Kaisernetwork.org (Washington, DC)
28 October 2008
Across The Nation
Philadelphia Inquirer Examines HIV/AIDS in Philadelphia
[Oct 28, 2008]
The Philadelphia Inquirer on Tuesday examined how estimates indicate that new HIV infections in Philadelphia are occurring at a rate more than five times the national average. According to the Inquirer, the estimates, which are based on CDC data released in August, are part of a broader government strategy to slow the spread of the virus.
According to the Inquirer, approximately 1,400 Philadelphians contract HIV each year, and those who are not aware of their HIV-positive status are believed to be responsible for transmitting the majority of new infections. There currently are more than 16,000 people living with HIV/AIDS in the city. More than half of new cases in Philadelphia are transmitted through heterosexual contact, a third among men who have sex with men and 13% from injection drug use. John Cella, director of the city's AIDS Activities Coordinating Office, said that the high number of new cases is "a wake-up call that we've got to do better."
According to experts, "the local picture is of a disease that is transmitted largely by people who do not think of themselves as being at high risk and have not until recently been primary targets for prevention efforts," according to the Inquirer. For example, rates of HIV nationwide are highest in black communities, and Philadelphia has the second-highest percentage of black residents of the 10 most populous U.S. cities at 43.2%, according to the 2000 census. Consequently, the Inquirer reports that public health workers are "trying to get past cultural barriers that contribute" to high HIV/AIDS rates among minority communities with initiatives such as needle-exchange programs and efforts by the city's Department of Public Health to offer HIV testing in emergency departments, city prison intakes, homeless shelters and mobile units that travel to neighborhoods and social gatherings. According to Cella, the number of HIV tests performed in Philadelphia is expected to double by the end of 2008 from the 30,000 tests typical of previous years.
Nevertheless, research suggests that more than one-fifth of HIV-positive people are not aware of their status, and CDC believes this demographic is responsible for the majority of new cases. Cella added that although advocates in MSM communities, who primarily are white, have been educating themselves about HIV/AIDS for decades, there is "a lot of hidden homosexuality in black and Latino communities." Karam Mounzer, medical director of the Jonathan Lax Center, said, "There is no question in my mind that we are seeing a younger population of African-American kids with the virus," adding, "We are also seeing more young African-American females."
David Metzger, director of the HIV prevention research division at the University of Pennsylvania School of Medicine, said that the structure of Philadelphia and its neighborhoods also help explain the city's high rates of the virus, adding that old Northeast cities tend to have fixed boundaries while other cities periodically "annex" surrounding suburbs. Although this does not affect who contracts HIV, it could lower a city's rate, according to Metzger. In addition, neighborhood structures might cause HIV to spread faster, Metzger said, adding that in some poor black and Hispanic communities, there is a greater chance of coming in contact with HIV "even if you are not doing practices that are considered particularly risky" (Sapatkin, Philadelphia Inquirer, 10/28).
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Science & Medicine
Merck's Antiretroviral Isentress More Efficient in Suppressing HIV Among Untreated Patients
[Oct 28, 2008]
Merck's antiretroviral drug Isentress suppresses levels of HIV in previously untreated patients better than the company's antiretroviral efavirenz, according to research presented Sunday at a meeting of the American Society of Microbiology and the Infectious Diseases Society of America, Reuters reports. According to Phase III clinical trial results, Isentress -- known generically as raltegravir -- reduced HIV viral loads to undetectable levels in 86% of patients compared with 82% of patients treated with efavirenz (Fox, Reuters, 10/26).
FDA in October 2007 approved raltegravir for use by HIV-positive people who have not responded to other treatments. Raltegravir works by blocking an HIV enzyme called integrase. Integrase is one of the three enzymes necessary for HIV to replicate in the body, and integrase inhibitors stop HIV from inserting its genes into uninfected DNA (Kaiser Daily HIV/AIDS Report, 10/15/07). The agency also granted Isentress accelerated approval for use among patients who showed initial signs of resistance to existing antiretrovirals. According to Merck, up to 40% of the approximately 500,000 HIV-positive people in the U.S. receiving antiretrovirals have developed resistance to the drugs. In addition, researchers at the conference said that drug-related adverse effects were significantly fewer in patients treated with Isentress (44%) than with efavirenz (77%) (AFP/Yahoo! News, 10/26).
Robin Isaacs, executive director for infectious disease clinical research at Merck, said, "There was a desperate unmet medical need for those patients who had failed other therapies" until recent years. He added that Isentress and Pfizer's Selzentry -- also approved last year -- helped address that need, along with three other new drugs: Boehringer Ingelheim's Aptivus, and Johnson & Johnson's Prezista and Intelence. According to Isaacs, patients "have all these different options now, which they didn't before, to build new successful regimens."
According to AP/Yahoo! Finance, Pfizer at the conference also presented research from a 48-week study comparing its antiretroviral Selzentry with Bristol-Myer Squibb's antiretroviral Sustiva in a total of 417 patients also receiving GlaxoSmithKline's antiretroviral combination drug Combivir. In both groups, 68% of patients had the HIV virus reduced to undetectable levels; however, 4.2% of those who got Selzentry and 14.2% taking Sustiva stopped because of side effects (Johnson, AP/Yahoo! Finance, 10/26).
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Global Challenges
Lebanon Holds HIV/AIDS Workshop for Religious Leaders
[Oct 28, 2008]
Lebanon on Monday opened a three-day conference for religious leaders in the country to raise awareness about HIV/AIDS issues, the Daily Star reports. More than 60 participants attended the workshop, which was organized by the United Nations Development Program and the Public Health Ministry. In a statement read by UNDP Country Director Seifeldin Abbaro, UNDP Resident Representative Martha Ruedas said, "Until now, the Arab world had not addressed the issue of HIV/AIDS with enough energy because people were too scared or not sufficiently informed to discuss the disease." She added that the situation is beginning to change, according to the Daily Star.
One of the workshop's goals is to acquaint participants with the Cairo Declaration of Religious Leaders in the Arab Region in Response to HIV/AIDS, which was signed in 2004 by 80 religious leaders from 19 Arab countries. It also has been endorsed by more than 300 other leaders. The workshop also discussed the Tripoli Declaration, which was endorsed by 80 female religious leaders who said they would focus on the rights of women and children in relation to HIV/AIDS.
Mostafa Mahmoud al-Nakib -- national AIDS program manager at the health ministry who was representing Health Minister Mohammed Jawad Khalifeh -- said that attitudes in Lebanon need to shift away from the belief that HIV/AIDS affects only sex workers or others who engage in high-risk sex. "Statistics proved that this disease affects everyone," he said, adding, "It does not discriminate against age, gender, religion or nationality." Workshop participants also discussed how to prevent HIV/AIDS-related discrimination, and Ruedas and other speakers stressed that religious leaders should become involved with HIV/AIDS efforts at the grassroots level. "You can access all communities once a week, every week, across Lebanon," Ruedas said, adding, "You work on a daily basis with community-based organizations, and I respectfully tell you that it is you who are well-placed to lead." Participants also were provided with references from the Koran and the Bible to use in their HIV/AIDS work (Tabar, Daily Star, 10/28).
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Global Fund's Technical Review Panel Recommends Zimbabwe's Funding Application Be Approved
[Oct 28, 2008]
The Technical Review Panel of the Global Fund to Fight AIDS, Tuberculosis and Malaria has recommended that Zimbabwe's Round 8 application to scale up HIV/AIDS and tuberculosis programs in the country be approved, IRIN/PlusNews reports. Zimbabwe's "relationship with the Global Fund has not been a rosy one," IRIN//PlusNews reports, adding that "in seven rounds of funding disbursements, Zimbabwe's applications have been successful in only two."
The TRP -- an independent group of health experts and academics that reviews all Global Fund applications -- has said Zimbabwe's application for at least $500 million is "technically sound." Zimbabwe's Country Coordinating Mechanism requested about $300 million for HIV/AIDS efforts, $58 million for TB programs and $80 million to improve the country's health sector. Douglas Gwatidzo, chair of the Zimbabwean Association of Doctors for Human Rights, said the decision to apply for health system strengthening was "very wise" because the effectiveness of HIV/AIDS, TB and malaria programs will depend on the capacity of health systems. The Global Fund's board of directors will meet in New Delhi in November to review and approve Round 8 funding applications.
Zimbabwean Health Minister David Parirenyatwa said the country is "delighted" that TRP has recommended that Zimbabwe's application be approved because the country's "financial coffers had run dry" and additional funding would be a "welcome relief." Jon Liden, head of communications at the Global Fund, said that it would be "premature" to announce that the application would be approved in advance of November's board meeting. Gwatidzo agreed that it might be too early to assume approval, adding that Zimbabwe has an "urgent need of HIV/AIDS funding" and should seek alternative solutions while waiting for a possible Global Fund grant (IRIN/PlusNews, 10/24).
Zimbabwe has an HIV prevalence rate of about 15.3%, and about 1.3 million people in the country are HIV-positive. About 98,000 HIV-positive people in the country have access to no-cost HIV treatment provided by the government, but about 570,000 people are in need of antiretroviral drugs (GlobalHealthFacts.org)
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Funding Shortage Hindering HIV/AIDS Programs in Burundi, IRIN/PlusNews Reports
[Oct 28, 2008]
HIV/AIDS programs in Burundi are unable to expand their services because of a shortage of government funding, IRIN/PlusNews reports. The National AIDS Control Council of Burundi said that in 2008, the government experienced an $11 million shortfall in the $28 million budget needed to address HIV/AIDS in the country. In addition, there was an $83 million shortage in funding needed to fulfill the national AIDS strategic plan from 2007 to 2011.
According to Jean Rirangira, interim executive secretary of NACC, the Global Fund To Fight AIDS, Tuberculosis and Malaria's Technical Review Panel has recommended that the government's request for a five-year, $150 million grant to fight HIV/AIDS be approved. The current application for funding from the Global Fund was designed to include aims of the 2007-2011 strategic plan. The government plans to strengthen HIV-prevention activities, prevention of mother-to-child HIV transmission programs and other aspects of the strategic plan if the Global Fund application is approved, Rirangira said.
The government has had to postpone plans to expand programs aimed at preventing mother-to-child HIV transmission because of a lack of funding, Rirangira said, noting that Burundi's PMTCT programs are "very underdeveloped." Less than 20% of the 500 health centers in Burundi offering prenatal services offer PMTCT services. Between 15,000 and 18,000 HIV-positive women give birth annually in the country but only about 1,000 of them receive PMTCT services, Rirangira said. In addition, AIDS orphans and other vulnerable children also "have suffered" during the funding shortfall, Rirangira said.
Nongovernmental organizations -- including the Association Nationale de soutien aux Seropositifs et Sideens, or ANSS -- have limited expansion efforts because of the shortfall. Jeanne Gapiya -- founder of ANSS, which provides antiretroviral treatment to more than 2,600 people -- said that the group cannot offer access to antiretroviral drugs to new patients. According to Gapiya, increased funding would enable ANSS to train and hire more doctors to "maintain the quality of service" the group provides.
Nicolas Demey, a media liaison for the Global Fund, said that the proposal will need to be endorsed by the Global Fund board before it is considered successful but added that Burundi should consider internal funding sources so HIV programs are less affected by external factors. According to IRIN/PlusNews, Burundi's HIV prevalence has increased from 3.5% in 2002 to 4.2% in 2008 (IRIN/PlusNews, 10/24).
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Sex Workers in Bali Begin Working in Remote Villages, Increasing Risk of HIV Transmission, Report Says
[Oct 28, 2008]
Commercial sex workers in Bali in response to strict monitoring by city officials have begun working in remote villages, increasing the risk of HIV transmission in the region, according to a report released Friday by the Bali Regional AIDS Commission, or KPA, the Jakarta Post reports.
The report was based on interviews and reports from local hospitals and found there were 2,323 documented HIV cases in Bali in September, with heterosexuals and people ages 20 to 29 accounting for the largest number of infections, followed by injection drug users and people ages 30 to 39, the Post reports. The report found that 20% of the estimated 3,000 sex workers in Bali use a condom during intercourse, which has contributed to new HIV cases in 840 male clients, KPA program coordinator Yahya Hanshori said.
According to Yahya, the rise of sex workers working in remote villages "increases the possibility of a wider spread of HIV because villagers are even less aware of sexually transmitted [infections] than city people." Yahya added that the high number of sex workers in villages is a "really troubling development." KPA plans to work with sex workers and "those key population groups who are most prone to HIV infection," Yahya said, adding that people "who feel like they need [HIV] counseling" should go to KPA. The group estimates that there are more than 4,000 people living with HIV/AIDS in Bali, according to the Post (Wisnu, Jakarta Post, 10/26).
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