Day two of the International AIDS Conference of 2010

Day two of the International AIDS Conference of 2010 began with a bang: an address at the opening plenary by former President Bill Clinton. As expected, it was standing room only. Prior to today, I had only gotten a glimpse of the sheer number of delegates present. However, it was at the Clinton address that I began to see just how many people are here. It is truly amazing-So many people of different hues, nationalities, and roles: physicians, researchers, representatives from government and non government entities and, of course, people living with the virus.

As you can imagine, the address from former President Clinton was thoughtful and moving. I was first struck by his knowledge of the issue (of HIV/AIDS). His address covered many areas. For example, he spoke of the work of his foundation in countries as varied as the Ukraine to Zambia. He also spoke about the progress being made especially in reducing mother to child transmission and in increasing the number of people living with HIV who receive life-sustaining medication. He challenged us to spend our limited HIV funds more smartly before we demanded more. He even acknowledged that, as President of the United States for 8 years, how he did not do enough about HIV/AIDS. However, being the politician that he is, his most controversial statements covered the direction that he believes we should take for activism. While acknowledging the rights of activists to protest whatever and whoever they choose, he also reminded those who have recently protested President Obama for his failure to fund PEPFAR at the level that he ‘promised,’ that his (Obama’s) commitment came long before the almost complete economic collapse of our country. I acknowledge that my respect for Bill Clinton had dwindled as a result of his tactics in campaigning for his wife Hillary against Obama. Therefore, I was even more pleased to hear his common sense defense of President Obama, Former President Clinton expressed that activism would be better served by putting more pressure on Congress to cooperate (yes, I used the words ‘Congress’ and ‘cooperate’ in the same sentence) with the Obama administration and to appropriate more funding.

This raises a very controversial topic: Just how much ‘slack’ should Obama receive. As the first Black president, Obama, unfortunately was given an extremely rotten hand to play: two long, expensive wars; financial instability; and a totally uncooperative Republican party, to name a few. Should we wait for some of the smoke to clear before we go on the attack? Does his successful push for more health care in the United States count for anything? At the heart of the matter is, do we really trust him? Can we trust any politician?

I believe that it is a delicate balancing act between maintaining consistent, but flexible pressure on all of the powers that be, including Obama, but at the same time ‘turning up the heat,’ as it were, on those who have historically opposed universal health care. Personally, I am grateful for the contributions thus far and in anticipation of those to come from these two great men: Clinton and Obama.

Goodbye from Vienna. Will be in touch tomorrow!

Day One of the International AIDS Conference of 2010

Day One of the International AIDS Conference of 2010, but Day Three for me in Vienna, Austria. This is a time of ‘firsts’ for me. This is my first International AIDS Conference and my first time travelling to Europe . I am attending the conference as a delegate of BTAN, the Black AIDS Treatment Network of the Black AIDS Institute. My day job is as the Executive Director of BEBASHI- Transition to Hope; the first Black AIDS Services Organization in the country which is, this year, commemorating its 25th anniversary. I was honored to be chosen for this important job that will include a three year commitment and will involve creating a treatment advocate/education initiative in Philadelphia. It was a difficult trip. I am sure that veterans of international travel will understand, but I have certainly learned a few lessons. However, so far, it has been well worth it. When I told my collegues that I would be attending the conference and that it was in Europe, I was meant with virtually universal support. However, whenever I embark on a new endeavor or initiative, I have trained myself to ask a crucial question: What for? In other words, why an international AIDS conference when the focus of my career has been to help primarily minority people in the Philadelphia metropolitan area. To be blunt: how will learning more about HIV/AIDS around the world help poor black folks in Philly? It’s an important question but one that was easily answered in my first two days of meetings and presentations. While I expect this to be (and it has so far) been a life changing experience, I will summarize the main expectations in three ways:
1. Information: With eight days of meetings, presentations, poster sessions as well as informal conversations and networking, I have already begun to learn a great deal especially about new trends, interventions, etc... that I can utilize in my work in Philadelphia. For example, yesterday, I attended a special session facilitated by the Black AIDS Institute that featured some of the best minds in African American HIV/AIDS Treatment, Policy and Care, including Dr. Kevin Fenton of the Centers for Disease Control, Dr. Helene Gayle, of CARE and United States Representative Barbara Lee. Their words and careers have been an inspiration to me and I valued the opportunity not just to hear, but to meet them.
2. Context: Another program that I attended today was a meeting facilitated by the African and Black Diaspora Global Network on HIV and AIDS (ABDGN). Launched at the International AIDS conference in Toronto Canada in 2006, ABDGN's mission is to strengthen the response to emerging HIV/AIDS epidemics among African and black communities in the Diaspora. While I am certainly aware of the existence of black people in many countries around the world, this session, as well as the one sponsored the day before by the Black AIDS Institute, helped to remind me of the devastation of HIV, not just in Sub Saharan Africa and the Caribbean, but among other black people including those in Canada, Germany, France, England, etc… As a loooong term HIV/AIDS activist (since 1987), I and many like me have struggled to get our folks in the United States to recognize that while this is a global epidemic, that the United States is a part of that globe. Yet, we cannot lose sight of the fact that there are no walls around the United States and some of those very same people, my brothers and sisters from the Diaspora, may end up here. Moreover, we cannot allow others around the world to suffer because of the lack of information or access to treatment that is readily available to us. An International AIDS Conference helps to remind me of something that we actually have printed on one of BEBASHI’S T-Shirts: “One World, One Epidemic.”
3. Contribution: This final theme is one that hasn’t really happened yet and that is: What will my contribution be; both to this Conference and to my community. The final presentation of the day that I attended was on the United States National HIV/AIDS Strategy. There have been Strategic Plans, such as the one led By Dr, Helen Gayle when she was at the CDC, to cut the number of new HIV infections in half; yet there has never been a true United States Strategy. Without elaborating too much on the plan, it focuses on three primary goals: Reducing the number of new infections; increasing access to care and optimizing health outcomes for people living with HIV/AIDS and; reducing HIV-related health disparities. Needless to say, even though developing the strategy was not an easy task, now comes the hard part: implementing it.

Goodbye from Vienna. Will be in touch tomorrow!

Does Pregnancy Pose an HIV Infection Risk for Men?

Previous studies have demonstrated that pregnant women are at greater risk of HIV infection. However, a new study, presented at the International Microbicides Conference in Pittsburgh in May seems to demonstrate that men have almost double the risk of HIV infection if their partner is pregnant and HIV+. The study, conducted in 7 countries in Africa, involved over 3,300 serodiscordant (one partner is HIV+ and the other is not) couples. Over two years and 800+ pregnancies it was demonstrated that pregnancy increased the risk of HIV infection for both males and females. The study reports that several factors other than pregnancy, such as sexual behavior, probably contributed to the increased risk for women. However, even when accounting for those factors and even circumcision, the heightened risk for men seemed much more direct. The researchers theorized that certain physiological and immunological changes that occur in a woman during pregnancy may be behind this remarkable finding. Therefore, further study to zero in on these changes is warranted. However, for those who may feel that pregnancy gives one a 'free pass' as far as the concern of the woman getting pregnant, this study demonstrates that it is even more imperative to use protection, especially if HIV status is unknown.

New Developments in HIV Eradication

One of the most persistent myths about the HIV epidemic is that the government (or the other perceived villain- pharmaceutical companies) have discovered a cure but that, for whatever reasons, have not made it available. This reasoning fails to take into account the complexity of vaccine development in general, not to mention the unique challenge of curing HIV. One of the crucial steps to finding a cure involves eradicating all of the virus from the body. Complicating this are stubborn reservoirs of HIV that remain in the body and seem out of reach of antiretroviral medication. These reservoirs consist of old CD4 cells that preserve latent HIV throughout the body, essentially storing, or 'archiving' it for decades. Therefore, even though antiretroviral medication may significantly reduce viral reproduction and clear the host of most HIV virus, they never completely purge HIV from the body. When the medication is interrupted or ceases its effectiveness, because of viral resistance, this reservoir can become reactivated, ensuring more viral replication and eventually, more illness. Therefore, the inability to eradicate HIV from the body has been the main stumbling block towards finding a cure.

However, recent developments by Dr. Robert Siliciano of Johns Hopkins University has brought new hope that HIV eradication may be achievable. Dr. Siliciano believe that there are two reservoirs of old (or latent) HIV, one that consists of what are called CD4 memory cells. These cells are created to combat various infections that we have developed, such as measles. HIV meds are only effective against cells infected with HIV that are active. However, activating all memory cells simultaneously can be dangerous. Therefore, the goal is to activate only those cells that are infected with HIV, so that the HIV meds can, in effect, take them out. Dr. Siliciano and group have found a handful of compounds that they believe may selectively activate HIV infected cells. The trick will be finding compounds that will be safe in humans.

Sound complicated? Well this is just a small glimpse of the work being done all over the world to either create a vaccine for HIV, or to find a cure. However, as this brief snapshot demonstrates, it is a very difficult, frustrating and costly endeavor. Therefore, we should be more appreciative of the efforts of researchers such as Dr. Siliciano and his colleagues or Michael Swanson, a doctoral student at the University of Michigan and his group who have discovered a lectin (naturally occurring chemicals in plants that bind to sugars on the surface of disease-causing microorganisms such as viruses) found in bananas, that might lead to the development of inexpensive microbicides to prevent HIV transmission or even new treatments.

In the meantime, while these dedicated researchers wage their own battle in laboratories around the world, we to must do out part to reduce HIV infection: Prevention.

A New Super Villain: Gonorrhea?

We used to call it venereal disease. Many preferred the more common term: "The Clap." Eventually, a more appropriate term evolved: sexually transmitted disease. Recently, the term "disease" has been exchanged for "infection." Whatever name it was called, we all knew that Gonorrhea, while embarrassing and painful, was also curable. In other words, many felt that is was just a minor inconvenience.

Now comes new information that a strain of Gonorrhea may be evolving into a "superbug," a drug resistant bacteria that will be much harder to treat. Speaking at the Society for General Microbiology’s spring meeting in Edinburgh, Scotland, Catherine Ison, a microbiologist with the Health Protection Agency in London, reported that the bacteria Neisseria gonorrhoeae has become multi-drug resistant and threatens to make the STI more and more difficult to treat. Gonorrhea infects approximately 700,000 Americans a year, with the highest infection rates in the U.S. among teens, young adults and African Americans, according to the Centers for Disease Control and Prevention. Gonorrhea can infect the eyes, throat and mouth as well as male and female genital areas. For decades it has commonly been treated with first tier antibiotics such as Penicillin. Now, even newer medications such as ceftriaxone and cefixime may be becoming less effective. According to Dr. Ison, "choosing an effective antibiotic can be a challenge because the organism that causes gonorrhea is very versatile and develops resistance to antibiotics very quickly."

Multi drug resistance is not a new phenomenon. We have struggled with it for years in HIV treatment, as well as in treatment a variety of infections such as Staph, MRSA, and Campylobacter Bacteria (one of the most common causes of diarrheal illnesses in humans). One potential culprit to this phenomenon is the increase of antibiotic use in farm animals. Recently, "major increases in antibiotic-resistant bacterial infections in human populations have led to public health concerns regarding antibiotic use for non therapeutic purposes (i.e., not used to treat disease) in animals destined for food production," according to a statement by the Pew Charitable Trusts. "Bacteria are able to develop antibiotic resistance when exposed to low doses of drugs over long periods of time. To promote growth and weight gain, entire herds or flocks of farm animals are routinely fed antibiotics and related drugs at low levels in their feed or water — a practice that has been identified as a major contributor to antibiotic resistance."

Gonorrhea is often asymptomatic in women and can be mistaken for a bladder or vaginal infection with symptoms such as painful urination and vaginal discharge. Men may experience a burning sensation when urinating as well as painful or swollen testicles. Untreated gonorrhea can cause infertility in both sexes, join infection and, when passed by a pregnant woman to her fetus, blindness and a life-threatening blood infection in babies. Moreover, sexually transmitted disease can make one more vulnerable to HIV infection.

Yet, as with most sexually transmitted infections, Gonorrhea is 100% preventable. The answer is not rocket science. It's about making better choices, knowing one's partner, getting screened for STI'S and good old fashioned safe (abstinence) and safer (condoms, dental dams, etc) sex.

African American Women and STI'S

Recent news has not been kind about women and girls of color and their sexual health. In 2008, a Centers for Disease Control and Prevention (CDC) study reported that almost one-half of adolescent black females were infected with at least on STI (Sexually Transmitted Infection). Now, new evidence has further documented the impact of STI'S on women and girls of color. According to the CDC, 48 percent of black women between ages 14 and 49 have the virus which causes genital herpes. Blacks in general are more than three times as likely as whites to have herpes simplex virus type 2 (HSV-2) (39.2 percent vs. 12.3 percent). Biological factors make women more susceptible to genital herpes than men. American women in general are nearly twice as likely as men to be infected (21 percent vs. 11 percent). Moreover, up to 80 percent of genital herpes infections in the United States are undiagnosed.

The news is no better on the local front. A recent report from the Philadelphia Department of Public Health revealed a dramatic 238% increase in primary and secondary cases of Syphilis in females. Many of the cases in females occurred in adolescents and young adults aged 15-24 years old.

The high rates of genital herpes infections and syphilis, as well as other STI'S among women of color, may contribute toward the high rate of HIV in the black community by making transmission easier. In 2007, more than 25% people infected with HIV in the United States were among women and girls aged 13 years and older. More than 278,000 women and adolescent girls in this country are living with HIV. For female adults and adolescents, the rate of HIV/AIDS diagnoses for black females was nearly 20 times as high as the rate for white females and nearly 4 times as high as the rate for Hispanic/Latino females.

Last year, the CDC implemented new guidelines to encourage HIV testing to be a part of routine medical care. Clearly, sexually transmitted infection screening should also be a part of this routine care. Significant progress in reducing the spread of HIV in Sub-Saharan Africa has been made by preventing, diagnosing and treating STI's. It's time we apply these priorities in this country, especially in women and girls of color.

Don't Believe the Hype

I recently ended a very frustrating e-mail correspondence with a well meaning, yet uninformed woman who originally contacted me to sing the praises of a herbalist who she claims has cured HIV (and lupus and cancer, by the way). In response to my polite skepticism, she directed me to his website where the "documentation" of his alleged success (and no doubt the pictures from his Nobel prize for medicine) could be found. Needless to say, I found no concrete evidence that his treatments cured anything, let alone HIV. Most troubling was her insistence that his claims were "proven." It reminds me of another conversation with a gentleman who read a book written by a dietitian who claimed that he had evidence that there was no link between HIV and AIDS. Supporting his claim were 1500 people who placed their name in the book indicating support of this theory. Not one, of course, held any reputable position at any research institution or university.

Those of us who have worked in the HIV/AIDS field have experienced communication with people who are convinced that there is a cure for HIV and that either:
1. The Government has it and wants "black people to die so they are hiding it or;
2. The Pharmaceutical companies have it but want people to keep spending money on
medication or;
3. Some other individual (usually an alternative medicine professional) has it but
the government and pharmaceutical companies have banded together to stop it
from being distributed.

We call these beliefs: "Conspiracy Theories." The troubling thing about these theories is less that a few individuals will submit to an unproven treatment and possibly have there hopes dashed, but that many of us are so willing to believe in theories and claims with so little basis in fact. Moreover, there cynicism makes HIV prevention efforts that much harder.

I pray that, one day, a cure for HIV/AIDS is found. However, HIV is a very difficult viral adversary, perhaps one of the most difficult that we have every encountered. Many of the greatest minds in the world have been struggling, without success to find a vaccine or a cure. Maybe, one day, someone will find a natural substance or treatment that will cure HIV. But, shouldn't that individual be required to subject that treatment to the rigors of science to prove, not only that it works, but that it doesn't harm the patient? Don't get me wrong, I believe that we should should not blindly believe everything we are told. Moreover, there are many non-medication treatments such as accupunture and light therapy (for Seasonal Affective Disorder)that work! Yet, why are we so willing to embrace treatments that have never fully been studied, but reject those with reams of documented evidence supporting them-not just for HIV, but for other conditions such as mental illnesses? Many cite the Tuskegee study as the underlying reason for this skeptisism, but many people to whom I speak, have never even heard of the Study. Clearly, the scientific and medical communities have a long way to go to regain the trust of the American Public. Until it does, we will continue to see people shun, and even reject modern medicine, often to our detriment.