Kaisernetwork.org (Washington, DC)
22 May 2008
Uganda AIDS Commission Drafts Plan To Streamline HIV/AIDS Messages
[May 22, 2008]
The Uganda AIDS Commission has drafted a strategy to streamline HIV/AIDS communication in the country, the New Vision reports. The plan seeks to unify various national HIV/AIDS awareness messages, UAC Director-General Kihumuro Apuuli said at a recent meeting for the Young, Empowered and Healthy initiative in Kampala, Uganda.
"Not all stakeholders in HIV/AIDS give the same message," he said. According to Apuuli, some people think that antiretroviral drugs "are a cure for HIV," some "think that circumcision prevents HIV, while others are opposed to condoms." He added, "We will analyze the type of messages delivered. These messages must be clear."
Apuuli also said that HIV/AIDS efforts have focused on young people in the country at the expense of older groups, causing a resurgence of HIV cases among older populations, the New Vision reports.
YEAH was launched in 2004 by UAC. The initiative designs and conducts behavior change campaigns for people ages 15 to 24 to help curb HIV, early pregnancy and school dropout rates (Baguma, New Vision, 5/22).
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Photo Exhibit in Moscow Aims To Raise Awareness, Reduce HIV/AIDS-Related Stigma
[May 22, 2008]
A photography exhibit featuring 25 well-known women from Russia and Ukraine that aims to raise awareness and reduce stigma associated with HIV/AIDS opened Thursday in Moscow, the Moscow Times reports. The goal of the exhibit, sponsored by UNAIDS, is to promote public and private discussions about the disease, particularly among women, the Times reports. The exhibit, titled "Stars Against AIDS," will run for two weeks in Moscow at the Stella Art Foundation. The exhibit will then tour the country, and a selection of photographs will be published as a 2009 calendar scheduled to be launched Dec. 1 on World AIDS Day.
According to the Moscow branch of Russia's Consumer Protection Service, of the 28,000 people living with HIV/AIDS in the city as of January, more than 50% are women -- a 14% increase from 2007. In addition, most new HIV/AIDS cases among women occur among women ages 20 to 29, the Times reports.
Some experts said the increasing "feminization" of the epidemic in the country is a result of the changing nature of HIV transmission, as well as changes in gender-based social norms and sexual customs, the Times reports. Although injection drug use remains a primary mode of HIV transmission in the country, sexual intercourse is increasingly contributing to the spread of the virus, according to the Times.
In addition, many women cannot negotiate sex or condom use with their husbands or partners. "Some women suspect their husbands have many sexual partners but fear to be abandoned or beaten if they resist their husbands," Maria Ivannikova, head of the information department at the nongovernment organization AIDS Information Service, said. Unemployment and economic insecurity also lead some women to commercial sex work, according to the Times. Surveys conducted in various cities throughout Russia indicate that most sex workers are between ages 17 and 23 and do not consistently use condoms, the Times reports (Osadchuk, Moscow Times, 5/21).
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Drug Access
U.S. Patent Office Upholds One of Four Patents on Gilead's Antiretroviral Viread
[May 22, 2008]
Gilead Sciences on Tuesday announced that the U.S. Patent and Trademark Office upheld one of four patents on its antiretroviral drug Viread, Reuters reports. The four patents had been challenged by the not-for-profit group Public Patent Foundation, or PUBPAT, last year. PTO has not ruled on the remaining three patents, according to Reuters (Beasley, Reuters, 5/20).
PUBPAT last year submitted evidence to PTO that the scientific knowledge on which the four patents were based existed before Gilead held the patents. The foundation in its challenge to the patents submitted prior knowledge that Gilead had not disclosed to PTO during the patent application process. In its challenge, PUBPAT said that the prior knowledge would have prevented PTO from issuing the patents. PTO in January rejected the four patents in response to the challenge. Gilead had the right to respond to the PTO decision, and the patents will be protected while Gilead responds. Amy Flood, a spokesperson for Gilead, said that rejection is a "typical step in the re-examination process" (Kaiser Daily HIV/AIDS Report, 1/24).
Gregg Alton, a lawyer for Gilead, said the company has "always believed" that PTO "would recognize that Viread is a novel product, and we remain confident that the office will rule similarly on the remaining three patents under review." Mark Schoenebaum, an analyst at Bear Stearns, said that the PTO decision to uphold one of the patents "reduces a minor overhang on Gilead shares," adding that "the risk had been low that the patents would be rejected in a final manner" (Reuters, 5/20).
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Science & Medicine
Study Finds Increased Risk of Some Cancers Among HIV-Positive People in U.S.
[May 22, 2008]
HIV-positive people in the U.S., many of whom are living longer because of antiretroviral drugs, are at an increased risk for certain types of cancers, according to a study published Tuesday in the Annals of Internal Medicine, Reuters reports.
The study was conducted among 54,780 HIV-positive people and was based on cancer trends from 1992 to 2003. It found that as of 2003, anal cancer was 59 times more common among HIV-positive people than among the general population. In addition, Hodgkin's disease was 18 times more common among people living with HIV, followed by liver cancer at seven times more common, lung cancer at 3.6 times more common, skin cancer melanoma and throat cancer both at three times more common, and colorectal cancer at 2.4 times more common. Rates of Kaposi's sarcoma and non-Hodgkin lymphoma, which have typically been associated with HIV/AIDS, became relatively less common among people living with the disease, according to the study.
CDC's Pragna Patel, who led the study, said the most significant finding is the higher risk for anal cancer even in the "era" of highly active antiretroviral therapy. She added that multiple factors could explain the increased risk but that the risk might be linked to the spread of human papillomavirus, which is known to cause anal cancer, among men who have sex with men
The study also found that prostate cancer was less common among HIV-positive people compared with the general population. Researchers explained that HIV-positive people possibly have a smaller risk for prostate cancer because men with HIV are more likely to have low testosterone levels, which could provide some protection against the cancer.
"The study was done because we all know that now people with HIV are living longer, and HIV is looking more like a chronic disease," Patel said, adding, "So we wanted to look at one of the other very large chronic killers in America -- cancer." Patel called the study the largest analysis of cancer trends ever done among HIV-positive people in the U.S., adding that doctors who provide care for HIV-positive people should be aware of the increased risk for certain cancers among their patients and consider screening for the conditions (Dunham, Reuters, 5/20).
The study is available online.
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Most HIV Cases Traced to Transmission of Single Virus, Study Finds
[May 22, 2008]
Most HIV cases can be traced to the transmission of a single virus, according to a study published online Monday in the Proceedings of the National Academies of Science, the Birmingham News reports. According to researcher George Shaw, a professor at the University of Alabama-Birmingham, the findings are surprising and could have an impact on HIV/AIDS vaccine development.
For the study, Shaw and colleagues analyzed blood samples from 102 people who had recently contracted HIV. The study was funded by NIH's National Institute of Allergy and Infectious Diseases and the Bill & Melinda Gates Foundation. The researchers genetically analyzed the samples and were able to count generations of HIV. They found that 76% of the cases could be traced back to a single virus. The remaining 24% could be traced to two to five viruses, according to Shaw. Shaw noted that in the "vast majority" of cases, a single virus has "gone across the sexual mucosa, and that virus has infected a cell." He added, "That cell then makes a lot of virus. Now you just have a firestorm of HIV replication in the next couple weeks. Very quickly the person is populated by millions of viruses." According to Shaw, the findings help explain why it usually takes several exposures for a person to contract HIV, why transmission of the virus is so inefficient and why condoms help prevent HIV transmission.
The findings are significant because they indicate that if researchers are "trying to develop a vaccine or microbicide or whatever to prevent [HIV] infection, the only thing it has to do is prevent the transmission of a single virus," Shaw said. He added, "That should be possible. All you have to do is provide some additional block to what already is an efficient process." The findings "provide light on what was previously a very cloudy area of HIV infection," Shaw said, adding, "It puts acute and early transmission of HIV-1 in very sharp focus."
Most other sexually transmitted infections -- such as gonorrhea and syphilis -- "invade the body en masse," according to the News. "They just all come across 10, 20, 100, 200 bacteria or spirochetes," Shaw said. Several research centers worldwide were involved in the project, including Duke University, the University of California-San Francisco, the University of Cape Town in South Africa, the University of Massachusetts-Amherst, the University of North Carolina-Chapel Hill, the University of Maryland, the University of Rochester, and the Los Alamos National Laboratory and the Santa Fe Institute in New Mexico (Parks, Birmingham News, 5/20).
The study is available online (.pdf).
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Public Health & Education
St. Louis Post-Dispatch Examines Small Pharmacies' Efforts To Provide Specialized Services to People Living With HIV/AIDS
[May 22, 2008]
The St. Louis Post-Dispatch on Wednesday examined the efforts of some small pharmacies to provide specialized services to people living with HIV/AIDS. According to the Post-Dispatch, HIV/AIDS care is "resisting" the pharmaceutical industry's overall trend toward distributing medication through mail-order pharmacies rather than through traditional retail.
According to the Post-Dispatch, small, specialty retail pharmacies -- such as the pharmacy chains CarePlus and BioScrip -- are able to provide personal attention, advice and resources to people living with HIV/AIDS. In addition, such specialty pharmacies often are located in neighborhoods that have a high percentage of people living with HIV/AIDS, offering HIV-positive people the convenience of a pharmacy near their homes. About 90% of the patients at the BioScrip in St. Louis' Richmond Heights neighborhood are living with HIV/AIDS, and the store has plans to relocate to a larger space in the area, the Post-Dispatch reports.
Most traditional retail pharmacies do not sell enough antiretroviral drugs to justify the additional cost of stocking the drugs and hiring staff who are specially trained to address HIV/AIDS. However, some Medicine Shoppe and Walgreens stores have added specialized services for patients living with HIV/AIDS. Sam Bae, a pharmacist who owns three Medicine Shoppe stores, said antiretroviral prescriptions account for about 10% of the business at his store in St. Louis' Central West End neighborhood. Bae said that the increase in antiretroviral prescriptions "just kind of fell into our pharmacy."
According to the Post-Dispatch, many people living with HIV/AIDS appreciate the attention they receive at specialty pharmacies, as well as the privacy of small pharmacies. Steve Miller, vice president of pharmacy for the pharmacy benefits manager Express Scripts, said that he does not think specialty pharmacies will be as successful as mail-order pharmacies among HIV-positive people in the long term. Miller said that receiving antiretrovirals through the mail is more convenient for HIV-positive people who do not live near specialty pharmacies, adding that over-the-phone drug counseling is more private than counseling provided at traditional pharmacies (Feldstein, St. Louis Post-Dispatch, 5/21).
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