World AIDS Day was on December 1, 2009- Did you notice?

Each year, despite the ever growing AIDS epidemic, it seems that media coverage of World AIDS Day steadily decreases. Started on December 1, 1988, the objective of World AIDS Day has been to increase awareness about the AIDS epidemic, raise money and to help to dispel the myths, sterotypes and prejudices that continue to abound. The theme for this year's World AIDS Day theme was 'Universal Access and Human Rights'.

According to UNAIDS estimates, there are now 33.4 million people living with HIV, including 2.1 million children. In 2008, 2.7 million people became newly infected with the virus and an estimated 2 million people died from AIDS. Approximately one-half of all people who become infected with HIV do so before they are 25 and are killed by AIDS before they are 35.2

2008 also achieved another somber milestone: HIV/AIDS is now the leading cause for women internationally. Maybe its just me, but as HIV/AIDS becomes younger, darker and impacts more women, is there any coincidence that it falls further off of our radar screen.

Obama Lifts HIV Travel Ban

On October 30, 2009, President Barack Obama announced that the United States would be doing away with its 20 year old ban preventing people living with HIV/AIDS from entering the country. The U.S. has been one of about a dozen countries that bar HIV+ travelers. The change will officially take place starting January 1, 2010, after a 60day waiting period. The ban was established in 1987 when there was widespread fear and ignorance about HIV. The federal government's tried to eliminate the ban in 1991, but was thwarted by Congress. In 1993, Congress made HIV infection the only medical condition specifically listed as ground for inadmissibility to the U.S.

While many may feel that such a law protected Americans from HIV infection from immigrants and travelers, there has been no evidence that it has done so. In reality, HIV rates continue to soar, especially among the poor and minorities. The law also had other adverse consequences by keeping out hundreds of thousands of tourists, refugees and students. Another impact of the law was the unforseen obstacle that it created for the international adoption of children with HIV. Moreover, no major international HIV/AIDS conference has been held in the U.S. since 1993, because HIV-positive activists and researchers were not allowed to enter the country.

The elimination of this law is another example of how the Obama Administration may have begun to turn the corner pertaining to the HIV/AIDS epidemic. However, there is still a long way to go.

New HIV Vaccine Shows Promising Results

Researchers and HIV/AIDS activists are have been encouraged by the results of an experimental HIV vaccine. According to a Wall Street Journal/Associated Press report: "For the first time, an experimental vaccine has prevented infection with the AIDS virus." The vaccine reduced the risk of HIV infection by more than 31%. While this result may not seem overwhelming, it is a significant moment in the often frustrating race to find a vaccine for HIV. Previous efforts have resulted in failure after failure. One such effort, Merck's experimental Phase II vaccine trial which began in late 2004 and involved HIV-negative volunteers was stopped after the experimental vaccine failed to prevent HIV infection in participants or prove effective in delaying the progression of the virus to AIDS. As a result, several vaccine trials were being postponed or modified following the abrupt halt of Merck's vaccine trial. As a result of so many recent failures, many researchers had begun to feel that a vaccine might not be possible and that resources should be redirected to new techniques to prevent HIV infection such as microbicides and cheaper versions of the female condom.

However this new HIV vaccine trail, involving 16,000 volunteers in Thailand, might just provide new hope. The new vaccine combined two previously ineffective ones: the first to rouse the immune system to launch an attack on the virus and the other to strengthen the response. Researchers caution that we are still a long way away from implementation of widespread immunization of any type of vaccine. However, for the first time, scientists and epidemiologists are expressing optimism that a HIV vaccine is possible.

Every day, 7,500 people world-wide are newly infected with HIV and two million died of AIDS in 2007 , according to the U.N. agency UNAIDS.

Demonizing HIV

AIDS activists have been buzzing lately about a new German HIV awareness advertisement depicting a woman having sex with Adolph Hitler. By now, I am sure you are wondering: what does the Fuhrer have to do with AIDS? Well, in the ad, which is available online, a heterosexual couple is seen having sex. The man's face becomes that of Adolph Hitler followed by a slogan describing AIDS as a "mass murderer. Print versions of the campaign also use Saddam Hussein as well as other despots.
The company that created the campaign, Das Comitee, defended the advertisement stating that it was meant to show "the ugliness of the illness."

I understand the philosophy of using 'shock value' to get people's attention. Its discomforting to realize that in 2009, we have to 'shock' people to make them aware of HIV/AIDS. However, the designers of this campaign are obviously missing something and it underscores the danger of developing public awareness campaigns in a vacuum-with vetting them with a diverse audience, especially people living with HIV. Now, I don't know for sure if that was done. However, given the tremendous stigma associated with HIV, I would hope that someone would have realized that many people viewing the ad would associate the people living with HIV with these dictators. Despite good intentions, it's the wrong message!

HIV Testing

Few would argue that HIV testing is one of the most vital tools in addressing the HIV epidemic. But, does everyone feel that way, or even understand the significance of knowing his/her HIV status. A recent study conducted by the Kaiser Family Foundation (June 2009) found that despite efforts to encourage more HIV testing, including making it a part of routine medical care, "reported rates of HIV testing have remained flat over time." In fact, the share of non-elderly (ages 13-64) who report having been tested within the last year has not changed in over a decade. Although some groups, such as African Americans, Latinos and young adults are more likely to report having been tested, even their rates have remained virtually unchanged over the last several years. In 2009, less than one-half of the adults in the United States say that they have ever been tested.

Another study conducted by the Centers for Disease Control (Morbidity and Mortality Report-June 27, 2009) suggests that many people do not submit to HIV testing until late into the course of their infection. In the study, 45% of the testers progressed to a full blown AIDS diagnosis within 3 years of their positive HIV test. More troubling is that over a third (38%) progressed to full blown AIDS within a year. Moreover, minorities, especially African American men, were more likely to progress to full blown AIDS within 3 years of HIV diagnosis, e.g... were late testers.

The moral of the story, get tested: even if you do not think you are at risk. Too many people are apparently waiting until they get sick to get an HIV test. Consequently, they are giving HIV a head start and limiting the possibilities for successful treatment. HIV may be becoming a chronic disease, but the quality of life may be significantly improved by early testing and treatment. So, what are you waiting for?

Zoonoses

Confused? I had not heard of that word either, until I did a little research for this blog about animal to human disease transmission. Zoonoses are emerging infectious diseases that have transferred to humans from animal hosts. I embarked on this research after learning of the discovery of a new HIV strain thought to have originated from gorillas native to Cameroon. This makes the fourth documented strain of HIV: strain "M, the most common and "N," "O" and now "P." The latter three seem to manifest themselves primarily from the Cameroon region.

With so much evidence available that HIV is a Zoonose; ie..., that it originated from an animal host, in this case, chimpanzees, then why do so many people still believe that the HIV epidemic is a government conspiracy or some equally paranoid theory. In fact, most of the temperate diseases (found in temperate of tropical climates) such as measles, mumps, rubella, smallpox, influenza A and tuberculosis, are believed to have come from domestic animals. Moreover, most of the major infectious diseases also originated in animals: West Nile, Mad Cow, Cholera, Syphilis, Malaria, Ebola, Lyme Disease, Hantavirus, SARS, Swine Flu.

Clearly we need a little science lesson. Its time to jettison the conspiracy theories and understand that WE, our behavior, our ignorance, our intolerance and our apathy pose our greatest risk for HIV infection, not a government test tube!

Men are Driving The HIV Epidemic

That's right, I said it: its men who are driving this epidemic. For all of the talk about the disproportionate impact of HIV on minority women, who do we think are infecting them: men. By the way, the fastest growing population being infected with HIV is not women; its young black men who have sex with men (MSM) between the ages of 13-29. Overall, there are 30,000 new HIV infections annually among MSM. Now before you go into the "AIDS is a gay disease mode," we must remember that gay and bisexual men probably make up a small percentage of men overall. We have to stop focusing so much on labeling people: "gay," "straight," "down-low," etc.. Many people are resistant to accepting certain labels. A man who primarily has sex with women but occasionally also has sex with men, may consider himself straight. Likewise, the incarcerated man who see his sex with another man in prison, a partner who by the way, may be officially labeled in the prison as a "b***h," therefore making it more socially acceptable. The focus has to be on responsibility such as: knowing one's HIV status; prompt diagnosis and treatment of sexually transmitted infections and last but not least; safe and safer sex. So for the men reading this, the 'ball's in your court.' Man-up!

Adolescent Hopelessness and HIV

A new report published in Healthday News on Jun 29, 2009, has found that almost 15 percent of American adolescents believe that they will die before age 35, a belief that may be strongly linked to unsafe behavior. Greater than one in seven youths have a pessimistic view about their future mortality and are more likely to take risks. The findings, published in the July issue of Pediatrics, are based on a three-year study of attitudes and behaviors among 20,594 teens from the 7th through 12th grades. The teens were asked about their views on personal mortality as it related to behaviors such as attempting suicide, using illegal drugs, sustaining fight-related injuries that required medical care, engaging in unprotected sex, being arrested by the police and contracting HIV or AIDS. Other important findings included:
*Race and wealth were important variables. While 10 percent of
white teens expressed this pessimism, 21 percent of Hispanic teens and 26
percent of African American youth harbored this fatalistic view.
*Adolescents who predicted a short lifespan were more likely to engage in risky
behavior, and teens who engaged in risky behavior (throughout the first year of the
study) "were more likely to develop a pessimistic view of their future."

Clearly, more needs to be done to both assess these attitudes early on, especially for minority and low income children, and to make every effort to develop programs that help to instill a sense of optimism and hope. Without this new focus, we will continue to raise a generation of children who feel that "they have nothing to lose."

Obama and HIV

As with most things its a good news, bad news scenario. Clearly, Obama is more in tune with the AIDS epidemic than his predecessor. He has proposed a budget increase for domestic HIV prevention and direct services. Moreover, his administration will soon launch Act on AIDS, an ambitious 5 year social marketing campaign to raise awareness of HIV/AIDS and encourage people to get tested. Sadly, however, his 2010 budget cuts funding to fight AIDS globally, cuts funding for federal AIDS housing, and fails to lift the federal ban on syringe exchange.

What people, including AIDS activists, need to realize is that he is playing with a shaky hand. Our nation is mired in the deepest recession in years, he is constantly under siege by the Republican party and he is trying desperately to hold onto a shaky coalition of "Blue Democrats," ie.. conservative Representatives from formerly Republican controlled states. He also has very ambitious plans for climate control and health care. So the question is: what are our expectations? I too, am a little disappointed but, I understand that he has to pick his battles right now.

Will the recession increase HIV infection?

The answer is, probably. We all know that one of the first casualties of economic down times are programs that help those in the most need. Its hard enough to make ends meet when there is less money and rising prices. People who were living check to check can find themselves out on the street if that check stops coming. Now comes word that two states with the highest numbers of persons living with HIV/AIDS, California and Pennsylvania, may be making significant cuts in vital HIV prevention and direct care services. The Governator (Arnold Swarzenegger) is proposing 55.5 million in funding cuts to HIV prevention, education and treatment programs. The Republican version of the state budget proposes to cut PA State AIDS Programs by 25%. Sadly, some of the proposed cuts could jeopardize federal matching funds, further spreading the pain.

It s not to late to send a message to state government legislators that cutting HIV/AIDS funding as well as other services to the poor and disabled in the midst of a surging epidemic is penny wise and pound foolish and will only exacerbate the problem.

A new survey by the Kaiser Family Foundation recently reported that, less than a year after the CDC revised their HIV statistics to reflect that the U.S. HIV epidemic is much larger than previously reported, the public’s sense of urgency is unexpectedly low. Some of the key findings were:

• Only six percent of American felt that HIV was the most urgent health problem facing the nation. Only 40% of African Americans and 35% of Latinos see it as a "more urgent" problem now than in 2006.
• Over one-half (51%) of the public says they would be uncomfortable having their food prepared by someone who is HIV positive.
• One-third (34%) of Americans incorrectly believe or are unsure whether HIV can be transmitted by one of the following actions: sharing a drinking glass (27%), touching a toilet seat (17%), or swimming in a pool with an HIV positive person (14%).
• Nearly one in five (18%) do not know there is no cure for AIDS and about one-quarter (27%) believe or are unsure whether former professional basketball player Magic Johnson has been cured of AIDS. Moreover, many misconceptions are more common in the African American community: 37% of African Americans thinks that Magic Johnson has been cured or are unsure; 36% believe that there is a vaccine available to prevent infection and; 30% believe that there are drugs available that can cure HIV and AIDS.

I am speechless. Its hard to believe after of this all of this time that we still have so many people who are so uninformed.

Obama launches new HIV/AIDS Awareness campaign

Today the White House announced a new initiative through the Department of Health and Human Services and the Centers for Disease Control and Prevention to launch a $45 million campaign to raise awareness on AIDS, an issue the President has spoken passionately about for years. This is the first federally funded national domestic HIV/AIDS campaign in almost twenty years. It appears that the program will especially target the African American community. The first phase will encourage people to be tested for HIV. Stay tuned!

Hey Pope, Can I have a moment with you...

Pope Benedict XVI recently stated that condoms are not the answer to the AIDS epidemic in Africa and can make the problem worse. His comments have set off a firestorm among, even many Catholic clergy who have dedicated their lives to helping people living with HIV around the world. I understand the Catholic Church's positions on fidelity and its overall teaching against artificial contraception. However, to state that condoms actually worsen the problem is going too far. Leaders, like Pope Benedict, what they say. the AIDS epidemic is no ordinary health problem and it will take extraordinary efforts to win this battle. Here's hoping that the Pope wakes up and chooses his words more carefully.

I just read a sobering story about the first person to be convicted in Idaho of knowingly spreading the HIV virus. This gentlemen, a term which I use loosely, who has served two jail terms for the same offense, is now facing new charges for the same offense. A grand jury on Tuesday returned an indictment charging him with seven counts of knowingly transferring the HIV virus. He has already served two separate jail terms of 3 and 7 years respectively. I hope that they finally put this serial perpetrator away. However, lost in this story is the fact that people continue to have umprotected sex and place themselves at risk despite the publicity about HIV and other sexually transmitted infections. Know your HIV status, but also insist that your partners get tested as well.

The Power of Protest

On February 12, 2009, organized by a Washington D.C. -based labor group called Change to Win, BEBASHI, CHOICE and a number of other organizations and individuals protested in front of the CVS store at Broad St. and Girard Avenue against their practice of locking up their condoms in the in targeted areas where mainly people in poverty reside and/or in predominately African American areas. While BEBASHI recognizes the right of retailers to display their merchandise as they see fit, they should also take into consideration the communities where they have chosen to place their stores. In this case, with HIV ravaging low-income communities, especially among the young, this policy, while probably designed to limit theft, also serves to discourage shoppers for buying condoms if they have to track down a busy store employee to find a key. As a result of the protest, CVS now displays some condoms in more convenient areas in more stores.

Who's infected and doesn't know it

Recent data from the CDC provides more detail about the approximately 232,700 living in the U.S. living with HIV who do not know it:

• Over 113,000 are African American
• Men infected through heterosexual contact (male/female) were more likely to be undiagnosed that either MSM (male-male) or hetersexual women.
• Almost half (47.8%) of the young people (ages 13-24) living with HIV were undiagnosed, a greater proportion than any other age group.

Clearly, HIV testing remains a essential tool to addressing the HIV epidemic. At least one quarter (1/4) to one-half (1/2) of all new HIV infections are transmitted by undiagnosed people. Studies show that most HIV diagnosed people make an effort to protect their partners. Moreover, early detection is a key to successful treatment.

Are you positive that you're negative (for HIV) ?

CONDOMnation I

On December 11, 2008, an FDA advisory panel unanimously recommended the approval of the FC2, a new female condom. The FC2 would be 30% cheaper than the current version, even though male condoms are much less expensive. A cheaper female condom, if widely distributed, could prevent tens of thousands of HIV infections worldwide in part because it allows women to take the lead in protecting themselves. Nationally, the rate of AIDS diagnoses for black women was nearly 23 times the rate for white women and high-risk sexual contact was responsible for 74 percent of those infections. Lets hope that the FDA gets it right and approves the new female condom soon.