News (Updated August 7 2011)

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HIV infections in U.S. stable but disparities exist

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Wed, Aug 3 2011

By Julie Steenhuysen

CHICAGO (Reuters) - The number of Americans newly infected with HIV remained stable between 2006 and 2009, but infections rose nearly 50 percent among young black gay and bisexual men, U.S. experts said on Wednesday.

New data from the U.S. Centers for Disease Control and Prevention reveal progress since the peak of the HIV epidemic in the 1980s. But the sharp increases in infection rates among young black men who have sex with men show there is much more work to do, they said.

"We're very concerned about these increases among young gay men," Dr. Kevin Fenton, director of the CDC's National Center for HIV/AIDS, said in a telephone interview.

"We can't allow the health to a new generation to be lost to what is essentially a completely preventable disease."

According to the estimates, published in the journal PLoS ONE, there were 48,600 new HIV infections in the United States in 2006, 56,000 in 2007, 47,800 in 2008 and 48,100 in 2009. Over the four-year period, that amounts to an average of 50,000 cases per year.

But communities of color, and especially blacks, were disproportionately affected.

While blacks represent 14 percent of the U.S. population, they accounted for 44 percent of new HIV infections in 2009. HIV infection rates among blacks were nearly eight times higher than rates in whites, according to the study.

Hispanics, who represent about 16 percent of the population, accounted for 20 percent of new HIV infections in 2009 - a rate that was nearly three times as high as that of whites.

HARDEST HIT

Men who have sex with men - which includes openly gay and bisexual men and those who do not identify themselves as gay or bisexual - remain most heavily affected.

While this group represents 2 percent of the overall U.S. population, they accounted for 61 percent of all new HIV infections in 2009.

And young men who have sex with men - those aged 13 to 29 - are the hardest hit, accounting for more than one quarter of all new HIV infections nationally.

New HIV infections affected young men who have sex with men of all races, but the CDC saw very sharp increases among young black men who have sex with men.

"We saw increases of up to 48 percent - nearly a 50 percent increase between 2006 and 2009," Fenton said.

The reasons for this are not yet clear, he said, but the CDC said several factors are influencing this trend.

They said young black men who have sex with men are less aware of their infection status. They may encounter more homophobia than other groups, which could keep them from getting tested. They may have less access to treatment, and they have higher rates of other sexually transmitted diseases, which increases the risk of HIV transmission.

"HIV remains one of the most glaring health disparities in this country," Fenton said in a statement.

"While we all have individual responsibility to protect ourselves from HIV infection, the research clearly shows that individual risk behavior alone doesn't account for the significant racial disparities in HIV," he said.

"It is essential to understand the underlying factors that contribute to these disparities, such as poverty, discrimination and lack of access to health care."

To fight these increases, Fenton said the CDC will focus on areas where HIV infection is most heavily concentrated - among gay and bisexual men of all races, blacks and Hispanics, as outlined in the National HIV/AIDS Strategy introduced by the White House last summer.

The plan calls for better methods to gather data among affected populations and increased use of prevention tools, including earlier testing and treatment with drug cocktails that have been shown to reduce HIV transmission.

SOURCE: bit.ly/oOSezp PLoS ONE, August 2, 2011.

 

Life expectancy rises with AIDS therapy in Uganda

Jul 22 2011

By Kerry Grens

NEW YORK (Reuters Health) - Ugandan HIV and AIDS patients receiving antiretroviral "cocktail" therapy can expect to live nearly as long as their compatriots who don't have HIV, a new study finds.

"They can have almost a normal life expectancy, and live approximately two thirds as long as if they had not had HIV," said Edward Mills, a professor of global health at the University of Ottawa in Canada and lead author of the study. "This is very good news."

In the United States and other developed countries, combinations of antiretroviral therapies are known to increase the life spans of people with HIV to near-normal lengths, but how far these drugs can go in settings where patients don't have excellent health care was unclear.

Mills and his colleagues looked at the health records of more than 20,000 people who received medications from The AIDS Support Organization in Uganda .

The total cost of an individual's AIDS treatment in Uganda averages about $1,000 a year. Much of the funding for the drugs, which became available to these patients in 2004, has come from the United States .

About 1,500 of the patients died between 2000 and 2009.

From the data, the researchers predicted that patients in their 20s and 30s who are on the drugs would be expected to live an additional 27 years.

The normal life expectancy in Uganda is 55.

"One of the reasons this study is important is it looks at the most simple therapy available," Mills said, referring to the lack of laboratory testing and treatments for other diseases that are available to HIV patients in the U.S. "Given that, we still demonstrate excellent outcomes."

"We were heartened" by the results, said Dr. Deborah Cotton, deputy editor of the Annals of Internal Medicine, where the study was published.

"Even in a country like Uganda that has fewer options for drugs and people start later than is ideal, there's a significant benefit of treatment," said Cotton, who was not involved in the research.

The results do reveal some weaknesses in the HIV initiatives.

Children do not achieve life spans as long as adults do, and men do not fare as well as women.

Mills said children with HIV don't live as long as adults because many of them were born with the disease and did not get early treatment.

A teenager starting therapy, for instance, can expect to live an additional 26 years, falling short of the average life span in the country.

As for men, there are no clinics or public health campaigns geared toward men, Mills told Reuters Health. "We need to figure out how to deal with men."

At 35 years of age, a man with HIV on antiretroviral therapy can expect to live 22 additional years, compared to 32 extra years for a woman, for instance.

Though the drugs may work, only a minority of people eligible to receive them actually do.

In Uganda alone, the authors report, 80,000 people are waiting to start HIV therapy.

"The difficult and ironic part is we are seeing an advance at a time when economics are constrained," Cotton told Reuters Health.

Mills said his findings can make an economic argument for investing in access to HIV drugs, because it means those most affected -- the young adults in Africa, the workforce -- will be healthier.

"I remember the days when someone would come to the clinic and we'd tell them to start preparing for their death," Mills said. "Now what we're able to tell people is you can live a very long life, and that means going back to work as well."

SOURCE: bit.ly/pxk958 Annals of Internal Medicine, online July 19, 2011.

 

Survey reveals gaps in HIV programming for MSM

15 Jul 2011

Source: Content partner // IRIN

NAIROBI, 14 July 2011 - A new global survey of more than 5,000 men who have sex with men (MSM) reveals a marginalized group of people with little access to basic HIV prevention tools such as condoms and few means to learn about HIV.

Conducted by the Global Forum on MSM & HIV [ http://www.msmgf.org/files/msmgf//Publications/GlobalSurveyReport.pdf ] between 24 June and 17 August 2010, the survey sought to highlight key gaps in global efforts to provide MSM with evidence-informed HIV prevention services. More than 1,000 of the study participants - drawn from all over the world - were health workers; 22 percent reported being HIV-positive.

The authors recommend expanding access to HIV prevention services for MSM across the globe, more focus on promoting awareness of emerging HIV prevention interventions and more robust and sustained stigma-reduction efforts. Some of the major findings of the survey include:

Access to health services - Fifty-three percent of participants said they could easily access testing for sexually transmitted infections, while 51 percent said they had easy access to HIV counselling; 47 percent found STI treatment easily accessible.

Just 36 percent of MSM surveyed reported having easy access to HIV treatment, while 27 percent said it was available but difficult to access, was not available or had never heard of HIV treatment.

Access to HIV prevention - Free condoms were easily accessible only to 44 percent of participants, while just 29 percent could obtain lubricant.

Just 30 percent of participants reported easy access to each of the basic HIV prevention services, including behavioural HIV/AIDS interventions, HIV education materials, mental health services, free or low-cost medical care, media campaigns focused on reducing HIV, and laws/policies to ensure access to HIV prevention.

Just 25 percent said they had access to sex education.

Stigma - Africa reported the highest levels of stigma and external homophobia, followed by the Middle East, Asia-Pacific, Central/South America and the Caribbean, which all reported similar levels of stigma. Australia and New Zealand reported the lowest levels of stigma and external homophobia.

MSM from Africa and the Asia-Pacific region reported the highest levels of internalized homophobia.

MSM-specific services - Some 52 percent of respondents reported that MSM health facilities were not available or unknown.

Media campaigns to reduce homophobia were rare, with 30 percent of the survey's participants reporting that anti-homophobia campaigns were not available and another 20 percent saying they were "unheard of".

Knowledge of and access to emerging HIV prevention strategies - Fifty percent of respondents said medical male circumcision was easily accessible and just 10 percent had not heard of circumcision as a biomedical strategy for HIV prevention.

Post-exposure prophylaxis (PEP) was described as easily accessible by only 18 percent of respondents, with 35 percent reporting that they had never heard of PEP.

Thirty-nine percent of participants had never heard of pre-exposure prophylaxis for HIV prevention, while 44 percent of MSM had never heard of topical microbicides.

 

'HIV murderer' in Canada gets life in prison

(AFP) – 3 August, 2011 

MONTREAL — A Canadian man convicted of murder in 2009 for knowingly transmitting HIV to women was sentenced to life in prison Tuesday and may not be eligible for parole due to the risk he could commit the same crime.

Johnson Aziga, a 50-something man of Ugandan descent, was found guilty in April 2009 of two counts of premeditated murder --- a first in Canada -- and 10 counts of aggravated sexual assault for spreading the AIDS virus to his lovers.

A life sentence in Canada often carries with it the possibility of parole after 25 years behind bars, but an Ontario court designated Aziga a "dangerous criminal," meaning a commission will decide whether parole can be granted.

Aziga -- who learned of his condition in 1996 -- had unprotected sex with 11 women, none of whom were told of his HIV-positive status.

Seven women were infected, and two have since died of AIDS-related complications.

Aziga, a former employee of the provincial justice ministry, told the court he never intended to transmit the virus to the women, and that he had not revealed his status due to cultural and religious taboos in his homeland.

He said he wished to renounce his Canadian citizenship and serve out his sentence in Uganda or Kenya because he believed he had not received a fair trial in Canada , according to CBC public television.

Prosecutors argued Aziga was at heightened risk of infecting other women if eventually released.

But his defense lawyers countered that during the eight years in prison since his 2003 arrest, Aziga had changed, learned of the health risks posed by his condition and would not repeat the same behavior.

Copyright © 2011 AFP.

 

US expands no-cost women's health services

By Kerry Sheridan (AFP) – 1 August, 2011

WASHINGTON — Birth control pills, breast-feeding equipment and HIV testing will be covered under US health plans at no cost to women beginning next year, but a religious exemption has some advocates fuming.

The US government on Monday announced the sweeping changes that should save US women hundreds of dollars per year by eliminating partial co-pays and deductible limits on eight preventive care services.

Women's advocates hailed the move as a major advance but expressed disappointment over a clause that exempts religious groups, while conservatives blasted the plan for including free access to emergency contraceptives.

"These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need," said Department of Health and Human Services Secretary Kathleen Sebelius of the rules, which take effect in August 2012.

The changes are part of President Barack Obama's health care reform initiative, the Affordable Care Act, signed into law last year.

"The end of co-pays for birth control is the biggest victory for women?s health in a generation," said Nancy Keenan of NARAL Pro-Choice America.

"It will allow a woman to choose the birth-control method that she and her doctor agree works best for her, whether that's a pill, patch, IUD, or something else."

Among the services to be covered are "FDA-approved contraception methods and contraceptive counseling; breast-feeding support, supplies, and counseling; and domestic violence screening and counseling," HHS said.

Also included are annual office check-ups, or well-woman visits, screening for gestational diabetes, human papillomavirus (HPV) testing for women 30 and older, sexually transmitted infection counseling and human immunodeficiency virus (HIV) screening and counseling.

An amendment was added to the rules to allow religious institutions that provide health insurance for their employees to decide "whether or not to cover contraception services," HHS said.

The National Organization for Women joined a host of women's advocacy groups in applauding the changes, but took issue with the religious loophole.

"Forcing insurance companies to cover contraception is one of the most important things you can do for women's health," NOW president Terry O'Neill told AFP.

"The fanatics who want to withhold birth control from women should not be coddled by the secretary of health and human services, so we are deeply disappointed that she would do this."

Catholics for Choice president Jon O'Brien said Obama's administration "has once again sided with the Catholic bishops over the needs of women and their families."

But the conservative Family Research Council's Jeanne Monahan said the religious exemption did not go far enough, describing it as a "fig leaf of conscience protection for certain churches that fulfill very specific criteria."

She also highlighted the group's concerns over coverage of two emergency contraceptive options, which can be taken up to 72 hours after unprotected sex to prevent pregnancy.

"This administration is promoting mandates that will violate the consciences of millions," she said.

The recommendations were made by the Institute of Medicine (IOM) in a July 19 report that urged that the health services be covered in order to improve the state of women's health.

Women in the United States tend to face higher costs to maintain their health than men because of a range of reproductive conditions that are unique to them. Often, private health insurance covers only part of the annual costs.

The IOM said that DNA tests for HPV could cut back on cervical cancer rates, and free access to lactation counseling and equipment could boost rates of breastfeeding by new moms, a practice that is considered beneficial to babies' health.

Free access to contraception could also cut back on the rate of unintended pregnancies in the United States , where about half of all pregnancies are unplanned, the IOM said.

The US government said that health plans could save money by "continuing to charge cost-sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use."

According to the Guttmacher Institute, 98 percent of American women have used contraception at some point in their lives.

A 2010 study in the journal Contraception said that average out-of-pocket expenses for contraception were about $168 per year, making up 29 percent of a woman's annual self-paid costs for health care.

Copyright © 2011 AFP.

 


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