AIDS Treatment as a form of Prevention

A lot of people thought Julio Montaner was a little crazy when he first suggested that the best way to eliminate the AIDS epidemic would be a massive scheme to give AIDS medicine to every infected person.

What about the huge financial cost? What about the moral issues, the human-rights issues, the overwhelming number of tests and drugs that would be required? Wouldn't it undermine years of lecturing on monogamy and abstinence? Wouldn't it promote "condom-free sex," as some critics said?

Faced with a host of objections, the Canadian scientist was a lone voice in the wilderness for the past three years, unable to win support from the global AIDS establishment.

But this year, Dr. Montaner's solitary crusade - the controversial notion of "treatment as prevention" - has suddenly become one of the hottest issues in AIDS science. And yesterday, at the International AIDS Society conference in Cape Town, his once-ridiculed idea was endorsed by experts from around the world.

Among the latest support for his proposal is a model by World Health Organization researchers that predicts a 95-per-cent reduction in new HIV cases within 10 years if his idea is adopted.

The proposed new strategy - universal voluntary testing for HIV, combined with immediate anti-retroviral drug treatment for those who have the virus, even in its earliest stages - could save more than seven million lives by 2050, the model says.

The WHO, which had resisted the treatment-as-prevention concept for years, is now organizing a special conference this November to discuss the "feasibility and acceptability" of the concept.

"Treatment as prevention is the topic of the year," Swiss scientist Bernard Hirschel told the AIDS conference yesterday.

"I think Julio deserves a lot of credit for this. Is treatment going to be the answer? We don't know, but we'd better find out."

Dr. Montaner, president of the International AIDS Society and director of the B.C. Centre for Excellence in HIV/AIDS, has been a prominent scientific researcher on AIDS since 1981, before the virus was even identified. A pioneer in the use of anti-retrovirals and other AIDS drugs, he has been campaigning for the treatment-as-prevention strategy since 2006.

Willy Rozenbaum, one of the early discoverers of the AIDS virus and now the president of France's National AIDS Council, was another scientist who lent his support to Dr. Montaner yesterday. Providing proper treatment to those who have the AIDS virus "sharply reduces the chances that they will transmit the virus," he told the conference.

Dr. Rozenbaum acknowledged that researchers must study whether the use of medical treatment as a prevention strategy would encourage "risky" behaviour by those who think that the AIDS virus has been virtually eliminated from their bodies. But medical treatment and condom use can coexist, he said.

In an interview, Dr. Rozenbaum said the notion of treatment as prevention is being resisted by many governments because they are afraid of the cost and reluctant to admit the failure of the traditional prescription of condoms and monogamy. "They've been promoting condoms as the answer for 20 years," he said.

After initial progress in reducing AIDS in the developed world, the condom strategy has failed to make further progress in recent years, he said. "I'm not happy with a plateau. We can't accept just a stabilization of the problem."

As for the short-term financial cost of a massive expansion in AIDS medicine, it would be outweighed by savings within five or 10 years as the transmission rate is swiftly reduced, he said.

The new WHO model of how this strategy could work, presented at the conference by WHO researcher Reuben Granich, says the treatment strategy would drive up costs at first, but "may provide cost savings" in the long run as it increasingly prevents new HIV cases.

Dr. Montaner conceded that some "recalcitrant" people with the AIDS virus will refuse to be tested or treated. His plan would not force them to be tested, but this would not weaken the strategy, he said.

"A person who is appropriately treated becomes dramatically less likely to transmit," he said. "The more you treat, the more you reduce the cases. ... When we first suggested this in 2006, people thought we were a little loony. But it's now fully accepted. We just need to get started."

The notion of treatment as prevention "creates a powerful new rationale" for the expanded use of anti-retrovirals and other AIDS drugs, he said. "We have transformed treatment from being merely a life-saving tool. Now it means we are protecting society, we are protecting our children."

The Harper government in Ottawa is still resisting the proposed new strategy, even as global experts are accepting it, Dr. Montaner said. When he suggested the strategy in a letter to the federal Health Minister, he received only a form letter in response. "It's been increasingly adopted around the world, but where is Canada on this?"

*****

The global AIDS battle

World health leaders are gathering in South Africa to discuss ways to fight the disease

PEOPLE WITH HIV/AIDS AROUND THE WORLD

PERCENTAGE OF WORLD TOTAL/ 2007

Latin America and the Caribbean/ 5.0%

High-income countries/ 5.4%

Eastern Europe and Central Asia/ 3.9%

Asia/ 21.4%

Africa/ 64.4%

The overwhelming majority of people with HIV/AIDS, 95%, live in the developing world.

MONEY AVAILABLE FOR GLOBAL AIDS FIGHT, IN BILLIONS $ US

'05/ $7.9

'06/ $8.8

'07/ $11.3

"08/ $13.8

THE GLOBE AND MAIL / SOURCE: UNAIDS, AVERT.ORG

HIV Vaccine Ready for Human Tests

An HIV/AIDS vaccine developed in Canada has passed safety tests in animals and the researchers are awaiting approval to begin human trials in the U.S.

"It is a very important milestone for us," said Yong Kang, a professor of microbiology at the University of Western Ontario in London who has been working on the vaccine for 20 years.

Kang said he expects to get the go-ahead soon from the U.S. Food and Drug Administration to begin human toxicology tests and two phases of clinical trials in the United States.

If all three trials are successful, the vaccine should be available within the next decade, Kang told CBC News on the phone while attending a meeting in South Korea.

According to a 2008 United Nations report on the global AIDS epidemic, 33 million people were living with HIV in 2007. Two million people died of causes related to the disease that year.

Dozens of HIV vaccines have already been developed and tested in animal models, but few have been tested in humans, none successfully. A promising trial in 2007 by pharmaceutical giant Merck and Co. was shut down after those receiving the vaccine contracted HIV at a higher rate than those who received the placebo.

Kang has partnered with a Curacom, a South Korean holding company, that has agreed to open an office in London, Ont., to help fund research in Kang's lab and commercialize the vaccine.

A test vaccine is being manufactured in a lab in Maryland near Washington, D.C.

Lab tests showed the vaccine produced no adverse effects or safety risks during immunology tests on animals.

The toxicology tests are expected to include 40 to 50 HIV-positive volunteers in the U.S., and will be designed to test whether the vaccine is toxic in humans.

http://www.cbc.ca/health/story/2009/07/01/health-canadian-aids-hiv-vaccine-kang.html

Eliminate HIV

‘UNIVERSAL VOLUNTARY HIV TESTING WITH IMMEDIATE ANTIRETROVIRAL THERAPY AS A STRATEGY FOR ELIMINATION OF HIV TRANSMISSION: A MATHEMATICAL MODEL’

In November 2008, an article was published in the renowned medical journal, the Lancet. The article is co-authored by Reuben Granich, Kevin de Cock and Charlie Gilks. The authors of the article are leading members of World Health Organization (WHO) HIV and TB team, but the study is an independent work that has not been endorsed by the WHO. Based on computer modeling, the authors argued that universal HIV testing, followed by the immediate initiation of ART for those who were HIV-positive, could virtually eliminate HIV transmission in the future and reduce the number of people developing AIDS by 95%.

The article aroused heated debate amongst HIV activists, healthcare workers, scientists and officials at organizations like UNAIDS and the World Health Organization (WHO). The debate focused on the human rights implications of the implementation of universal mandatory testing, the potential criminalisation of HIV transmission, and the lack of consideration given to the negative outcomes proven to be associated with universal mandatory HIV testing. However debaters agreed that it is essential that new information that presents the possibility of a solution to HIV epidemic must be seriously considered and researched.

The WHO will hold a consultation in Geneva to discuss the implications of the article. From 28 – 30 April, TAC representatives attended a meeting organized by the AIDS and Rights Alliance of Southern Africa (ARASA) and the Open Society Initiative for Southern Africa (OSISA) in Johannesburg to discuss the article and to formulate a position with other Southern African HIV activists. This position will be presented at the WHO meeting in Geneva. TAC’s briefing on the article is being finalized, and district workshops are planned to discuss the contents of the article and the responses of TAC members to the strategies it proposes. Please click here for TAC’s full brief and response.

HIV-Positive People at Increased Risk of New Flu Strain

HIV-positive people worldwide are at an increased risk of the H1N1 flu strain, the World Health Organization said on Saturday in guidelines for health workers published on its Web site, Reuters India reports. According to WHO, people with immodeficiency diseases, such as HIV/AIDS, likely will be vulnerable to complications related to the flu strain, just as they are from the seasonal flu, which results in about 250,000 to 500,000 deaths annually. According to WHO, the H1N1 strain and HIV could prove to be a hazardous combination, similar to HIV and tuberculosis. "Although there are inadequate data to predict the impact of a possible human influenza pandemic on HIV-affected populations, interactions between HIV and A(H1N1) influenza could be significant," WHO said, adding that HIV-positive people "should be considered as a high risk and a priority population for preventive and therapeutic strategies against influenza, including emerging influenza A(H1N1) virus infection."

According to WHO, countries with high HIV/AIDS burdens, many of which are in Africa, should ensure that vulnerable people have drug access, including to medicines such as Tamiflu and Relenza. The agency added that it is best if people with the flu strain take antiviral drugs within 48 hours of the onset of symptoms. In addition, there are no known issues with taking flu medications with antiretroviral drugs, according to WHO (MacInnis, Reuters India, 5/2).

Life Insurance for HIV-Positive People

The insurance company Prudential will begin to offer life insurance policies to HIV-positive people in the United Kingdom, London's Daily Telegraph reports. According to the Telegraph, PruProtect -- a partnership between Prudential and a South African firm -- initially will offer the insurance to 7% of HIV-positive people and hopes to extend coverage to 20% of HIV-positive people. The policy will offer up to 250,000 British pounds -- or about $368,000 -- for a maximum of 10 years. The policy premiums will be higher than standard premiums for life insurance "to accurately and fairly reflect the risks involved." Premiums will be determined on an individual basis and dependent on medical history, the Telegraph reports.

Kevin Carr, director of protection development at PruProtect, said, "We are pleased to be the first mainstream insurer to provide life cover for people living with HIV," adding "I believe it is better to provide some cover for some people than nothing at all." The Terrence Higgins Trust said, "We welcome this move from PruProtect and are glad to see an insurer who recognizes the reality of living with HIV in the U.K. in the 21st century." The group added that it "hope[s]" the program "will be the start of a wider move to offer appropriate financial products to people with HIV" (Simon, Daily Telegraph, 4/29).

Early HAART Initiation Improves Vaccine Response Among HIV-Positive Children

HIV-positive infants who begin treatment with highly active antiretroviral therapy within the first year of life can develop normal immune responses to childhood vaccines, according to a study published online Monday in the Proceedings of the National Academy of Sciences, Reuters Health reports. Vaccines function by stimulating the production of antibodies for a particular disease, but HIV causes a decline in these antibody-producing cells and therefore reduces immunity. Prior to the new study, researchers were unsure whether the timing of HAART initiation could help preserve these cells and promote normal immune responses to vaccines among children.

For the study, Paolo Rossi of the University of Tor Vergata in Rome and colleagues examined 70 children who contracted HIV through mother-to-child transmission and 50 HIV-negative control participants. Of the HIV-positive children, 13 received HAART during their first year, six received no treatment and the remaining children received therapy later in life. All of the children in the study group received the recommended vaccinations for measles and tetanus. According to the study's findings, children who received HAART during their first year maintained normal levels of antibody producing cells, while children in the other groups had lower levels of these cells.

According to Rossi, the timing of HAART initiation is a key factor in determining whether HIV-positive children will develop normal vaccine responses and how long the response will last. The authors write that their findings support early HAART initiation for the purpose of preserving normal immune responses among HIV-positive infants. However, they add that health officials might need to revise vaccine schedules for HIV-positive children who begin treatment after the first year of life (Reuters Health, 4/29).

An abstract of the study is available online.

Canada Should Pass Bill That Would Expedite Export of Low-Cost Drugs for HIV

"For many years, countries such as Canada have avoided the uncomfortable truth that millions are dying in the developing world due partly to legal barriers that render access to medicines unaffordable," Michael Geist, chair of Internet and E-commerce law at the University of Ottawa, writes in a Toronto Star opinion piece in response to a recently introduced bill that would reform Canada's Access to Medicines Regime by expediting the process of exporting generic drugs for diseases such as HIV to developing countries. According to Geist, Canada "became an early adopter" of a 2003 World Trade Organization agreement aimed at easing the export of drugs. However, "[s]everal years later, most agree the policy has been a near-total failure," he adds. According to Geist, the law "has only been used once, and the company involved in the process found it so burdensome that it has vowed not to repeat it."

The new bill, introduced by Sen. Yoine Goldstein, "includes important reforms to" Canada's Patent Act, Geist writes, adding that it "would not remove all barriers, but it would help to streamline the process of obtaining the necessary approvals." He adds, "Most importantly, it would establish a 'one-license solution' to enable generic pharmaceutical manufacturers to send shipments of the same medication to multiple countries without needing new approvals for each shipment." In addition, current law allows only governments to "buy medicines on behalf of citizens," Geist writes, concluding that the bill "would make it easier for the many nongovernmental organizations focused on access to medicines to buy and distribute generic medications" (Geist, Toronto Star, 4/13).

Delaying HAART Might Prevent Complete Immune System Recuperation

People living with HIV who do not start highly active antiretroviral treatment until their CD4+ T cell counts drop below 200 might not be able to reach a normal CD4 cell count, even after 10 years of otherwise effective treatment, according to a study in the March 15 issue of Clinical Infectious Diseases, Reuters reports. According to Reuters, an HIV-positive person is considered to have a normalized immune status after CD4 counts are maintained above 500.

For the study, researchers examined 366 HIV-positive people who had maintained plasma HIV RNA levels of no more than 1,000 copies per milliliter of blood for at least four years after starting therapy. About 25% of the study's participants were followed for more than 10 years, with a median follow-up of 7.5 years. Reuters reports that 95% of the participants who started therapy with a CD4 cell count of at least 300 were able to reach a normalized CD4 cell count of at least 500. The researchers reported that 44% of participants who began treatment with a CD4 cell count of less than 100 -- as well as 25% who began treatment with a CD4 cell count of between 100 and 200 -- were not able to reach a CD4 cell count higher than 500.

Lead author Steven Deeks of the University of California-San Francisco and colleagues wrote that a "persistently low CD4 cell count during treatment is associated with increased risk of both AIDS and non-AIDS related events," such as liver disease, cardiovascular disease and cancer. They added that "novel immune-based therapeutic approaches may be necessary to restore immunocompetence in these individuals." In a related editorial, Boris Julg and Bruce Walker, both of Massachusetts General Hospital, wrote that major treatment guidelines recommend beginning antiretroviral therapy when CD4 cell counts drop below 350, adding that it can be difficult for developing and low-income countries to follow such advice. Julg and Walker wrote that "adequate early therapy, leading to more-complete immune reconstitution, may save resources because of the resulting lower incidence of opportunistic infections and reduced need for medical care" (Reuters, 4/7).

An abstract of the study is available online. An abstract of the accompanying editorial also is available online.

Miami Herald Examines Issues Surrounding HIV Status Disclosure Among MSM

The Miami Herald on Monday examined issues that some HIV-positive men who have sex with men face when determining when to reveal their status to potential partners. According to the Herald, a recent study from the Gay Men's Health Crisis found that half of U.S. residents surveyed said they believe that HIV/AIDS contributes to discrimination against MSM. In addition, discrimination in the MSM community toward HIV-positive MSM is not discussed widely, according to the Herald. This stigma often leads to a fear of disclosure among HIV-positive MSM, which can contribute to high-risk sexual activity and the spread of HIV.

Spencer Lieb, senior epidemiologist at the Florida Department of Health Bureau of HIV/AIDS, said, "Non-disclosure is one of the challenges of HIV prevention." Reports in Florida show a 48% increase in newly recorded HIV cases in Miami-Dade County from 2006 to 2008, as well as a 74% increase in Broward County. Lieb said these figures could point to an enhanced reporting system. However, the Herald reports that the increase in new cases also could be in part because of increased HIV/AIDS complacency. Linda Simon, a psychotherapist with the Miami Beach Community Health Center, said that among some MSM, disclosing their HIV-positive status is a "struggle," because "on the one hand they want to be responsible, but on the other they want to protect themselves from breaching confidentiality and rejection" (Roth, Miami Herald, 4/6).

The Gay Men's Health Crisis study is available online.

California HIV/AIDS Group Launches Internet-Based Program Aimed at MSM

The Palm Springs, Calif.-based Desert AIDS Project has launched an Internet-based education and prevention program aimed at men who have sex with men, the Desert Sun reports. The program was launched ahead of the area's White Party Easter weekend, according to the Sun. "With the White Party literally in our backyard, we feel a responsibility each year to get out the message about safer sex while not throwing the proverbial wet blanket on the fun people are here for," David Brinkman, AIDS Project executive director, said.

The program, called "I-Connect," allows project staff to distribute information about safer sex, HIV testing, mental health and substance abuse counseling on several Web sites, according to a release. In addition, some staff plan to be in the lobby of the host hotel for the White Party throughout the weekend, according to Brinkman. The AIDS Project aims to reach about 3,000 people during the program's first year. MSM are the primary attendees of the White Party, and Palm Springs has one of the largest MSM populations per capita in the U.S., according to the Sun (Brambila, Desert Sun, 4/3).

160,000 Children in Ghana Orphaned by HIV/AIDS, Commission Says

Recent data compiled by the Ghana AIDS Commission indicate that about 160,000 children have been orphaned by the disease in the country, Ghana's GNA/My Joy Online reports. According to Damien Punguyire, medical superintendent of the country's Kintampo Hospital, without adequate care, more people will be affected by the pandemic and more children will be orphaned within the next five years.

Punguyire also expressed concern about HIV/AIDS prevalence among young people and those of reproductive age, saying that the situation could negatively affect Ghana's economy and national development. "There is the need for increased education to create more awareness for the people to become cautious about their sexual practices, and that would help minimize spread of the pandemic," Punguyire said. In addition, he urged teachers to educate students about HIV/AIDS prevention methods in an effort to maintain awareness about the epidemic. He also called for an end to stigma and discrimination against HIV-positive people to help curb the spread of the virus (GNA/My Joy Online, 3/31).

Microbicide Containing Natural Compound Provides Protection in Monkeys Against Simian Version of HIV

An experimental microbicide containing a naturally occurring compound provides protection in monkeys against the simian version of HIV by diminishing immune responses to the virus, according to a study published Wednesday in the journal Nature, the Los Angeles Times reports. HIV typically spreads in the body by entering CD4+ T cells, which the immune system sends out to attack the virus after exposure. The compound -- called glycerol monolaurate, or GML -- works by inhibiting immune signals that dispatch the T cells to attack the infection. It is those T cells that HIV infects and uses to proliferate throughout the body (Engel, Los Angeles Times, 3/5). GML occurs naturally in the human body and already is approved for use as an antimicrobial and anti-inflammatory ingredient in cosmetics and toiletries, as well as an emulsifier in foods. In addition, each dose of GML used in the study costs less than one cent. According to the researchers, the study's findings have promising implications for the development of effective microbicides to prevent HIV (AFP/Google.com, 3/4).

For the study -- led by Ashley Haase, head of the microbiology department at the University of Minnesota Medical School, and microbiologist Patrick Schlievert -- researchers administered the GML gel vaginally to five rhesus monkeys and then repeatedly exposed them to the simian version of HIV, or SIV. After two weeks, all of the five monkeys tested negative for the virus. However, four out of five monkeys that did not receive the GML gel contracted SIV. According to the researchers, five months after the experiment, they learned that one of the monkeys treated with GML tested positive for the virus. The researchers said they are unsure how this monkey contracted SIV, but they suggested that a small amount of the virus might have spread in the body undetected or the monkey might have been exposed to SIV after the study ended (Lerner, Minneapolis Star Tribune , 3/4).

Haase said the current research is "a relatively preliminary study but worth sharing because it establishes a novel approach." The researchers added that a mathematical model suggests that even if the microbicide were 60% effective and used 20% of the time, it still could prevent about 2.3 million HIV cases over a three-year period. According to the study authors, researchers will need to conduct further animal studies to determine whether the microbicide should be administered over a longer period of time to provide long-term protection against the virus (Los Angeles Times, 3/5). Further study also will be needed to demonstrate whether GML prevents HIV transmission among humans, they added. The researchers said they plan to undertake a larger study with monkeys, followed by a study with female volunteers. In addition, the University of Minnesota has applied for patents for the new compound combining GML with a personal lubricant, which currently is not available commercially. According to Schlievert, the ultimate goal will be to develop a gel that can be used for both men and women (Minneapolis Star Tribune, 3/4).

According to the study authors, the research "represents a highly encouraging new lead in the search for an effective microbicide to prevent HIV transmission that meets the criteria of safety, affordability and efficacy" (Fox, Reuters, 3/4). Haase said that although the research "sounds counter-intuitive, halting the body's natural defense system might actually prevent transmission and rapid spread of the infection" (AFP/Google.com, 3/4). Charlene Dezzutti, laboratory network director of the Microbicides Trial Network at the University of Pittsburgh, said the research illustrates "a new approach to thinking about microbicides." She added that she believes scientists "definitely" could develop an effective microbicide before developing an HIV/AIDS vaccine. "It's just a matter of getting all the right pieces together," she said (Lauerman, Bloomberg, 3/4). Rowena Johnston, vice president of research for the Foundation for AIDS Research, said that if further studies confirm these results, "then this is really a fabulous new finding." She said that although future microbicide research could encounter setbacks, the study is "absolutely a great beginning to a research project."

According to Schlievert, women could apply the GML microbicide "an hour or so before they had sex" to protect against HIV transmission. In addition, the gel might provide protection against other sexually transmitted infections, such as chlamydia, he said (Minneapolis Star Tribune, 3/4). According to AFP/Google.com, Schlievert first identified the microbicidal properties of GML when studying the use of the compound in preventing toxic shock syndrome associated with tampons. He said research repeatedly has found that the compound is safe and has no effect on beneficial vaginal bacteria (AFP/Google.com, 3/4). Lorraine Teel, executive director of the Minnesota AIDS Project, said the gel could provide women with a way to prevent disease transmission in areas of the world where many people do not use condoms because of cultural or other pressures. The research has "absolutely enormous implications" for women worldwide, she said (Minneapolis Star Tribune, 3/4). Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said an effective microbicide would "empower women to protect themselves in a sexual situation in which they may not have complete control" (Los Angeles Times, 3/5).

An abstract of the study is available online.

Texas Bill To Make HIV Screening Part of Routine Care Would Help Efforts To Curb Virus

"More than two years after" CDC "recommended routine HIV screening, two state lawmakers" in Texas have proposed a bill to align the state with the federal recommendations, a Lubbock Avalanche-Journal editorial says. It adds that between 2003 and 2007, "more than one-fourth of Texans with HIV were diagnosed late in the course of the disease and were diagnosed with AIDS within a month." According to Ed Sherwood, chair of the Texas Medical Association Committee on Infectious Diseases, making HIV tests a part of routine care "would help avoid situations where patients assume they couldn't be infected and decide not to get tested," the editorial says. In addition, if the legislation "passes, it will be a model for other states," according to bill sponsor Sen. Rodney Ellis (D), the editorial says, adding, "California and Illinois are the only other states to pass HIV screening legislation, but not as comprehensive."

The state "already has legislation requiring inmates in Texas prisons to be tested for HIV when they enter and leave the system," according to the editorial. It adds that state law "also requires doctors to offer HIV screening at checkups for pregnant" women. The editorial concludes that the bill is a "good idea ... as long as people can opt out" (Lubbock Avalanche-Journal, 3/4).

New York Times Examines Web Site on Male Circumcision

The New York Times on Tuesday examined a new Web site -- launched by the World Health Organization, UNAIDS, the AIDS Vaccine Advocacy Coalition, Family Health International, and several U.S. and British public health schools -- that aims to serve as a resource on male circumcision and HIV/AIDS. According to the Times, since WHO and UNAIDS two years ago recommended that male circumcision be made available in countries highly affected by HIV/AIDS to help reduce transmission of the virus through heterosexual sex, much "misinformation has circulated" regarding the procedure in some countries. In addition, there has been a "dangerous surge in complications as traditional healers without sterile instruments began offering cheap circumcisions," the Times reports.

The Web site includes scientific studies, policy documents and news articles and aims to address some popular myths, including one that circumcision provides complete protection from HIV, so circumcised men do not need to use condoms, according to Kim Eva Dickson, a WHO medical officer who oversaw the creation of the Web site. It also includes a handbook that demonstrates surgical techniques, although Dickson said that it is not meant to train traditional healers or surgeons. She added that the handbook could help at some small hospitals in rural areas by demonstrating new methods for further investigation and teaching that men need pain management, sex advice and condoms in addition to surgery. According to Dickson, the Web site in its first week has had visitors from the U.S., Switzerland and the United Kingdom, as well as India, Kenya, Namibia, South Africa and Turkey (McNeil, New York Times, 3/3).

HIV/AIDS Funding Cuts in Connecticut

The Connecticut AIDS Resource Coalition on Friday held a press conference to protest a proposed $2.7 million cut to state programs that provide HIV/AIDS services, the New Haven Register reports. Gov. M. Jodi Rell's (R) budget proposal for fiscal years 2009-2011 would allocate $4.95 million annually over the next two years to HIV/AIDS services, a 40% decrease from FY 2008-2009 funding levels. Jeffrey Beckham, spokesperson for the state Office of Policy and Management, said the proposed cuts would reverse an additional $2.51 million in FY 2007-2008 and $3.09 million in FY 2008-2009 in state HIV/AIDS funding following a $3.3 million reduction in federal Ryan White CARE Act funding.

Beckham said, "We're more or less at a constant base amount for this AIDS services account for the last several years," adding the proposal brings HIV/AIDS funding back to traditional levels. Leif Mitchell, co-chair of CARC's AIDS Legislative Initiative and Funding Effort, said that a 40% reduction in funding is "absolutely unacceptable," adding that HIV advocates in the state had said they were "willing to suffer a 10% cut." Christopher Cole, executive director of AIDS Project New Haven, said the agency could lose about 6% of its budget, or $66,000, that will affect transportation, mental health and substance abuse programs for HIV-positive people.

According to CARC, about 10,860 people are living with AIDS in the state. In addition, there are more AIDS cases among injection drug users in Connecticut than in any other state, the Register reports (Stannard, New Haven Register, 2/21).

When HIV Funding services are cut and alternative treatment methods are required, please visit www.aids-drugs-online.com for other treatment options.

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).

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).

New Orleans Officials Should Ensure That 'Glitch' in Ryan White Process Will Not Create 'Problem' With 2009 Grants

"The grant process for agencies working with" HIV-positive people is "maddening," a New Orleans Times-Picayune editorial says. According to the editorial, it "took six months" for Mayor Ray Nagin's administration to "distribute $7 million in federal grant money this year," and the city's Office of Health Policy "received the money" from the Ryan White Program in March but did not "send out grant award notices to agencies until June." It adds that contracts were not "finalized until last month."

Following criticism from the City Council on the "slow-moving process," Health Policy Director Fran Lawless "promised that her office would do better with the next round of grants," the editorial says, adding, "Unfortunately, that hasn't been the case so far." According to the editorial, a "public notice published last week to launch the 2009 process included errors that forced the city to cancel the effort and push back its start." It adds, "Even the best operations can make the type of clerical errors in the failed notice. And there are points in the public notice process where things can occasionally go wrong." However, "these problems are worrisome considering the office's history of delays," the editorial says, adding that Nagin "needs to make sure the office's director and employees can efficiently accomplish this task or find some who can." Concerns from officials involved with the grant process "surely pal[e] in comparison with the anguish of more than 4,000 people with HIV/AIDS who get treatment and case management services from the entities that the grants fund," according to the editorial. It adds, "At least one of those agencies had to close during the summer because of the city's delays. That left hundreds of people without the help they need." The editorial concludes that city "officials promise that the glitch in the process won't cause a problem with the 2009 grants. They need to ensure that it doesn't" (New Orleans Times-Picayune, 12/22).

In the event that service disruptions affect your health care management plan, be sure to visit http://www.aids-drugs-online.com

Women More Susceptible to HIV/AIDS than Originally Thought

A new study has found that HIV appears to attack normal, healthy genital tissue in women and does not require breaks in the skin to infiltrate cells, offering new perspectives on how the virus is spread, researchers said on Tuesday, Reuters reports. Thomas Hope, a study author from Northwestern University's Feinberg School of Medicine, said that scientists have had little detailed understanding of how HIV is transmitted sexually in women and that it was "previously thought there had to be a break in [genital tissue] somehow" for women to contract the virus. He added that the study's findings show that "[n]ormal skin is vulnerable."

For the study, researchers in a partnership between Northwestern and Tulane University introduced HIV -- which carried fluorescent, light-activated tracers, a new method developed to better see how the virus worked -- to newly removed vaginal tissue taken from hysterectomy surgeries. A microscope was used to observe the virus as it penetrated the outer lining of the female genital tract -- also called the squamous epithelium -- and found that HIV was able to move quickly past the skin barrier to reach immune cells. The process also was observed in nonhuman primates, according to Reuters. In addition, the results of the study suggest that HIV focuses on areas of the genital tissue where skin cells recently had been shed, Hope said (Steenhuysen, Reuters, 12/16). Hope said the results are "an important and unexpected result -- we have a new understanding of how HIV can invade the female vaginal tract." He added, "We urgently need new prevention strategies or therapeutics to block the entry of HIV through a woman's genital skin" (BBC News, 12/17).

According to Reuters, researchers in the past have assumed that HIV sought out breaks in the skin -- like a herpes sore -- to gain access to immune system cells deeper in tissue, and some thought the normal lining of the vaginal tract could work as a barrier to transmission during sexual intercourse. Reuters reports that the study "casts doubt" on the theory that HIV transmission requires a break in the skin or that the virus gains access through the cervical canal's single layer of skin cells. The findings also "might explain why some prevention efforts" -- such as diaphragms or herpes treatment -- have "failed," Reuters reports (Reuters, 12/16).

Lisa Power from the Terrence Higgins Trust in the United Kingdom said the results are an "important finding" but "sadly, not surprising" because it has been "long known that it is easier for a man to transmit HIV sexually to a woman than for a woman to transmit it to a man." She added that the study "helps us understand why" and "will help in developing better prevention mechanisms -- but until then, it's more clear than ever that a condom is a vital part of safer sex." The British not-for-profit organization AVERT said that the study "serves to strengthen" the argument for condom use during heterosexual intercourse and "will hopefully give weight to the need for safer heterosexual sex to be advocated further by governments and practitioners worldwide" (BBC News, 12/17). According to Hope, the findings emphasize the importance of methods to prevent transmission, such as a vaccine and condom use. He said, "People need to remember that they are vulnerable. The sad part is if people just used a condom, we wouldn't have this problem" (Reuters, 12/16).