Because of recent successes and advances in HIV therapy, patients are seeking access to HIV treatments much earlier than before. Some HIV clinics are experiencing a 40 to 50 percent increase in demand for outpatient care, and consequently an increase in the overall costs for treatments to suppress HIV. "However, these cost increases are offset by the significant drop in hospitalizations, treatment costs for opportunistic infections associated with HIV and AIDS, and an actual decrease in AIDS deaths," explained Dr. Richard Moore, an infectious disease specialist and associate professor at Johns Hopkins.
ADAP is a joint federal- and state-funded program under Title II of the Ryan White CARE Act that covers the cost of HIV medications for uninsured and underinsured patients, including those who do not qualify for Medicaid. According to Martin Delaney, Founding Director of the San Francisco-based advocacy organization Project Inform, "Although the Congress and many state leaders have responded by committing new funding to meet increased demands, some ADAPs are still limiting their programs in ways that are unethical, arbitrary, and threatening to the lives of people who must depend on this program." Such limiting measures including wait-listing patients and curtailing or denying coverage for certain drugs, especially protease inhibitors.
Federal guidelines recommend initiating treatment for HIV with highly potent combination therapies including protease inhibitors. Dr. John G. Bartlett, Chief of the Infectious Diseases Division at Johns Hopkins and co-chair of the committee that drafted the guidelines, explained that, "Not suppressing viral replication to the greatest extent possible means that patients are more likely to experience symptoms of HIV, and their risk of developing AIDS-related infections may be increased. Many patients who receive substandard treatment develop drug resistance, ultimately leading to treatment failure when they finally do get access to protease inhibitors."
Recently, the U.S. Centers for Disease Control and Prevention announced that deaths from AIDS fell 44 percent from 1996 to 1997 and that AIDS is no longer the leading cause of death among Americans aged 25 to 44. Other CDC data illustrate that fewer than one in five people with HIV are covered by private health insurance, leaving most people with HIV infection to rely on public programs such as ADAP, or without insurance coverage at all.
In a part of the world where the subject of AIDS is taboo and people with HIV are treated as outcasts, Bahrain's Health Ministry has taken the extraordinary step of televising candid interviews of people with AIDS. The initial broadcast, that was timed to coincide with the 12th World AIDS Conference in Geneva and to Bahrainians' annual large-scale summer exodus to cooler climes, is expected to be followed up with other televised discussions of the disease later this year. At the same time, mosque attendees at Friday prayers are being urged to help prevent the spread of the virus by adhering to Islamic principles.
Health officials believe that AIDS is probably not widespread in Bahrain, but point out that there are no official figures.
Senegal, which has long led Africa in the fight against AIDS, is poised to become the first nation on that continent to make triple-drug therapy available to its HIV-infected population. The country currently has a budget for AIDS drugs of approximately two million French francs (about $333,333) and has managed to negotiate with the drugs' suppliers for special rates. The high price of these medications has put them out of reach for the approximately 90 percent of the world's HIV-positive population that live in developing countries.
Thanks largely to early recognition of the epidemic and preventive action begun in the mid-1980s, Senegal has succeeded in containing the spread of the virus. Less than two percent of Senegalese adults -- 72,000 people -- now carry the virus, according to UNAIDS, while the figure is twenty percent in other parts of Africa. Senegalese officials credit prevention efforts that include AIDS awareness education, strict testing of the blood supply, and a condom-promotion program that has seen a 900 percent increase in their use over the past decade.
On the heels of this country's recent decision to ban federal funding for needle-exchange programs, delegates to the 12th World AIDS Conference in Geneva called for a worldwide increase in their number. The incidence of HIV infection through drug injection is on the rise, according to the latest figures, and in some countries outstrips sexual transmission. A recent United Nations report found that 75 percent of those known to have HIV in Malaysia and Vietnam, among other countries, are intravenous drug users. The number climbs to 80 percent in Russia.
Worsening economic conditions in many countries, along with a collapse in the price of injectable drugs, has exacerbated the problem. Obtaining clean needles may not have been a major problem for middle-class drug users, but poverty and cheap drugs are spreading heroin and cocaine use into the slums where needles are routinely shared.
The World Health Organization reported that 116 countries reported cases of intravenous drug use in 1997, and 96 of those reported cases of HIV related to it.
The eight television public service announcements are in American Sign Language (ASL) with full voice-interpreted audio and open captions. All end with a very specific call to action, telling viewers that they can obtain more information by calling the toll-free telephone number of the Centers for Disease Control and Prevention's National AIDS Hotline for the deaf and hard of hearing at 1-800-AIDS-TTY.
According to David H. Pierce, who produced, directed, and co-wrote the spots for Kaleidoscope Television, "AIDS information that is designed for the mainstream, hearing society tends to be English-based. As a Deaf person myself, I cannot stress enough the importance of also educating our community about HIV and AIDS in American Sign Language." American Sign Language uses a different syntax and grammatical structure from English, and English-language information does not always translate effectively for those whose primary language is ASL.
If passed, the initiative would allow patients with HIV, as well as with cancer, multiple sclerosis, epilepsy, glaucoma, and some forms of intractable pain, to obtain limited amounts of medical marijuana through their physicians. It would not affect existing state law prohibiting the use of the drug for nonmedical purposes.
The signatures were collected by Washington Citizens for Medical Rights, a coalition of doctors, patients, and other concerned citizens. According to Tacoma Physician Dr. Rob Killian, sponsor of the initiative, "I-692 is about taking care of those who are in greatest need in a responsible way."
Marketing for the tests are occuring under the trademarks Antivirogram and VircoGEN by Laboratory Corporation of America and VIRCO, who promise that, used together, they indicate how and to which drug the viral population of each patient is going to respond. According to John Mellors, M.D., Director of the AIDS Program at the University of Pittsburgh Medical Center, "Testing resistance in the clinical setting empowers physicians and patients to make rational decisions about drug therapy. Knowing which medications are most likely to be effective against the HIV virus prior to treatment permits us to make better informed choices."
Studies were conducted to measure the ability of these new tests to predict the effectiveness of ritonavir/saquinavir therapy. Patients found to have "sensitive" virus as indicated by Antivirogram (with "sensitivity" defined as the drugs' ability to inhibit the virus) were twelve times more likely than others to respond, and those whose virus was classified sensitive by VircoGEN were four times more likely to respond.
"Our team of scientists has been working dilligently to bring the Antivirogram and VircoGEN to the market," stated the medical director of LabCorp.
It is not known how Viagra will interact with protease inhibitors (PIs) (no specific studies have been conducted), but it is believed that PIs may aggravate some of Viagra's side effects, such as headaches and flushing. Also, some medications commonly used by people with HIV -- protease inhibitors and some antibiotics, especially the newer macrolides such as clarithromycin and azithromycin -- may affect the way Viagra is metabolized by the liver and cause increased levels of Viagra in the blood. As with all newly approved medications that may be taken by patients with HIV, GLMA is urging medical providers to monitor patients carefully for possible drug-drug interactions.
This is very important since, already, there have been some personal reports of men who are on protease inhibitors taking Viagra in combination with recreational drugs to enjoy a night out on the town. This adds another level of potentially dangerous drug-to-drug interactions that may not be easily traceable by medical professionals. People who are using recreational drugs need to be as honest as possible with their physicans about the drugs they have taken.
According to GLMA, "Viagra is a major advance in the management of erectile dysfunction, but people with HIV and their providers should remember that there are many reasons for erectile dysfunction, ranging from low levels of testosterone to depression, and that a full medical work-up is indicated prior to initiating therapy with this agent."