Kaisernetwork.org (Washington, DC)
2 September 2008
Across The Nation
CDC Report on New HIV Infections in U.S. Did Not Include Data From Puerto Rico; Omission Has Widespread Consequences, Advocates Say
[Sep 02, 2008]
A CDC report released last month about new annual HIV infections in the U.S. did not include data from Puerto Rico, an omission that Hispanic HIV/AIDS advocates say could have widespread consequences nationwide, the Orlando Sentinel reports.
According to the advocates, CDC ignored the seriousness of HIV/AIDS in Puerto Rico, which has the fifth-largest concentration of HIV cases nationwide, by not including data in the report. In addition, the omission significantly lowers estimates on the number of Hispanics nationwide affected by HIV/AIDS. According to Guillermo Chacon, vice president of the Latino Commission on AIDS, the share of new HIV infections represented by Hispanics increases from the 17.3% reflected in the CDC report to 22% when data on Puerto Rico are included.
Accurate new infection estimates also help gauge how quickly HIV is spreading, which groups are at high risk and which areas have higher rates of HIV, all of which are necessary to develop effective prevention and treatment strategies, according to advocates. Chacon said that the report is "not acceptable," adding that the "number the CDC came up with doesn't fully reflect the severity of this epidemic among Latinos." Chacon added that "[n]ew policies" that address HIV/AIDS "are being formulated based, precisely, on the numbers" in the CDC report.
National HIV/AIDS estimates that do not accurately reflect HIV incidence among Hispanics could result in fewer resources allocated for prevention and treatment targeting Hispanics. "Excluding Puerto Rico, which has such a high incidence [of HIV], implies a reduction of funds for everybody," Rosaura Lopez, director of an HIV clinic in the San Juan suburb of Rio Piedras, said.
CDC said it did not include data on Puerto Rico in the report because it uses census population data for the report, and population is estimated differently in Puerto Rico than in the rest of the country. Kevin Fenton -- director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention -- said the agency is working with health officials in Puerto Rico to estimate HIV incidence. According to the Sentinel, CDC "further complicated" the issue last month when officials announced that eight states and Puerto Rico would not receive federal funding for an advanced HIV monitoring system (Rivera-Lyles, Orlando Sentinel, 8/30).
Related Editorial
CDC's new estimate of HIV incidence "has critical implications for the nation," David Holtgrave -- chair of the Department of Health, Behavior and Society at Johns Hopkins Bloomberg School of Public Health -- and Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors, write in a Baltimore Sun opinion piece, adding that the U.S. "has much work to do."
Holtgrave and Scofield outline "seven things the U.S. can do now to get smarter and better at fighting the [HIV] epidemic," including increasing funding for HIV prevention services and funding a "new testing technology that enables better HIV incidence estimates" in additional states. In addition, CDC should aim to reduce new HIV cases by 50% in five years and increase efforts to fight HIV among minority communities and men who have sex with men, the authors write.
The authors add that the "next president must go further and once again make HIV in the U.S. a priority," concluding that the current "national path of apathy is not only ill-advised and expensive but also unethical and a public health error of the greatest magnitude" (Holtgrave/Scofield, Baltimore Sun, 8/31).
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Washington Post Examines HIV/AIDS Outreach Efforts Aimed at African Immigrants
[Sep 02, 2008]
The Washington Post on Tuesday examined HIV/AIDS outreach efforts aimed at African immigrants in the U.S. According to the Post, some health researchers say that the "message" that HIV/AIDS also affects Africans in the U.S. is "growing in importance as they become increasingly concerned that the AIDS epidemic ravaging sub-Saharan Africa is following migrants from that continent to America."
Local studies conducted across the U.S. have found "greatly disproportionate" HIV/AIDS rates among Africans, and health care providers in the Washington, D.C., area are recording similar trends, the Post reports. However, many providers are encountering a similar problem in that because many health departments do not ask patients where they were born, most HIV-positive African immigrants are categorized in surveys as "black" or "African-American."
"Quite frankly, many providers don't distinguish between Africans and African-Americans," Garth Graham, deputy assistant secretary for minority health at HHS, said. He added, "It doesn't take into account the different cultural backgrounds and perceptions of wellness and disease that these individuals have ... that's one of the glaring challenges that we're facing."
Other health care providers say that the issue is compounded by stigma, language barriers and fears over deportation. Some immigrants are not familiar with the concept of preventive medicine and do not realize that an early HIV diagnosis can improve survival changes, according to providers. "You have to be sick to go to the doctor in Africa," Ashenafi Waktola, a district-area physician who was born in Ethiopia, said, adding, "That is disastrous with AIDS."
According to the Post, there are no "precise" national data about HIV/AIDS among African immigrants. However, studies conducted in places such as Minnesota and the Seattle area, which have relatively large African immigrant populations, have found much higher HIV/AIDS rates among Africans. Studies in Canada and Europe have found similar results, the Post reports. In the district area, information on country of origin "varies so much by jurisdiction and is so spotty that it provides only a blurry snapshot," according to the Post. However, a recent district Health Department survey conducted among groups that provide HIV/AIDS services to impoverished populations in the region found that 10% of those clients were born in Africa.
In addition, of the 31,256 AIDS cases reported in Maryland through September 2007, African immigrants accounted for 716, or 2.3%, of the cases -- slightly higher than their percentage of the population, which is about 2%. In Montgomery County, Md., 392, or 15%, of all reported AIDS cases were among Africans, who account for about 4% of the population. According to officials with Maryland's AIDS Administration, they are unsure how to explain the disparity between the Montgomery County and statewide data because reporting about country of origin by health providers is "often inconsistent or incomplete," William Honablew, an administration spokesperson, said. Other officials said that it is possible that health providers in Montgomery more routinely offer HIV tests to immigrants and record country of origin data more reliably. According to Honablew, the large majority of AIDS cases among African immigrants in Maryland have been recorded in Montgomery and Prince George's counties, and the AIDS Administration is planning an HIV program targeting African communities in those counties.
In Virginia, country of origin was recorded in 26% of the 1,062 new HIV cases reported in 2006, according to the state Department of Health. African immigrants, who account for less than 1% of the population in the area, accounted for 5% of all 1,062 newly recorded cases. According to the Post, African immigrants "almost certainly would account for a higher share if national origin were consistently recorded." According to a study conducted by a Seattle-King County epidemiologist, African immigrants in 2003 and 2004 accounted for at least 13% of the 639 new HIV infections in nine Northern Virginia counties.
Many health care providers and researchers said they believe that most HIV-positive immigrants contracted the virus in their homelands in part because the virus is diagnosed in the later stages in many cases. Because few educational materials aimed at African immigrants are available, outreach workers sometimes use materials written for U.S.-born blacks that have little cultural relevance for Africans, the Post reports. In addition, stigma often presents a large obstacle. Because African immigrant communities are "segmented and tight-knit," providers say that African immigrants "fear they would know a doctor or interpreter from the same community and that word of their condition would spread," according to the Post (Brulliard, Washington Post, 9/2).
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Science & Medicine
HIV-Positive People Might Be at Increased Risk of Bone Fractures, Study Finds
[Sep 02, 2008]
As HIV-positive people live longer primarily because of antiretroviral treatment, they might face an increased risk of bone fractures, researchers from Massachusetts General Hospital reported last week, Xinhua/Individual.com reports. According to the study, the prevalence of bone fractures in people living with HIV is 60% greater compared with HIV-negative people. According to Steven Grinspoon of MGH, the study group included more than 8,500 people living with HIV and more than two million control patients. He added that researchers evaluated data from patients treated over an 11-year period. The size of the study group "has the power to detect significant differences in risk for both men and women at critical sites such as the hip and spine, risks that increased with age," Grinspoon said.
The researchers found that the prevalence of bone fractures was 1.8% in HIV-negative participants, compared with 2.9% of HIV-positive people who were diagnosed with fractures of the wrist, spine and hip. The study also found that fracture rates associated with HIV were seen in both women -- 2.5% of HIV-positive women compared with 1.7% of HIV-negative women -- and men -- 3% of HIV-positive men compared with 1.8% of HIV-negative men. In addition, the researchers said that older patients have an even greater risk of bone fractures. Grinspoon said the results of the study indicate that as people living with HIV age, they should be screened for bone density, adding that researchers "need to learn more about the mechanisms of this bone loss -- whether [antiretroviral] drugs, the virus itself or other metabolic factors are responsible" (Xinhua/Individual.com, 8/28).
Link to this story.
Global Challenges
Local, Regional Artists Should Become Involved With Fight Against HIV/AIDS in Southern Africa, Official Says
[Sep 02, 2008]
Local and regional artists and celebrities should become increasingly involved in the fight against HIV/AIDS in Southern Africa because they understand the cultures affected by the disease, Eugene Marillier-Malotana, founder and director of the Southern African Development Community Artists AIDS Festival and the SADC Artists AIDS Support Network, said recently, the Financial Gazette/AllAfrica.com reports. According to Marillier-Malotana, it would be more effective for local HIV/AIDS programs if local and not international celebrities were involved.
Marillier-Malotana has initiated an artists' forum that brings together Zimbabwean poets, musicians and actors to discuss HIV/AIDS issues. The forum allows artists to be "candid" about HIV/AIDS, Marillier-Malotana said, adding that the group hopes to open an HIV/AIDS testing and counseling center for artists. According to the Gazette/AllAfrica.com, the centers will be promoted through the SADC region, and they will help people living with and affected by HIV/AIDS. Marillier-Malotana said that SasNet will undertake research to provide data and statistics about artists living with HIV/AIDS and in need of antiretroviral therapy. The organization also aims to provide services, information and support to all artists, in particular to those living with HIV/AIDS (Financial Gazette/AllAfrica.com, 8/28).
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Philippine Health Department To Promote Condom Use in Fight Against HIV/AIDS Despite Opposition From Catholic Church
[Sep 02, 2008]
Despite opposition from the Roman Catholic Church, the Philippine Department of Health will support the use of condoms to prevent the spread of HIV/AIDS in addition to encouraging education on the topic and promoting measures to guard against sexually transmitted infections, the Philippine Star reports. Health Undersecretary Mario Villaverde at the second Asia Pacific Regional Meeting on universal access to HIV prevention in Manila, Philippines, said, "The use of condoms to prevent the spread of HIV/AIDS is different from their use for birth control," adding, "The church's position is detrimental to public health" (Crisostomo, Philippine Star, 8/29).
According to Villaverde, "We cannot really prevent people, regardless of their religious belief, from engaging in high-risk behavior, and so we must educate them and we must provide some preventive and control measures for them" (Alave/ Bordadora, Philippine Daily Inquirer, 8/28). Villaverde added, "Generally, the approach of the DOH in terms of HIV prevention is really through education and advocacy. Awareness and behavioral change are important." Villaverde did not say how condoms would be promoted in the country, where all forms of contraception are opposed by the church, according to the Star (Philippine Star, 8/29). The Catholic Church has been campaigning against the use of government funds for and universal access to contraception, the Daily Inquirer reports.
Although the Philippines is considered a low-prevalence country, with less than 0.1% of the population testing positive for HIV, the number of HIV-positive people continues to grow. DOH data indicate that the number of recorded HIV/AIDS cases rose to an average of 29 per month in 2007, up from 20 cases monthly in past years. Estimates place the number of HIV/AIDS cases recorded between 1984 and 2007 at 3,061, but DOH and the World Health Organization say the actual figure could be higher. In 2007, the agencies estimated that there could be 7,490 people living with HIV/AIDS in the Philippines, up from the 6,000 estimated in 2002. According to DOH, the spread of the disease primarily is through sexual transmission, and condom use among the most at-risk population is below target (Philippine Daily Inquirer, 8/28).
Link to this story.
Sri Lankan Health Official Says Strong Family Bonds, Family Values Responsible for Low Prevalence of HIV/AIDS in Country
[Sep 02, 2008]
Supportive family values and strong family bonds, in addition to the practice of monogamy, have contributed to the low prevalence of HIV/AIDS in Sri Lanka, Health Care and Nutrition Minister Nimal Siripala De Silva said recently at the second Asia Pacific Regional Meeting on universal access to HIV prevention in the Philippines, Sri Lanka's Daily News reports. The adult HIV prevalence is less than 0.1% in Sri Lanka, De Silva said. He added that at the end of 2007, the estimated number of people living with HIV was 3,500 to 4,000.
De Silva said that HIV transmission through blood and blood products is extremely low and that the country has recorded two such cases. Several million transfusions have been conducted in the country, which has adopted a strict blood safety policy. In addition, the government has regulatory oversight of blood transfusion services. According to De Silva, the male-to-female ratio of HIV/AIDS cases is narrowing and the feminization of the disease is emerging, with almost 60% of women living with HIV/AIDS having contracted the disease from their spouses.
De Silva said that the highest levels of political leadership and commitment to HIV/AIDS prevention are critical to maintaining Sri Lanka's status as one of the few countries in the world with a low HIV/AIDS prevalence. The National AIDS Council, which is chaired by President Mahinda Rajapaksa, aims to address alcohol and drug abuse in an effort to curb the spread of HIV. De Silva added that although antiretroviral drugs are expensive, the government has taken on providing them at no cost to HIV-positive people (Daily News, 8/28).
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