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Archive for June, 2007

Aidsmap | Hospital admissions involving people with HIV fall by 40% between 2000 and 2004 in US

Posted by pozlife on June 28, 2007

 

Michael Carter, Thursday, June 21, 2007

Hospital admission involving HIV-positive individuals fell by almost 40% between 2000 and 2004, a US study, published in the June 1st edition of the Journal of Acquired Immune Deficiency Syndromes reports. The study, which looked at hospitalisations in six US states, also found that the average age of patients with HIV being admitted to hospital increased. The author of the study suggests that this is due to the general ageing of the HIV-positive population thanks to the success of antiretroviral therapy. However, such ageing is having an important impact on the type of illnesses HIV-positive patients develop, and the author notes that it is increasingly probable that people with HIV “are likely to be treated for conditions that affect the general population of hospital patients, such as gastrointestinal disorders, cardiovascular problems, and cancer.”
The US federal government spends in excess of US$12 billion per year on HIV care. The proportion of expenditure per-patient devoted to paying for hospital care has fallen significantly since the introduction of potent antiretroviral therapy. Indeed, in the early years of the HIV epidemic nearly all the money spent on patient care was devoted to paying for in-patient treatment, but by 1998, only two years into the era of effective anti-HIV therapy, this had fallen to 38%.
Dr FJ Hellinger, a healthcare researcher, wished to see if there had been any changes in the pattern of hospital care required by people with HIV between 2000 and 2004. Information was gathered from six US states (California, Florida, New Jersey, New York, South Carolina and Washington State, selected to have a broad geographical spread and to include high- and low-prevalence states). Dr Hellinger compared the number of total admissions in 2000 and 2004, the health of patients at the time of their hospitalisation, and age, gender, and ethnicity.
In 2000 there were 91,343 admissions to hospital involving HIV-positive patients. This fell to 72,829 admissions in 2004. Overall this was a 20% reduction in admissions. However, during this period there was also a 28% increase in the total number of people living with HIV. Taking into account this increase in HIV prevalence, Dr Hellinger calculated that hospital admissions actually fell by 39% in the four-year period. This meant that there was a 44% reduction in the average monthly cost to provide hospital care to HIV-positive patients.
A general ageing in HIV-positive patients requiring admission to hospital was also observed. In 2000, individuals requiring in-patient care had an average age of 41 years, but by 2004 this had increased to 44 years. Patients admitted to hospital in 2004 were in poorer health than those hospitalised in 2000 – the average number of diagnoses per patient in 2000 was six, but this had increased to seven by 2004. Dr Hellinger also noted that there was a very slight increase in the average duration of each admission to hospital from 8.3 days in 2000 to 8.4 days four years later.
There were no significant shifts in the gender or ethnicity of patients requiring in-patient care. In both 2000 and 2004, 34% of those hospitalised were women and 51% were black.
Dr Hellinger concludes that the information provided by his study is a “prerequisite for physicians and planners to ensure that persons living with HIV receive the appropriate mix of health care services.”

Source: Aidsmap | Hospital admissions involving people with HIV fall by 40% between 2000 and 2004 in US

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Report Examines Programs That Would Give HIV-Positive People Access to New Drugs Before Final Federal Approval

Posted by pozlife on June 28, 2007

 

June 22, 2007

Rethinking the Approach to Expanded Access Programs,” Forum for Collaborative HIV Research: The report says that reform of expanded access programs that allow HIV-positive people to take new drugs before final federal approval is needed. Although EAPs can be important to HIV-positive people who have developed resistance to currently available drugs, the system for providing access to experimental drugs is “fragmented and underfunded,” according to the report. It adds that the system “discourages academic health centers and private physicians from participating.” The report reviews the problems associated with the system and provides guidelines aimed at improving it, including a recommendation that pharmaceutical companies reimburse health care providers for EAP costs. “The goal of expanded access programs is to make promising drugs in the late stages of clinical trials available to patients who urgently need treatment and have exhausted all currently approved therapies,” Ben Cheng, deputy director of the forum said, adding, “Unfortunately, the current mechanism for early access to these promising drugs serves neither patients, companies nor regulators” (Forum for Collaborative HIV Research release, 6/14).

Source: Report Examines Programs That Would Give HIV-Positive People Access to New Drugs Before Final Federal Approval – The Body

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FDA Issues Approvable Letter for Pfizer’s Antiretroviral Maraviroc

Posted by pozlife on June 28, 2007

 

June 21, 2007

Pfizer in a statement released on Wednesday said it has received an approvable letter from FDA for its antiretroviral drug maraviroc, the Wall Street Journal reports. According to the Journal, an approvable letter means that FDA believes the drug is worth approving but needs additional information before doing so. The company is in discussions with the agency to address outstanding questions and finalize the product labeling as soon as possible, according to the statement (Corbett Dooren/Johnson, Wall Street Journal, 6/21).
An FDA panel of outside experts in April unanimously recommended that the agency approve maraviroc. Pfizer has proposed using the drug to treat people with advanced HIV or AIDS who have not responded to other medications. Maraviroc works by blocking a protein, called CCR5, on human immune system cells that HIV uses as a portal to enter and infect the cell. Pfizer plans to offer the drug with a test developed by Monogram Biosciences that determines if people likely will respond to the treatment.
FDA in April raised concerns that maraviroc could be associated with an increased risk of liver damage, lymphoma and infections. According to FDA, other CCR5 inhibitors under development have been shown to increase safety risk issues. Pfizer said its studies have shown that maraviroc has no significant effect on the heart and did not increase the incidence of liver problems, cancer or infection compared with other HIV/AIDS drugs.
Although FDA in April said it “continues to be concerned about potential safety issues with the entire class of drugs,” some agency reviewers said they noted no increases in lymphomas or infections among people taking maraviroc. FDA reviewers have noted a “modest” increase in liver problems among people taking the drug. Pfizer has proposed selling maraviroc under the brand name Celsentri (Kaiser Daily HIV/AIDS Report, 6/8).
According to an unnamed Pfizer spokesperson, the company is working to answer the additional questions in the approvable letter, adding that the questions will not require new clinical trials (AP/Houston Chronicle, 6/20). The company did not elaborate on what questions were raised by FDA. It also did not give a new time line for FDA action, Dow Jones reports (Corbett Dooren, Dow Jones, 6/20). According to the Journal, because additional clinical trials are not needed, the drug could be available as soon as the third quarter of this year. Pfizer also has pledged to make maraviroc available to HIV-positive people in 30 countries through an access program, which is not affected by FDA’s decision (Wall Street Journal, 6/21).

Source: FDA Issues Approvable Letter for Pfizer’s Antiretroviral Maraviroc – The Body

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Forum on Strategies for Treatment-Experienced HIVers: Dual HIV

Posted by pozlife on June 27, 2007

 



Dual HIV
Jun 24, 2007

I’ve recently infected with the both HIV-1 & HIV-2,, First I want to know if this is unusual ,,, Much of what I’ve been reading on here indicates that most treatments are center around HIV-1,, – How are specialist dealing with the dual infection in regards to medication and is there expectation differences with life span with dealing with the two combined– second question – If hiv-2 was introduced in 1986– why are most medication that are 1 pill a day only for hiv-1,, just asking ,, look forward to you response- thanks in advance



Response from Dr. Daar

Dual infection with HIV-1 and HIV-2 has been reported but is not very common. In general, HIV-2 infection is relatively uncommon compared to HIV-1, which is part of the reason why most clinical research is focused on the latter.

While there may be several differences between the two viruses, from a clinical perspective the most important differences are that we do not have a standardized viral load test for HIV-2 and the NNRTIs are not active against this virus. Consequently, for someone with HIV-2 alone or with HIV-1 treatment will usually be with NRTIs and PIs which together should be very effective.

Best, Eric

Source: Forum on Strategies for Treatment-Experienced HIVers: Dual HIV

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Forum on Understanding Your Labs: HIV, Syphlis & Depression

Posted by pozlife on June 27, 2007

 



HIV, Syphlis & Depression
Jun 23, 2007

I have recently been diagnosed with HIV & Syphlis. I have gone through the 3 shots but still have a few marks on my body that I feel are related to the syphlis. I dont have my lab numbers back yet, Im suffering depression. I am 36 yrs old, slender (always) and I just dont know what to do about the marks on my skin and the depression. I cant see my doctor until next month for my lab numbers but I sure would like some kind of answers before then.



Response from Dr. Holodniy

It is hard to know what those marks on your skin are without seeing them. Syphilis can cause a skin rash and other assorted skin lesions. It also could have nothing to do with syphilis. Somebody will have to look at them. The treatment you received should be adequate to resolve those lesions if they are syphilis associated. Depression frequently accompanies knowing of an HIV diagnosis. You need to educate yourself as much as possible about HIV, support groups and family are helpful and there is nothing wrong with a trial of antidepressants either.

Source: Forum on Understanding Your Labs: HIV, Syphlis & Depression

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Forum on Managing of Side Effects of HIV Treatment: Dying Early, courtesy of the CDC Biostatistians

Posted by pozlife on June 27, 2007

 



Dying Early, courtesy of the CDC Biostatistians
Jun 8, 2007

You folks are doing a great job-many, many thanks. I have a question that has been eating away at me since the CDC in their infinite wisdom issued their findings, as usual, without caveats, additional resources, or other possible ways of more fully understanding their pronouncements.

The question: I have been HIV/AIDS positive since 1980….yes, yes, I know that is Before the CDC issued their “Presenting Symptoms” notice in 1984 as the Dr. in charge, who was gay and fearful he would be “outed” if he released the information-which he had sat on for two years and who knows how many of us were lost because of his personal cowardice. But in 1980 I had ALL the Presenting Symptoms and KNEW I was infected.

My question follows on the heels of a misguided or simply stupid and very inconclusive revelation a couple of months ago by a CDC Biostatistician that have HIV/AIDS would foreshorten your life by 16 years and more if you were a member of a particular minority group. As usual, there were no caveats, extenuating circumstances, or any attempt to put this in a contextual frame-just the facts Mam. It’s back to the good ole days of Dragnet. SIGH.

In my 27 years, I am still undetectable, CD4s at 450, everything else looking great-I do pay attention to my diet, am extremely diligent regarding my dosing schedule, exercise regularly, have been in a great relationship with a fella for 20 years, raised a great daughter who just finished her first year as a teacher in Texas…We were “married” in 1981-in front of 250 friends in a real church with a real pastor, even caught the eye of Herb Caen who mentioned us on the front page of the SF Chronicle (I was asked by my many friends the next day at work why they weren’t invited-my only excuse was that it was a small church). Anyway, I digress.

My point is, good for the statistician, she was doing her job, but damn her — to put that kind of information out with NO qualifications, extenuating circumstances, etc. etc. etc. is despicable to say the least.

So here I sit at 59 wondering if I’m really in the “sundown” of my existence or that the CDC person was playing the averages. I know that in some ways I am a lab rat, as no longitudinal studies of folks who have been infected as long as I have exist. But to put this kind of damning data out with no consideration of those impacted by it is not only insensitive, but irresponsible.

I’m interested in what your experts have to say not only about her behavior, but her findings and should I be planning to just fall over one day and that’s all she wrote folks.

As far as I’m concerned, she can take her data and choke on it. It’s totally useless, unless you’re trying to rise through the ranks of the CDC and stay on the good side of Dr. Julie Gerberding in case there a Nobel Prize or something equally pompous at the end of the tunnel.

Many thanks for the great job all of you are doing — it’s vital, life affirming, positive and wonderfully informing and empowering information that you are sharing with the HIV/AIDS Community.You folks deserve the Nobel for being very noble in your efforts and successes at becoming a valuable resource and friend to our, unfortunately, growing community.

Cheers, Erin S



Response from Dr. Henry

In my opinion, the current goal of HIV therapy is to achieved a normal life expectancy (not shortened by HIV infection) and have a full and enjoyable life. Recent estimates of the “average” life expectancy of HIV+ persons with access to good treatment have been as much as 34 years (US study) and up to 40 years (European study).

There is a wide range of clinical outcomes, but increasingly the major threats to health/life for HIV+ persons are non-AIDS related (heart disease/cancer/liver. kidney) that may still be impacted by HIV infection. The overall negative impact of HIV on health seems to be diminished when the CD4 count is regularly more than 500. Thanks for sharing your story with the readers here. KH

Source: Forum on Managing of Side Effects of HIV Treatment: Dying Early, courtesy of the CDC Biostatistians

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Forum on Safe Sex and HIV Prevention: data & longevity

Posted by pozlife on June 27, 2007

 



data & longevity
Jun 22, 2007

Hi:

thank you for all the insightful information. I am compelled to write again. I was diagnosed 1 yr ago on the 25th anniversary of HIV. (Not the best celebration for me!) I am in my very late 40s and am very sensitive to the nearing turn, its effect on me, my hiv, and longevity.

Do we really know that much about people with hiv over 40? It seems that more people like me are getting infected and we really have no idea of the future for us? Regular aging mixed with HIV, meds, and OIs, etc?? Can you shed some light.

I do love this site, but I must admit, I’d like to see a section/sections on POSITIVE results. I need the doses of reality provided by the questions and answers but many times I could use a “shot in the arm” or some good news, good results!

Is there any information/ site that has data on HIV infected over 50?

Thanks for all your continued help.



Response from Dr. Frascino

Hi,

First off, I must point out that 50 is the new 30. Next, we are continuing to accumulate data on “HIV-Daddies” year by year as more of us survive into our midlife crisis years. At this point all the news is “positive,” so to speak. I see no reason you shouldn’t plan on dying of old age. As a good friend who is also virally enhanced recently told me, “I plan to live forever. So far so good.”

I’ll print some basic information about HIV in older folks below.

Stay well. See ya in the old folks’ home, OK?

Dr. Bob

Older People and HIV

How Many Older People Have AIDS?

About 78,000 people age 50 or over have AIDS in the United States. This is about 10-15% of all people with AIDS. In some cities, 15-25% of people with AIDS are 50 or over. The number of older people diagnosed with AIDS is increasing. About half of the older people with AIDS have been infected for one year or less. Many people don’t consider age 50 to be “old.” However, age 50 is being used more often to keep statistics on “older people” with HIV and AIDS.

Why Are Older People Getting Infected?

There are several reasons: Health care providers may not test older people for HIV infection Older people may lack awareness of the risk factors for getting HIV (see Fact Sheets 150 and 152) Many older people are newly single. They get divorced or lose their mates. While they had a partner they may have ignored HIV prevention messages.

Lack of HIV prevention education targeted at older people Belief that HIV only affects younger people No training in safer sexual activities (see Fact Sheet 151) Sharing needles with infected people (about 17% of infections of people over 50)

Unprotected sexual activity. This may be heterosexual or homosexual sex. Viagra and other drugs that help men get and maintain an erection may contribute to increased rates of sexual activity and sexually transmitted diseases among older people, as they do for younger people.

Is HIV Disease Different for Older People?

The first studies of HIV in older people were done before strong antiretroviral drugs (ARVs) were available. Most of them showed that older people got sicker and died faster than younger people. This was thought to be due to the weaker immune systems of older people. Also, older people usually have more health problems besides HIV. Normal aging leads to a decline in the immune system. Older people still tend to have long-term health problems. They may not do as well as younger patients with HIV. However, ARVs strengthen the immune system. Also, most older patients, unless they are drug users or have mental problems, take their medications more regularly (have better adherence, see Fact Sheet 405) than younger patients.

Is HIV Treatment the Same in Older People?

ARVs seem to work the same in older people as in younger people. Unfortunately, we don’t have good information on older people because they were usually not included in clinical trials of new drugs. People who become infected when they are over 50 seem to do about as well as people who started receiving HIV treatment before age 50 and then got older.

Treatment side effects may not be any more frequent in older people. However, changes caused by aging can resemble or worsen treatment side effects. For example, aging is a major risk factor for heart disease and for increasing fat in the abdomen. Some older people without HIV lose fat in a way that looks similar to the changes caused by lipodystrophy.

What Other Health Problems Are Common?

As people age, they develop health issues that continue for the rest of their lives. These can include heart disease, depression, osteoporosis (see Fact Sheet 557), high blood pressure, arthritis, diabetes, Alzheimer’s disease and various forms of cancer. Older people often take many different medications to deal with their health problems. This can make it more difficult for a health care provider to choose ARVs, because of interactions with other medications.

Some ARVs may increase the risk of diabetes, high blood pressure, or osteoporosis. This makes it harder to choose the right HIV regimen.

Mental Problems

Older people may have more problems with thinking and remembering than younger people. These symptoms can be the same as HIV-related mental problems. Fact Sheet 505 has more information on HIV and nervous system problems.

These problems, sometimes called dementia, are less severe than they were before the use of strong ARVs. It is difficult to know what is causing mental problems in older people with HIV. Is it normal aging, or is it HIV disease? Research studies have linked both age and higher viral load (see Fact Sheet 125) to mental problems.

Rates of depression and substance use haven’t been well studied in older people. However, these problems may be related to HIV disease, aging, or both. They need to be diagnosed and treated correctly.

The Bottom Line

The number of people over 50 with HIV or AIDS is growing rapidly. Between 10% and 15% of people with AIDS in the United States are over age 50.

Older people get HIV the same way as younger people. However, they may not be aware that they are at risk of HIV infection. They also may not know how to protect themselves from HIV transmission.

Older people have to deal with other health issues. These can complicate the selection of ARVs. They can also be confused with some of the side effects of ARVs.

ARVs work about as well in older people. Also, older people may be better about taking their medications than younger people.

This article was provided by AIDS InfoNet.

Source: Forum on Safe Sex and HIV Prevention: data & longevity

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Forum on HIV and Mental Health: how can I stop thinking I’m positive?

Posted by pozlife on June 27, 2007

 



how can I stop thinking I’m positive?
Jun 24, 2007

I take 100mg of zoloft, 1 atripla and have a UD viral load, cd4 of 794 and I can’t stop thinking about myself being positive. it’s not always in a negative way. it’s just always there. I am fatigued and tired all the time. I really hate I did this to myself. there is always going to be something that lets me and others know. I just want to feel good again. I will never feel normal again and for that I am very sad and afraid.



Response from Dr. Horwath

Having HIV is certainly not a cause for celebration. However, it is like many other illnesses. It requires great personal resolve and strength to cope with it. You have no way to turn the clock back. You cannot undo your HIV infection, but you can decide how you intend to move forward. You can make your best effort to get good treatment (as you seem to be doing) and then carry on your life in the most productive way you can.

If you’re feeling tired and fatigued all the time and are having constant negative thoughts, then you should be evaluated by a mental health professional to see if you’re suffering from depression. Fatigue and constant negative, pessimistic thoughts are common symptoms of depression, and if they persist, you should be evaluated and get appropriate treatment.

Source: Forum on HIV and Mental Health: how can I stop thinking I’m positive?

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Laura Bush Presses AIDS Fight In Africa

Posted by pozlife on June 26, 2007

 


by The Associated Press

Posted: June 26, 2007 – 1:00 pm ET 

(Dakar) U.S. first lady Laura Bush picked vegetables and handed out mosquito nets in Senegal on Tuesday to emphasize that fighting AIDS in Africa also means tackling some of the continent’s even more widespread afflictions – malnutrition and malaria.

“It’s often overlooked that one of the essential things in the treatment of AIDS or HIV is good nutrition,” she said after touring a garden whose produce is used to supplement the meals of AIDS patients at a Dakar hospital.

Bush gave mosquito nets to AIDS patients as a doctor explained that insect-borne malaria – the biggest killer in Senegal – is even more dangerous for those who are HIV positive.

Bush and her daughter Jenna are on a four-nation African tour in which the first lady is expected to focus on how the U.S. can help a poverty-stricken continent provide health care and economic opportunity. Laura Bush is also visiting Mozambique, Zambia and Mali on her third trip to Africa.

They were accompanied on Tuesday’s visit by Senegal’s first lady, Viviane Wade, and her daughter. The four women picked eggplants and kale at the Fann Hospital garden. AIDS patients at the center are instructed on how the different vegetables can boost their nutrition, and are allowed to sell excess produce for income.

Malnutrition is a serious problem in Senegal and the surrounding region, where poverty often determines food choices. In some parts of West Africa, fruits and vegetables disappear during the dry time of year and diabetes is becomingly increasingly common in the region.

Last month, President George W. Bush called on Congress to authorize an additional $30 billion (euro22.3 billion) to fight AIDS in Africa, a figure that would double the U.S. commitment to the continent. The current program, which provided $15 billion (euro11 billion) over five years, expires in September 2008.

The U.S. president’s Emergency Program for AIDS Relief has supported treatment for 1.1 million people in 15 countries, he said in calling for the program’s renewal. His wife did not discuss how the additional funds should be targeted.

The AIDS garden and the mosquito net program have both been recipients of U.S. funding. The U.S. government has allocated US$16.7 million to anti-malarial programs in Senegal this year, and plans to continue at a similar level through 2010.

“We just eradicated malaria in the United States in about 1950. We know malaria can be eradicated, and so we stand with you as you try to eradicate malaria in Senegal,” Laura Bush said.

Still, some international organizations have complained that President Bush has only truly committed to maintaining current funding levels at a time when the crisis is growing.

David Bryden, of the Global AIDS Alliance lobbying group, said that the U.S. House of Representatives has already approved more than US$5.4 billion in AIDS spending next year – a level which would about equal the president’s proposal over five years.

“If the Congress accepts his proposal it would be a disaster, because the epidemic is expanding,” Bryden said.

Still, West Africa generally has a lower prevalence of AIDS than eastern and southern Africa, and Senegal is often held up as an example that the disease has not doomed the continent.

The country has one of the lowest rates in the region. A range of reasons have been given, including an organized education effort by the government, a strong culture of conservative Muslim values, a tradition of male circumcision and the simple geographic distance from the southern African countries where AIDS first took hold.

In Senegal, the AIDS debate often takes a back seat to more pressing questions of crushing poverty and a lack of jobs. The former French colony is one of the poorest countries in the world and thousands of its young men risk their lives annually on fishing boats bound for Europe.

Source: Gay News From 365Gay.com

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LA Tackles Rising STD Rates With Graffiti

Posted by pozlife on June 26, 2007

 


by 365Gay.com Newscenter Staff

Posted: June 26, 2007 – 1:00 pm ET 

(Los Angeles, California) Faced with what it calls an alarming increase in gonorrhea and syphilis among gay men and mounting rates of chlamydia among African and Hispanic women in Los Angeles County the Department of Public Health is going to the streets to warn people about risky sex.

The Department on Tuesday announced a campaign using guerilla marketing tactics to reach out to people.

It will utilize graffiti murals, sidewalk drawings, printed drink coasters and mirror stickers in night clubs and gyms, along with traditional media such as posters and billboards to try to curb STDs. 

“Gay and bi-sexual men represented at least 1,000 cases of syphilis in 2006,” said County Health Officer Jonathan E. Fielding.

In 2005, 85% of the recorded syphilis cases were among this group. Six out of 10 of those cases occurred among HIV-positive men Fielding said. 

Untreated syphilis can have devastating health consequences, including impairment of the ability to walk, permanent vision loss, permanent hearing loss, and brain damage. Public Health identifies patients with these health outcomes every year he said.

There are more than 30,000 cases of chlamydia and more than 5,000 cases of gonorrhea in women alone every year in LA County said Peter R. Kerndt, the Director of the Sexually Transmitted Disease Program.

African American and Latina women make up the largest number of those reported cases out of any other group he said.

“Gonorrhea and chlamydia are often asymptomatic, so that infected individuals do not know they are infected, and do not seek medical care,” Kerndt said. “However, these diseases can have serious consequences, including complications during pregnancy, chronic pelvic pain, and infertility.”

The campaign was conceptualized and developed by Fraser Communications in Santa Monica.

It is part of a comprehensive public health strategy that includes augmented Public Health Investigator field staff to follow-up on treatment with patients; additional field staff placed at community agencies that have rapport with gay and bi-sexual men, and have detected large numbers of syphilis cases in their clients; and enhanced testing in the LA County Jail System, where high rates of syphilis have been previously detected.

Source: Gay News From 365Gay.com

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