People living with HIV are invited to participate in an online survey on HIV and employment in Canada. The purpose of this survey is to learn more about the education, training, employment and health needs of people living with HIV. Our ultimate goal is a national network that will provide employment support, information and advocacy opportunities for people living with HIV whether in or out of the workforce. Your responses to the survey will inform us on the employment-related issues that matter to you most.

The survey is available electronically and will take approximately 25 minutes to complete. You will be able to save survey responses and then submit the final version at a later date. If you would like to request a hardcopy of the survey please send your contact information to the address below.

You do not have to give personal information and we do not plan to publish personal information. If this plan changes, we will only do so with your agreement. You have the right to opt out of any question(s) at any point throughout the survey. You may choose to provide us with contact information if you would like to be kept updated on the progress of this project.

The link to the survey is provided below. The survey will be open for responses through Friday, March 13. This opportunity is unique to people with HIV. We look forward to your response to the survey.

http://www.surveymonkey.com/s.aspx?sm=BxPMtNFSCtrk5n1CZTiWPQ_3d_3d

March 13, 3009

Vancouver - Employees of inSite Housing, Hospitality and Health Services in British Columbia have voted 95% in favour of accepting a first collective agreement.

The agreement, which covers 125 inSite employees across the province, includes wage increases, shift premiums and a signing bonus. The workers are represented by the B.C. Government and Service Employees' Union (BCGEU/NUPGE).

"It's always exciting when new BCGEU members ratify their first contract," says BCGEU president Darryl Walker. "It means that they will now have protections like a grievance procedure, shop stewards, strong health and safety language and, of course, higher wages."

Workers from inSite's operations have been voting to join the BCGEU since July 2008. BCGEU was granted certification for all inSite employees province-wide on Nov. 19, 2008.

InSite provides independent, supportive and assisted living to seniors. Currently, inSite has operations in Vancouver, West Vancouver, Port Coquitlam, Winfield, Barriere, Quesnel, Revelstoke, Sicamous and Ashcroft. It plans to open a new facility in Kelowna this summer.

NUPGE

The National Union of Public and General Employees (NUPGE) is one of Canada's largest labour organizations with over 340,000 members. Our mission is to improve the lives of working families and to build a stronger Canada by ensuring our common wealth is used for the common good.

http://www.nupge.ca

March 18, 2009

Vancouver - The RCMP say they have busted a pot-delivery operation that was masquerading as a compassion club that provided marijuana for medical needs.

Mounties in North Vancouver yesterday announced 13 people had been charged with trafficking in a controlled substance, following an investigation that began in September, 2007, after police received an anonymous tip through Crime Stoppers. The arrests put an end to the operation of the so-called Internet Compassion Association, police said.

"People would call them up and make their order. [The organization] would make the delivery," RCMP Corporal Marlene Morton said.

Cpl. Morton said the customers were not people with medical marijuana needs, but rather recreational drug users looking for a convenient source of product.

It's an unusual case, she said. "We have busted other dial-a-dope rings, but this is the first time I have seen one that has been passing themselves off as a compassion association," she added.

Police say they seized six kilograms of marijuana from a storage locker of the alleged ringleader of the operation, 39-year-old Jason Thon, who is charged with a count of trafficking in a controlled substance. Some arrests in the case were made in the middle of last month, with some suspects appearing in court late last week, but police announced details of the investigation only yesterday.

A total of 41 charges have been forwarded against various individuals, with more charges expected, police said. Arrest warrants are out for four individuals accused of being parties to the ring.

The B.C. Compassion Club Society said the group had caused some concern.

"It was definitely creating some confusion, and we were receiving calls from people looking for them and not aware we have much more stringent requirements for becoming a member," said Jay Leung, a spokesman for the non-profit organization that has been providing medicinal cannabis since 1997.

Mr. Leung said club officials did not contact police, but rather considered the whole situation a bit of a nuisance. "We set whoever called us straight," he said.

He said the club never had any direct contact with the alleged ring, and did not think it affected his group's credibility. But he said the ring might stir up lingering controversy around medical marijuana in society, despite its benefits.

"There's still this controversy, so the compassion clubs worked long and hard over the past decade to establish good practices and standards and establish our credibility," he said. "So it's problematic when people don't have those motivations, aren't following those guidelines but are just using the name in the hopes of protecting what they are doing."

By Ian Bailey, http://www.theglobeandmail.com

March 18, 2009

A generic drug company plans to halt the production and shipment of cheap life-saving HIV/AIDS pills to Africa unless changes are made to Canada's Access to Medicines Regime.

This has prompted concerns from Rwanda, which is the only country to receive medication under the regime, and comes amidst demands the government not turn its back on Africa as a whole.

Canadian generic pharmaceutical company Apotex became the first company to take advantage of the Access to Medicines regime when it shipped seven million pills to Rwanda last year. It will send a second batch in September, said Apotex public affairs director Elie Betito, after which time it will cease production unless the government amends the Regime.

"We are not ready to participate if the rules are the same," Mr. Betito said, though he did not sound optimistic the company's concerns would be addressed. "This government is not interested in reviewing [the legislation again]."

Parliament unanimously passed the regime—known at the time as the Jean Chrétien Pledge to Africa—in 2004.

The generic medicines regime is one of only a few in existence in the world and is based on an agreement hammered out by the WTO in 2003. The agreement loosened patent rules so generic drug companies like Apotex could work with the compulsory licensing of patented medicines and proceed with legally producing and exporting lower-cost versions of brand-name medicines to developing countries.

But by the time the government got around to conducting a mandatory review of the legislation in 2007, not a single pill had been produced and exported. While Apotex and others said the government needed to change the law to make it easier for developing countries and the company to take advantage of the legislation, the government ended up recommending no changes to the regime.

Despite the apparent setback, Apotex developed Apo-TriAvir, a combination of three medications in one pill, which is designed to prolong the life of most AIDS patients for years and costs two-thirds less than brand-name medications. Rwanda became the first country to receive the pills when a shipment arrived in September.

Though Rwandan officials said they had not been informed of Apotex's intention to end production, they were hopeful the company would not follow through on its threat.

"The bottom line is that experts from [Rwanda] selected Apotex because it provided a combination with fewer tablets and was cheaper," said Déo Nkusi, first counsellor at the Rwandan Embassy in Ottawa.

According to Dr. Jules Mugabo, from Rwanda's Treatment and Research Aids Center, which negotiated the Apotex deal, the African nation will have no choice but to wait and see.

"Being able to get the medication that our people need so much from Apotex was an opportunity we could not just leave," he said in an interview from Kigali, Rwanda's capital.

"We will go through the same process, from tendering to when the medication will reach us because we don't have control or any influence over those mechanisms."

The process for securing drugs continues to be the subject of criticism from the likes of the Canadian HIV/AIDS Legal Network, which says the whole thing can take more than four years and does not match the situation's urgency.

"It's an unnecessarily complicated process for the suppliers and the purchasers—and the people who end up paying the price are the patients, because this logjam doesn't end up getting broken," said Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network.

The current system requires a generic company to have separate negotiations with patent-holders and arrange a separate licence for each purchasing country, as well as each new order of medicines that follows.

What's needed instead, argued Mr. Elliott, is a "one-licence solution" that authorizes manufacturers to produce the same drug for export to any number of approved countries, rather than go through a renewal process every time.

This would allow faster, cheaper and ultimately more competitive pricing and markets for life-saving medicine, he said.

Critics also blame intense lobbying by brand-name pharmaceutical companies at the WTO and in Ottawa.

"For 12 years the response from the brand-name pharmaceutical industry has been: block it, stop it, slow it down, make it difficult, [and] harass the governments and generic drug makers," said Jeff Connell, director of public affairs with the Canadian Generic Pharmaceutical Association.

He said "big pharma intentions" were made clear when 58 multi-national drug companies "lined up" to sue South Africa, which had sought to change its Patents Act in 1998 as a vehicle to import cheap generic drugs from Brazil and India.

No other countries have sought to apply the Canadian legislation yet, but sources tell Embassy that Ghana did make preliminary contacts. Though Apotex said no governments have started the process for new orders, the Ghanaian Embassy in Ottawa did not rule out the possibility of direct contacts from its government back home.

Details are also emerging suggesting opposition MPs could table a private members' bill in both Houses proposing 13 specific reforms to CAMR. They have been courted by an alliance of numerous groups, and the bill should be in this March, according to people familiar with the process.

The United Nations estimates there are more than 30 million people infected with HIV/AIDS, more than 80 per cent of whom live in developing countries. In Rwanda some 290,000 people are living with HIV/AIDS with about 63,000 requiring antiretroviral treatment.

By Fred Mwasa, http://embassymag.ca

March 15, 2009

At least 3 percent of District residents have HIV or AIDS, a total that far surpasses the 1 percent threshold that constitutes a "generalized and severe" epidemic, according to a report scheduled to be released by health officials tomorrow.

That translates into 2,984 residents per every 100,000 over the age of 12 -- or 15,120 -- according to the 2008 epidemiology report by the District's HIV/AIDS office.

"Our rates are higher than West Africa," said Shannon L. Hader, director of the District's HIV/AIDS Administration, who once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe. "They're on par with Uganda and some parts of Kenya."

"We have every mode of transmission" -- men having sex with men, heterosexual and injected drug use -- "going up, all on the rise, and we have to deal with them," Hader said.

In addition to the epidemiology report, the city is also releasing a study on heterosexual behavior tomorrow. That report, funded by the CDC, was conducted by the George Washington University School of Health and Health Services.

Among its findings: Almost half of those who had connections to the parts of the city with the highest AIDS prevalence and poverty rates said they had overlapping sexual partners within the past 12 months, three in five said they were aware of their own HIV status, and three in 10 said they had used a condom the last time they had sex.

Together, the reports offer a sobering assessment in a city that for years has stumbled in combating HIV and AIDS and is just beginning to regain its footing. A more accurate accounting of the crisis offers a chance to contain what is largely a preventable disease.

So urgent is the concern that the HIV/AIDS Administration took the relatively rare step of couching the city's infections in a percentage, harkening to 1992, when San Francisco, around the height of its epidemic, announced that 4 percent of its population was HIV positive. But the report also cautions that "we know that the true number of residents currently infected and living with HIV is certainly higher."

The District's report found a 22 percent increase in HIV and AIDS cases from the 12,428 reported at the end of 2006, touching every race and sex across population and neighborhoods, with an epidemic level in all but one of the eight wards. Black men, with an infection rate of nearly 7 percent, carry the weight of the disease, according to the report, which also underscores that the District's HIV and AIDS population is aging. Almost 1 in 10 residents between the ages of 40 and 49 has the virus.

The report notes that "this growing population will have significant implications on the District's health care system" as residents face chronic medical problems associated with aging and fighting a disease that compromises the immune system.

Men having sex with men has remained the disease's leading mode of transmission. Heterosexual transmission and injection drug use closely follow, the report says. Three percent of black women carry the virus, partly a result of the increase in heterosexual transmissions.

"This is very, very depressing news, especially considering HIV's profound impact on minority communities," said Anthony Fauci, director of the National Institutes of Health's program on infectious diseases. "And remember: The city's numbers are just based on people who've gotten tested."

Ron Simmons, who is black, gay and HIV positive, said he's not shocked by the study's findings. "You have a high incidence of HIV among African Americans, and a lot of African Americans live in the city," said Simmons, who is a member of a black gay support group. "D.C. also has a high number of gay men, and HIV is high among gay black men."

Charlene Cotton, a D.C. resident who got an HIV positive diagnosis five years ago, said breaking the taboo on discussing HIV is the key to moving forward. "You need to start at home and talk about it," Cotton said. "It's so hush-hush."

Mayor Adrian M. Fenty (D) said he is aware that some advocates have called on elected officials and others to more aggressively and publicly address the crisis. He praised the city's recent efforts, however, and expressed his frustration about the struggle ahead.

"In order to solve an issue as complex as HIV and AIDS, you have to step up," he said. "It's the mayor and certainly other elected officials. But it's also the community. You have this problem affecting us, and you tell people how serious it is and it literally goes in one ear and out the other."

David Catania (I-At Large), chairman of the D.C. Council's health committee, said that although the District's testing and monitoring have improved in the past two years, the AIDS office is still playing catch-up. The city was in the forefront of the crisis when it created the office in 1986, but it fell far behind. Hader took control in 2007. She is its 12th director and the third in five years.

"Frankly, there can be no excuse for the state of the HIV/AIDS Administration that I found in 2005," Catania said. "I cannot speak to why it was not a priority previously. For years prior to 2005, mayors and previous individuals allowed things to exist in an unacceptable way. And I do blame this government for part of the epidemic we're confronting."

Until recently, the District's AIDS office lacked a fully staffed surveillance unit to collect, analyze and distribute data. Inevitably, the office lost credibility, and although it has received millions in federal and local funds -- $95 million this year -- some care providers questioned whether resources were being properly allocated.

Critics also say congressional control over the District had restricted the AIDS office's ability to combat the virus among drug injection users by banning the use of local tax dollars for a needle exchange program. After almost a decade, the ban was lifted last year.

The study is the most precise count to date, according to the authors. The document is an update of a breakthrough 2007 report, which brought into clearer focus a picture of a city in the grip of a complex and "modern epidemic" that had traveled from a mostly gay population to the general one and disproportionately hit blacks.

For years, District HIV/AIDS workers depended on estimates that put the rate at 1 of 20 living with HIV and 1 of 50 living with AIDS.

The current study notes that its tracking occurred as the city made a switch from a code-based counting system to a name-based one. The surveillance unit interviewed medical providers to find unreported cases, pressed providers who did not consistently report to the administration and searched databases for unreported cases.

More than 4 percent of blacks in the city are known to have HIV, along with almost 2 percent of Latinos and 1.4 percent of whites. More than three-quarters -- 76 percent -- of the HIV infected are black, 70 percent are men and 70 percent are age 40 and older.

Heterosexual sex was the principal mode of transmission for blacks with the disease, 33 percent. Men having sex with men was the chief mode of transmission for white residents, 78 percent; and Latinos, 49 percent. Black women represent more than a quarter of HIV cases in the District, and most, about 58 percent, were infected through heterosexual sex. About a quarter of black women were infected through drug use.

The companion study, "Heterosexual Relationships and HIV in Washington, D.C.," is a detailed look at those whose social networks include individuals at high risk of infection and aims to analyze people's choices and actions before they set foot in a clinic or get HIV.

The 750-participant study targeted four areas in wards 1, 2, 5, 6, 7 and 8 with both high rates of AIDS and poverty. Salaries of a majority of participants -- 60 percent -- were under $10,000 yearly; a similar percentage had never been married; and 43 percent were unemployed.

The survey's methodology -- interviewing those with connections to high-risk networks rather than those who exhibit high-risk behavior themselves -- highlights a shift in the direction by the CDC, which developed the survey protocol.

There is good news in the AIDS office's report: More people are getting HIV diagnoses early, while they are still healthy, as a result of a policy of routine testing implemented by the city in mid-2006. Publicly supported HIV testing expanded by 70 percent.

Walter Smith, executive director of the DC Appleseed Center for Law and Justice, praised the study but also lamented that it did not offer more current data on new infections. The report said that detailed information on new HIV cases is not included because the transition from the code-based tracking system to a name-based one takes five years to be mature, according to the CDC.

"I'm not criticizing them for that," he said. "But we've had more testing, more needle exchange programs. We don't have, at this moment, any understanding about what impact the new programs have had."

By Jose Antonio Vargas and Darryl Fears,  Staff writers Jon Cohen and Jennifer Agiesta contributed to this report, http://www.washingtonpost.com

March 16, 2009   

AIDS Healthcare Foundation (AHF), the largest non-profit HIV/AIDS healthcare provider in the US which currently provides treatment, care and support services to more than 97,000 individuals in 21 countries worldwide in the US, Africa, Latin America/Caribbean and Asia, today commended Congresswoman Maxine Waters (D, CA) for reintroducing a bill to provide comprehensive HIV testing, treatment and prevention for inmates in federal prisons and upon re-entry into the community. The bill, which is known as the Stop AIDS in Prison Act (H.R. 1429), had been previously introduced by Waters (as H.R. 1943) where it was passed by the House of Representatives during the 110th Congress by voice vote; however, the Senate did not complete action on the bill prior to adjournment.

"The 'Stop AIDS in Prison Act' seeks to address a major and growing public health issue that disproportionately affects minorities and women," said Michael Weinstein, President of AIDS Healthcare Foundation. "By providing comprehensive HIV testing, treatment and prevention services for inmates in federal prisons and upon their re-entry back into the community, this legislation will go a long way to help break the chain of new infections. We applaud Congresswoman Waters for reintroducing and carrying this urgent lifesaving legislation."

Waters announced the introduction of this bill at the Congressional Summit on the Effects of HIV and Incarceration on Communities of Color, an event on Capitol Hill organized by the National Minority AIDS Council (NMAC). The legislation directs the Federal Bureau of Prisons to test inmates upon entering and exiting federal prison and includes an "opt-out" provision should inmates wish to decline being tested. The bill also ensures that inmates found to be HIV-positive receive treatment.

"In order to best address the nation's growing HIV/AIDS epidemic, the CDC has recommended routine testing for HIV in all healthcare settings, and health policy implemented in federal prisons should remain in line with the government's own health guidelines," said Whitney Engeran-Cordova, Director of the AHF's Public Health Division. "H.R. 1429 follows these sensible CDC guidelines. By making HIV testing routine among the prison population, this bill will not only help reduce the spread of infection among inmates, but it will also protect the health of the community at large."

About AHF

AIDS Healthcare Foundation (AHF) is the nation's largest non-profit HIV/AIDS organization. AHF currently provides medical care and/or services to more than 97,000 individuals in 21 countries worldwide in the US, Africa, Latin America/Caribbean and Asia. AIDS Healthcare Foundation

http://www.medicalnewstoday.com

March 19, 2009

Tony Award winner Natasha Richardson has passed away at the age of 45 after being removed from life support.

Family and friends, including mother Vanessa Redgrave and sister Joely Richardson, were gathered around the actress in a New York hospital. Richardson was hospitalized after a fall during a ski lesson on Monday in Montreal.

Richardson was hospitalized in Montreal before being airlifted to a New York hospital on Tuesday. Doctors said that blood was leaking between her brain and skull, according to People .

"Liam Neeson, his sons, and the entire family are shocked and devastated by the tragic death of their beloved Natasha," Neeson's rep, Alan Nierob, said in a statement. "They are profoundly grateful for the support, love, and prayers of everyone, and ask for privacy during this very difficult time."

Time Out: New York reported Tuesday that her family had learned from doctors that she was brain-dead, but several websites followed with reports that the announcement was premature.

Richardson is married to actor Liam Neeson and is the daughter of screen legend Vanessa Redgrave. The 45-year-old actress won a Tony Award for her role in the musical Cabaret in 1998, and has also starred in several films, including Patty Hearst and The Handmaid's Tale.

A tireless advocate for HIV/AIDS research and education, Richardson served as a trustee on the board of amfAR, the Foundation for AIDS Research. Her father, Academy Award–winning director Tony Richardson, died of AIDS-related complications in 1991.

By Michelle Garcia, http://advocate.com

March 16, 2009   

There is "some good news" in the fight against HIV in the Americas, Cesar Chelala -- an international public health consultant -- writes in a Miami Herald opinion piece, adding that "most surprisingly, it's coming from Haiti, one of the countries hardest hit by the epidemic." Chelala writes that United Nations data show that about 2.2% of Haiti's population -- or 120,000 people -- are living with HIV/AIDS and that AIDS-related deaths in the country have decreased in recent years. This compares with an HIV/AIDS prevalence of 6.1% in 2001, according to Chelala. Haiti's progress has been "particularly significant for a country where 60% of the population lives below the poverty line of $2 per day," he writes, adding, "Only four of every 10 Haitians have access to potable water, and there is one doctor for every 10,000 inhabitants." However, the "scenario is optimistic," Chelala writes, noting that the percentage of HIV-positive test results among pregnant women has decreased by 50% over the past 10 years.

The progress in fighting HIV/AIDS in Haiti is "due in large part to the work of people like" Jean Pape -- a Haitian doctor who focuses on HIV/AIDS and founded GHESKIO -- and Paul Farmer of Partners in Health, Chelala writes. PIH, along with its HIV Equity Initiative, are "dedicated to preventing and treating AIDS in the context of primary care; improving care for tuberculosis; optimizing treatment for sexually transmitted infections; and emphasizing women's health," Chelala writes. More than 400 workers have been trained to administer no-cost antiretroviral drugs within the community, and more than 1,500 HIV-positive people are receiving treatment, he writes.

According to Chelala, "many challenges remain," and a majority of Haitians "still lack sufficient sex education, for example." He adds that only 15% of women and 28% of men between ages 15 and 24 know HIV prevention methods, and both boys and girls are becoming sexually active at earlier ages. In addition, Chelala notes that prevalence and incidence rates have been declining more slowly in rural areas than in urban areas.

Chelala concludes that the "advances in fighting the epidemic in Haiti show that although much remains to be done to achieve better results, a committed leadership, good planning, parallel attention to prevention and care, and community involvement can successfully control this terrible epidemic, even under the worst of circumstances" (Chelala, Miami Herald, 3/12).

An abstract of Chelala's report -- "AIDS: A Modern Epidemic" -- is available online.

http://www.kaisernetwork.org

March 16, 2009

A new study suggests that thousands of HIV-negative Kenyans and Ugandans were incorrectly diagnosed as positive due to faulty tests at voluntary counseling and testing (VCT) centers, the Daily Nation reports.

The study involved 6,255 people between ages 18 and 60 who sought VCT services at testing sites in both countries. When two different tests were performed on participants, 131 had “discrepant” results where one was positive and the other negative. On the third test, 27 were confirmed to be HIV positive.

Researchers found that rapid tests such as Determine, Uni Gold and Capillus are normally used in poor societies because they are cheap and that confirmatory tests are not usually done at VCT sites in either country. However, assistant medical services director Peter Cherutich maintained that these rapid tests are the best method for countries such as Kenya and Uganda because they are cheap and easy to use and do not require refrigeration.

The risk of inaccurate diagnoses rises when rapid tests are done once without a confirmation test. According to the report, this is because they are “fraught with errors and as such, cannot alone be used to determine whether an individual is positive or not.” Therefore researchers suggest that positive results always be administered with a follow-up test before a diagnosis is made.

http://www.poz.com

March 18, 2009

Distributing condoms is not the answer to curbing the spread of HIV in Africa, Pope Benedict XVI said on Tuesday while heading to Yaounde, Cameroon, as part of a seven-day pilgrimage to the continent, the AP/Washington Post reports. "You can't resolve it with the distribution of condoms," Benedict said, adding, "On the contrary, it increases the problem" (Simpson, AP/Washington Post, 3/18). According to Benedict, addressing HIV/AIDS will require a "two-fold" solution. He said, "The first is a humanization of sexuality, spiritual renewal which brings with it a new way of behaving ... secondly, a true friendship, especially for those who are suffering, a willingness to make personal sacrifices" (Ward, Toronto Star, 3/18). Benedict, who also said the Roman Catholic Church is at the forefront in fighting HIV/AIDS, will visit Angola and Cameroon (Simpson, AP/Washington Post, 3/18).

Although the Vatican's policy states that sexual abstinence should be used to curb the spread of HIV, this stance has led some nuns and priests working with HIV-positive people to "question the church's opposition to condoms amid the pandemic ravaging Africa," the AP/Washington Post reports (AP/Washington Post, 3/18). Jon O'Brien, president of Catholics for Choice, said, "No responsible health care provider would suggest condoms are a panacea." However, he added that condoms "are an absolutely vital measure that people must have if they are to protect themselves and their partners and stem the spread of the virus." According to O'Brien, opinion polls indicate that millions of Catholics worldwide support condom use. Therefore, the pope's statement was "a real tragedy because it's not just an issue for Catholics," O'Brien said (Toronto Star, 3/18).

Many HIV/AIDS advocates also have spoken out about the pope's stance. Rebecca Hodes -- director of policy, communications and research for the Treatment Action Campaign -- said that if Benedict were serious about curbing the spread of HIV/AIDS, he should focus on promoting access to condoms and disseminating information about their use. Hodes said, "Instead, his opposition to condoms conveys that religious dogma is more important to him than the lives of Africans" (Simpson, AP/Washington Post, 3/18). Stephen Lewis, head of AIDS-Free World, said, "Every stitch of scientific evidence says condoms are the best preventive measure we have against the virus." According to Lewis, Benedict's statements were "another example of complete indifference to the vulnerability of women, who are so hugely and disproportionately affected by HIV/AIDS" (Toronto Star, 3/18).

According to London's Guardian, in 2005 during a meeting with senior clergy from Africa, Benedict called HIV/AIDS a "cruel epidemic" and said it could not be eradicated with condoms. The pope said that the "traditional teaching of the church has proven to be the only failsafe way to prevent the spread of HIV/AIDS" (Butt, Guardian, 3/17).

According to CNN analyst and senior correspondent for the National Catholic Reporter John Allen, Benedict been clear that he intends to uphold the traditional Catholic ban on artificial contraception. However, according to Allen, Benedict also has asked a panel of scientists and theologians to consider whether to allow condoms for married couples in which one partner is HIV-positive, adding that it is not clear how the pope will decide the issue (CNN, 3/17).

Related Editorial
The pope "has every right to express his opposition to the use of condoms on moral grounds, in accordance with the official stance of the Roman Catholic Church," according to a New York Times editorial. However, the editorial continues that Benedict "deserves no credence when he distorts scientific findings about the value of condoms in slowing the spread" of HIV/AIDS. According to the Times, Benedict's statement that condom distribution will not eradicate HIV/AIDS is "clearly right" because condoms "alone won't stop the spread of HIV." Instead, HIV/AIDS prevention programs should incorporate initiatives to reduce the number of sexual partners, promote safer-sex practices and advance other interventions to "bring the disease to heel," according to the editorial. However, Benedict's statement that condom use could worsen Africa's HIV/AIDS burden is "grievously wrong," the editorial continues. It states, "There is no evidence that condom use is aggravating the epidemic and considerable evidence that condoms, though no panacea, can be helpful in many circumstances."

The editorial states, "From an individual's point of view, condoms work very well" in preventing HIV transmission. In addition, from "a national perspective, condom promotion has been effective in slowing epidemics in several countries among high-risk groups, such as sex workers and their customers, but less effective in slowing epidemics that have spread into the general population, as in sub-Saharan Africa," the editorial says. It continues that this occurs "probably because far too few people use condoms consistently and correctly." According to the editorial, public health officials have cautioned that condom use "cannot provide absolute protection" because condoms sometimes "break, slip or are put on incorrectly." It continues that the "best way" to avoid HIV transmission "is to abstain from sexual intercourse or have a long-term mutually monogamous relationship with an uninfected person." However, health officials regardless "consider condoms a valuable component of any well-rounded program to prevent the spread" of HIV/AIDS, the editorial says. It concludes, "It seems irresponsible to blame condoms for making the epidemic worse" (New York Times, 3/17).

http://www.kaisernetwork.org

March 19, 2009

Washington D.C - It's estimated one-third of the people living with HIV, the AIDS virus, are also infected with tuberculosis. Health officials say this dual epidemic is one of the most significant challenges facing modern medicine. Now, South Africa is home to a new research facility looking for new ways of treating the diseases.

 

The KwaZulu-Natal Research Institute for Tuberculosis and HIV is a partnership between the Howard Hughes Medical Institute and the University of KwaZulu-Natal in Durban. It's located in the epicenter of South Africa's HIV/AIDS epidemic and the site of some of the first cases of multi-drug and extremely drug resistant TB.

Dr. Bruce Walker, a specialist in infectious diseases, says, "We're talking about a really serious problem in terms of the convergence of these two epidemics."

Dr. Walker is director of the Ragon Institute, which is supported by Massachusetts General Hospital, the Massachusetts Institute of Technology and Harvard University.

"One of the most exciting parts of this whole project is the ability to conduct research at the heart of these two epidemics. And have it really be focused on the local problems that need to be solved," he says.

Dr. Thumbi Ndung'u, an associate professor at the University of KwaZulu-Natal, says HIV/AIDS makes TB infection much easier. "People don't normally die of HIV/AIDS as such. People usually die of opportunistic infections that come about as a result of the virus (HIV) weakening the immune system. And among the common of the opportunistic infections that affect people with HIV is tuberculosis," he says.

He says that the new institute is a great opportunity for African researchers. "If you look at the HIV/AIDS-TB problems as they exist today, they have an African face. If you look at the people who are infected with HIV, with TB, these people tend to be predominantly Africans. But you don't see Africans at the forefront of inventive research on these problems. You don't see the Africans at the forefront of trying to confront these problems in a comprehensive and sustainable way. I think that there is a tremendous opportunity here," he says.

One of the new institute's goals is to train a new generation of African scientists.

Dr. Ndung'u says the extent of the HIV/AIDS epidemic in KwaZulu-Natal Province is reflected among pregnant women who go to health clinics.

"In some provinces like KwaZulu-Natal, where I'm working, the infection rates actually approach 40 percent among women attending ante-natal clinics. It's a very, very severe problem. And of course that's compounded now by the problem of tuberculosis," he says.

Dr. Walker says the institute will take a different approach to tackling these diseases.

He says, "Traditionally, in Africa, TB has been treated by one group of doctors and HIV by a completely separate group of doctors. What we need is integration both at the clinical level and at the research level, so that we have under the same roof people that are trying to deal with this co-epidemic."

But he says although the research focuses on HIV and TB, the findings may help in other areas as well. "These sorts of studies have wide ranging implications for the way the immune system deals with all sorts of things, like cancers. So, the point of this is to try and take what is a very careful, basic look at the underpinnings of the immune system, but then extend it all the way out to figuring out how best to treat people that are coming into the clinic," her says.

It's estimated more than 33 million people are now living with HIV/AIDS. More than 10 million of them are also believed to be infected with tuberculosis. TB is the cause of death for many of them. The CDC, US Centers for Disease Control, says since 1990, TB infection rates have increased four-fold in countries with high rates of HIV.

World TB Day is March 24th.

By Joe De Capua , http://www.voanews.com

March 11, 2009

People who begin antiretroviral (ARV) therapy before their CD4 cells drop below 200 have a significantly reduced risk of developing an AIDS-defining opportunistic illness (OI), but some OIs remain deadly, according to a study published online March 10 in the journal Clinical Infectious Diseases.

Numerous studies have reported the significant reduction in AIDS-related OIs since the introduction of combination ARV therapy. While many studies now focus on the risk of non-AIDS-related diseases that can affect people living longer with HIV, AIDS-related OIs are still a risk to some people on ARV treatment. Yet not many recent studies have explored the most common, and most deadly, OIs among HIV-positive people who receive ARV treatment and have moderately healthy immune systems.

To determine the impact of ARV initiation on deaths from AIDS-related illnesses, researchers with the Antiretroviral Therapy Cohort Collaboration examined the medical records of 31,620 HIV-positive patients from 15 cohort studies around the globe. All of the patients started ARV therapy before December 31, 2004, and none had been previously diagnosed with AIDS. The average CD4 count before starting ARV therapy was 256.

Over an average follow-up period of 43 months, 2,262 people developed an AIDS-defining illness and 377 died after such a diagnosis. The most common illnesses were esophageal candidiasis, Pneumocystis jiroveci pneumonia (PCP), Kaposi’s sarcoma (KS), pulmonary tuberculosis (TB) and non-Hodgkin’s lymphoma (NHL). The average time from ARV initiation to the development of an AIDS-defining illness was nine months

Though relatively few people died after being diagnosed with an AIDS-defining illness, certain illnesses were more likely to be associated with deaths, including NHL and progressive multifocal leukoencephalopathy (PML). Diseases with a moderate risk of death included disseminated Mycobacterium avium complex (MAC), AIDS dementia complex, toxoplasmosis and cryptococcosis. All other diseases had a low risk of death among patients using ARV therapy.

The authors acknowledge that because of the way that records were kept, they could not be certain that people who died after diagnosis of an AIDS-defining illness actually died directly as a result of that illness, rather than some other cause. Thus the magnitude of the risk of death could be somewhat lower than recorded for some of the illnesses listed above.

http://www.poz.com

March 17, 2009

Cosmetic doctors and activists say that people treated with Bio-Alcamid, a popular facial and buttock area filler for people with HIV and lipoatrophy, may end up with complications months or years after treatment. Online forums and message boards have been collecting more and more Bio-Alcamid complaints in recent years, including migration of the filler from the cheeks to the jowls and serious infections requiring heavy-duty antibiotic therapy and surgical removal of the product. At the same time, a leading cosmetic dermatologist sounding the alarm regarding Bio-Alcamid stresses that there’s no need for those who have been injected with the filler to panic.

Not yet approved in the United States—though an application has been filed—the gel-based Bio-Alcamid (polyalkylimide) was at one time a popular product used to permanently replump sunken facial and butt cheeks in people with HIV. According to Luis Casavantes, MD, a highly respected dermatologist from the Center for Cosmetic and Reconstructive Dermatology in Tijuana and Puerto Vallarta, Mexico, several thousand people spent a great deal of money to travel to other countries for treatment.

Now, some people who achieved their dream of a full and healthy-looking face after being injected with the product have instead begun to deal with what they call a nightmare—and Casavantes, who once touted the wonders of Bio-Alcamid, has publicly written to a British medical board urging it to recommend against the product’s use for people with HIV.

Casavantes is well known to many HIV-positive Americans who ventured south of the border for solutions to facial wasting. Thus, lipoatrophy treatment advocates and patients took notice when he published his letter to the National Institute for Health and Clinical Excellence (NICE) in London—which judges the cost effectiveness of treatments and has power over what treatments the United Kingdom’s National Health Service will cover. In his recent letter to NICE, he wrote: “I am at a loss for words when it comes to describing the numbers of different sorts of horrendous complications arising from the use of Bio-Alcamid and of the personal devastation wrought on the lives of these people.”

In his own practice, Casavantes estimates that as much as 15 percent of his patients who received Bio-Alcamid injections experienced complications. The Italian company Polymekon, the maker of Bio-Alcamid, claims that the actual rate of complications caused by the gel itself is less than 1 percent and that most of the reports it has seen likely involved poor administration of the product or subsequent procedures, such as dental work, that introduced bacteria into the implants. The company also claimed that the product does not migrate. Unfortunately, published data on Bio-Alcamid complications are scarce.

Even if rates of complications are as high as Casavantes believes them to be, the vast majority of people will not have problems. “You shouldn’t live in fear,” he says, adding that he never meant to alarm people with his letter. Rather, given the alternatives available today, he wants to make sure that people turn to those treatments rather than Bio-Alcamid. For people who’ve already been treated, Casavantes and advocates such as J.J. McMillen, from Houston, say that people can take precautions to guard against problems, or to catch them quickly.

What’s the Problem?

Polymekon claims that its product is ideal, because it isn’t absorbed by the body and it doesn’t provoke the body to forcibly evict its foreign matter. The company says this makes Bio-Alcamid a permanent filler, compared with several other products that are eventually broken down and removed by the immune system. But McMillen, a 47-year-old HIV-positive man who had Bio-Alcamid treatments in his face in 2004 and a subsequent infection in 2007, says that doctors have since told him that these qualities are what potentially make Bio-Alcamid dangerous.

When many fillers are injected, the body will often enclose them in layers of scar tissue (collagen) fed by blood vessels and tagged for removal from the body by the immune system. Not so with Bio-Alcamid. Thus, if bacteria make their way to the implant, McMillen says, “you don’t have the benefit of the [immune system] to deal with it.”

Polymekon might be technically correct in saying that the gel itself does not cause infections. But the implant might serve as a safe harbor for infections down the line if bacteria are somehow introduced, such as through dental procedures that occur very close to the facial areas where Bio-Alcamid is injected. We depend on our immune systems to successfully fight off these sorts of infections.

For Casavantes, this means recommending that people who want a solution for facial and buttocks wasting turn to implants that aren’t off limits to the immune system. One possible option is PMMA (polymethyl methacrylate), another permanent filler Casavantes now uses. PMMA relies on the formation of collagen and continuous blood flow, resulting in long-lasting facial filling with protection from the immune system.

Finding someone to treat infections and remove the Bio-Alcamid, McMillen says, can be frustrating and difficult. “[Doctors will] do it if they have to, but they don’t want to, and they don’t like to,” he says. “A lot of people I’ve talked to on the phone that have had infections, they can’t get anybody to work on them.”

Unfamiliarity with the product is one likely reason for this. As McMillen explains, health care providers will ask, “Why’d you put that stuff in your face?”

Casavantes says extracting Bio-Alcamid usually isn’t difficult and can be performed on an outpatient basis. Occasionally though, he says, it can be more challenging and the facial skin must be lifted off the muscle, as with a face-lift, which is a far more intensive, potentially painful and a complicated procedure.

Since people had to leave the United States to get Bio-Alcamid in the first place, and since leaving the country to deal with an infection is not usually realistic or wise, it is up to U.S. surgeons to extract the product and treat the infections. In fact, Casavantes often consults with U.S. doctors about Bio-Alcamid extraction.

An Ounce of Prevention: Disclosure and Antibiotics

Both Casavantes and McMillen urge people who’ve had Bio-Alcamid to inform all their health care providers about their implants—especially dentists, dermatologists and plastic surgeons. McMillen says: “The majority of the complications, the infections that we see with Bio-Alcamid, [are in] people who went in to have a root canal or other dental work.”

When dentists inject anesthesia into patients’ mouths, it can introduce bacteria into the Bio-Alcamid. McMillen’s HIV doctor prescribes an antibiotic for him for the day of, and the day after, any dental procedure.

McMillen says the second most common reason for problems with Bio-Alcamid involves people who’ve had touch-ups to their faces or buttocks with another filler, usually by a plastic surgeon different from the one who implanted the Bio-Alcamid. McMillen understands why people “who’ve finally gotten their faces back” would want to keep looking well, but he urges that they approach touch-ups with caution.

Larry Smyle, 61, of San Francisco fully understands the deep and painful repercussions that can come with HIV-related facial wasting. After participating in the Hawaii AIDS ride in 2001 and losing a lot of weight, he had a date with someone he’d met online. “When the guy walked in, he visibly recoiled when he saw me,” Smyle recalls, “and that’s when I decided that it was time to do something.”

Smyle says he was one of the first people with HIV to receive Bio-Alcamid implants in Mexico and, unfortunately, one of the first to experience problems. First there was dislocation: Some of the gel had migrated down into his jowls after three years, prompting him to revisit Mexico to have it removed. His doctor used a needle to do the extraction by going through the inside of his mouth, which Smyle describes as “uncomfortable, but tolerable.” Then, to add insult to injury, Smyle’s cheek became infected days later, requiring a course of heavy antibiotics.

Don’t Panic!

Casavantes reiterated that people who have received Bio-Alcamid shouldn’t panic. Most, he says, won’t have any problems. And if McMillen is right—that disclosure to other providers, caution about facial trauma and judicious use of antibiotics can help prevent problems—then most people who’ve had Bio-Alcamid treatment will probably do just fine in the long run.

Data would be useful to back up these claims. Activists might need to call for some kind of cohort, on an international level, to track what happens, over months and years, to people who’ve been treated with Bio-Alcamid, and possibly other fillers.

Though McMillen was pleased with the Bio-Alcamid treatment before the infection, he has opted to forgo further cosmetic treatment for his facial wasting. He says, “I finally had to break down and look in that mirror and see that dent in my face and say, ‘That’s all right, I’m alive, and I’m enjoying today!’”

By David Evans, http://www.aidsmeds.com

March 17, 2009

A drug approved to treat lymphoma, Zolinza (vorinostat, SAHA) can wake up CD4 cells latently infected with HIV and render them vulnerable to antiretroviral (ARV) medication, according to a study published in the Journal of Biological Chemistry and reported by EurekAlert. Activating these dormant cells is a goal for researchers who hope to find ways to either eradicate the virus or help the body control HIV infection without ARV therapy.

Scientists have experimented with several different drugs to try to wake up dormant infected cells, but the compounds used were either ineffective or too toxic. Matija Peterlin, MD, and Xavier Contreras, PhD, from the University of California in San Francisco and their colleagues had previously identified a promising drug called HMBA, but they had to discard it due to likely toxicity. A related drug, Zolinza, however, is already approved for lymphoma and has a well-known side effects profile.

Peterlin, Contreras and their colleagues found that Zolinza was able to wake up dormant cells, both in laboratory cell cultures and in blood taken from people on ARV medication. The next step will be to explore the treatment in people on ARV therapy.

Zolinza’s most serious side effects can include blood clots in the legs and lungs, diabetes, fewer platelets and red blood cells and dehydration from nausea and vomiting. The drug, however, would likely be used in HIV patients only for short periods of time.

Search: lymphoma, dormant, latently infected, reservoir, Zolinza, vorinostat, SAHA, HMBA, Matija Peterlin, Xavier Contreras

http://www.aidsmeds.com

Anal infection with human papilloma virus was almost universal amongst HIV-positive gay men in a Canadian study published in the April 1^st edition of the Journal of Infectious Diseases. The study also found that there was a high prevalence of infection with cancer-associated strains of human papilloma virus and that few men cleared such infections in the course of the study.

Furthermore, during the three years of the study a significant proportion of men became infected with strains of human papilloma virus associated with a high risk of pre-cancerous and cancerous cell changes in the anus.

The findings of the study are likely to inform the emerging debate about the value of providing HIV-positive individuals with the recently-approved vaccines for human papilloma virus. Although the use of these vaccines is only approved for girls in their early teens, some HIV physicians are privately speculating that it may be worthwhile screening their patients for infection with strains of human papilloma virus associated with a high risk of anal and cervical cancer and administering the vaccine to patients who are not infected.

HIV-positive gay men are significantly more likely to develop pre-cancerous and cancerous cell changes in their anus than HIV-negative gay men. HIV treatment does not appear to offer direct protection against the development of anal cancer.

Development of pre-cancerous and cancerous cell changes in the anus is strongly associated with certain strains of human papilloma virus.

Previous research has found a high prevalence of anal infection with human papilloma virus in HIV-positive gay men, but there is little information on the natural history of such infections in this population.

Canadian researchers from the HIPVIRG (Human Immunodeficiency and Papilloma Virus Research Group) therefore designed a three year prospective study involving 247 HIV-positive gay men to answer this and a number of other questions.

Men recruited to the study were assessed for infection with human papilloma virus at baseline and followed-up every six months for three years for further evaluation. Blood tests were performed to determine which strains of human papilloma virus patients were infected with. Demographic information was also obtained, as was information on the use of HIV treatment, CD4 cell count and viral load.

The mean age of men participating in the study was 43 years. The average (median) duration of HIV infection was eleven years, and 36% of men had been diagnosed with AIDS. On entry to the study, the median CD4 cell count was 380 cells/mm³ and 56% of individuals had an undetectable viral load. A total of 93% of patients were taking HIV treatment. The mean duration of follow up was 31 months. After 24 months of follow up, median CD4 cell count had increased from baseline to 480 cells/mm³.

Testing conducted on entry to the study showed that almost all (98%) of the men had anal infection with human papilloma virus. Of the five men not infected at baseline, three acquired anal human papilloma virus infection during the course of the study.

Most of the men (91%) were infected with multiple strains of human papilloma virus (median, five strains).

The most prevalent type of human papilloma virus was the cancer-associated HPV-16 (38%), HPV-6 infection was present in 35% of men, HPV-42 in 29%, and HPV-18, another type strongly associated with a high risk of anal cancer, was present in 25%.

Few of the men cleared the infection. The strain of human papilloma virus with the lowest clearance rate was HPV-16 (twelve episodes cleared per 1000 person months). The clearance rate of HPV-18 was 20 per 1000 person months.

There was also a high rate of new human papilloma virus infections in the study. Over a third of patients uninfected with HPV-16 acquired the infection during the course of the study, with 13% becoming infected with HPV-18. No information was provided by the investigators about the role or otherwise of immune reconstitution in the clearance of human papilloma virus infection.

"HIV infection not only increases HPV persistence but also increases the risk of acquisition of new HPV infections and reactivation of latent infections", write the investigators.

Reference

De Pokomandy, A. et al. Prevalence, clearance, and incidence of anal human papillomavirus infection in HIV-infected men: the HIPVIRG study. J Infect Dis 199: 965-73, 2009.

By Michael Carter, http://www.aidsmap.com