.
According to the researchers, "The use of a single, 'one-size-fits-all' value for the heterosexual infectivity of HIV-1 obscures important differences associated with transmission co-factors." They added that 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" (AFP/iAfrica.com, 8/5).
MSM Remain at High Risk for HIV; Official Data Lacking, Report Finds
Government and global health agencies have failed to adequately address the HIV/AIDS epidemic among men who have sex with men, according to a report by the American Foundation for AIDS Research released Monday at the XVII International AIDS Conference in Mexico City, Reuters reports. Although the disease has come to affect women and children as well, the researchers said MSM - the demographic originally most at risk of HIV/AIDS - remains at highest risk of infection. According to the report, research has found that MSM are 19 times more likely to be living with HIV than the general population, yet they are ignored in many countries.
Based on data from 128 countries submitted to UNAIDS, the report also found that 44% of countries failed to provide any data on MSM. According to the report, despite a unanimous commitment that all United Nations member countries made in 2001 to monitor HIV among high-risk groups, 71% of countries said they did not have any information on the percentage of MSM contacted by HIV prevention groups. According to the report, Benin, Ghana, Jamaica, Kenya and Thailand are the countries with the highest reported HIV prevalence rates among MSM. Although data were scarce, the study found MSM were 33 times more likely to be living with HIV than the general population in Latin America, 18 times more likely in Asia and at least four times more likely in Africa.
AmfAR CEO Kevin Frost said the failure of the Global Fund To Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief, the World Bank and other global health organizations to allocate "significant resources toward reducing HIV rates among MSM is indefensible." Frost added, "These organizations have policies on women, drug users, migration - but not one of them has a comprehensive policy on MSM." Joe Chan of AIDS Concern in Hong Kong said some new cases of HIV/AIDS among MSM were occurring even after they had undergone repeated HIV tests, and counseling. "These are clients who have undergone repeated tests and we find that they are still engaging in unsafe sexual behavior," Chan said (Lyn, Reuters, 8/5).
Miami Herald Examines Research on Crack Users and HIV
The Miami Herald on Tuesday profiled the efforts of two researchers at hospitals in Atlanta and Miami to break the "grim cycle" in which crack users engage in risky sexual behavior, become HIV-positive and transmit the virus to others. Lisa Metsch of the University of Miami's School of Medicine and Carlos del Rio of Emory University's School of Medicine and Atlanta's Grady Memorial Hospital are testing an eight-session intervention program aimed at getting crack users into HIV and long-term drug treatment programs. The researchers presented their findings at the XVII International AIDS Conference in Mexico City on Monday.
For the study, the researchers interviewed 190 HIV-positive, sexually active crack users who were admitted to Grady Hospital and Jackson Memorial Hospital in Miami for HIV-related medical problems, such as infections, diarrhea, pneumonia and cancer. Del Rio and Metsch worked with the patients to get them in long-term HIV care, group counseling to reduce risky sex practices and drug treatment programs. The researchers paid patients $10 per counseling session. Del Rio and Metsch will report progress as the 14-month program continues. The program is part of a five-year nationwide study funded by NIH.
In interviews with the patients, the researchers aimed to learn which life situations were most likely to influence the drug users to have unsafe sex with an HIV-negative or unknown status partner. According to the researchers, hypersexuality associated with crack use and its users' heavy involvement in sex for the drug and money poses a significant risk of HIV. The researchers found that one-quarter of study participants reported having unprotected vaginal and/or anal sex with an HIV-negative or unknown status partner in the previous six months and that women were more likely to have unprotected sex, by 32% to 18%. Women also were more likely to be homeless, report annual income of less than $5,000 and not have health insurance. In addition, researchers found that half of the drug users had not seen an HIV specialist in the past six months and that three-quarters were not on antiretroviral drugs.
Del Rio said, "On average overall, the addicts have three diseases - HIV, mental health problems like schizophrenia and substance abuse." Metsch said, "Too many people think HIV is just a chronic disease, and people can live very well with it if they take their meds," adding, "This group is not living good lives. They're engaged in hard-core drugs. They're at high risk" (Tasker, Miami Herald, 8/5).
Advocates, Experts Discussing Allegations of Inadequate Treatment of HIV-Positive Immigrants
Researchers, immigration experts and human rights advocates at the XVII International AIDS Conference in Mexico City are discussing claims that some HIV-positive immigrants in U.S. Immigration and Customs Enforcement custody do not receive appropriate medications regularly, the AP/New York Daily News reports (Watson, AP/New York Daily News, 8/4).
Human Rights Watch in December 2007 released a report on care and treatment to HIV-positive detainees at U.S. detention centers after the death of an HIV-positive inmate at a San Pedro, Calif., detention center. Victor Arellano - who was transgender and went by the name Victoria - allegedly was denied vital medical care at the San Pedro center. Attorneys for Arellano's family say that while in custody, Arellano's condition deteriorated to the point that fellow detainees urged staff to provide medical care. Roman Silberfeld, the family's attorney, said that 70 detainees signed a petition urging that Arellano receive medical attention. When Arellano's condition became critical, Arellano was transferred to a San Pedro hospital and died several days later (Kaiser Daily HIV/AIDS Report, 12/10/07). ICE spokesperson Brandon Alvarez-Montgomery said he could not comment on the case because Arellano's family is suing the agency.
The HRW report found 14 cases in which the organization said HIV-positive immigrants did not receive proper care. According to HRW, ICE detention facilities do not collect adequate information to monitor HIV cases or provide antiretrovirals regularly to HIV-positive detainees. According to HRW, ICE does not prescribe prophylactics to prevent HIV transmission, and officials do not ensure continuity of care when HIV-positive detainees transfer to a different facility.
ICE spends approximately $100 million each year on medical, dental and mental health services for its detainees, the AP/Daily News reports. Out of the 1.5 million people who have been in ICE's custody since the agency's founding in 2003, 71 have died. According to officials, the number of deaths last year decreased to seven, despite a rise in the detainee population. A June 11 report issued by the U.S. Department of Homeland Security found that ICE's standards equaled those of other detention agencies. However, the report recommended that ICE improve oversight and screening procedures, as well as fill clinical staff shortages at detention centers (AP/New York Daily News, 8/4).
AIDS 2008 New Studies and Development
Kaiser Daily HIV/AIDS Report Summarizes Reports, Initiatives From International AIDS Conference
As part of its expanded coverage of the XVII International AIDS Conference, which is being held Aug. 3 through Aug. 8 in Mexico City, the Kaiser Daily HIV/AIDS Report will feature studies and initiatives released during the conference. Summaries of select publications and initiatives appear below.
"Expanded Access to Highly Active Retroviral Therapy: A Potentially Powerful Strategy To Curb the Growth of the Epidemic," Journal of Infectious Diseases: For the study, researchers from the British Columbia Centre for Excellence in HIV/AIDS used a mathematical model to examine the potential impact of increased treatment coverage with highly active antiretroviral therapy among HIV-positive people in need of treatment in British Columbia, Canada. The model is reflective of the next 25 years. According to the study, an increase in HAART coverage from the current level of 50% among those in need to 75%, 90% and 100% could lead to a decrease in the number of people newly testing HIV positive each by more than 30%, 50% and 60%, respectively (IAS release, 8/6).
"Priority Interventions: HIV/AIDS Prevention, Treatment and Care in the Health Sector," World Health Organization: WHO released the package of priority interventions in an effort to help low- and middle-income countries move toward universal access to HIV/AIDS prevention, treatment, care and support. The package includes such interventions as expanding condom programs, as well as treatment recommendations, guidelines and standards. The package will be periodically updated with new recommendations (WHO release, 8/5).
"Running in Place," Medecins Sans Frontieres: The series of briefing papers aims to highlight issues that MSF field teams face in providing HIV/AIDS care and treatment worldwide. The papers focus on health worker shortages; effective pediatric care and prevention of mother-to-child transmission; HIV/TB co-infection; access to drugs and diagnostics; and program indicators of quality and continuity of care (MSF Web site, 8/6).
"UNITAID, UNICEF and WHO Announce Massive Scale-Up in the Fight Against HIV in Mothers and Children," UNITAID /UNICEF/WHO: The agencies ahead of the AIDS conference announced a $50 million initiative aimed at addressing mother-to-child transmission of HIV in nine countries. The nine countries - Central African Republic, China, Haiti, Lesotho, Myanmar, Nigeria, Swaziland, Uganda and Zimbabwe - account for about 25% of the world's HIV-positive pregnant women giving birth each year. Under the initiative, 10 million pregnant women in the countries will be tested for HIV and 285,000 women and children will receive HIV/AIDS treatment. The project will allow UNICEF to negotiate reduced drug prices, and funding will provide a one-year course of antiretroviral treatment to HIV-positive pregnant women in need in the focus countries (WHO release, 7/31).
Global Challenges
Canada Commits $45M to Fighting HIV/AIDS in Africa, Health Minister Clement Says at AIDS Conference
Canadian Health Minister Tony Clement on Monday at the XVII International AIDS Conference announced that Canada will commit $45 million to fighting HIV/AIDS in Africa, the Canadian Press/Victoria Star reports. The funding, which is earmarked primarily for projects in Mozambique and South Africa, will be used to provide treatment for people living with HIV/AIDS and education about the virus for at-risk populations. The funds will build on the $515 million in global HIV/AIDS spending that Canada has committed over the past three years, Clement said in a statement (Canadian Press/Victoria Star, 8/5).
Canada is "committed to working with the global community to effectively respond to HIV/AIDS," Clement said, adding that the country's contributions are "achieving results and having a lifesaving impact on people around the world." Beverley Oda, the Canadian minister of international cooperation, said that the country's "investments in HIV/AIDS prevention, treatment and care initiatives are an integral part of helping to improve the health" of low-income people worldwide. Oda added that the Canadian government will "continue its significant support to programs that are well-coordinated, effective and accountable for outcomes that are making a difference" (Public Health Agency of Canada release, 8/4).
Across The Nation
'NewsHour with Jim Lehrer' Examines HIV/AIDS Cases in Black Communities, Highlights Washington, D.C.
PBS' "NewsHour with Jim Lehrer" on Tuesday reported on the HIV/AIDS epidemic in the Washington, D.C., area. The segment focuses on HIV cases among blacks in the district. About 12,000 of the 600,000 district residents are HIV-positive, 81% of whom are black, according to the NewsHour. Phill Wilson, CEO of the Black AIDS Institute, said that the federal government needs to focus more on the domestic HIV/AIDS epidemic and that more resources are needed to fight the epidemic among blacks in the district and nationwide.
Pierre Vigilance, director of the Washington, D.C., Department of Health, said that many residents are not using advice on safer-sex practices. "What drives [HIV/AIDS], as far as we're concerned, is the multiplicity of behaviors that go on out there and people just really feeling they don't need to do the things that they know to do." Theo Hodge, an infectious disease specialist in the district, said he often has a difficult time convincing people to use condoms. Hodge said that he is seeing new HIV cases among blacks in all demographic groups - including people under age 30, women men who have sex with men. According to "NewsHour," some community leaders, including Terry Hawkins of the Greater Mount Calvary Holy Church, are working to educate young residents about safer-sex practices, including condom use.
Shannon Hader, director of the district's HIV/AIDS Administration, is calling on every physician in the city to offer voluntary HIV tests to their patients, "NewsHour" reports. "Part of the reason most people aren't getting tested is it's not being offered," Hader said, adding that studies in the district have shown that 75% of newly diagnosed HIV cases are among people who have visited a physician within the past 12 months. Sabrina Heard, a volunteer of the Women's Collective who is HIV-positive, encourages people to get tested in one of the group's mobile units. According to Heard, many people do not take HIV/AIDS as seriously as they should because they do not believe they are at high risk (Bowser, "NewsHour with Jim Lehrer," PBS, 8/5).
Public Health & Education
OraQuick Oral HIV Test Produces Higher Number of False Positives Than Expected, Study Finds
OraSure Technologies' OraQuick Advance Rapid HIV 1/2 Antibody Test produced more false positive results than expected when administered to patients in the emergency department at Brigham and Women's Hospital, according to a study published this week in the Annals of Internal Medicine, the Washington Post reports.
For the study, Rochelle Walensky, a physician at the hospital, and colleagues over eight months administered the OraQuick test to 854 ED patients who did not know their HIV status.
According to the study, 31 patients tested positive initially; however, only five were found to be HIV-positive after undergoing a test to confirm the results of the OraQuick test. Previous studies have reported similar rates of false positives, the Post reports.
Instead of replacing the OraQuick test with a more accurate rapid test, the researchers learned to anticipate a higher number of false positives and act accordingly. Walensky said that although blood tests are more accurate, patients are less willing to receive a blood test than the OraQuick test, adding that "more people accept HIV testing" with the OraQuick test "than otherwise might."
Walensky said that physicians administering the OraQuick test should be prepared to handle potential false positives and discuss the possibility of a false positive with patients. Physicians also should ensure that all initial positive results are followed with a blood test.
According to the Post, 13% of EDs offered the OraQuick test in 2006, but that percentage likely has increased. Each hospital determines its own testing strategy, according to Bernhard Branson, a CDC epidemiologist and lead author of the 2006 guidelines that called for HIV testing in EDs. Christopher Pilcher, associate professor of medicine in the HIV/AIDS division at the University of California-San Francisco, said, "If we're going to ... start widely testing in a population where there hasn't been wide testing before, we're going to have to be really careful to have accurate and robust testing" (Ganguli, Washington Post, 8/5).
Opinion
HIV Vaccine Development 'Frustrating, Challenging,' but Progress Being Made, NIAID's Fauci Writes in Opinion Piece
In a CNN opinion piece in advance of his talk at the XVII International AIDS Conference in Mexico City on Wednesday, Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, examines the progress against HIV/AIDS, as well as the work that "remains to be done." He writes that with his talk he hopes to "leave the audience with at least a tentative answer to an important question ...: Will we ever have a cure or a vaccine for HIV?" Despite "considerable success" in managing HIV and improving the length and quality of life for people living with HIV/AIDS, there are "no well-documented cases of anyone truly being cured of HIV," he writes.
He adds, "HIV vaccine development has been frustrating and challenging for a number of reasons, including the fact that the virus mutates rapidly, hides from the immune system, and targets and destroys the immune system cells that are successful in fighting and clearing most other viruses from the body." He writes, "With HIV we will have to do better than nature if we are to develop a vaccine."
Although no "avenues of prevention" are "more essential than an HIV vaccine," the world's "best hope for eradicating HIV ... may be to diagnose and treat people aggressively very early in infection," he writes. Fauci adds, "Even if the virus is not completely eradicated ... early, intense treatment, perhaps with the help of immune-boosting drugs, might keep the reservoir small - and the immune system strong - thereby allowing a person to come off therapy. This would be a 'functional' cure. Other approaches are being pursued as well."
A "cure is critical to our attempts to ultimately contain the pandemic," Fauci writes. He adds, "As antiretroviral therapy is at present a lifelong commitment, it is extremely unlikely that we will have the logistical or financial capacity to reach and treat - indefinitely - everyone who requires antiretroviral therapy."
Fauci writes that he is "cautiously optimistic that we will be able to cure some patients under certain circumstances" and "develop a vaccine that will protect some people against HIV infection or slow the progression of disease in some patients who do get infected." Fauci invokes the conference theme, concluding, "we need 'Universal Action Now' to accelerate the exceptional momentum of the past few years ... in delivering proven tools of HIV prevention and therapy to communities around the globe" (Fauci, CNN, 8/5).
Addressing Stigma Key in Fight Against HIV/AIDS, U.N. Secretary-General Writes
Although a recent UNAIDS report shows "encouraging progress in preventing HIV in a number of the most vulnerable countries," one "of the biggest hurdles for our global response to AIDS" is "the stigma factor," United Nations Secretary-General Ban Ki-moon writes in a Washington Times opinion piece. Ban continues, "Stigma remains the single most important barrier to public action," and it "helps make AIDS the silent killer, because people fear the social disgrace of speaking about it or taking easily available precautions." He writes, "Stigma is a chief reason the AIDS epidemic continues to devastate societies around the world."
According to Ban, "To a greater or lesser degree, almost everywhere in the world, discrimination remains a fact of daily life for people living with HIV." He adds, "One-third of all countries have virtually no laws protecting their rights. Almost all permit at least some form of discrimination - against women and children who contract the disease, against gay men, against communities at risk."
"We can fight stigma," he writes, adding, "Enlightened laws and policies are key." At the XVII International AIDS Conference in Mexico City this week, Ban says he called on world leaders to "speak out against discrimination and to guarantee the rights of people living with HIV." He adds, "Schools should teach respect and understanding. Religious leaders should preach tolerance. The media should condemn prejudice and use its influence to advance social change, from securing legal protections to ensuring access to health care."
"Fortunately, more and more people are finding their voices," Ban writes, adding that HIV-positive people who work to fight stigma are "at the heart of the global campaign against AIDS. It is impossible not to admire their courage and commitment. Yet their efforts, alone, are not enough."
Ban concludes, "Above all, we must recognize that those who bear the stigma of HIV should not be those who live with the disease. It is those who allow it" (Ban, Washington Times, 8/6).
Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click HERE to sign up for your Daily Update email during the conference. A webcast of the opening ceremony during which Ban spoke also is available online. |
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