News (Updated March 21, 2010)

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New HIV infections increasing among homosexuals

By Edith M. Lederer, Associated Press Writer Mar 16, 2010

A nurse draws blood from a patient for an HIV test in Johannesburg. ...NEW YORK – New HIV infections are increasing among homosexuals, drug users and prostitutes who don't seek help because of laws that criminalize these practices, the head of the U.N. AIDS agency said Monday.

Michel Sidibe, the head of UNAIDS, said "it is unacceptable" that 85 countries still have laws criminalizing same sex relations among adults, including seven that impose the death penalty for homosexual practices.

He called a proposed Ugandan law that would impose the death penalty for some gays "very unfortunate" and expressed hope it will never be approved.

At a time when UNAIDS is scaling up its program and seeking universal access to HIV treatment, Sidibe said he was "very scared" because bad laws are being introduced by countries making it impossible for these at risk groups to have access to services.

"You have also a growing conservatism which is making me very scared," Sidibe added.

"We must insist that the rights of the minorities are upheld. If we don't do that ... I think the epidemic will grow again," he warned. "We cannot accept the tyranny of the majority."

Sidibe told a group of journalists at a luncheon hosted by the United Nations Foundation that in countries from China to Kenya and Malawi , about 33 percent of new HIV infections are in men having sex with men, a significant increase.

By contrast, he said that in the Caribbean where most countries don't have repressive laws, only between 3 and 6 percent of HIV infections are in male homosexuals.

Even in the United States , where laws are not restrictive and the gay community was the first to tackle AIDS, Sidibe said it is "shocking" that more than 50 percent of new HIV infections last year occurred among homosexuals. And he said in the 19-25 age bracket the infection rate was even higher.

"It seems like we have come full circle" in the United States , he said. "After almost no cases a few years ago we are seeing again this new peak among people who are not having access to all the information, the protection that is needed."

In addition to failing to adequately deliver the right messages about AIDS prevention, Sidibe blamed complacency in a new generation that has access to treatment.

He added that this was not just a problem in the U.S. but in Europe and in Africa as well.

Sidibe said drug users are also getting the HIV virus that causes AIDS in high numbers.

"You have 70 percent of new infections occurring in Eastern Europe and Central Asia among drug users, but they are criminalized," he said. "They don't have access to services. They have to hide themselves and go underground."

Of the 16 million people in the world who are injecting drugs, almost 3 million are HIV positive, and among them less than 4 percent have access to treatment and less than 8 percent have access to services, Sidibe said.

"It's the same for men having sex with men," he said.

In Nigeria, where there are 1,000 new HIV infections every day, over 30 percent are in vulnerable groups — drug users, sex workers and homosexuals, he said.

Sidibe called for "a prevention revolution" including a campaign in major cities around the world like the anti-smoking campaigns launched in recent years.

 

Calif. board to study requiring condoms in porn

Shaya Tayefe Mohajer, Associated Press Writer, On Thursday March 18, 2010,

LOS ANGELES (AP) -- California 's worker safety board voted Thursday to further study a proposal that would require porn actors to wear condoms during sex scenes.

The six-member California Occupational Safety and Health Standards Board voted unanimously to assign an advisory committee to study the proposal from the AIDS Healthcare Foundation. The advocacy group filed a petition in December seeking to require the use of condoms in the porn industry.

"We feel like this is the game-changer. The sentiment expressed by the board members indicates that the majority if not all of them are willing to vote for regulations," said Michael Weinstein, president of the Los Angeles-based advocacy group.

The group wants the same sort of protections in place for nurses and doctors who work with bodily fluids to be extended to porn to prevent the transmission of diseases.

By law, U.S. adult film actors must prove they have tested negative for HIV and other sexually transmitted diseases within 30 days of going to work on a film.

Pornographers, including Hustler publisher Larry Flynt and Vivid Entertainment head Steven Hirsch, have said mandatory testing for adult film actors has been an effective way to prevent the spread of disease. Flynt added that adult film viewers don't want to see people using condoms.

Hirsch said the adult film industry would likely leave California if the use of condoms became mandatory.

In a statement, an adult entertainment trade group praised the state's decision to form a committee to study the matter.

"I hope that they choose someone responsible from the adult community to participate and I'm hopeful that, eventually, some workable regulations will be put in place," said Paul Cambria, a lawyer for the Free Speech Coalition.

The AIDS Healthcare Foundation's other efforts to mandate condom use have been unsuccessful.

A lawsuit the foundation filed over the issue use was dismissed in December.

Last month, Los Angeles County public health director Dr. Jonathan Fielding said regulating condom use on porn sets is nearly impossible, citing typically clandestine porn shoots that require little more than a bed and a camera.

The foundation also has written three pieces of legislation to require condoms in porn but can't find a legislator willing to sponsor their bill.

 

TB cases in Britain at highest since 1980s 

Tuesday, March 16 04:41 pm

Reuters

Cases of tuberculosis (TB) in Britain rose by 5.5 percent in the past year and are at their highest levels since the 1980s, health authorities said on Tuesday. Skip related content

The Health Protection Agency (HPA) said there were more than 9,150 cases of TB in 2009, most of them among immigrants.

The main burden of infection was in London with 3,476 cases reported in 2009, accounting for 38 percent of the nationwide total. Nearly three-quarters of all cases were in people born outside Britain , the figures showed.

"The increase we have seen this year is the biggest rise in the number of cases since 2005," said Ibrahim Abubakar, a TB expert at the HPA. An official said infection rates were at their highest since the 1980s.

TB is caused by bacteria and usually affects the lungs. Antibiotics can cure it, but about 1.7 million people around the world die from it every year.

"We must remain vigilant in our fight against TB. This is an entirely preventable and curable infection, but it can be fatal if prompt diagnosis and treatment are not given," Abubakar said.

Health officials were not able to say exactly why the rise had occurred, and said no one particular factor was responsible for the increase, which has been gradual.

Up to a third of people worldwide are infected with the bacterium that causes TB, although only a small percentage ever develop the disease.

Some studies have shown that people with substance abuse problems and those who live in hard-to-reach communities are more prone to the illness than the general population.

The AIDS epidemic drove up the number of TB cases across the world in the late 1980s and 1990s because the immune suppression caused by HIV can make a person far more susceptible to TB.

The HPA said the West Midlands region reported the second highest number of cases, accounting for 11.3 percent of cases, and rises were seen in 8 out of 9 regions across the country.

(Reporting by Kate Kelland; Editing by Steve Addison)

 

WHO: Not sure if drug-resistant TB is worsening

By MARIA CHENG, AP Medical Writer  Mar 18, 2010

LONDON – The World Health Organization says it doesn't have enough information to know if it is winning the fight against drug-resistant tuberculosis.

In a new report on the global status of drug-resistant TB based on data from 2008, the agency says almost half of all people with the disease are in China and India , with both countries reporting about 100,000 new cases each.

High rates of drug-resistant TB strains were also seen in eastern Europe and central Asia, with up to 60 percent of people who already had TB in some parts of Tajikistan and Uzbekistan developing drug-resistant versions.

About 4 percent of all TB cases worldwide are thought to be non-responsive to the usual TB drugs. The agency estimated there were between 390,000 and 510,000 cases of drug-resistant TB in 2008, including about 150,000 people who were killed by the disease. But those numbers are based on modeling and come with a big margin of error.

The report is based on information from 35 countries worldwide, leaving a huge gap in the global TB picture.

"The country data reported to WHO make it impossible at this time to conclude whether the (drug-resistant TB) epidemic worldwide is growing or shrinking," the agency wrote in its report.

In the United States , the proportion of TB cases that are resistant to at least two first-line antibiotics remained stable in 2008, at less than 1 percent. And there were no cases that year of extensively drug-resistant TB, which is resistant to most available treatments, according to the U.S. Centers for Disease Control and Prevention.

The CDC does not yet have data on drug-resistant TB for last year. But other, preliminary data indicate a historic drop in new tuberculosis cases of all kinds in 2009 — the largest single-year decrease in more than 50 years of federal record keeping.

TB rates fell more than 11 percent in 2009, to 3.8 cases per 100,000 people. Generally, the annual decline is about 4 percent. CDC officials are investigating, but say it could be related to fewer cases coming in to the country through immigration.

Drug-resistant tuberculosis usually arises when people are poorly treated or take substandard medicines. It takes longer to treat than regular TB and requires more expensive drugs, which also cause bad side effects like liver damage.

In recent years, WHO and other health authorities have warned the collision of TB with the AIDS virus could fuel simultaneous epidemics — and asked for more money to fight both. In its latest report, however, the agency acknowledged there is little proof of that.

Again citing missing data, the agency says "it has not been possible to conclude whether an overall association between (drug-resistant) TB and HIV epidemics exists."

In Estonia , Latvia and Moldova , WHO said people infected with both HIV and TB were more likely to develop drug-resistant TB. But there is no information from many countries across Africa where the most people with HIV live.

Some health experts wondered why WHO's report failed to mention in detail one of the main drivers of drug resistance: bad medicines.

"Many substandard drugs are fakes, but we are also concerned about legitimately manufactured copies — mainly from India and China — which are not made to exacting high standards," said Philip Stevens, a health policy expert at the London think-tank International Policy Network.

Stevens said the lack of global TB data was troubling. "WHO doesn't really have a clue as to the true extent of the problem," he said. "It's difficult then, to start promoting targets and goals when you don't know what baseline you are starting from."

WHO reported rates of drug-resistant TB were dropping in some parts of Russia with previously large outbreaks.

"It's good news that it can be controlled even in those difficult regions," said Ruth McNerney, a TB expert at London 's School of Hygiene and Tropical Medicine, who was not connected to the report.

McNerney said that though progress was being made, authorities need more money to fight it, and more information about where the disease is striking. "We've got to find out where there are very serious problems, otherwise we won't know about it until it's too late."

___

AP Medical Writer Mike Stobbe in Atlanta contributed to this report.

 

Disproportionate impact of HIV on men who have sex with men in US underlines need for better outreach

18 March 2010



New data analysis released on 10 March by the United States Centers for Disease Control and Prevention (CDC) highlights that HIV and syphilis disproportionately impact men who have sex with men in the United States (U.S.).
The data, presented at CDC's 2010 National STD Prevention Conference, found that the rate of new HIV diagnoses among men who have sex with men (MSM) in the U.S. is more than 44 times that of other men and more than 40 times that of women.

"While the heavy toll of HIV and syphilis among gay and bisexual men has been long recognized, this analysis shows just how stark the health disparities are between this and other populations," said Kevin Fenton, M.D., Director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "It is clear that we will not be able to stop the U.S. HIV epidemic until every affected community, along with health officials nationwide, prioritize the needs of gay and bisexual men with HIV prevention efforts."

According to CDC many aspects contribute to the high rates of HIV and syphilis among gay and bisexual men in this country. Homophobia and stigma can prevent MSM from seeking prevention, HIV testing and counselling, and treatment services. Other causes include limited access to prevention services, unsafe sex practices and complacency about HIV risk due to existence of treatment, particularly among young gay and bisexual men.  Also, the risk of HIV transmission through anal sex is much greater than the risk of transmission via other sexual activities.

''It seems like we have come full circle in the United States ,'' said UNAIDS Executive Director Michel Sidibé. ''Efforts must be redoubled to include gay and bisexual men in AIDS programming and reach out to and address the HIV prevention needs of all men who have sex with men.'' 
Prevention programmes

According to UNAIDS, HIV prevention measures for men who have sex with men should include consistent and proper use of condoms, and access to water-based lubricants. High quality HIV-related services, like voluntary counseling and testing in a non-discriminatory environment,, should be made available as well as specific and targeted information on prevention and risk reduction strategies designed to appeal to and meet the needs of men who have sex with men. Further quality treatment for sexually transmitted infections with referral for HIV services must be made available.

The U.S. Department of Health and Human Services notes that in the United States men as a whole, are less likely to use the health care system than women. Men often seek care when they are experiencing critical health problems. Men who have sex with men who do not access health care may not know they are infected with HIV or an STD, thus compromising their own health status. The persistence of stigma and homophobia compounds the situation still further.

CDC officials noted that the new analysis underscores the importance of the HIV and STD prevention efforts to reach gay and bisexual men recently announced as part of the U.S. President's fiscal year 2011 national budget proposal.

The new analysis is the first step in more fully assessing the extent of HIV among MSM and other populations in the United States . The CDC is developing more detailed estimates of infection rates among MSM by race and age, as well as among injection drug users. Ultimately, these data can be used to better inform national and local approaches to HIV and STD prevention to ensure that efforts are reaching the populations in greatest need.


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