Kaisernetwork.org (Washington, DC)
19 December 2008
Science & Medicine
Study Looks at Male Circumcision as HIV Prevention Among Black Men in Baltimore
[Dec 19, 2008]
HIV risk appears to be lower among U.S. black men who have been circumcised and are considered at high risk of contracting the virus than among black men who have not been circumcised, according to a study published on Wednesday in the Journal of Infectious Diseases, Reuters reports. Two other studies in the journal also examine the benefits of male circumcision to prevent the spread of disease and infection.
For one of the studies, CDC researcher Lee Warner and colleagues looked at black men living in Baltimore and found that 10% of those who were at high risk of HIV and were circumcised had the virus, compared with 22% of those who were not circumcised. According to the report, "Circumcision was associated with substantially reduced HIV risk in patients with known HIV exposure, suggesting that results of other studies demonstrating reduced HIV risk for circumcision among heterosexual men likely can be generalized to the U.S. context."
Ronald Gray of Johns Hopkins University and colleagues in an editorial accompanying the study noted that in the U.S., circumcision is less common among blacks and Hispanics. However, blacks and Hispanics are the most at-risk of groups for contracting the virus. "Thus, circumcision may afford an additional means of protection from HIV in these at-risk minorities," they wrote.
The American Academy of Pediatrics does not recommend routine circumcision for infants, and as a result, Medicaid does not cover the procedure, according to the editorial. The editorial adds that "this is particularly disadvantageous for poorer African-American and Hispanic boys who, as adults, may face high HIV exposure risk" (Fox, Reuters Health, 12/17).
The study is available online. The editorial also is available online.
Link to this story.
Researchers Find Evidence About Evolution of HIV in Lemurs
[Dec 19, 2008]
Researchers at the Stanford University School of Medicine have discovered a virus related to HIV in the genetic makeup of the Madagascar grey mouse lemur, a finding that could provide new evidence about the origins of HIV, according to a study recently published in the Proceedings of the National Academy of Sciences, IRIN/PlusNews reports. According to the researchers, the study suggests that lentiviruses -- the family of viruses to which HIV belongs -- have been present in primates for more than 14 million years. Madagascar was last linked with mainland Africa about 14 million years ago, and this allowed lentiviruses to pass to lemurs. According to IRIN/PlusNews, it was widely believed that HIV-1 and HIV-2 were passed to humans from primates in mainland Africa and that the primates have harbored the virus for about one million years at the most. However, the study's findings contradict this theory. One of the two senior authors of the study, Robert Shafer, called the discovery "one of the most important missing links" needed to understand the evolutionary history of HIV-related viruses.
Robert Gifford, another lead author of the study, said that the lentivirus material found in the genetic makeup of the lemur will aid scientists in understanding the functions of different genes within the virus and the limit to which the virus can adapt. This information could be used to help develop HIV/AIDS treatments and prevention methods for humans, IRIN/PlusNews reports.
Gifford said, "Our discovery means that primate lentiviruses have been present in Madagascar historically and may still be circulating there. Since Madagascar has been very isolated throughout evolutionary history, it's not clear how we could have these viruses present both there and in Africa, unless they are in fact many millions of years old." He added, "If we are ever going to properly understand the relationships between lentiviruses and disease, assess the risk of new epidemics occurring, and harness the body's natural defenses to prevent and control HIV infections, we need to establish the proper ecological and evolutionary contexts." According to IRIN/PlusNews, some scientists now believe that lentiviruses could be at least 50 million years old and that they could be present in primates worldwide.
Although the findings are unlikely to dramatically alter the course of HIV/AIDS research in the immediate future, they are expected to affect scientists' understanding of the disease, IRIN/PlusNews reports (IRIN/PlusNews, 12/16). Shafer said, "If we understand how hosts have controlled infection over millennia, then that opens the way to developing new drugs or to other ways of encouraging innate resistance," London's Guardian reports.
In addition, the study's findings also indicate that the lemurs might have survived an epidemic similar to HIV/AIDS before developing immunity, "promising important insights into how the human epidemic might unfold," according to the Guardian (Beaumont, Guardian, 12/18).
The study is available online.
Link to this story.
Across The Nation
South Carolina Medicaid Cuts $61 Million in Services, Ends Enrollment in HIV/AIDS Program
[Dec 19, 2008]
South Carolina's Medicaid agency will stop enrolling people living with HIV as part of a $61 million round of budget cuts, officials announced on Wednesday, the AP/Charlotte Observer reports. According to the AP/Observer, no longer enrolling HIV-positive people will save the agency $40,000. Some health care advocates argue the budget cuts mean that many people will become even sicker when left without care, leading to more costly emergency department visits "or worse," the AP/Observer reports. Carmen Julious, executive director of Palmetto AIDS Life Support Services in Columbia, said the Medicaid HIV/AIDS program provides "lifesaving medications," adding, "Compared to people's lives, that ($40,000) doesn't seem like a good balance to me." Sue Berkowitz, executive director of the low-income advocacy group South Carolina Appleseed Legal Justice Center, said that people "are going to die" because of the budget cuts.
The AP/Observer reports that other budget cuts include ending hospice care for Medicaid-only patients; decreasing the amount of assistance for prescription drug costs for low-income, elderly populations; reducing home health nurse visits from 75 to 50 per year; and reducing assistance to hospitals and nursing homes. The Medicaid program has lost $137 million since July while state spending has been reduced by $1 billion because of the economic situation and faltering tax collections (Davenport, AP/Charlotte Observer, 12/17). The Columbia State reports that the $61 million in state budget cuts will result in the loss of $398 million in federal matching funds. Jeff Stensland, a spokesperson with the state health department, said the budget cuts will affect patients but not essential care, adding that a proposed federal aid package for states could help fund some of the programs that will be eliminated or reduced (O'Connor, Columbia State, 12/18). Stensland also said that the department is "not happy about having to do any of these" cuts and that an increase in the demand for the state's Medicaid program is "just around the corner" because of the economic situation (AP/Charlotte Observer, 12/17).
Link to this story.
Fresno County, Calif., Officials Approve Needle-Exchange Program
[Dec 19, 2008]
The Fresno County Board of Supervisors in California on Tuesday approved a one-year needle-exchange pilot program, the Fresno Bee reports. Supervisors voted 3-2 in support of the program, which was proposed by County Health Officer Edward Moreno and will provide injection drug users with clean needles in an effort to curb the spread of HIV and other bloodborne diseases. Supervisors said that they understand concerns from some law enforcement officials about illegal drug use but that the county needs ways to reduce the spread of diseases such as HIV and hepatitis C. Volunteers have been illegally dispensing 6,000 to 8,000 clean needles each Saturday to IDUs in the county, according to advocate Dallas Blanchard, who has been distributing clean needles for about 13 years. According to the Bee, although these efforts have been tolerated by police, an official program previously had never been endorsed by the Board of Supervisors, which last voted against a needle-exchange program in 2006.
The program will include a needle exchange once weekly at The Living Room, a support center for people living with HIV/AIDS operated by the not-for-profit agency WestCare. County substance abuse staff and health workers will offer information about drug treatment options and referrals. According to Jena Adams -- a communicable disease specialist with the county's Department of Public Health -- health workers also will offer HIV and hepatitis C tests. Physician Marc Lasher also will offer no-cost medical care to IDUs who come to the needle exchange. Lasher credited Moreno for successfully proposing a treatment-based initiative that helped the needle-exchange program win approval. According to Alessandra Ross of the state Office of AIDS, 17 counties and three cities in the state have needle-exchange programs. A 2005 study found that 15,169 IDUs live in Fresno County and that 11,377 likely are living with hepatitis C (Anderson, Fresno Bee, 12/17).
Link to this story.
Opinion
Southern U.S. Needs To Do More To Address HIV/AIDS Among Hispanics, Opinion Piece Says
[Dec 19, 2008]
"Demographers have noted that the South is one of the regions that have seen the most rapid influx of Latino workers," Marisa Trevio, who writes the blog "Latina Lista," writes in a USA Today opinion piece. She adds, "So with a steady influx of Latinos, and a growing number of them contracting HIV/AIDS, why aren't states making inroads via aggressive public awareness campaigns in attacking this preventable and treatable disease?"
According to Trevio, a recent study from the Latino Commission on AIDS "found that HIV/AIDS cases are rising at alarming rates among the two million Latinos in Alabama, Georgia, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee." She adds, "Prevention education isn't keeping pace." Trevio writes that public awareness efforts likely are not having much effect among Hispanics because the "targets of these messages -- which include legal and undocumented workers -- don't trust the messenger." A report from Progressive States Network found that "every state identified by the study, with the exception of Alabama, has passed policies criminalizing undocumented immigration," according to Trevio. "These laws intimidate people from seeking any assistance," she writes, adding, "For example, South Carolina passed a series of laws that include establishing a hotline to report suspected nonresidents and making it a crime to transport or harbor undocumented immigrants." The report found that as a "result of this anti-immigrant climate and the high rate of people without health insurance," many HIV-positive Hispanics do not "seek medical attention until they are in its late stages," Trevio writes.
However, some "states are trying to confront this crisis," according to Trevio, who adds that North Carolina in October "conducted a bilingual campaign to encourage people to get tested. Even so, the report found that these states didn't have enough bilingual professionals to address the crisis." Trevio writes that the study "made several recommendations, all rooted in communication. Whether it's utilizing more Spanish-language media to market prevention programs, training more people to speak Spanish, partnering with Latino organizations to replicate their successful programs or connecting with Hispanic religious and community leaders, it all comes down to opening lines of communication to a population that has been forced to stay in the shadows of society." She concludes, "For their health and for the health of the country, these Latinos must come forward -- and the sooner the better" (Trevio, USA Today, 12/19).
Link to this story.
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