Kaisernetwork.org (Washington, DC)
7 February 2008
Across The Nation
Groups Seek Repeal of Ban on Federal Funding for Needle-Exchange Programs; Campaign Coincides With National Black HIV/AIDS Awareness Day
[Feb 07, 2008]
The NAACP, the National Urban League and other advocacy groups on Thursday, which also is National Black HIV/AIDS Awareness Day, called on Congress to repeal a 20-year-old ban on federal funding for needle-exchange programs, the AP/Seattle Times reports.
Injection drug use contributes to one-third of new HIV cases in the U.S., and it accounts for a higher proportion of HIV cases among blacks compared with whites, according to the AP/Times. According to federal figures, blacks comprised 13% of the U.S. population but accounted for about half of new HIV/AIDS cases in 2005.
Despite the ban on federal funding, more than 200 needle-exchange programs have been established nationwide -- including in Washington, D.C., and New Jersey -- in an effort to reduce the spread of HIV among injection drug users, according to the AP/Times. However, some advocates say the federal ban on needle-exchange programs leaves many of the programs in unstable financial situations, making local and state officials reluctant to support needle exchanges, the AP/Times reports. According to Daniel Raymond, policy director for the Harm Reduction Coalition, there are about one million IDUs in the U.S., and less than 20% of them use needle-exchange programs. "There's a huge unmet need," he said, adding, "Even in places where there are programs, they can't always meet the demand."
Those who oppose needle exchanges question the programs' health benefits and ability to rehabilitate drug users, the AP/Times reports. David Murray, chief scientist with the Office of National Drug Control Policy, said he supports drug-related programs aimed directly at ending addiction. "Needles are not the magic bullet," Murray said, adding, "We are being politically pressured to make this decision (in favor of needle exchange). But it's time to rethink if there's a more humane, effective public health response than continuing to support injection drug use."
Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, on Wednesday said that he supports needle-exchange programs. In a separate statement, Fauci said the high rates of HIV/AIDS among blacks require "drastic action." He added, "In particular, black leaders -- religious, secular and political -- have a key role to play in reducing the stigma often associated with HIV/AIDS and influencing African-Americans to get tested, counseled and treated" (Crary, AP/Seattle Times, 2/6).
In related news, several celebrities and advocates have joined together to raise awareness about HIV/AIDS among blacks on the awareness day, the Miami Herald reports. The celebrities include actresses Tatyana Ali, Angela Basset, Sheryl Lee Ralph, Theresa Randle, Angel Moore, Tracie Thomas and Gina Ravera; the Rev. Creflo Dollar; NFL coach Tony Dungy; actor Sydney Poitier; singer Patti LaBelle; retired Gen. Colin Powell; and political commentator Tavis Smiley. "I encourage everyone to make Feb. 7 the day you get educated about HIV and a day when you talk to others, your family members, your friends and your partners about HIV," Kevin Fenton, director of CDC's National Center for HIV, STD and TB Prevention, said (Miami Herald, 2/5).
Opinion Pieces
Newspapers recently published opinion pieces to mark National Black HIV/AIDS Awareness Day. Summaries appear below.
Bob Johnson, Louisiana Weekly: "In these times, when HIV/AIDS is the fourth leading cause of death worldwide, individuals from all walks of life must come together to confront the crisis," Johnson -- founder and CEO of RLJ Companies and founder of BET -- writes in a Weekly opinion piece. He adds, "We must act immediately to establish an honest dialogue within the black community regarding persistently high rates of infection, high rates of death, attitudes that blame those who are infected rather than support them and how we can come together to move toward positive change" (Johnson, Louisiana Weekly, 2/4).
Sen. Frederica Wilson, Miami Herald: The response to HIV/AIDS in the black community is "far from proportionate" to the number of black people living in the U.S. for "a variety of economic and cultural reasons," Florida state Sen. Wilson (D) writes in a Herald opinion piece. She adds that the disease is a "problem that needs to be, and is being, addressed through long-term improvements in economic conditions, as well as in attitudes and culture." According to Wilson, one of the "surest and quickest ways" to fight the "scourge" of HIV/AIDS in the state's black community is to increase testing (Wilson, Miami Herald, 2/7).
James Loyce, Adrian Tyler and Malik Russell, San Francisco Chronicle: While HIV/AIDS "decimates" the black community, the U.S. has "failed to implement a national health policy that addresses how this disease is spread," Loyce -- executive director for the Black Coalition on AIDS -- Tyler -- director of development and communications for BCA -- and Russell -- communications coordinator for the Harm Reduction Coalition -- write in a Chronicle opinion piece. The writers add that "[n]owhere is this discrepancy as great as over the issue" of needle-exchange programs. Needle exchanges are a "viable means" of slowing the spread of HIV, they write, adding, "Unfortunately, for nearly 20 years Congress has maintained a no-longer-rational ban on the use of federal dollars" for such programs. "Removing the federal ban" on needle-exchange programs "makes sense economically, politically and morally," they write, concluding, "Better policy must not be strangled by Beltway politics -- after all, we are talking about people's lives" (Loyce et al., San Francisco Chronicle, 2/7).
Events
Florida: The Florida Department of Health is partnering with community-based groups and leaders statewide to recognize the awareness day. Events include activities in Tallahassee and Miami-Dade County (Department of Health release, 2/6).
Kansas: Several events will be held throughout the state to recognize the awareness day, including a youth summit sponsored by the Topeka AIDS Project; the re-establishment of quarterly meetings by the Douglas County AIDS Project; an informational booth hosted by the United Methodist Mexican-American Ministries; and no-cost, rapid HIV tests offered by the Reno County Health Department (Kansas Department of Health and Environment release, 2/5).
Kentucky: Advocates, health care providers and leaders are calling on communities in the state to increase their efforts to raise awareness about HIV/AIDS among blacks and promote counseling and testing. In addition, several events and observances are planned to recognize the awareness day throughout Kentucky (Kentucky Cabinet for Health and Family Services release, 2/6).
Minnesota: The Minnesota AIDS Project AIDSLine offers statewide information and referrals, education, risk assessments and testing. The group also provides community resources and prevention programs aimed at black and African populations (Minnesota AIDS Project release, 2/5).
Oklahoma: The state this year will host events in 100 cities, including an event hosted by the Oklahoma City HIV/AIDS Community Awareness Project. Many of the city's black leaders and organizations will participate in events to mark the awareness day (Oklahoma Department of Health release, 2/4).
Washington, D.C.: Del. Eleanor Holmes Norton (D-D.C.), Mayor Adrian Fenty, the Washington Wizards and Verizon Washington, D.C., have joined the Test for Life campaign to promote and provide no-cost HIV testing events in the city. Television and radio public service announcements will be launched to inform district residents about no-cost testing events throughout February (Test for Life release, 2/5).
Statements
HHS: John Agwunobi, HHS assistant secretary for health, said, "AIDS continues to have a devastating effect on black communities, taking many lives ... This is not acceptable." To fight the disease, leadership is needed from black communities, including faith and civic leaders, health professionals, educators and families, Agwunobi said. He added, "We can stop HIV/AIDS," but to "do so, we need leaders who will educate others about the importance of being tested and the devastating effects of the disease" (HHS release, 2/5).
Office of Minority Health: Garth Graham, head of HHS' OMH, said he believes the silence and stigma surrounding HIV/AIDS in the black community remain significant barriers to HIV prevention, testing and treatment. "Without a vaccine or a cure, prevention and other positive public health messages -- such as the ABC approach to HIV prevention, which stands for abstinence, be faithful and use condoms -- are the "only real hope of stopping the spread of HIV," Graham said. He added, "We need to make sure we respond to the rise in the rate of new HIV infections aggressively and effectively -- before it's too late to stop it" (OMH release, 1/30).
Initiatives
The AIDS Foundation of Chicago has unveiled a set of resources and tools created specifically to assist black churches to start a dialogue about HIV/AIDS in their communities and with their church members. The toolkit includes a training manual to help churches create HIV/AIDS ministries, fact sheets about the disease and information about how to combat stigma related to HIV/AIDS (AFC release, 2/4).
BET in partnership with the Kaiser Family Foundation recently announced that it will air a special program about HIV/AIDS on Thursday at 8:00 PM ET/PT. The 30-minute program, called "Stigma: The Silent Killer," will examine the issue of HIV-related stigma from multiple perspectives. It will explore the challenges faced by blacks living with HIV/AIDS, as well as the impact of stigma on prevention efforts. The show also will examine HIV prevalence in black communities and how religious leaders have responded to the virus. The show will highlight the role that media have taken to address the epidemic and will feature personal interviews with political and religious leaders, public health experts, entertainers and people affected by HIV/AIDS. The program is part of BET and the Kaiser Family Foundation's Rap-It-Up partnership (BET/Kaiser Family Foundation release, 1/30).
The National Minority AIDS Council recently launched a new Web site that includes news, a calendar of events, grant deadlines and downloads related to HIV/AIDS (NMAC release, 2/5).
Headlines
"Black AIDS Awareness Pushed" (Brown, Albany Herald, 2/3).
"Free HIV Testing Offered Downtown" (Pittman, Amarillo Globe-News, 2/5).
"AIDS Awareness Events, Testing Set for Thursday" (Kraft, Arizona Daily Star, 2/4).
"Black HIV/AIDS Day Thurs." (Bridgeton News, 2/5).
"Blacks More Likely To Get HIV/AIDS" (Charleston Post and Courier, 2/7).
"Event Brings HIV/AIDS Awareness to Local Black Community" (Putnam, Charlotte Sun-Herald, 1/31).
"Chicago To Mark Black HIV/AIDS Awareness Day" (Chicago Tribune, 2/7).
"Free HIV Test Focus on Blacks, Hispanics" (Geggis, Daytona Beach News-Journal, 2/4).
"Play About HIV/AIDS Presented in Braden" (Lasseigne, Daily Vidette, 2/6).
"Spreading Epidemic" (Andyshak, Frederick News-Post, 2/5).
"'Prevention is Power' on Black HIV/AIDS Day" (Gleaton, Orangebury Times and Democrat, 2/6).
"Local Group To Mark Black HIV/AIDS Awareness Day Tonight" (Pittsburgh Post Gazette, 2/7).
"State Health Officials Note Racial Disparities in HIV/AIDS" (AP/Richmond Times-Dispatch, 2/4).
"Activists To Discuss HIV Prevention Among African-Americans" (Rochester Democrat and Chronicle, 2/5).
Link to this story.
Global Challenges
HIV Can Be Transmitted Through Pre-Chewed Food, Researchers Say
[Feb 07, 2008]
HIV can be transmitted to infants through food that is pre-chewed by an HIV-positive parent or caregiver, CDC researchers said Wednesday at the 15th Conference on Retroviruses and Opportunistic Infections in Boston, the New York Times reports. Specific findings from the study have not been released, the Times reports.
According to the Times, pre-chewing food most often occurs in developing countries, where commercially prepared infant food and blenders are not available and caregivers need to soften food before giving it to an infant. The practice is rare in the U.S. but does occur among several racial and ethnic groups, according to a CDC study on infant feeding. The virus is transmitted in blood in the saliva of HIV-positive people who have inflammations or sores in their mouths through cuts associated with teething in the infants' mouths (Altman, New York Times, 2/7). Previous studies have linked pre-chewing to the spread of other infections such as Helicobacter pylori, which causes stomach ailments, and streptococcal pharyngitis, which causes sore throats, the AP/Google.com reports (Strobbe, AP/Google.com, 2/6).
At the conference on Wednesday, CDC epidemiologist Kenneth Dominguez and colleagues from St. Jude Children's Research Hospital and the University of Miami said three cases of HIV transmitted through pre-chewing have been identified in the U.S. since 1993 (New York Times, 2/7). In at least two of the cases, the infants' mothers were HIV-positive and had bleeding gums or mouth sores while they were pre-chewing food for their children (AP/Google.com, 2/6). The researchers ruled out other possible transmission modes, such as blood transfusions or breastfeeding, in all three cases (Dunham, Reuters, 2/6). In two of the cases, genetic studies of the infants' viruses matched those of their mothers, according to the Times (New York Times, 2/7).
All three of the children were teething and had inflamed gums when they contracted the virus. According to the researchers, it might be necessary for both the caregiver who pre-chewed food and the child to have inflammation or open sores in the mouth for the virus to be transmitted (AP/Google.com, 2/6). The researchers said that pre-chewing as a mode of HIV transmission "warrants further investigation in order to continue reducing cases of HIV transmission in the U.S.," adding that the findings "could have more significant implications for developing countries." The researchers advised health care providers and HIV-positive caregivers to be aware of the risks of pre-chewing. They also advised caregivers living with HIV/AIDS to not pre-chew food for infants (Reuters, 2/6). The researchers also said that they reported the three cases in an effort to ask health care providers and family members to report suspected cases to officials to quantify the situation (New York Times, 2/7).
Kimberly Hagen of the Emory Center for AIDS Research said that programs in developing nations aimed at reducing pre-chewing among HIV-positive caregivers could be nutritionally harmful for infants. "This would really take a lot of thinking before you could say, 'We've had three cases in 11 years, so you have to stop pre-chewing your child's food,'" Hagen said (AP/Google.com, 2/6).
Link to this story.
Roche, Clinton Foundation Partner To Deliver HIV Tests to Infants in Africa
[Feb 07, 2008]
Pharmaceutical company Roche and the Clinton Foundation HIV/AIDS Initiative have partnered in an effort to increase access to HIV testing among infants in 24 sub-Saharan African countries, Rwanda's New Times reports. According to the agreement, Roche will deliver diagnostic tests at reduced costs to children younger than 18 months in the region who have been exposed to HIV. The company also will supply products to collect and process dried blood samples, which will be procured by CHAI. Dry blood spot methodology can provide advantages in resource-poor settings, where storage and transportation pose challenges (Buyinza, New Times, 2/6).
Knut Seifert, senior vice president of International Public Health Organizations for Roche, said that because infants are "particularly vulnerable to the disease, it is crucial to know whether or not children have been exposed to HIV/AIDS as soon as possible," adding, "Together with CHAI, we are proud and happy to be able to bring in our diagnostics expertise and products in order to make a difference for the youngest and most vulnerable HIV/AIDS patients" (Accra Mail/AllAfrica.com, 2/6).
According to 2007 statistics from the World Health Organization, more than 90% of HIV cases among children occur in sub-Saharan Africa (New Times, 2/6).
Link to this story.
New HIV Cases in Sweden Increased by 20% in 2007, Health Officials Say
[Feb 07, 2008]
The number of new HIV cases recorded in Sweden in 2007 increased by 20%, according to preliminary data published on Tuesday by the Swedish Institute for Infectious Disease Control, AFP/Google.com reports. According to the data, about 500 new HIV cases were recorded in the country in 2007, compared with 390 new cases recorded in 2006. The number of new cases recorded among men who have sex with men increased from 50 in 2006 to about 80 in 2007, and the number of cases recorded among injection drug users increased from 35 in 2006 to about 70 in 2007, according to the institute. The data also indicate that the number of people newly diagnosed with HIV who contracted the virus inside the country increased to 70% of cases, according to AFP/Google.com.
Researcher Claes Herlitz, who has been examining Swedish attitudes toward HIV since the late 1980s, said that the data suggest that people are becoming less worried about contracting the virus than they were 10 years ago. "Interest in HIV/AIDS has gradually declined as people have become more accustomed to the threat," he said, adding, "They've seen that HIV hasn't spread as quickly as we thought it would in the late '80s, and there are new medicines making it more difficult to get AIDS. Fewer people are dying." Herlitz added that people living with HIV in Sweden face less stigma and discrimination. "But perhaps the fear has declined too much," he said, adding, "Risky sexual behavior has increased, and a greater number of people are having casual sex without using a condom." According to institute statistician Malin Arneborn, cases of most sexually transmitted infections are increasing in Sweden because people are "having more unprotected sex" (AFP/Google.com, 2/5).
Link to this story.
Science & Medicine
NIAID Director Fauci To Convene Meeting of HIV Vaccine Researchers To Examine Research Strategies
[Feb 07, 2008]
Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, recently agreed to convene a summit of leaders in HIV vaccine research to "rethink strategy" and examine "new directions" for research and funding, the San Francisco Chronicle reports. Fauci's announcement comes after 15 vaccine researchers wrote to him requesting a reassessment of strategies in HIV vaccine research in response to the failure of three vaccine trials in recent months. The meeting is scheduled for March 25 in Bethesda, Md., the Chronicle reports.
According to the Chronicle, after last fall's cancellation of a Merck HIV vaccine candidate, as well as the failure of two other candidates, HIV/AIDS experts are calling for a delay in trials of new vaccine candidates until research can identify new strategies to develop a vaccine against the virus.
On Tuesday at the 15th Conference on Retroviruses and Opportunistic Infections in Boston, Ronald Desrosiers, a Harvard University HIV/AIDS researcher and director of the New England Primate Research Center, said that NIH has "lost its way" in HIV research, adding that there "is no rational basis for believing that any of the [vaccine candidates] in the pipeline have any reasonable hope of being effective." He added that the only value of continuing current or planned human vaccine trials would be to prove that the vaccines are ineffective at preventing HIV. The HIV/AIDS research community should accept that HIV is the "undisputed champion" among viruses in its ability to mutate resistant strains, Desrosiers said.
In response to Desrosiers, Fauci said he does not believe NIH has "lost its way" but added that there is a consensus among HIV/AIDS researchers that more research needs to be done to determine what biological steps are needed to cause the human immune system to fight the virus. Fauci declined to comment on whether planned vaccine trials will be delayed or canceled because of the recent trial failures. Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, said HIV vaccine research is at a critical point, adding that he does not believe researchers have the "luxury" to "abandon clinical trials" (Russell, San Francisco Chronicle, 2/6).
Link to this story.
Antiretroviral Drugs Could Be Used To Prevent HIV Transmission, Study Says
[Feb 07, 2008]
Antiretroviral drugs might be effective at preventing the transmission of HIV, according to a study published online in the February issue of PLoS Medicine, the San Jose Mercury News reports (Johnson, San Jose Mercury News, 2/4). For the study, Jose Gerardo Garcia-Lerma of CDC and colleagues exposed five groups of macaques to SIV, the simian form of HIV, once a week for 14 weeks.
Researchers then gave four groups various dosages and combinations of Emtriva, or emtracitibine, and Viread, also known as tenofovir. The remaining group did not receive antiretrovirals (Joshi, ANI/Topnews, 2/5). One group received a daily injection of emtracitibine, which reduced the risk of HIV transmission by 3.8-fold compared with the control group. A second group received daily oral doses of both emtracitibine and tenofovir, which reduced the risk of transmission by 7.8-fold compared with the control group. A third group of macaques received daily injections of emtracitibine and higher doses of tenofovir before being exposed to SIV, and the fourth group received the same combination before and after exposure to the virus. Walid Heneine, a CDC researcher and co-author of the study, said the combination of emtracitibine and higher doses of tenofovir provided 100% protection against SIV.
"The findings from this intermittent study suggests that ultimately it is possible to provide a promising new avenue for future research, where it opens up the floor for a lot of more research for intermittent dosing," Heneine said (Berman, VOA News, 2/5). Heneine cautioned that the formulation the monkeys received contained more tenofovir compared with the version administered to humans. He added that it is too early to know if the combination could prevent HIV transmission among humans. According to the Mercury News, other studies to test if the combination could prevent HIV in humans are under way in the U.S. and several other countries (San Jose Mercury News, 2/4).
The study is available online.
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