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May 10, 2006

In This Update:
  • HIV Treatment
  • News & Views
  • HIV Transmission
  • HIV Outside the U.S.
  •   HIV TREATMENT

    U.S. HIV Treatment Guidelines Updated, Urge Greater Use of Resistance Tests
    Doctors should greatly expand their use of resistance tests for all HIVers who have never before taken HIV meds, according to newly updated HIV treatment guidelines from the U.S. health department. The guidelines, which are usually revised twice a year, now recommend that all people with HIV -- whether they've just been infected or were infected years ago -- receive a genotypic resistance test before they start therapy. The guidelines also suggest that people get a resistance test even if they don't plan to start treatment just yet. On the treatment-interruption front, the guidelines now have extensive recommendations on how to take short-term treatment breaks (e.g., because of side effects or a surgical operation), and remind doctors and HIVers that long-term treatment breaks should only be done as part of a clinical trial and with a doctor's close supervision. Unlike many previous guideline updates, this revision does not include any changes to recommendations for when to begin HIV treatment or which HIV medications to begin with.



    Resistance Testing Can Level the Playing Field for People Starting Treatment, Study Says

    One of the most important changes in the new U.S. treatment guidelines (see the previous news item) is the recommendation that doctors increase their use of HIV drug resistance tests for people who aren't yet taking HIV meds. The reason is simple: A growing number of HIVers are being infected with strains of HIV that are already resistant to one or more meds, so a resistance test can help doctors decide which meds are likely to be most effective against that person's virus. In fact, a new study from Germany suggests that people with drug-resistant HIV who get a resistance test may be just as likely to do well once they start treatment as people whose HIV is not resistant to any meds. (Web highlight from aidsmap.com)


    Most HIVers Adhere to (and Don't Mind Being on) Treatment, Survey Finds
    Nine out of 10 HIVers on treatment feel confident that they can take all their HIV meds on time, every time -- but only seven out of 10 actually do so in a given week, according to the results of an online survey by the International Association of Physicians in AIDS Care. The survey of 403 HIV-positive people on treatment asked a host of questions about adherence, or a person's ability to take meds exactly as prescribed. More than a third of the HIVers surveyed said that they wanted to take all their meds on time, but that they sometimes forget to or fall asleep before taking their dose. Almost a third said that work or life demands sometimes get in the way of adherence. Yet the survey also found that people on HIV meds generally had an optimistic outlook: Only 37 percent of HIVers surveyed said that taking HIV meds meant having less freedom, and two thirds of all respondents said that taking HIV meds helped them take control of their HIV, worry less about having HIV, feel healthier, gain a sense of well-being or think less often about the fact that they're HIV positive.


    Nevirapine Resistance May Persist in Some Pregnant Women, Study Finds
    More than a fifth of HIV-positive pregnant women who take a single dose of nevirapine (Viramune) to prevent mother-to-child HIV transmission have some resistance to the drug one year after treatment, according to a new study. The 22-woman study, which was conducted in South Africa, found that resistance to nevirapine generally dissipates during the year after the drug was taken. At least 23 percent of the women in the study, however, had a higher level of nevirapine resistance after one year than they did before taking nevirapine to prevent HIV transmission to their babies. The level of resistance varied greatly from person to person, however.


    Wall Street Journal Spotlights HIVers With Heavy Drug Resistance
    It's rare to see the mainstream media delve deeply into HIV treatment issues in the United States, but the Wall Street Journal did just that last week: It published an article about the 40,000 Americans who are on "salvage therapy" -- regimens designed to suppress HIV as well as possible after a person has developed resistance to many HIV meds. Doctors tend to think of these salvage regimens as lifeboats, meant to keep a person with HIV healthy until new, more effective HIV meds are developed.

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      NEWS & VIEWS

    No-Fee Deadline Is Monday, May 15 for Enrollment in Medicare Part D
    Have you enrolled in Medicare's "Part D" prescription drug plan yet? If you're a Medicare recipient but you haven't yet signed up for Part D, you only have until Monday, May 15, to do so without paying extra fees. After May 15, Medicare recipients signing up for Part D will have to pay a penalty of higher premiums -- 1 percent higher for every month you delay. Check out our comprehensive Medicare Part D section for more information, and remember the May 15 deadline!


    A Look Back at 25 Years of AIDS
    This month marks the 25th anniversary of the first AIDS diagnosis. In the roller coaster of a quarter-century that began with whispers of a "gay cancer," HIV has irrevocably changed not just the lives of millions of people, but American culture and the world as well. Since 1981, some 25 million people have died from AIDS-related causes; another 40 million are living with HIV. The latest issue of Newsweek takes an in-depth look at the epidemic as it turns 25; in this article, Newsweek highlights milestones in the history of HIV in the United States, including the activism of Ryan White, the impact of HIV-positive celebrities, the rise of AIDS advocacy groups and the emergence of combination therapy. Major players in the world of HIV, including President Bill Clinton, Melinda Gates and Larry Kramer, speak out about the history and current state of HIV. This article also features three photo galleries: People living with the virus, an HIV timeline in images and Newsweek's HIV-related cover stories. (Web highlight from Newsweek)


    AIDS at 25: How Has the Virus Changed Us?
    Many people will be looking back this year as the AIDS epidemic turns 25. Dr. Timothy Murphy, head of medical humanities at the University of Illinois College of Medicine, has written prolifically about AIDS and ethics. In this essay in the Bioethics Forum, he offers an eloquent view of the past quarter-century. He writes: "The [AIDS] epidemic threw American identity and national dogmas into question: We were not one indivisible community, sharing the same social status, rules, and opportunities. We were not all heterosexual adults, faithful in marriage, abstinent outside marriage, immune to the lure of drugs, with the same access to health care. The epidemic told a very different story, and some social authorities were on edge, fearful to accommodate AIDS on its own terms, for what that meant about who 'we' were. Political fissures undermined a unified front against the epidemic from the very beginning." (Web highlight from Bioethics Forum)


    U.S. Congressman's Pressure May Have Altered Abstinence Panel at STD Prevention Conference
    Organizers at the 2006 National Sexually Transmitted Disease (STD) Prevention Conference say that the U.S. Centers for Disease Control and Prevention (CDC) allowed a Republican congressman to influence a symposium on the effectiveness of abstinence-until-marriage programs in reducing the rate of sexually transmitted infections. Following a written complaint from Rep. Mark Souder (R-Ind.) that the conference had an "obvious antiabstinence objective," the CDC altered the slate of speakers on the abstinence-until-marriage panel and changed its name from "Are Abstinence-Only-Until-Marriage Programs a Threat to Public Health?" to "Public Health Strategies of Abstinence Programs for Youth."

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      HIV TRANSMISSION

    U.S. Syphilis Cases Skyrocket Among Gay Men, but Fall for Other Groups
    Although the rate of new syphilis infections in the United States decreased among infants, women and blacks between 1999 and 2004, the overall infection rate during that period has risen because of a rapidly growing number of syphilis cases among men who have sex with men (MSM), the U.S. Centers for Disease Control and Prevention (CDC) announced. According to Kevin Fenton, director of CDC's National Center for HIV, STD and TB Prevention, about 64 percent of new syphilis cases in 2004 occurred among MSM, compared with just 5 percent in 1999. New syphilis cases were also concentrated in cities: More than 50 percent of new syphilis cases were reported in 20 counties in urban areas on the East and West coasts. Overall, the rate of new syphilis infections in the United States increased from 2.4 per 100,000 people in 1999 to 2.7 per 100,000 people in 2004.


    CDC to Recommend Routine HIV Testing for All U.S. Residents
    The U.S. Centers for Disease Control and Prevention (CDC) is determined to make HIV testing part of every American's regular medical care. The CDC plans to issue new guidelines within the next couple of months recommending that everyone in the United States be voluntarily tested for HIV when they access health care, whether it's at a doctor's office, clinic or hospital. The CDC is also suggesting ways to make it easier for people to get tested, by allowing people to agree to testing without having to sign an informed-consent form. The CDC hopes that expanded testing will reduce the number of Americans who don't know they're HIV positive (currently estimated at 250,000), which would get more HIVers on treatment and reduce HIV transmission, since people who don't know they are infected may be less likely to use protection.


    Can a Pill a Day Keep HIV Away? Educators Warn Against Jumping the Gun
    With reports increasing that some HIV-negative people are taking HIV meds regularly to reduce their risk of becoming infected during unprotected sex, some AIDS advocacy groups have decided it's time to educate the public about just how unproven this strategy is. "The studies that have been done so far have been done in animals and are based on theoretical models," said Richard Jeffries, an HIV prevention expert at Treatment Action Group. His organization recently cosponsored a forum in New York that tried to explain how little research has been done on so-called "pre-exposure prophylaxis." "I don't think we're at a point where anybody can be a cheerleader [for pre-exposure prophylaxis]," said Raffi Babakhanian, one of the experts who spoke at the forum.


    HIV Denial, Stigma Continue to Threaten U.S. Black Community, Author Says
    HIV "remains an unspoken taboo" among black people in the United States, despite "the litany of grim health statistics that define the high mortality rates of black Americans," Amy Alexander, an author and media critic, said in a commentary on National Public Radio's "News & Notes with Ed Gordon" last week. (You can hear a podcast of her commentary by clicking on this article.) Alexander said that because black men are "historically averse to seeking medical care," many would "rather suffer in silence than seek the help of clinical professionals," especially men who have sex with other men or who use drugs. "The denial, shame and stigma that continue to surround blacks and HIV must be vanquished" before the black community is, Alexander said.


    Battling a Black U.S. Epidemic: Long Avoided, Efforts Finally Start to Gain Traction
    African Americans make up only 13 percent of the U.S. population, yet they account for a shocking 51 percent of newly infected HIVers. Despite the still-common stereotype that HIV affects only white, gay men, a host of factors have come together to make HIV one of the biggest health concerns for African Americans, including the effects of poverty, lack of health care and the reluctance of many religious leaders to take a stand on safe sex. But, as this report in Newsweek explains, community organizations are fighting back: Many are sending teams of educators into hard-hit neighborhoods to educate people about HIV prevention. Large companies and agencies, such as Black Entertainment Television and the Centers for Disease Control and Prevention, have also joined the fight, by using creative outreach efforts to educate black youths and encourage people to get tested for HIV. (Web highlight from Newsweek)

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      HIV OUTSIDE THE UNITED STATES

    British Resort Town Shocked by News of Local HIV Outbreak
    The small coastal town of St. Ives in the United Kingdom got some unsettling news this month: For years, HIV has been spreading through the community largely unchecked. The announcement has highlighted just how little HIV awareness there is in many parts of the developed world. "It's a real shock," one resident said. "Everyone's been looking around, wondering has he got it, has she got it? Have I got it?" The local epidemic in this picturesque resort village, which is home to about 6,000 people, may have begun more than eight years ago, experts say -- and appears to have originated with one man. (Web highlight from the Guardian)


    Media Grossly Under-Reports HIV in Southern Africa, Study Shows
    While southern Africa is home to the world's largest number of HIV-positive people, its regional media fails to report on the full impact of the virus. In fact, only 3 percent of all news stories discuss the HIV epidemic, according to a study by the Media Monitoring Project. Critical topics went mostly uncovered by the media, including home-based care, nutrition, and information on HIV services and resources, the study found. However, the study did note some slight improvements: The media has been doing a better job avoiding stereotypes and using more sensitive language.

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    Also Worth Noting

    Be a Young Activist
    Summer Training Camp
    Deadline Is May 15!

    Charles Long holding "I am a global AIDS activist" sign
    Charles Long, 27, went to last year's Youth AIDS Institute and is helping to organize this summer's gathering.

    Are you between 16 and 26 years old and looking for a way to get involved in AIDS advocacy this summer? The Campaign to End AIDS (C2EA), one of the country's largest nationwide AIDS activism groups, is holding a five-day advocacy training camp in Chicago, Ill. -- and the application deadline is right around the corner!

    From June 28 through July 2, a few dozen up-and-coming AIDS activists like yourself will get together for an extensive training session with veterans of the AIDS advocacy movement. You'll use what you learn at this special camp to organize efforts in your own community.

    Interested? Click here for more information, or download and send in this application before the May 15 deadline.

    Connect With Others
    A
    t The Body's Bulletin Boards

    I Was a Foolish Top; Now I'm No Longer Fooling Myself
    (A recent post from the
    "I Just Tested Positive" board)

    "I was more than taken aback when I learned [that my latest HIV test] had come back positive. I am [a 29-year-old], bi but mostly gay, white male with a graduate degree and a voracious sexual appetite, who is now experiencing irony at its most potent. ... I'm a total top who has never been f***ed -- no, really! ... I had read the pamphlets warning tops of their risks to HIV exposure, and I have read academic journal articles concerned with the same. ... Three days ago, however, my confidence seemed to have been due a big reality check.

    "Tops who never, ever, ever bottom, and who now and again have unprotected sex with HIV-positive persons, are definitely at risk of contracting HIV. Who cares that for 12 years of f***ing the same way, sometimes safe, sometimes not, I had consistently tested negative? Odds are ... that risk [that] we fool ourselves into believing is minor or highly unlikely, will at some point rear its illusion-shattering head. ...

    "Am I sad? No, but I anticipate some sadness to come. Right now, I am confused by my lack of an emotional response -- my mood seems to be the same as it was before I knew. Mostly, I am embarrassed for proving an old cliche: that men really do think with their pricks. So, Top Men -- you are at risk! Condoms truly suck, but what sucks more is the obligatory HIV status disclosure 'talk' you will be forced to endure before every sexual encounter with a new partner."

    -- JakeLA

    Click here to join this discussion thread, or to start your own!

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the May 2006 Visual AIDS Web Gallery
    "Untitled Self-Portrait ... Holy Juggler," 1999; Gregg Cassin
    Visit the newly launched May 2006 Visual AIDS Web Gallery to view this month's collection of art by HIV-positive artists! The May gallery is entitled "The 'Me' You See"; it's curated by Reed Massengill, a widely published writer and photographer who specializes in male nudes.