Archive for June, 2008
Posted by pozlife on June 27, 2008
Posted: June 27, 2008 04:13 PM
Updated: June 27, 2008 04:13 PM
INDIANAPOLIS (WISH) – A big outbreak of syphilis in Marion County has the health department setting up several testing sites, primarily in gay bars. What has health officials especially concerned is that 70 percent of the syphilis victims are HIV positive.
On June 23, there were 72 local cases of syphilis reported. One year ago, there were only 19.
Syphilis cases have been decreasing steadily since 1999 when Dr. Virginia Caine said Indianapolis had the biggest epidemic of the sexually-transmitted disease in the nation.
“Not only are we spreading syphilis, we’re also spreading HIV infections at the same time and that can be a life sentence,” said Dr. Caine.
Dr. Caine said 95 percent of the current victims are young, gay men. Most are Caucasian and 70 percent already have HIV.
“So they’re not as afraid and you know, the younger generation, they’re a little bit more risk takers,” said Dr. Caine.
Now, at local gay bars and bath houses, the health department is setting up syphilis blood test sites.
Metro bar and restaurant owner Chet Van Wye said his gay customers were leery at first.
“Initially, I think some of them were a little shocked to see a testing site here at Metro. But I think most people were open to the idea and realized this is important, we need to do it,” said Van Wye.
Van Wye is grateful for proactive STD programs that the heath department and other organizations are ramping up. Unfortunately, he worries that condom kits passed out at his place and others may be getting tossed aside.
The health department reminds people that condoms, HIV and syphilis blood tests and even treatment is free for those who can’t afford to pay.
Posted by pozlife on June 18, 2008
July 25, 2003
“The South’s inclination to avoid speaking about uncomfortable subjects” has helped make the Southern United States the new HIV/AIDS “epicenter” by encouraging “sexual silence,” Michael Alvear, a syndicated sex advice columnist, writes in an Atlanta Journal-Constitution opinion piece. The South has the highest concentration of the two groups most likely to be infected with HIV — African Americans and low-income individuals — and silence surrounding sex has “amplifie[d]” these demographic factors, Alvear says (Alvear, Atlanta Journal-Constitution, 7/25). According to CDC figures cited in the “Southern States Manifesto,” written by HIV/AIDS directors from various states and presented at a two-day conference in Tampa, Fla., in December 2002, more than 130,000 people in the South have AIDS, compared with about 100,000 people in the Northeast, 36,000 in the Midwest and 62,000 in the West. In addition, the officials said that the South has a bigger HIV/AIDS problem than elsewhere in the United States because of its racial and economic demographics and “a cultural conservatism that interferes with attempts to arrest the disease” (Kaiser Daily HIV/AIDS Report, 1/14). One of the most effective ways to prevent HIV transmission is for sexual partners to be aware of each others’ HIV status and “the only way to know is ask,” according to Alvear. However, many Southerners would consider such a question “too rude for words,” Alvear says, adding, “There’s a tradition here — if you can’t be kind, be vague. Problem is, you can’t be vague with a plague.” Alvear concludes, “The South, ever mindful of its manners, is killing itself with its own kindness” (Atlanta Journal-Constitution, 7/25).
Posted by pozlife on June 18, 2008
The southern United States is a region both famous for fried chicken, sweet tea, and a slow pace of life, yet notorious for its religious conservatism and a history of slavery and segregation. The South has gained another reputation in the past few years, however, that is not so widely known: it is quickly becoming the center of the HIV/AIDS epidemic in the United States.
One reason why AIDS prevalence in the south has gone unnoticed for so long is that the average southerner doesn’t think the epidemic can affect them. Most associate HIV with large urban cities, like New York City, San Francisco, and Los Angeles, places that don’t have much in common with small southern towns. They also still see AIDS as a “gay disease” and are generally uneducated about HIV and what it means to be HIV+.
The southern region of the United States, as defined by the US Census Bureau, includes 16 states and the District of Columbia. The Deep South represents a group of six southern states (Alabama, Georgia, Louisiana, Mississippi, South Carolina, and North Carolina) that are disproportionately affected by the AIDS epidemic. From 2000-2003, CDC estimates show a 35% increase in new reported AIDS cases in the Deep South, but only a 5.2% increase nationally. The Deep South also has some of the highest AIDS death rates in the country.
Other health indicators, such as measures of diabetes prevalence, stroke rate, heart disease deaths, infant mortality and preterm births also show high mortality rates in the Deep South. Furthermore, the Deep South also has very high levels of STD infection. The Kaiser Family Foundation reported that in 2002, the five states with the highest rates of gonorrhea were all in the Deep South; these states also had high rates of chlamydia and syphilis. STD prevalence is of particular importance because the presence of an STD facilitates HIV transmission.
Since its discovery, HIV has disproportionately attacked socially marginalized groups, starting with the gay community and spreading to the poor and disenfranchised. Deep South states generally have higher poverty rates than other regions. Poverty contributes HIV/AIDS rates because individuals do not have access to health education or preventative services and cannot afford treatment. Poverty has also been associated with drug use, which can lead to HIV transmission through the sharing of needles.
The south also experiences a large number of rural HIV/AIDS cases. The 1995 US Census estimated that 43% of people living in the south live in rural areas. In rural areas it is often hard to find nearby healthcare, and many patients won’t or can’t get to services. This leads to late diagnosis and unintentional infection of others.
Nearly 80% of new AIDS cases in the South are among African Americans. The HIV/AIDS epidemic is concentrated in poor communities, where African Americans are disproportionately represented. This is particularly true in the Deep South, where populations are approximately 30% Black, compared to the 18.5% in other southern states. Overall, 25% of African Americans live in poverty and are 1.5 times more likely than Whites to lack health insurance. Medical and social service barriers for African Americans are not uncommon in the rural South, and access to HIV medication and care is no exception. Many African Americans feel distrust and anger towards the healthcare system due to historical oppression and enduring medical inequalities. This has led to conspiracy theories that are believed by even the most educated and has created barriers for HIV prevention.
HIV prevalence in the Deep South cannot be studied without a look at historical and cultural factors as well. Many people often blame the lack of medical professionals and poor access to healthcare for the South’s high HIV rates, yet the South is just as rural as the Midwest and does not have fewer health providers than other rural areas. The southern “culture of politeness” prevents discussion of topics that are deemed offensive, such as sex and homosexuality. Religious conservatism also contributes to the spread of HIV by affecting education. Many schools teach abstinence-only curriculums and don’t provide information about other forms of protection, putting youth at risk for infection. Religious conservatism is also associated with close-mindedness, which increases the perceived HIV stigma.
In the end it is important to consider all possible causes of AIDS prevalence in the Deep South states in order to provide more effective preventative and treatment services to everyone who is afflicted by HIV.
Adams B. Polite to a Fault? HIV Plus.com May 2003; http://www.hivplusmag.com/column.asp?id=49&categoryid=1.
Adams B. The South Has Risen. HIV Plus.com May 2003; http://www.hivplusmag.com/column.asp?id=48&categoryid=1.
CDC. Fact Sheet: HIV/AIDS Among African Americans. Feb 2006. http://www.cdc.gov/hiv/topics/aa/resources/factsheets/aa.htm.
Reif S, Geonnotti KL, Whetten K. HIV Infection and AIDS in the Deep South. Am J Public Health 2006; 96: 970-973.
Whetten, K, Nguyen, T. You’re the first one I’ve told: new faces of HIV in the South. New Brunswick: Rutgers University Press.
Posted by pozlife on June 18, 2008
June 16, 2008
More than half of the AIDS-related deaths that occurred in Washington, D.C., from 2000 to 2005 were missed by the city’s system for reporting such deaths, according to an analysis by the district’s Department of Health and CDC that was published recently in CDC’s Morbidity and Mortality Weekly Report, the Washington Post reports. The underreporting of AIDS-related deaths suggests that the epidemic “may be taking a far greater toll” on the district than health officials had originally thought, according to the Post.
For the analysis, city health officials worked with CDC to review all death certificates from 2000 to 2005 in an effort to identify deaths that appeared to be AIDS-related. They compared that number with the deaths that had been reported and discovered the discrepancy, the Post reports. According to the analysis, of the 2,460 deaths from AIDS-related illnesses that occurred between 2000 and 2005, 1,337 had not been reported because the city’s system for tracking them was “inadequate,” the Post reports. Officials launched the investigation because of health officials’ increasing concern that they were undercounting the number of district residents living with HIV and those dying of AIDS-related causes, in part because they discovered boxes of unexamined paper records. Shannon Hader, senior deputy of the health department’s HIV/AIDS Administration, said the analysis “tells us our surveillance system wasn’t complete enough,” adding, “We’re clearly underreporting.”
According to the Post, at least 12,500 district residents have developed AIDS — one of the highest rates in the country — and officials estimate that between 3% and 5% of people living in the city are HIV-positive. Hader said that in order to curb the spread of HIV in the district and ensure that HIV-positive people receive appropriate care, the department needs an “accurate count.” In addition, the amount of federal HIV/AIDS funding the district receives is based on such estimates, Hader said, adding, “We want everything they owe us.”
In response to the findings, Hader said the district has initiated several efforts to improve its reporting system, including a mass mailing in January to about 4,000 physicians and laboratories to try to increase the number of reported diagnoses. Officials also have begun routinely reviewing death records and have launched a campaign to try to identify more people for treatment.
“What we need to do is get more people who don’t know they have HIV diagnosed and into care and treatment,” Hader said, adding, “Every time you go into a health care provider, they should be offering to test you for HIV. We want to drive down the number of people living with HIV and [who] don’t know about it” (Stein, Washington Post, 6/14).
The analysis is available online.
Posted by pozlife on June 18, 2008
June 16, 2008
On Friday, the Cape High Court ruled that the vitamin firm that makes VitaCell cannot advertise it as an AIDS treatment, the South African Press Association reported. The ruling was hailed by the South African AIDS group Treatment Action Campaign (TAC), which had brought the case against vitamin entrepreneur Matthias Rath.
In addition to banning the advertisement of the claims, Judge Dumasini Zondi ruled that clinical trials being conducted in black townships by Rath and his Dr. Rath Foundation are illegal and must stop. The judge said Health Minister Manto Tshabalala-Msimang and her department also have a duty to investigate Rath’s activities, including taking “reasonable measures” to prevent Rath from advertising VitaCell as having anti-AIDS benefits and from carrying out clinical trials.
“This judgment this morning is a victory for the rule of law and the scientific governance of medicine,” said Nathan Geffen, TAC’s spokesperson. “Over the last decade in this country, a culture of impunity has been created such that charlatans like Matthias Rath can get away with deceiving vulnerable people into taking snake oils such that those people end up progressing to AIDS and dying.”
TAC knows of at least 12 people who died from AIDS after relying on Rath’s clinics instead of seeking actual AIDS treatment at a public health clinic, Geffen said.
Posted by pozlife on June 15, 2008
Until 50 years ago, cervical cancer was the leading cause of cancer-related deaths among women in the United States. It now ranks 15th. Experts credit a simple procedure called a Pap smear—in which a doctor swabs the cervix and sends the sample to a lab to check for abnormalities—for the plummeting death rates. Now some treatment opinion leaders are saying that Pap smears around back may help protect against anal cancer, notably among HIV-positive men and women who may already be facing a higher risk of this potentially fatal disease.
Anal Paps, the experts argue, can help detect clusters of precancerous cells in the anus. These lesions, caused by two menacing strains of the human papilloma virus (HPV), are common in men who have sex with men (MSM) and HIV-positive people of any gender or sexual orientation. And as HIV-positive people live longer lives due to antiretroviral therapy, they may be at increased risk of anal cancer as they age.
Rates of anal cancer are fairly low in the general population—approximately one diagnosis per 100,000 people. Stats also suggest that MSM, smokers and people living with HIV are at increased risk. In fact, a study to be published in a forthcoming issue of the Annals of Internal Medicine found that the rate of anal cancer in people living with HIV doubled in the past decade and was 60 times higher than in the general public.
And it’s not just those engaging in anal sex who are at risk. A Parisian study reported last year found high rates of precancerous lesions among HIV-positive men and women who had never been on the receiving end of anal sex but had a history of other HPV-related problems, such as cervical lesions and penile warts. Though they were half as likely to have precancerous lesions as MSM with HPV and a history of receptive anal intercourse, the rate, 36 percent, is still quite high.
Could anal Pap smears revolutionize anal health care the way that cervical Paps did with women’s health care? Experts disagree.
The U.S. Centers for Disease Control and Prevention (CDC), for instance, says there isn’t enough evidence to recommend routine anal Pap smears. But Joel Palefsky, MD, a professor of laboratory medicine at the University of California, San Francisco, and other independent HPV experts argue that while more data will certainly be helpful to fine tune screening and treatment strategies, enough evidence exists to support the regular testing and care of precancerous anal lesions in high-risk individuals.
Two HIV-positive gay men—Matt Sharp, from Chicago, and Mark Milano, from New York City—have braved anal cancer scares in the last year. Both caught their cancer at an early stage, largely because they’d been screened with anal Pap smears years ago, found to have precancerous lesions, and have been monitored closely ever since.
Jeffery Schouten, MD, the board chair of the American Academy of HIV Medicine (AAHIVM) and a member of the National Institutes of Health’s AIDS Malignancy Consortium, says that while the majority of providers in his own practice at the Harborview Medical Center, in Seattle, don’t routinely screen all HIV-positive patients with yearly anal Pap smears, there is a “growing consensus” that doing so may be a good idea.
Although anal screenings might not seem the easiest conversation topic, it’s a chat worth having with a health care provider.
Pap smears, whether for the cervix or the anus, aren’t perfect. They can fail to pick up abnormal cells as much as half the time. Fortunately, both cervical and anal cancers typically develop slowly. Cervical screenings end up being effective because of their frequency—if they’re conducted every year, as gynecologists usually recommend, the chance of detecting precancerous cells, if they’re present, increases with each test.
If abnormal cells are found in the anus, Palefsky recommends a procedure called high-resolution anoscopy (HRA). This procedure involves the insertion of a thin, powerful scope into the rectum to examine the anal wall. Palefsky says that the scope should help a clinical specialist, called an anoscopist, to spot anal lesions. If they are found, the anoscopist will remove a small pinch of tissue (a biopsy) and send it to a lab for closer examination. The lab will determine whether the cells represent a low-, moderate- or high-grade lesion. It is the moderate- and high-grade lesions that are believed to have the highest likelihood of developing into cancer; low-grade lesions and anal or cervical warts are typically caused by strains of HPV that aren’t associated with cancer.
In a 2004 expert panel discussion recorded and published in AIDS Clinical Care, Palefsky and Sue Goldie, MD, from the Harvard School of Public Health, laid out the rationale for routine Pap screening in MSM and people with HIV. While anal cancer isn’t common, even in higher-risk populations, anal cancer in MSM does now occur more frequently than cervical cancer in women. They also point out that a variety of health care providers, including primary care providers, can be trained not only to conduct and read the results of Pap smears but also to perform HRA in patients with abnormal anal Paps.
Palefsky prefers that providers enhance their services to offer both Pap screening and HRA in the same office. This isn’t possible in many offices and clinics, however, and at a minimum, patients found to have irregular anal Pap smears should be seen by a specialist who is familiar with diagnosing anal lesions.
“If resources were unlimited, with lots of trained people, it would be ideal to forgo [an anal Pap and instead regularly check with HRA instead] because of [the Paps] limited sensitivity and because such a high proportion of HIV-positive MSM have anal lesions,” Palefsky says. “However, given the limited number of trained people, cytology can be used to prioritize who should be referred to a trained anoscopist, with people with [precancerous lesions] sent first.”
Also participating in that panel discussion was Kimberly Workowski, MD, from the CDC, characterizing what she feels is a critical lack of data supporting routine anal Paps, even in high-risk individuals. She argues that without good long-term studies pinpointing when, how, and how quickly anal lesions progress to cancer in various populations, it remains impossible to solidify screening or guidelines.
Schouten of the AAHIVM, however, agrees with what he calls a growing consensus among providers treating MSMs and people with HIV to do more routine screening. Despite the holes in the data, he says, “it probably makes sense that if you know that someone has [moderate- or high-grade lesions], you would probably follow them closer and do more vigorous exams with anoscopy and pick things up earlier if they do develop invasive cancer.”
Sharp and Milano largely agree with Schouten. Sharp, who was diagnosed with HIV in 1989, and Milano—who tested HIV positive in 1985 when the test first became available but was suspected by his doctor to be infected as far back as 1982—are both long-time AIDS activists and treatment educators. They urge people with HIV not to be squeamish about discussing anal health with their providers. Though both acknowledge the limitations of Pap smears, they encourage people with HIV to ask their providers to be screened and to follow up if abnormal cells are found.
Palefsky says he’s designed a study that will, he hopes, provide some of the data that the experts at the CDC and elsewhere are requesting before they’ll recommend routine anal Pap smears in people with HIV. In the meantime, however, as has often been the case with HIV, people living with the virus will have to make decisions about their health care without all the answers in place, and may have to advocate for themselves and others with HIV to at least get screened and monitored for anal lesions.
Posted by pozlife on June 15, 2008
June 13, 2008
Some colleges in Northern California have banned campus blood drives, saying that FDA’s lifetime ban on donations from men who have had sex with men violates the schools’ nondiscrimination policies, NPR’s “All Things Considered” reports.
FDA in a statement maintained that lifting the ban on donations from MSM could increase the spread of HIV through blood donations because of the group’s increased risk for the virus. In addition, blood bank officials have said that ending campus blood drives could compromise the banks’ ability to maintain adequate supplies. Some health care advocates also maintain that FDA’s policy is justified.
The segment includes comments from Cathy Bryan of Works With Blood Collection, Northern California; Rick Luttman, a professor at Sonoma State University who authored the campus’ ban on blood drives; David Magnus, director of Stanford University’s Center for Biomedical Ethics; Glenn Mones of the National Hemophilia Foundation; and a recent graduate of the University of California-Berkeley (Varney, “All Things Considered,” NPR, 6/11).
Posted by pozlife on June 15, 2008
Conjugal visits from female spouses and condom distribution could help reduce the spread of HIV through male homosexual sex in the Caribbean region’s correctional facilities, according to the Association of Caribbean Heads of Corrections and Prison Services, Agence France-Presse reports (afp.google.com, 6/12).
Marcus Day, the head of the organization, told the AFP that the spread of HIV in Caribbean prisons can be attributed largely to rape and homosexual sex. According to the article, 3 percent of men in Caribbean prisons are HIV positive.
“Given our [sodomy] laws [and] our high levels of homophobia, we have kind of not looked at the scientific evidence about these kind of transmissions and we just ignored it,” Day said. “Allow men to have the women come and visit them in prison and have a private room where they can make love to each other and the desire to have same-sex relationships will be greatly reduced.”
Day also recommended that prisoners get access to condoms, which has been widely opposed.
Posted by pozlife on June 15, 2008
Acknowledging that more than 60 percent of India’s HIV-positive people die of tuberculosis, the country is integrating its national HIV and TB programs, The Times of India reports (timesofindia.indiatimes.com, 6/12).
Patients diagnosed with TB will now also be offered testing for HIV; those testing positive will undergo prophylactic treatment recommended by the World Health Organization to ward off opportunistic infections like pneumonia. These combined services will be implemented in nine Indian states with high prevalences of both HIV and TB by October 1.
At the United Nations’ high-level meeting on AIDS, held June 10 and 11, leaders stressed the need to address both infections together, noting that the global prevalence of TB is further complicating the fight against AIDS.
“Selective testing for HIV will continue on those diagnosed with TB if they are found to have a high-risk behavior and are suffering from sexually transmitted diseases,” said the National AIDS Control Organization’s (NACO) national consultant for HIV, Rahul Thakur. “However, in the nine states, all TB patients, irrespective of their lifestyle, will be offered free HIV testing.”
According to Thakur, 50,000 to 80,000 people suffer from HIV/TB coinfection in India. He added that NACO identified 40,000 cases from 2007 through 2008 alone.