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October 2004


Battling Crystal and HIV

On July 13 in New York City, some 300 people attended "Barebacking, Drugs, Internet Hook Ups: Is HIV Unstoppable?" at the Fashion Institute of Technology -- the fourth in a series of town hall meetings on gay men, club drugs and HIV. The audience was more ethnically and racially diverse, and younger, than at previous meetings, said Dan Carlson, who organized the events with Bruce Kellerhouse.

Four panelists described their struggles with drugs, unsafe sex, or both. "I did crystal [methamphetamine] for 15 years," said Michael K. "It has been a long, exhausting battle to get off crystal." During his addiction, he had mostly unsafe sex. "I had a total disregard for what I was doing, what I was doing to my body," he said.

"I thought all gay men wanted was sex," said Christian Gonzalez, whose introduction to the gay community was through the Internet. At large drug-and sex-filled circuit parties, he could usually find drugs, including crystal. "I never used condoms when I was on the circuit scene," said Gonzalez, who quit the drug.

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Brian G., a recovering addict, explained the fear that drove his drug use. "I was in tons of sex parties having lots of unprotected sex, but the thing that scared me was being the old, lonely gay man at the end of the bar," said Brian. "If HIV is stoppable in my life then, as a community, we can stop it," he said.

The meeting's last hour was spent in an audience questions and comments session, where people talked about their own experiences with drugs and unsafe sex and offered suggestions about how to respond to these issues. The event moderator was John Cameron Mitchell, who wrote, directed and starred in "Hedwig and the Angry Inch." Kellerhouse said that the group would soon turn the town hall meetings from discussion to action. (Gay City News, 07.15.04, Duncan Osborne)


New Illinois Law Permits Organ Donors With HIV

Illinois Gov. Rod Blagojevich signed a bill into law Thursday, effective immediately, allowing people with HIV/AIDS to donate organs to other HIV-infected people. Federal authorities raised questions about the law, saying that it would violate the National Organ Transplant Act of 1984, which "specifically states that no organs can be donated by those with HIV" in order to prevent transmission, said Kevin Ropp, Health Resources and Services Administration spokesperson.

However, attorneys for Blagojevich said their interpretation of federal regulations differed. They believe the state can proceed, said Abby Ottenhoff, the governor's spokesperson. Illinois doctors may need to seek variances to the regulations, attorneys said, but exceptions have been granted in the past.

Details on how the plan would work have not been sorted out. Advocates said it would require a separate organ pool in the state for those with HIV. All organ donors are already screened for infection, disease and other problems. The number of HIV patients needing organs is unknown, but the most common organ needed is a liver, since it can fail swiftly in some HIV patients or hepatitis-coinfected patients, said David Munar, associate director of the AIDS Foundation of Chicago.

Reasonable safety concerns were raised in considering the legislation, said bill author Larry McKeon (D-Chicago), including accidental transplants into HIV-negative recipients and infections by different HIV strains that pose an additional danger. McKeon said he and the medical community believe "that this doesn't add any increased risk."

"This is safe," said Dr. Robert Murphy, professor of infectious diseases at Northwestern University. "What's not safe is to let a person who is infected with HIV just die because they can't get an organ." But the new practice is untested, said Dr. Robert Harland, a University of Chicago transplant surgeon who also referred to the potential of infection by different HIV strains. "This is in its infancy," he said. "It's totally unknown at this point in time." (New York Times, 07.16.04, Monica Davey)


UN Labor Agency: HIV/AIDS Devastating Work Forces and Economies

AIDS will have killed some 28 million working people by the end of next year, putting massive strain on the remaining labor force and economic growth in some of the world's poorest countries, according to a new UN labor agency report. By 2015, based on current infection rates, sub-Saharan Africa will have lost 12 percent of its workforce to AIDS, said the International Labor Organization (ILO). Zimbabwe will have lost 40 percent of its total labor force by that time.

"HIV/AIDS is not only a human crisis, it is a threat to sustainable global, social and economic development," said ILO Director-General Joan Somavia. "The loss of life and the debilitating effects of the illness will lead not only to a reduced capacity to sustain production and employment, reduce poverty and promote development, but will be a burden borne by all societies -- rich and poor alike."

According to the 99-page report "HIV/AIDS and Work," the disease has infected 36.5 million people who would normally contribute to their nations' economies. Around 2 million of those at any given time will be unable to work by 2005, and another 2 million people will have to leave their own jobs to look after the sick, ILO said. The study showed that between 1992 and 2002, AIDS had cut the world's Gross Domestic Product by $25 billion per year.

The poorest economies are most affected by the death and disability of wage earners, as communities see children forced to give up school and households growing less food. Report author Odile Frank said employers are beginning to understand that providing care and treatment is cheaper than having employees unable to work. More governments are recognizing the private sector's important role in fighting the epidemic, she added. (Associated Press, 07.11.04, Naomi Koppel)


HIV/AIDS Anemia: Prevalence and Severity of Anemia Increases With Advancing HIV Disease

The current study describes the prevalence of anemia, a common hematologic abnormality that can significantly impact clinical outcomes and quality of life (QOL), in several populations of patients with HIV. Specifically, P.S. Belperio and colleagues looked at the "effects of anemia, morbidity, disease progression, transfusion requirements, and QOL" in these populations.

"The prevalence of anemia in HIV disease varies considerably, ranging from 1.3% to 95%: it depends on several factors, including the stage of HIV disease, sex, age, pregnancy status, and injection-drug use as well as the definition of anemia used," the authors noted. Commonly, they continued, the prevalence and severity of anemia increases as HIV progresses. "Anemia is also more prevalent in HIV-positive women, children, and injection-drug users than in HIV-negative women, children, and injection-drug users."

"Anemia has been shown to be a statistically significant predictor of progression to [AIDS] and is independently associated with increased risk of death in patients with HIV," wrote the investigators.

"Treatment of anemia with epoetin-a has resulted in significantly fewer patients requiring transfusion as well as decreases in the mean number of units of blood transfused," said Belperio and colleagues, noting that resolution of HIV-related anemia has been shown to improve physical functioning, energy, fatigue and QOL in HIV-infected patients. "More recently," they concluded, "the use of highly active antiretroviral therapy has also been associated with a significant increase in hemoglobin concentrations and a decrease in the prevalence of anemia." (Women's Health Weekly, 6.17.04)


NY City Council Hammers Mayor on AIDS

A staff report submitted to the New York City Council found numerous instances of sub-standard housing and services provided by the HIV/AIDS Services Administration (HASA). Staff examined 25 HASA-provided emergency and transitional housing facilities (randomly selected from a list of 114), interviewed 19 clients, and checked records of three city agencies other than HASA.

A number of facilities violated parts of Local Law 49 governing HASA or court orders issued with lawsuits against HASA. Violations included having more than one client per bedroom (excluding couples); communal refrigerators; communal bathrooms; not supplying mattresses, linens or toilet paper; failure to supply heat; water leaks; no running water; broken windows; doors without locks; holes in walls or ceilings; and roach or rodent infestations.

The Environmental Control Board cited 12 of 25 facilities for unresolved boiler, electrical, site safety, or local law violations. The Department of Buildings had unresolved violations regarding the electrical system, elevators, or boilers at 17 of 25 facilities. The Department of Housing Preservation and Development found five of 15 facilities had "immediately hazardous" violations, 11 had "hazardous" violations, and five had "non-hazardous" violations.

HASA was also criticized for inadequate assistance to clients in obtaining temporary and permanent housing. City Council recommended HASA create a central housing referral system and comply with Local Law 49. The report suggested the council itself should strengthen that law. "I can't spend the next six years responding to every crazy press conference that people who don't know that they're talking about have," said Mayor Michael Bloomberg, prefiguring a winning re-election bid next year.

Human Resources Administration (HRA), the agency that oversees HASA, said it provides homeless clients "medically appropriate" housing and has appropriate procedures to ensure clients get housing. Clients should notify HRA of any housing problems, it said. HRA performs inspections and asks for repairs when substandard conditions are identified; facilities that jeopardize clients' health are removed from the referral list and clients are immediately moved elsewhere, said the agency. (Gay City News, 07.01.04, Duncan Osborne)


US Policy Criticized for Halting Flow of Cheap AIDS Drugs to Poor Countries

Navigating the Obstacle Course
How to get generic drugs to AIDS patients in developing countries was a topic hotly debated at the 15th International AIDS Conference in Bangkok. Experts say only 7 percent of people in poor countries now get the drugs they need.

The US government maintains the expedited Food and Drug Administration approval process it announced two months ago is quick and designed to ensure that US tax dollars allocated to overseas AIDS relief are well-spent. That process can be used by generic and brand-name drug manufacturers to show proof of safety and effectiveness. Under it, approval could come in six weeks, compared to a year at present. FDA is waiving its $500,000 filing fee and will review generic versions of drugs still under US patent, provided they are only marketed abroad.

Many AIDS activists insist, however, that the US policy is less concerned with quality than with ensuring that the money goes to brand-name drug companies. The World Health Organization already publishes a list of generics it has reviewed for safety and quality. The Lancet recently published a study indicating that a triple-combination pill made by India's Cipla was effective. But supporters of the US policy note that WHO is not a regulatory agency like FDA. And they point out that two Cipla drugs have been pulled from WHO's list because of manufacturing facility problems.

Cipla Managing Director Amar Lulla said he is waiting for answers to questions about FDA's approval process before he submits an application for its triple-combination pill, including assurances Cipla will not be sued by brand-name makers. Department of Health and Human Services spokesperson Bill Pierce said he was not aware of any outstanding questions from Cipla. Generic makers are asked to sign a pledge not to market their versions of patent-protected drugs in the United States; this should settle concerns about lawsuits, Pierce said. (Associated Press, 07.10.04, Theresa Agovino)


Devastated by AIDS, Africa Sees Life Expectancy Plunge

According to a UN Development Program report released Thursday, infants born in seven nations hard-hit by HIV could expect to live less than 40 years. UNDP last year predicted it would take more than 140 years for Africa to halve the number of people living in extreme poverty, but the new report says that "no date can be set because the situation in the region is worsening, not improving."

The setbacks follow decades of progress. Life expectancy in developing countries climbed from 46 to 63 years between 1960 and 2000. Africa shared that progress until AIDS began to erode it in the mid-1990s. UNDP's "2004 Human Development Report" measured well-being based on life expectancy, literacy, school enrollment rates and per capita income. By these criteria, South Africans are worse off now than when apartheid ended. That finding derives largely from the nation's falling life expectancy, which now stands at 48.8 years, according to UNDP.

South African government spokesperson Joel Netshitenzhe called that estimate "nonsensical." South Africa's Medical Research Council said that life expectancy fell from 57 in 1995 to 55 in 2000. Mark Malloch Brown, UNDP administrator, said he had had difficult exchanges with South Africa over the findings. Even as he acknowledged the nation's post-apartheid progress in education and the provision of water and electricity, he called the life expectancy data "catastrophic." Asked what South Africa must do, Malloch Brown responded, "Fix the AIDS problem." Netshitenzhe defended South Africa's record on AIDS, saying the nation has Africa's biggest prevention program and expects to provide treatment to 53,000 people by March. (New York Times, 07.16.04, Celia W. Dugger)





  
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