Obama, U.S. Foreign Policy, and HIV

Some advocates are calling on President Obama's administration to change the nation's approach to global social and health issues, including HIV/AIDS, the Washington Post reports. According to the Post, the efforts are part of a push by advocates to "transform the way the United States deals with matters of sex, marriage and religious values in the international arena," which "will play out in upcoming United Nations conferences and meetings that set international norms on issues including human rights, public health, family planning and HIV/AIDS." Joseph Amon, head of the HIV/AIDS and Human Rights Program at Human Rights Watch, said that although President George W. Bush made significant investment in global efforts against HIV/AIDS, the programs relied too heavily on abstinence-based initiatives. Amon said, "If we want to have an impact on the AIDS epidemic, we cannot allow moral ideological consideration to trump scientific evidence and human rights." The Post reports that some liberal advocates anticipate the Obama administration will "pursue a cautious pace" in making global policy changes and some social conservatives "are bracing for a long period in the political wilderness" (Lynch, Washington Post, 1/18).

Sugar Molecule to Protect Against HIV/AIDS

A sugar molecule called the Pk blood group antigen might provide a defense against HIV, according to a study published last week in the journal Blood, Toronto's Globe and Mail reports. Researchers from Toronto's Hospital for Sick Children and Lund University in Sweden studied the sugar molecule, which is found on the surfaces of some red and white blood cells. They found that Pk antigens act as magnets for HIV, neutralizing the virus once it attaches to the antigen and stopping its spread to other immune cells, the Globe and Mail reports.

The study's findings indicate that "the higher the level of [Pk] blood type you have, the less susceptible you are to HIV," according to Donald Branch of Canadian Blood Services, who led the study. Although most people have a certain amount of Pk in their blood supply, only about one in one million people have very high levels, making them "very resistant" to HIV, Branch said. The study "represents a breakthrough," he said, adding that he hopes other people could acquire the same protection against HIV by artificially boosting the Pk level in their blood. Researchers already have developed an artificial version of the antigen for possible use "to sop up the HIV," Branch said. Once the approach is tested in animals, Branch said researchers could move to clinical trials in humans (Taylor, Globe and Mail, 1/16).

An abstract of the study is available online.

Hispanic and Haitian Youth Targeted for HIV Awareness

The Farmworker Association of Florida next month will begin a survey targeting Hispanic and Haitian youth that is designed to identify the best ways to educate teenagers and their families about HIV and sexually transmitted infection prevention, the Daytona Beach News-Journal reports. The program, funded with a more than $700,000, three-year grant from the Florida Department of Health, will cover seven counties in the state.

From February through March, Hispanics will be surveyed in Pierson and Fellsmere, Fla., as well as in Indian River County. Haitians will be surveyed from other counties, according to Holly Baker, grants coordinator for the association. In addition, the association later this year will offer no-cost HIV tests and condoms and distribute educational material to all communities, Baker said. FWAF also plans to develop a Web site and a blog and create pages on social networking sites such as MySpace to further reach Hispanics and Haitians with awareness and educational information.

Baker said, "We are dealing with a lot of cultural and generational gaps, but mostly cultural differences between parents who may be immigrants to this country" and their children who were born in the U.S. (Fernandez, Daytona Beach News-Journal, 1/20).

Drug Companies "Block" Cheap Medicine

Their actions cost EU healthcare providers 3bn euros ($3.9bn; £2.5bn) in savings between 2000 and 2007, it said. It added that drug firms used legal action and multiple patents to stop rivals getting to market.Drug firms said the "perfectly lawful" measures were justified to protect investment in research and development.

Market access

Generic drug companies - which sell cheaper versions of drugs once the patent has expired - have long complained that it is difficult to get their drugs to market in Europe. The Commission said that innovators filed multiple applications to stop generic drugs getting to market - in one case, there were 1,300 patents for a single drug.

The report found that owners of original drugs often intervened in national approval procedures for generic medicines. There were nearly 700 cases of reported patent litigation and more than 200 settlements between brand name drug companies and generic companies. More than 10% of these settlements limited the entry of the generic drug to the market.

Fine threat

"Market entry of generic companies and the development of new and more affordable medicines is sometimes blocked or delayed, at significant cost to healthcare systems, consumers and taxpayers," said Competition Commissioner Neelie Kroes. "It is still early days but the Commission will not hesitate to open antitrust cases against companies where there are indications that the antitrust rules may have been breached," she added.The Commission could impose large fines on drug companies if they have engaged in unfair practices. In 2005, AstraZeneca was fined 60m euros for blocking cheaper rivals to Losec, its heartburn and ulcer pill.

Pressure mounts

Drug firms use "perfectly lawful practices - such as patent portfolios, patent litigation and the release of improved medicines," the European Federation of Pharmaceutical Industries and Associations (EFPIA) said.

"These [practices] are essential for innovators to protect their huge investment in R&D [research and development]," it said, adding that the 17% of turnover industry spent on R&D exceeds any other sector in Europe. The EFPIA - which said the Commission's report missed the opportunity to tackle the real issues facing the industry - called for a more competitive market for generic drugs, pointing out that Europeans pay more for generic drugs than US citizens.

In response to claims that the delayed or blocked sale of generic drugs was pushing up healthcare costs, the EFPIA said: "A single member state, the Netherlands, achieved greater savings - up to 400m euros - in one year, on only 33 medicines, simply by promoting greater price competition between generics."

The Commission report increases the pressure on the global pharmaceuticals industry.

Barack Obama, the US President-elect, is also expected to try to cut costs as part of the reform of healthcare coverage in the US.

More information on the Woman Burned at the Stake in Papua New Guinea

A woman in rural Papua New Guinea was bound and gagged, tied to a log and set ablaze on a pile of tires this week, possibly because villagers suspected her of being a witch, police said Thursday.

Her death adds to a growing list of men and women who have been accused of sorcery and then tortured or killed in the South Pacific island nation, where traditional beliefs hold sway in many regions.

The victims are often scapegoats for someone else's unexplained death, and bands of tribesmen collude to mete out justice to them for their supposed magical powers, police said.

"We have had difficulties in a number of previous incidents convincing people to come forward with information," said Simon Kauba, assistant commissioner of police and commander of the Highlands region, where the killing occurred.

"We are trying to persuade them to help. Somebody lost their mother or daughter or sister Tuesday morning."

Early Tuesday, a group of people dragged the woman, believed to be in her late teens to early 20s, to a dumping ground outside the city of Mount Hagen. They stripped her naked, bound her hands and legs, stuffed a cloth in her mouth, tied her to a log and set her on fire, Kauba said.

"When the people living nearby went to the dump site to investigate what caused the fire, they found a human being burning in the flames," he said. "It was ugly."

The country's Post-Courier newspaper reported Thursday that more than 50 people were killed in two Highlands provinces last year for allegedly practicing sorcery.

In a well-publicized case last year, a pregnant woman gave birth to a baby girl while struggling to free herself from a tree. Villagers had dragged the woman from her house and hung her from the tree, accusing her of sorcery after her neighbor suddenly died.

She and the baby survived, according to media reports.

The killing of witches, or sangumas, is not a new phenomenon in rural areas of the country.

Emory University anthropology professor Bruce Knauft, who lived in a village in the western province of Papua New Guinea in the early 1980s, traced family histories for 42 years and found that one in three adult deaths were homicides -- "the bulk of these being collective killings of suspected sorcerers," he wrote in his book, "From Primitive to Postcolonial in Melanesia and Anthropology."

In recent years, as AIDS has taken a toll in the nation of 6.7 million people, villagers have blamed suspected witches -- and not the virus -- for the deaths.

According to the United Nations, Papua New Guinea accounts for 90 percent of the Pacific region's HIV cases and is one of four Asia-Pacific countries with an epidemic.

"We've had a number of cases where people were killed because they were accused of spreading HIV or AIDS," Kauba said.

While there is plenty of speculation why Tuesday's victim was killed, police said they are focused more on who committed the crime.

"If it is phobias about alleged HIV/AIDS or claims of a sexual affair, we must urge the police and judiciary to throw the book at the offenders," the Post-Courier wrote in an editorial.

"There are remedies far, far better than to torture and immolate a young woman before she can be judged by a lawful system."

Spreading Witchcraft and HIV in Papua New Guinea Causes a Repeat of the Salem Witch Trials

Officials in Papua New Guinea on Wednesday reported that a woman had been burnt alive at the stake after reportedly being accused of witchcraft, which often is linked to AIDS-related deaths in the country, AFP/Arab Times reports (AFP/Arab Times, 1/7). Papua New Guinea's Post Courier reports that there was speculation the woman was practicing sorcery or adultery, or had transmitted HIV to one of the suspects (Muri, Post Courier, 1/7). According to AFP/Arab Times, reports in recent years of women being tortured and killed after being accused of witchcraft have been linked with increasing AIDS-related deaths in the country. Witchcraft often is cited as the cause of death among some young people that village residents "have seen as otherwise inexplicable," AFP/Arab Times reports (AFP/Arab Times, 1/7).

Researchers with the Australian Center for Independent Studies in 2007 released a report that found that many women were being accused of practicing witchcraft to cause AIDS-related deaths among young people and, as a result, the women were tortured or murdered. The report estimated that there had been 500 such attacks in the previous year. According to a 2007 United Nations report, Papua New Guinea accounts for 90% of HIV cases in the Oceania region. High levels of sexual violence against women and inadequate access to sex education has contributed to the spread of the virus, according to the U.N. report. An estimated 60,000 people in the country were living with HIV in 2005 (Kaiser Daily HIV/AIDS Report, 7/25/07).

According to Reuters, women in Papua New Guinea's Highlands often are blamed for spreading HIV, killed for having extramarital affairs and accused of practicing sorcery. Witnesses reported that the woman was between ages 16 and 20 (Perry, Reuters, 1/6).

Increased HIV Risk Linked to Binge Drinking Among MSM in New York City

Binge drinking -- or the consumption of five or more alcoholic beverages on one occasion -- may be contributing to an increased risk of HIV among men who have sex with men in New York City, according to a study released Monday by the city's Department of Health and Mental Hygiene, the New York Times' "City Room" reports. For the study, titled "Alcohol Use and Risky Sex in New York City," the city's health department used data from its 2007 Community Health Survey and the National HIV Behavioral Surveillance project (Chan, "City Room," New York Times, 1/5).

According to the study, 24% of MSM in New York reported engaging in binge drinking at least once monthly, compared with a rate of 15% among the city's total adult population (Bindrim, Crain's New York Business, 1/5). The study found that binge drinkers were 50% more likely than non-binge drinkers -- and three times more likely than non-drinkers -- to report having two to four sexual partners in the previous year. In addition, 40% of MSM who engaged in binge drinking reported having five or more sexual partners in the past year, compared with 21% of non-binge drinking MSM. The report also used data from the surveillance study, which is based on interviews with MSM at gay bars and is not necessarily "representative of the gay population as a whole," according to the "City Room." This data indicate that 27% of MSM who had casual partners reported being under the influence of alcohol during their last sexual encounter, and 12% reported being under the influence of both alcohol and drugs. In addition, 48% of MSM who reported having 20 or more sexual partners in the past year reported being under the influence of alcohol during their last sexual encounter. The study also found that 65% of MSM who consumed alcohol were likely to use a condom during receptive anal intercourse, while 86% of non-drinking MSM were likely to use a condom during receptive anal sex.

Thomas Frieden, New York City's health commissioner, said, "Heavy drinkers are more likely to have multiple partners -- increasing their risk of HIV, [STIs] and unplanned pregnancy." According to Frieden, the prevalence of HIV and syphilis is rising among MSM in New York City ("City Room," New York Times, 1/5). Frieden added, "Many New Yorkers recognize that drinking increases the risk of injuries and auto accidents, but they may not recognize these other risks." Sean Cahill -- managing director of public policy, research and community health at Gay Men's Health Crisis -- said there is a "wide body of evidence" that consuming alcohol can lead to "lowered inhibitions and impaired judgment." He added that "people forget" that a "legal substance" such as alcohol can lead to an increased risk of HIV. According to Cahill, addressing binge drinking among MSM in New York City might prove difficult, because "gay bars are a site of social interaction and a site of community" among many MSM in the city.

The study also reported on binge drinking among teenagers and found that more than 25% of teens who drank alcohol in the last month reported having multiple sexual partners, compared with 11% of teens who did not drink. In addition, 60% of teens reported using condoms during sex while under the influence of drugs or alcohol, compared with 72% of teens not under the influence. About 14% of teens reported binge drinking during the past month (Crain's New York Business, 1/5).

Cell Phone Soap Opera's are Helping to Promote Condom use an HIV Awareness

A new campaign aims to provide women with messages about HIV awareness, safer sex and condom use through a series of 12 soap opera vignettes that can be viewed on a cell phone, the AP/Atlanta Journal-Constitution reports. Rachel Jones, an educator at Rutgers University's College of Nursing, developed the campaign using professional actors and scripts based on focus groups with women in Newark and Jersey City, N.J.

The soap opera's 20-minute episodes feature "nitty gritty stories of risk and risk reduction" with which women can identify, Jones said. She added that cell phones allow women to have privacy when viewing the episodes and enables them to watch them repeatedly. Jones said she believes that "knowledge alone is not effective at changing behaviors" but that woman in the targeted communities might change their behaviors if they identify with characters in the videos. According to Jones, many women experience pressure from their partners to have unprotected sex, and "[t]hese relationship concerns can feel much more important in the moment for some women than reducing HIV/AIDS, which can feel more distant." She added that the videos aim to "normalize condom use." According to Jones, 82% of new HIV infections affecting people ages 18 to 29 are transmitted through heterosexual sex with an HIV-positive partner. Jones said the percentage of HIV cases transmitted through heterosexual sex is "astounding" because the virus is a "completely preventable infection."

The Healthcare Foundation of New Jersey provided funding for the project and NIH recently granted $2 million for a study assessing the effectiveness of the campaign. For the NIH study, which will involve 250 women, one group of participants will watch the soap operas on their cell phones. Researchers will then measure their risk-reduction behavior against a control group receiving text messages, but no video, encouraging condom use. At the end of the study, all participants will receive a DVD of the soap opera episodes, which also will be available online (Delli Santi, AP/Atlanta Journal-Constitution, 1/5).

State of California Court Ordered to Provide care for HIV Positive

A Superior Court judge in Los Angeles late last month ruled that the California Department of Health Care Services must provide medical care to low-income state residents living with HIV in compliance with a 2002 state law, the AIDS Healthcare Foundation announced, Bloomberg reports (Pettersson, Bloomberg, 12/23/08). The ruling follows a Dec. 5 decision by the Los Angeles County Superior Court that said DHCS failed to enact the 2002 state law (AB 2197) that calls for the implementation of a program to provide medical care to low-income HIV-positive people. The Dec. 5 ruling came in response to a lawsuit filed last year by AHF claiming that DHCS failed to expand coverage under Medi-Cal, the state's Medicaid program, to HIV-positive residents who had not developed AIDS.

The law, signed by former Gov. Gray Davis (D) in September 2002, calls for the state to provide full Medi-Cal benefits to HIV-positive people who already are enrolled in the state's AIDS Drug Assistance Program, "who are not disabled and who would otherwise qualify for benefits under the Medi-Cal program." Before the law was passed, only people with an AIDS diagnosis who were considered disabled were eligible for benefits under Medi-Cal. To fund the program's expansion, the law suggested moving Medi-Cal beneficiaries with AIDS from the current fee-for-service system to a less expensive managed care program. The money saved would go toward financing the expansion of Medi-Cal benefits to people with HIV (Kaiser Daily HIV/AIDS Report, 12/5/08).

In a statement, AHF President Michael Weinstein said, "Despite an excellent record on AIDS issues," Gov. Arnold Schwarzenegger (R) "has been ill-served by his administration, which for six years has failed to enact this crucial -- and ultimately cost-saving -- health care legislation." DHCS spokesperson Anthony Cava said it was not possible to implement the law in a "cost-neutral environment" and that the law was "very clear that it should not be implemented if the costs could not be offset by savings." Cava added that DHCS "will continue to work with its partners to implement the law in a cost-neutral manner, just as the legislature intended" (Bloomberg, 12/23/08).