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November 8, 2006

In This Update:
  • HIV Treatment
  • Living With HIV
  • HIV Policy in the U.S.
  • HIV Outside the U.S.

    New HIV JournalView Highlights Key Published Research
    What's the most important HIV research that's been published in medical journals over the past two months? Look no further than The Body PRO's HIV JournalView for a full recap. In the latest issue, Dr. Pablo Tebas analyzes new research that has found:

    Click here to read the full September/October issue of HIV JournalView on The Body PRO, The Body's sister site for health care professionals!

    Using HIV to Fight HIV? Scientists Investigate
    It sounds like something out of a Hollywood action flick: The hero uses the enemy's own best weapon to defeat him. Researchers are now attempting to do the same thing with HIV: In a small, very preliminary clinical trial, they put a genetically modified version of HIV into HIVers' bloodstreams. The modified virus was made to infect cells already infected with HIV and short-circuit their reproduction process. One of the five people who received the experimental treatment experienced a dramatic drop in viral load; the other four had a stable or reduced viral load during the nine-month study. "The goal of this trial was safety and feasibility and the results established that," said researcher Carl June. "But the results also hint at something much more." (Web highlight from BBC News)

    HIV Treatment Strategies in 2006: What to Use -- and When?
    What is the current state of HIV treatment? With the number of HIV medications growing and treatment guidelines changing about twice a year, what do we now know about when HIVers should start or switch treatment, and what meds they should use? A comprehensive talk given at ICAAC 2006 by Dr. Sharon Riddler attempted to answer these questions. She focused both on the timing and type of regimens that are recommended for HIV-positive people who are just starting treatment, as well as those who have developed HIV drug resistance. The Body's Monica Gandhi, M.D., M.P.H., reports.

    As HIVers Live Longer, Lifetime Treatment Costs Soar
    Every year there are 40,000 new cases of HIV in the United States. If each of those people received the best treatment possible, the total bill would come to about $12.1 billion each year, according to a new study. A lifetime of care for an HIVer who begins his/her meds with a CD4 count between 200 and 350 currently comes to around $618,900 -- and an amazing 73 percent of that goes solely toward covering the cost of meds. The researchers hope that these findings will guide policy makers to allocate more funds to HIV care and prevention programs: "If [policy makers] rely on outdated cost information, treatment programs will be underfunded and the economic value of HIV prevention will be understated," said Bruce Shackman, Ph.D., the lead author of the study.

    To read the study abstract as it appears in the November 2006 issue of Medical Care, click here.



    Fifteen Years Later, Magic Johnson Is Still Fighting HIV
    In November 1991, one of the United States' most well-known professional athletes faced a crowd of reporters and courageously said: "Sometimes we think, 'Well, only gay people get it, only -- well, it's not going to happen to me. And here I am saying that it can happen to anybody. Even me, Magic Johnson, it can happen to." Fifteen years after his historic announcement, Earvin "Magic" Johnson is still alive, healthy and one of the most famous people with HIV in the world. "No, I'm not cured," he told Oprah Winfrey last week, quashing a persistent rumor. "I think I've been blessed. I've been able to take my medicine, work out, and do the right things. And that's why I've been doing so well." Johnson's using his stature to spread awareness of HIV and improve the lives of HIVers: In addition to speaking about his own status and treatment, he's opened four HIV clinics -- three in California and a fourth in Florida.



    Three People Die on South Carolina's ADAP Waiting List
    Three HIV-positive people have died while on a waiting list for the state's AIDS Drug Assistance Program (ADAP), the South Carolina Health Department has confirmed. South Carolina's ADAP currently serves about 1,800 people, with nearly 300 more on a waiting list due to a lack of funding. "It's like standing on a track watching the train coming at you, but you can't move," said Kathie Hiers, Chief Executive Officer of AIDS Alabama. "The ADAP waiting list in South Carolina keeps getting longer. ... In a poor state like this one, it's inevitable that these tragedies will continue to occur, simply due to a lack of resources."

    U.S. Abstinence-Only Programs May Be Forced to Axe the "Only"
    "For the better part of 25 years, abstinence-only-until-marriage programs have been permitted to use taxpayer dollars to lie about the effectiveness of condoms," says William Smith, a senior official at the Sexuality Information and Education Council of the United States. "The current administration has, time and again, failed to hold these programs accountable for much of anything except cashing their grant checks." This may be about to change, however: A U.S. government oversight office recently said that all federally supported materials promoting abstinence must contain "medically accurate" information. A 2004 review of these materials by Democratic researchers showed that 11 out of 13 commonly used materials contained unproven claims, propaganda and outright lies regarding sexual health. (Web highlight from The Bay Area Reporter)

    State Medical Marijuana Laws are Under Threat
    Did you know that 11 U.S. states grant people the right to grow or possess small quantities of marijuana with a doctor's recommendation? To the United States government, however, marijuana is illegal no matter what your doctor says. This disagreement has left people who use marijuana to relieve nausea, dampen pain or revive appetite in a hazy legal situation. Although scientific groups like the National Academy of Sciences have said that marijuana may be the best option for some people suffering from chronic pain or HIV-related wasting, the U.S. Drug Enforcement Administration [DEA] insists medical marijuana is illegal, end of story. The DEA says it won't arrest sick users, but it is prosecuting several groups that provide marijuana to people with HIV, cancer and other chronic diseases. (Web highlight from Associated Press)

    Ryan White CARE Act Reauthorization Demystified
    Having trouble understanding the ins and outs of the Ryan White CARE Act reauthorization? So are a lot of other people. That's why the Kaiser Family Foundation created an easy-to-read analysis and a fact sheet to help explain the current situation surrounding the CARE Act, which sets funding levels for HIV services throughout the United States.

    Political Asylum for People Living With HIV
    Many immigrants to the United States are eligible for political asylum and don't even know it. People living with HIV often experience persecution because of their HIV status, sexual orientation or gender, which may qualify them for asylum -- if they can successfully plead their case once they arrive in the United States. The application process can be daunting, since asylum applicants may have to relive traumatic experiences in front of an immigration judge, under the threat of deportation. But there's hope! In this article, Rosa Bramble Weed walks immigrant HIVers and service providers through the process of applying for U.S. asylum, and offers tips and strategies.



    Leaders at AIDS Summit Admit HIV Is a Threat to the Arab World
    For leaders in Arab countries, talking about HIV means confronting taboo subjects such as premarital sex, adultery, commercial sex work, homosexuality and injection drug use. Leaders of countries in the Middle East and North Africa have often preferred to pretend those things don't exist rather than deal with the relatively small but rapidly growing HIV epidemics their nations face. But some Arab leaders finally seem to realize that HIV needs to be confronted, not ignored. This week more than 300 Muslim and Christian leaders from 20 Arab states gathered in Cairo for a conference on HIV to talk about the urgent need for action. (Web highlight from Associated Press)

    In South Africa, HIV Meds Are Free, but People Don't Feel Free to Take Them
    Free HIV medicines are finally becoming available in South Africa, but after years of hearing misleading messages about HIV treatment -- Prime Minister Thabo Mbeki once called antiretroviral medications "poisonous," and the current health minister still promotes herbal remedies over the use of HIV meds -- many South Africans are afraid of the drugs the government is providing. In this article, a South African researcher illustrates how fear and ignorance are preventing people with HIV in a small town outside Tshwane (formerly Pretoria) from getting desperately needed treatment. One woman describes returning to the home of a neighbor she had just buried: In a cupboard she found bottles of antiretrovirals; none had ever been opened. (Web highlight from the Mail & Guardian)

    In Indian Brothels, "Johns" Are Teaching Safer Sex
    The HIV infection rate in Calcutta's Sonagachhi red-light district was 90 percent a decade ago. Now, thanks to community-based HIV prevention projects, it has dropped to 5 percent. In the latest project, nearly 200 regular clients of Sonagachhi's brothels have been enlisted to teach fellow brothel visitors about condom use and HIV testing. Deepak Bhattacharya, a frequent brothel visitor, explains that he and the other peer-educators volunteer because they feel responsible for the safety of the sex workers of Sonagachhi. "There are also thousands of men who come to Sonagachhi and refuse to wear a condom," he said. "That is where we step in."

    Battling the Obstacles to HIV Care in Developing Countries
    Providing the world with HIV treatment doesn't just mean giving it affordable HIV meds -- in fact, the meds may prove to be the easy part. Developing countries also need trained HIV health care providers, quality medical facilities and fundamental needs like transportation. In rural South Africa, the nearest HIV provider may be "a long walk, a steep hill, and many bus rides away," after which an HIVer may arrive to find "patient wards overflowing and doctors and nurses few and far between," writes Brook K. Baker in this sobering overview. Developing countries also experience chronic "brain drain," in which their medical professionals move away to richer countries, where they find better pay and working conditions. In this article, Baker describes the political and economic forces that undermine Africa's health care systems, and discusses the steps that must be taken to correct the problem and avert the deaths of millions.

    Catholic Church Rethinking Condoms for HIV Prevention
    In a move that could upset a long-standing ban on condoms by the Roman Catholic Church, Pope Benedict XVI earlier this year ordered a Vatican staff report on whether condoms should be approved for HIV prevention. The policy review comes after many years of prominent cardinals and bishops publicly asserting that condoms are necessary to control the spread of HIV -- a South African bishop once even went so far as to say that "denying condoms is a death sentence for women." In a recent opinion column, however, one religion pundit warns that we shouldn't expect a full reversal of the church's position; any changes will likely be small ones, he writes -- such as approving condom use only in developing countries.

    Also Worth Noting

    The Lowdown on the Ryan White CARE Act

    Greg Smiley

    Greg Smiley is Director of Public Policy at the American Academy of HIV Medicine, an organization of 2,000 HIV specialists providing care to more than 340,000 people with HIV. In this exclusive podcast interview (also available as a transcript), Smiley talks with The Body about why the Ryan White CARE Act is an "anchor of [HIV] care" for HIV-positive people in the United States, and offers his view on why the U.S. Congress is taking so long to reauthorize it.

    For more recent podcasts from The Body, check out our Podcast Central at ICAAC 2006 home page! You'll find one-on-one interviews with top HIV clinicians about key issues in HIV care today.

    Calling All Artists!
    The Deadline Nears: Submit Your Postcard by Nov. 10!
    Postcards From the Edge
    Time is running out, but Visual AIDS is still accepting submissions for its ninth annual Postcards From the Edge benefit! Postcards From the Edge is a charity event being held on Dec. 2-3 in New York City, at which the public will be able to purchase original, postcard-size artworks from artists around the country! Painting, drawing, photography, printmaking and mixed media are welcomed; proceeds go to Visual AIDS.

    The postmark deadline for submissions is Nov. 10; entries from amateurs as well as professionals are welcome! For more information on how to be a part of this unique event, click here.

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the November 2006 Visual AIDS Web Gallery
    "Dark Lights (Blue 1)," 2005;
    Sam Tan
    Visit the November 2006 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! This month's gallery is entitled "Hot Chicks and Others"; it's curated by Rocío Aranda-Alvarado, the curator at Jersey City Museum, where she organizes exhibitions of contemporary art featuring work by both established and emerging artists in the New Jersey and New York region.

    Connect With Others
    t The Body's Bulletin Boards

    "My Partner Has Suddenly Lost His Memory!"
    (A recent post from the
    "HIV Treatment" board)

    "My partner has an appointment for the middle of next week to get set up for meds. He was diagnosed this past summer; he had a CD4 count of 199 and PCP. ... His doctor at the time he was diagnosed ... started him on Combivir, and that only. We've since switched doctors to a much better hospital ... and learned that it's highly recommended to have a three-drug combination, not just the two in Combivir alone. He hasn't taken the Combivir since this past summer ... so he still has a lot of that med here at home. ...

    "I'm really worried because [my partner has had] some severe memory loss over the past four days. Would it help him or hurt him to go ahead and start back on just the Combivir by itself until we see his doc next Wednesday for meds? ... I'm afraid that something will happen to him and hope that maybe if he started his Combivir now it would help. ...

    "We tried to call and get him in sooner to see his doc, but there are no openings. I know they would just say to go to the emergency room if we are concerned enough about it. I'm a big worrier and worry about him a lot. Part of me says it will be OK and one week won't make a difference. ... Any thoughts?"

    -- Anonymous

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