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January 3, 2007

In This Update:
  • HIV in the News
  • Living With HIV & HIV Complications
  • HIV-Related Policy in the U.S.
  • HIV/STD Transmission
  • HIV Outside the U.S.
  •   HIV IN THE NEWS

    Wall Street Journal Investigation Says Norvir Price Skyrocketed to Protect Kaletra
    Three years ago, Abbott Laboratories caused an uproar in the HIV community when it dramatically raised the cost of its HIV med Norvir (ritonavir), which is an integral part of many HIV treatment regimens. Now the Wall Street Journal is reporting that documents and e-mails appear to support a theory held by many HIV advocates: that Abbott jacked up Norvir's price tag in an effort to protect Kaletra (lopinavir/ritonavir), an Abbott drug that the company feared would lose market share to competing meds from other companies. The main target: Reyataz (atazanavir), which usually needs to be "boosted" with Norvir. Although Kaletra is a combo pill that contains Norvir, Abbott didn't raise the price of Kaletra back in late 2003. However, it did raise the price of Norvir alone by 400%, making it much more expensive to take other regimens that use Norvir. Abbott maintains that the Norvir price hike was not meant to protect Kaletra sales, but simply to more accurately reflect the medical value of the drug.

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      LIVING WITH HIV & HIV COMPLICATIONS

    U.S. Approves New Treatment for Facial Fat Loss
    A new weapon in the fight against lipoatrophy has been approved in the United States. The U.S. Food and Drug Administration late last month gave a thumbs-up to Radiesse, a temporary facial filler that can help fill in the cheeks of HIV-positive people with facial fat loss (lipoatrophy). Technically, Radiesse isn't a drug, it's an implant, just like the already-approved treatment Sculptra (poly-L-lactic acid, New-Fill): Like Sculptra, Radiesse is injected into the skin to increase cheek thickness. In a 100-person study, most HIVers receiving Radiesse got a total of three injections over the course of six months, and saw a significant improvement in their facial lipoatrophy.

    The approval of new lipoatrophy treatments like Radiesse may be great news, but will your health insurance policy cover them? Judging by how U.S. health insurance companies have handled Sculptra, it's doubtful -- but some people have succeeded! Read this article for tips and the personal story of one man who was able to get his insurance company to pay for his lipoatrophy treatment.


    Stigma, Distrust and Fear: HIV Treatment Challenges in Black America
    As a senior staffer at the National Association of People With AIDS, you might assume that Vanessa Johnson is the embodiment of an empowered HIVer -- the sort of person who's engaged in her care, takes her meds correctly and keeps her immune system healthy. But despite living with HIV for the past 16 years, the 48-year-old Johnson is the first to admit that's not the case: "I am not a good patient. I am not adherent. … I'm the average HIV-positive person, who is scared to death and doesn't know what to do. I take it day by day." The challenges of adhering to HIV therapy are known to any HIVer, but Johnson's difficulties may be even more typical because she is African American. Many doctors and advocates believe that a complicated mix of reasons make adhering to HIV treatment particularly hard for the 500,000 African Americans now living with HIV. (Web highlight from HIV Plus)

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      HIV-RELATED POLICY IN THE UNITED STATES

    Huge Funding Cuts May Shut Down Many U.S. HIV Research Sites
    Steep funding cuts will likely force the closure of 10 of the United States' 32 AIDS Clinical Trials Units. These research centers are often involved in some of the country's most important HIV-related studies. Officials from the National Institutes of Health (NIH) say that the funding cuts, which are part of a major federal restructuring of AIDS research, are necessary to modernize the country's research efforts. However, Eric Lawrence, co-chair of the Network Community Advisory Board, an offshoot of the NIH-backed AIDS Clinical Trials Group, which oversees the units, noted the closings will greatly reduce the number of people eligible for clinical trials. "Site closures and funding cuts will delay or halt advancement and further progress of HIV science," he said. The funding cuts are likely to force the closure of AIDS Clinical Trials Units in Dallas; Galveston, Texas; Indianapolis; Los Angeles; Minneapolis; New York City; Omaha, Neb.; Philadelphia; Providence, R.I.; and Sacramento, Calif. A temporary cash infusion for the Hawaii AIDS Clinical Trials Unit in Honolulu will provide a six-month reprieve for that program, which also faced likely closure due to funding cuts.

    For more info on Hawaii's reprieve from the funding cuts, click here.


    Funding Lost, Funding Gained: Impact of Ryan White CARE Act Reauthorization
    Last month, the U.S. government finally reauthorized the Ryan White CARE Act, which funds more than $2 billion worth of critical HIV support and treatment programs throughout the United States. How will individual states fare under the renewed act? Some states stand to benefit, others may lose. South Carolina, for example, is slated to receive an increase in funding, which will help cover a $3 million budget shortfall in its AIDS Drug Assistance Program (ADAP). This increase is desperately needed, as four people have already died while on a waiting list to receive ADAP-funded meds. Maryland, on the other hand, could lose 5% of its $36 million in HIV funding this year.


    Ryan White CARE Act Reauthorization Could Improve HIV Services in Rural South
    For many low-income HIVers living in rural areas, just getting to and from their health care provider can be a challenge. This situation may improve under the newly passed compromise bill to reauthorize the Ryan White CARE Act. HIV-positive people living in the rural South will likely see a much-needed increase in funding, which could be used for transportation and improved treatment access. Kathie Hiers, CEO of the HIV organization AIDS Alabama, expects that the additional $7 million Alabama is scheduled to receive will be used not only for transportation programs, but to increase the number of medications covered by Alabama's AIDS Drug Assistance Program. According to Hiers, Alabama currently covers only 35 medications; by comparison, New York covers 500.

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      HIV/STD TRANSMISSION

    "Healthy Penis" = Healthy City: San Francisco's Successful Anti-Syphilis Campaign
    "We took a risk, and that risk paid off." That's how one San Francisco health official describes a unique educational campaign that may be the driving force behind a drop in syphilis rates within the city. The "Healthy Penis" campaign, which ran from 2002 to 2005, featured comic strip-style posters with penis-shaped characters. The department sponsored the ads in order to check rising syphilis rates among gay and bisexual men. According to a recent study, men who saw the ads were more likely to get tested for syphilis, and officials note that new syphilis infections have declined since the campaign began. Similar ads have been adopted in other U.S. cities.

    Click here to access the full study of the campaign, which was published in the open-access journal PLoS Medicine.

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      HIV OUTSIDE THE UNITED STATES

    HIV Advocate Crosses the Globe to Save Lives
    It can take Rachel Cohen two hours in a four-wheel-drive truck to get to one of the clinics she oversees in mountainous, rural Lesotho. For most patients, reaching the clinic is even harder: They must travel eight hours on a donkey. Cohen has come a long way from her childhood home of Portland, Ore., to this tiny, southern African country, where she works as an HIV advocate with Médecins Sans Frontières (MSF). Twenty to 30 percent of Lesotho's population is HIV positive -- the third-highest rate in the world -- yet only 40 doctors serve the nation's two million residents. In this interview, Cohen discusses the challenges faced by MSF's HIV treatment and testing programs, and the successes they've achieved. (Web highlight from The Oregonian)


    Sad to Be Alone: An AIDS Orphan From Malawi (a Photo Journal)
    At first glance, Fabiano looks like everyone's idea of a happy 12-year-old boy -- he smiles, plays soccer and enjoys spending time with his friends. But Fabiano's mother died of an AIDS-related illness when he was just one year old, and he's only met his father once. Luckily, Fabiano had an uncle in Malawi who was willing to take him in, but that doesn't mean his life has been easy, just as it isn't easy for the millions of other AIDS orphans in the developing world. "When you have a mother she would be the one to wake you up for school [and feed and take care of you]," Fabiano says, "but now I'm the one that has to do all that." But the extra work isn't what makes Fabiano miss his parents the most. "I feel sorry for myself when I look at my friends with parents and I don't have any. If mum had been around," Fabiano believes, "I would have been a very happy person." (Web highlight from BBC News)


    Opium Production in Afghanistan Thwarts HIV Prevention in Pakistan
    Ninety percent of the world's opium -- the raw material for heroin -- is grown in Afghanistan, and in 2006 the country had a record-breaking harvest. The impact of the opium glut echoes throughout the world, but it's especially severe in neighboring Pakistan, where officials warn it's harming the fight against HIV. According to Pakistan's Health Minister Mohammad Naseer Khan, Afghanistan's rapidly growing opium trade is undermining efforts to control the spread of HIV, especially among injection drug users. If HIV prevention is going to be successful in his country and others in the region, Khan says, "More has to be done by the government of Afghanistan and also all the donor agencies and coalition forces to stop that production."


    Egyptian Leaders Turn a Blind Eye to HIV
    In a world where 40.3 million people are living with HIV and virtually every corner of the planet has been affected, it's difficult to imagine that any country could be ignoring the pandemic. Yet many Egyptians are barely aware that HIV exists in their society, and their leaders have not made fighting the virus a priority. Sure, HIV prevalence in Egypt is very low -- less than one-tenth of one percent -- but little is known about HIV rates among recognized high-risk groups such as injection drug users, commercial sex workers and men who have sex with men. Even if the statistics were more reliable, mistrust, denial, stigma and a lack of government involvement would continue to stop Egyptians from seeking out HIV prevention and testing resources.


    HIV in Russia: Personal Stories From Four Corners of the Epidemic
    About one million Russians are now estimated to be living with HIV, but it can be easy to forget there are real faces and stories behind each of those people. This article from the BBC offers a window into the thoughts of four very different HIV-positive people: A former heroin addict who works for an HIV hotline discusses the blatant discrimination against HIV-positive people he has witnessed in rural parts of the country. A man who works as an HIV counselor laments how Russia's corruption and inefficiency has wrecked desperately-needed HIV programs. Sveta, a 26 year-old hair dresser who was named Miss Positive 2005 in a beauty contest for HIV-positive Russian women, talks about the baby she is expecting and the discrimination she faced when clients in a small village learned she had HIV. And finally, Sveta's husband -- who is also HIV positive -- speaks with optimism about their lives together and their child. (Web highlight from BBC News)

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    Also Worth Noting

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the January 2007 Visual AIDS Web Gallery
    "Evolution," 1999; Tara Popick
    Visit the newly launched January 2007 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! The first gallery of the new year is entitled "Energy"; it's curated by the Tisch Summer High School Photography Program at New York University.

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    "I recently tested positive, and my response is just to be numb to the whole thing. I want to live, live well and strive. But ... it's only been two months, so am I really supposed to be on the "let's go" activist bandwagon just like that? Trying to get informed, there is so much out there I didn't expect to be related with this disease -- what you can and can't eat, supplements, exercise, mental health. I'm overwhelmed. I'm scared. I feel as if I'm now a burden. ... Help!"

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