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July 2004


NYC Inmates Being Screened With New 20-Minute HIV Test

New York City has begun offering the 20-minute OraQuick HIV test to prisoners in all 10 Rikers Island facilities and at the Vernon C. Bain Center, an 800-bed detention center on a floating barge in the Bronx. Since the Health Department introduced the finger-prick test in the city prison system in March, roughly 1,000 inmates have been screened for HIV. Health officials are still analyzing the numbers to determine whether more inmates were choosing to get tested because of the new rapid test and whether positive diagnoses were up.

From the public-health perspective, the OraQuick test is ideal for city prisoners -- who move quickly through the system -- to find out their HIV status, and if positive, enroll in treatment and stop infecting others. "Given the turnaround time on this test and the high-risk population, we felt like offering it [in city prisons] was an obvious thing for us to do," said Dr. Farah Parvez, the Health Department's head of correctional public health. "We know that approximately 25,000 people in New York City have HIV and don't know it. It is reasonable to think that there are a portion of them coming through Rikers Island."

Health officials plan to roll out the rapid HIV test in other city corrections facilities, just as the state has done in many of its prisons. "We know that a very high percentage of the [prison] population is HIV positive," said Robert Berding, a colleague of Parvez. Health officials pointed out the prison population is made up of mostly low-income minorities who lack access to health care. "We want to make sure they have the opportunity to find out" their HIV status, said Berding. (New York Sun, 05.03.04, Jill Gardiner)

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Hunger and AIDS Create a Vicious Cycle in Africa, Experts Say

The Senate Foreign Relations Committee heard expert testimony that hunger and AIDS are trapping millions of Africans in a spiral of sickness and death. "AIDS dramatically undermines food production. Malnourished bodies are more receptive to HIV, and more receptive to the opportunistic diseases that follow," said UN World Food Program Executive Director James Morris.

AIDS has killed 7 million farmers in Africa, the UN estimates. It frequently deprives a victim's family of adequate food as they are forced to sell livestock or other assets to pay medical or funeral expenses, said Andrew Natsios, administrator of the US Agency for International Development. He noted that AIDS drugs often need to be taken with food, and the World Health Organization believes adequate nutrition strengthens the immune system and improves survival rates.

"Food assistance is essential if we are going to make any headway in the struggle against the virus," said Sen. Richard Lugar (R-Ind.), who chairs the committee.

Morris applauded the United States for its donations to food programs but called on Congress to fund a full assistance package -- food, water, medicine and shelter -- and to support extended food programs for all schools in hard-hit communities. (Associated Press, 05.11.04, Ira Dreyfuss)


World Health Organization Calls for AIDS-Drugs Coordination

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In a report, the World Health Organization called on donors and public-health agencies to coordinate their efforts to get AIDS drugs to patients. Governments and other donors have pledged some $20 billion to the global anti-AIDS effort: Now the task is to use that money to provide medicines to those most in need, said the report. A critical element will be how quickly individual countries can boost fledgling treatment programs and take them nationwide.

"Future generations will judge our era in large part by our response to the AIDS pandemic," said WHO Director-General Lee Jong Wook. "This is an historic opportunity we cannot afford to miss."

WHO said that AIDS has already killed 20 million people and is now the leading cause of death and lost years of productivity for adults ages 15-59. About 40 million people are HIV-infected. Six million are in desperate need of medications. Of those, only 400,000 were receiving them as of late last year.

In part because antiretrovirals are so expensive, many countries hard-hit by AIDS focus more on prevention than treatment. WHO hopes to change this with its project to get the drugs to 3 million people by 2005 -- an initiative that will cost about $5.5 billion. That plan, launched in September, has the backing of UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria. WHO hopes to raise an additional $218 million to fund its activities for the project. Canada on Monday announced it will contribute $100 million (US$72 million) to the effort.

Central components of the WHO plan will be small-scale treatment programs in the worst-hit nations. WHO also hopes the effort will spark broader improvements in poor countries' public-health systems, which will help them fight other killer diseases as well. (Wall Street Journal, 05.12.04, Gautam Naik)


NJ Says Atlantic City Can't Start Needle Exchange

Atlantic City does not have the legal authority to launch a needle-exchange program for heroin addicts, the office of New Jersey State Attorney General Peter C. Harvey told the city on Thursday.

While needle exchanges have long been considered illegal in the state, Mayor Lorenzo Langford told the city's Health and Human Services Department to pursue the possibility of initiating one. The city's needle-exchange program would be part of the its efforts to reduce AIDS and hepatitis C in a community where the HIV infection rate among blacks is the state's highest.

City officials believe a municipal-run program would be legal on the basis of a state criminal code that exempts government agencies from a state law that criminalizes possession and distribution of needles.

However, Atlantic County Prosecutor Jeffrey S. Blitz said the law only authorized government agencies to distribute needles and syringes to those with prescriptions. City officials have indicated that they may challenge this finding in court. Harvey concurred with Blitz's legal opinion, said his spokesperson, Chuck Davis. (Associated Press, 05.14.04)


US Promises Cheaper AIDS Drugs to Developing Countries

US officials promised to provide low-cost combination AIDS drugs for patients in Africa and the Caribbean, and to expedite the Food and Drug Administration process necessary to approve such drugs. FDA will propose new guidelines to smooth the approval process for products that combine several HIV drugs already approved individually by FDA. US Policy had previously favored more stringent standards for fixed-dose combinations made by foreign firms that manufacture low-cost generic HIV drugs.

"We are clearing the way to quickly deliver quality, lifesaving HIV/AIDS drugs to people who desperately need them in developing countries," US Health and Human Services Secretary Tommy Thompson said in Geneva, where he is attending a World Health Organization meeting. "The president has made clear that his goal is to put effective treatment into the hands of those who need it in the hardest-hit developing countries," said Randall Tobias, coordinator of the Bush administration's global AIDS activities. "At the same time, we must apply real discipline to ensure that the products we provide in poor nations are safe and effective. The new expedited process provides us with a solid foundation for purchasing drugs that work. With FDA review, we will have a gold-standard assurance that a combination product will be safe and effective."

Drug patent issues that apply in developing countries should not hinder purchasing those drugs for developing countries, Thompson added. Both brand-name manufacturers and foreign generics producers can apply for FDA approval. Because of patent laws, FDA approval of foreign generics would not allow their sale in the domestic US market, but the approved drugs could be purchased for distribution in developing countries. (Associated Press, 05.16.04, Sam Cage)


Demands for Prison STD Treatment

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On April 30 outside a hearing on New York's prison health policy, activists rallied in support of legislation that would subject prisons to the same health standards as hospitals and require the implementation of STD education and prevention efforts. One bill would task the state health department with reviewing HIV and hepatitis care -- a responsibility that is now the sole province of the department of corrections. The bills have passed the state Assembly but are mired in the Senate.

"This campaign has been going on for a year and a half. Protest and legislative strategy are going together," said Graziela Tanaka, an organizer of the protest at the Harlem State Office Building, who works with the New York City AIDS Housing Network.

Activists and former inmates charged that New York prisons carry out systematic neglect of prisoners' basic rights for HIV, hepatitis, and other STD treatment and prevention. "Not providing access to HIV prevention is criminal," said Charles Cobb of the Harlem Directors Group. "At Riker's Island, the doctors don't even have any training in HIV treatment," said Mary Solomon, an HIV-positive former inmate. "The doctors try their best, but the system's got to do something." The protesters also criticized the state's refusal to distribute condoms in prisons.

Numerous organizations, from AIDS groups to the Harlem Tenants Council and St. Mary's Church, participated in the rally. "There was lots of new collaboration," said Emmaia Gelman, a member of ACT UP's Harlem working group. The activists distributed flyers and spoke to community members in central Harlem. "People are glad to hear someone talking about these issues in this community," said Gelman. (Gay City News, 05.13.04, David Thurston)


Expressing Emotions by Writing Helps HIV Patients

HIV-infected patients who disclose their deepest emotions in writing report less stress and may have improved immune responses, according to a recent study by US and New Zealand researchers. Dr. Kevin J. Petrie of the University of Auckland and colleagues said a review of studies of writing about emotional topics by patients with various diseases, including arthritis and asthma, showed "consistent and significant improvements in health outcomes after written emotional expression." The current report investigated whether this strategy might help HIV patients.

The researchers recruited 37 subjects, who were randomly assigned to an emotional writing group or to a control group. The subjects were assessed individually and then assigned to write for 30 minutes each day for four consecutive days in a small, private room. Writing in both groups was anonymous. The emotional writing group members were encouraged to explore deep feelings previously unexpressed. "Subjects were told they could write about HIV-related topics or any other issues of emotional importance to them," the authors noted. The control group participants were asked to write objectively about how they spent their time.

The researchers found that the emotional writing group subjects rated the experience as being more valuable than did those in the control group. In addition, "The CD4+ positive lymphocyte count increased gradually and continuously in the emotional writing group in the 6 months after the sessions." No CD4+ count change was detected in the control group. The findings are consistent with those of other studies indicating that HIV-positive patients "who don't get to discuss their feelings, have a faster decline in their health," concluded the authors (Reuters, 04.28.04, David Douglas).


US Shifts Strategy to Curb HIV's Spread

In its first round of annual funding since last year's launch of an initiative aimed at keeping people with HIV from infecting others, CDC on Friday announced $49 million in HIV prevention grants to 142 community organizations. About 82 percent of grant-receiving organizations target minorities; 41 percent of the money goes to programs for gay men.

Part of the effort seeks to make testing more available, chiefly using a new rapid HIV test, so that the estimated 200,000 people who have HIV but don't know it can learn their status and reduce their risk of transmitting the virus to others. With proper information, two-thirds of people who learn they have HIV are willing to reduce risky behaviors, but only one-third who do not know they are infected will change their behavior, according to Dr. Rob Janssen, director of CDC's Division of HIV/AIDS Prevention.

After dropping dramatically in the 1990s, AIDS rates have stabilized, while HIV infections, especially among gay men, appear to be on the rise, CDC says, leading public health officials to focus more on encouraging safe sex for those with HIV.

The new grants include:

  • $23 million in prevention for positives, their partners, and people at highest risk of infection

  • $14 million for counseling and testing

  • $12 million for outreach and education.

Of organizations previously funded by CDC, two-thirds are not receiving money. Replacing these are 75 newly funded groups. While some blame politics for the change, Janssen said funding is based on groups' ability to meet CDC's goals, not politics, with money allocated according to AIDS rates. The South, where HIV has increased substantially, will get 43 percent of the funds.

Focusing on people with HIV can be counter-productive, said Terje Anderson, executive director of the National Association of People with AIDS. "When you start shaking your finger and saying, 'bad boy,' and 'bad girl,' it's creating an environment that is stigmatizing." (Atlanta Journal-Constitution, 05.22.04, David Wahlberg)


Health Professionals Discuss AIDS/HIV Epidemic Among Latinos

About 400 HIV/AIDS professionals, some from as far away as Venezuela, attended the United States' first National Conference on Latinos and AIDS in Philadelphia. "In America, we have lost the war on HIV/AIDS," said Miguel Gomez, director of President Bush's Leadership Campaign on AIDS. Though they comprise only 13 percent of the population, Latinos account for 19 percent of the approximately 40,000 new US HIV infections each year.

David Lopez, who works with young men at the AIDS Service Center of New York City, spoke about men who have unprotected sex with men and men who live "on the down low," secretly having sex with men while maintaining a relationship with a wife or girlfriend. Young people, Lopez said, have "grown up hearing about [AIDS] everywhere and they see ads showing people with HIV looking good and living with it." He despairs of clients who discount the danger of HIV by claiming it can be "managed like diabetes. It's nothing like diabetes," Lopez said.

Carolyn Jorge, who is a case manager for Catskill Regional Medical Center in Harris, N.Y., works with HIV-infected undocumented Mexican migrant farm workers. Most, she said, are sexually active even though they have wives back home.

Cynthia A. Gomez, co-director of the Center for AIDS Prevention Studies at the University of California-San Francisco, said Latino culture stifles discussion of HIV. She called for parents to speak bluntly with their children about the threat, and for women to demand that their partners be tested for HIV in spite of deportation fears and mistrust of the government.(Philadelphia Inquirer, 05.25.04, Virginia A. Smith)


HIV/AIDS Among Black Women

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Once, concern about black women and HIV/AIDS focused on those who had used drugs or had sex with drug injectors. But increasingly, HIV/AIDS transmission through heterosexual sex is a danger for African-American females. In government studies of 29 states, a black woman was 23 times more likely to be infected with HIV than a white woman.

In 2001, according to the Kaiser Family Foundation, an estimated 67 percent of black women with AIDS contracted the virus through heterosexual sex, compared to 58 percent four years earlier. CDC said black women accounted for half of all HIV infections in men or women acquired through heterosexual sex from 1999 to 2002.

Recent studies suggest that 30 percent of all black bisexual men may have HIV, and as many as 90 percent do not know they are infected. CDC researchers call such men a "bridge" to infection from gay men to heterosexual women.

However, Dr. Robert S. Janssen, director of CDC's Division of HIV/AIDS Prevention, warned that evidence was lacking about what drives infection among black women. "Yes, the risk of contracting HIV is highest in the African-American community and there's no question black women are at higher risk compared to other women, but there's still a lot we don't understand," he said. Janssen added that CDC is concerned enough to tell women of all socioeconomic groups to ask partners about their serostatus and if they are having sex with men.

The shortage of black men as potential partners, experts say, may lead some black women to make unsafe sexual decisions. "Large numbers of black men are in prison, or unemployed, or dead, so there is simply a smaller pool of available partners to choose from," said Dr. Gail E. Wyatt, a psychiatry professor and associate director of the University of California-Los Angeles AIDS Institute.

"When marriage rates are low, there is a higher likelihood of concurrence -- the pattern of having more than one partner at the same time," said Dr. Edward O. Laumann, professor of sociology at the University of Chicago. Such "fragile relationships" "can facilitate the spread of sexually transmitted diseases," the professor said. (New York Times, 04.05.04, Linda Villarosa)


Keith Cylar of Housing Works Dies at 45

Keith Cylar, the co-founder, co-president and chief operating officer of Housing Works, was found in his New York City apartment in April. The immediate cause of death was cardioarrhythmia, according to Housing Works. He was 45. Born in Norfolk, Va., Cylar was a psychology graduate of Boston University and obtained his master's degree in social work at Columbia in 1988, by which time he had lived with HIV for several years. He joined the AIDS Coalition to Unleash Power (ACT UP) in 1987 and helped found its housing committee. In 1990, Cylar co-founded Housing Works, which offers social services, mental care and referrals to 2,000 clients, and has by its own count found shelter for 15,000 people. More recently, Cylar and Housing Works became involved in RAND Corporation research on the cost-effectiveness of HIV services. He was an investigator with the Beth Israel Medical Center on how to provide minority patients better access to AIDS clinical trials. (New York Times, 04.08.04, Wolfgang Saxon)


New Evidence: HIV Not Linked to Polio Vaccine

Scientists say new research offers further proof that the AIDS epidemic was not sparked by polio vaccines used in the 1950s in Africa. Many medical experts have dismissed the controversial theory on the origin of AIDS, saying there is no scientific evidence to back it. Even so, persistent doubts about vaccine safety are blamed for hampering World Health Organization efforts to eradicate polio in countries where it is still a problem.

Generally accepted among scientists is the view that a chimpanzee virus jumped species when a human was bitten by a monkey or when people ate contaminated monkey flesh. However, the oral polio vaccine/AIDS (OPV/AIDS) theory suggests that chimpanzees from the Democratic Republic of Congo (DRC) were the source of the virus and that scientists accidentally triggered the AIDS epidemic with vaccines that were contaminated with the monkey virus.

The researchers, led by Michael Worobey of the University of Arizona, have discovered a new strain of chimpanzee virus near Kisangani in the DRC. It is very different from HIV, they said, offering further evidence that chimpanzees could not have been the source of human AIDS. Chimpanzees around Kisangani are endemically infected with simian immunodeficiency virus that is very different from the human strain. "The locally circulating strain [of the chimpanzee virus] is very distantly related to HIV. It is not a virus that could have been the progenitor and therefore HIV did not come from that region," Worobey said in an interview.

Worobey and colleagues said their data, together with information showing that the spread of HIV to humans started in the 1930s and the absence of detectable chimpanzee virus or DNA in stocks of the original vaccines, "should finally lay the OPV/AIDS theory to rest."

"Given the fears about the safety of polio vaccines are currently threatening the global campaign to eradicate the disease, our clear-cut evidence against one of the key sources of concern is timely," Worobey wrote in the report.

But Edward Hooper, who wrote about the OPV/AIDS theory in his book The River, said Worobey's conclusion is wrong and does not refute the theory. In a statement, Hooper said, "Although Worobey's new research is helpful, the chimp groups his team has sampled are far from being representative of the chimpanzees that were used for the polio vaccine research." (Reuters, 04.22.04, Patricia Reaney)


AIDS Dementia

In a discovery that may help explain why as many as a quarter of AIDS patients eventually develop dementia, researchers report they have found the mechanism HIV uses to destroy brain cells. The research suggests that proteins produced by HIV turn on at least two specific biochemical pathways that hasten the natural death of neurons.

Unlike other brain infections, including meningitis and herpes, HIV in the brain causes very little inflammation or increase in white blood cells. Even so, "neurons die and the brain atrophies," said Dr. Roger Pomerantz, the new study's lead author and a virologist at the medical college of Thomas Jefferson University-Philadelphia. "It's extremely unusual. Infectious agents don't do this, but HIV does."

Fewer patients taking antiretroviral drug therapy develop dementia than patients not taking the drugs. It is thought that some unknown genetic differences may make some people more susceptible to the damage. No one can predict which HIV patients will develop dementia.

Pomerantz and colleagues had previously found that certain HIV proteins are toxic to neurons. In the current study, they set up a controlled experiment to determine whether the body's natural toxins or the viral proteins were responsible for the high loss of brain cells in AIDS-related dementia. Most damage was due to the virus and the proteins, they found.

They then removed the virus from some T-cells and treated brain cells with infected T-cells and normal T-cells. "The only thing that kills neurons was the virus. Once the virus was removed, nothing from the T-cells would kill neurons," Pomerantz said. Most of the natural toxins in brain cells were at relatively low levels and so were unlikely to be a significant cause. Pomerantz said the results could lead to a way of blocking the dementia process by blocking the virus and to the development of drugs to protect neurons from HIV. (Seattle Post-Intelligencer, 04.20.04)


Needle Exchange Heads to Queens

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Community Board 2 in Queens is expected to approve a plan in May allowing the AIDS Center of Queens County (ACQC) to use a van to distribute clean needles to drug addicts in an effort to combat HIV and provide treatment access. "Our first reaction was not to want it," said board Chair Joe Conley. "But when you look at the facts, you realize there needs to be some sort of action." The board, covering Long Island City, Sunnyside and Woodside, has the largest HIV/AIDS population in the borough in ZIP code 11101, said Conley.

Intravenous drug abuse is the leading cause of AIDS in Queens, primarily among blacks and Latinos, according to ACQC statistics. Queens and Staten Island are the only boroughs without syringe exchange programs. An initial proposal to locate the mobile van at the corner of Vernon Boulevard and Queens Plaza South was tabled in March because the zone overlapped an area shared with Community Board 1, which objected that it had been consulted late in the approval process. The syringe site was moved to Hunters Street under a compromise reached between Conley, Borough President Helen Marshall, ACQC Executive Director Phil Glotzer, and other city officials. Making the treatment component of the program as high a priority as HIV prevention helped to seal the agreement, said a Marshall spokesperson.

Using the mobile van proposed for Queens, the syringe exchange could eventually extend to communities in Jamaica and Far Rockaway, where HIV rates are particularly high among intravenous drug users. If the Queens program is approved, the proposal will go to the state Department of Health for review before it is implemented. Each participant would register with the program and receive a permanent member card to access the clean needles. Glotzer said the exchange is supported by Mayor Michael Bloomberg and city Health Commissioner Dr. Thomas Frieden. (Gay City News, 04.15.04, Alex Davidson)


Health Department's Anti-Crystal Campaign

On April 20, Dr. Thomas R. Frieden, commissioner of the New York City Department of Health and Mental Hygiene, announced that the city will spend $300,000 to fund an anti-crystal meth education campaign and to produce a one-day conference in June to educate health-care providers about the drug. Brett Larson, director of the city's Office of Gay and Lesbian Health, said the campaign should be active by early summer.

Several West Coast studies have tied crystal use to higher rates of STDs and HIV among gay men. In New York City, six studies from the Center for HIV-AIDS Educational Studies and Training have tied meth use among gay men to unsafe sex. At present, the city health department has only anecdotal evidence of such a link. The department has begun asking people about their use of crystal and other drugs when they get an HIV test in city STD clinics. "We know it's a problem from what patients are telling us who have had recent unprotected sex," Frieden said.

Frieden said crystal's harm is evident from city meth overdose reports, which have grown from none three years ago to more than two dozen in each of the past two years. Further, "Among people who are already HIV-infected, crystal also increases risk. It reduces the likelihood that people will take medications. ... It has some dangerous interactions with HIV medications. It may increase HIV viral activity. It accelerates HIV dementia and other health problems related to HIV," Frieden said.

"We've involved the police department in our crystal meth task force," Frieden said, but he noted he is not advocating that the police arrest users, only dealers. Activists who have been pressuring AIDS groups and the city to respond to crystal use among gay men voiced approval of the city's action. (Gay City News, 04.22.04, Duncan Osborne)





  
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