Medical Marijuana Users More Than $500K In Arrears

April 14 2008

Ottawa - Medical marijuana users are on the hook for more than $500,000 in unpaid bills for government-certified weed, raising questions about the effectiveness of Health Canada's troubled dope program.

Newly disclosed statistics show that Health Canada has sent final notices - and sometimes dispatched a collection agency as well - to 462 registered users since government marijuana first became available in 2003.

"Most of the 462 individuals who have received a letter regarding their accounts in arrears have had their shipment ceased," department spokesman Paul Duchesne said in an e-mail.

The unpaid bills, totalling $554,255 as of Dec. 31, have tripled in value in the last two years and have resulted in some seriously ill citizens returning to the black market for their medication. The marijuana distribution service was specifically designed to give patients a legal alternative to street dope.

Officials have handed 29 overdue accounts to collection agencies who so far have been able to recoup just $2,000.

The statistics, acquired through the Access to Information Act and questions to Health Canada, suggest a deeply flawed program as the number of users in arrears has soared to about two-thirds of all 739 patients licensed to buy government dope.

A series of adverse court rulings since 2000 forced Health Canada into the medical marijuana business. The program licenses certified users who've been prescribed cannabis by their doctors, and allows them to grow their own, have someone grow it for them, or buy directly from the department.

Health Canada has paid Prairie Plant Systems Inc. more than $10 million to cultivate a strain of pot in a mine shaft in Flin Flon, Man. Accredited patients can then buy the dope, with a THC content - the active ingredient - of 12.5 per cent, for $5 a gram.

The department has said it plans eventually to end its licensing of home-grown dope, forcing all medical users to buy their supplies directly from the government, perhaps through pharmacy distribution. Prairie Plant Systems now couriers the weed in 30-gram packets directly to users.

Spokesmen for the department did not respond to requests for comment and reaction.

Health Canada previously allowed a 90-day grace period for payment but has since reduced it to 30 days before considering an account in arrears. Other restrictive changes have been made to the program in the last two years, including efforts to persuade doctors to keep doses low.

Many seriously ill medical users are impoverished, unable to work, and survive on disability payments, provincial drug plans and charity. Medical marijuana has never been assigned official drug status by Health Canada and is therefore not covered by pharmacare programs.

Users typically smoke marijuana to combat nausea and pain associated with chronic ailments, resulting from such infections as HIV and hepatitis C, after standard medicines fail.

Mark Schollenberg, 42, of Stoney Creek, Ont., uses marijuana to control chronic pain from a series of workplace injuries. Unable to work and on disability, he initially used street marijuana but changed his mind.

"I thought instead of causing myself any problems, I should get a licence and do it legally," he said in an interview.

With a doctor's approval, Schollenberg got a licence and ordered his first batch of Health Canada dope last summer assuming Ottawa would cover the costs.

He was cut off in October, now owes $3,962.34 including interest, and is back on the street to purchase his medicine.

"I can't even afford the black market," he says of his five-gram-a-day requirement.

Jason Wilcox of Victoria currently owes Health Canada $6,770.06, a number that will increase with interest charges each month.

Wilcox, 37, has been HIV-positive since at least 1993, and needs 10 grams of marijuana daily for nausea, for severe pain in his foot and to help him sleep.

He says he became angry on learning that Health Canada charges users 1,500 per cent more than it pays Prairie Plant Systems for the dope.

"At that point, I refused to pay," he said in an interview. "Also, not to mention that their product is crap."

Wilcox and his wife Theresa Anne Genovy, who herself owes Health Canada $3,297.21 for medical marijuana, now grow what they can but must still return to the streets for their full doses.

"I have no other source than the illegal underground," he says. "The only medication I pay for in this province is cannabis."

CP, www.ctv.ca

Gay Man Denied Claim as Refugee
Fears being sent back to El Salvador, where he says police raped him

April 14, 2008

Joaquin Ramirez is afraid to be sent home to his native El Salvador and face the three police officers that he claims raped him in a sugarcane field two years ago.

The 39-year-old HIV-positive man said the accused perpetrators have visited his family and threatened to kill him because he infected them with the virus that causes AIDS.

But the story of Ramirez, a closeted gay man, hasn't impressed Canada's Immigration and Refugee Board or a border service removal officer, who asked why he didn't ask authorities back home for protection.

"I didn't tell anyone that I was raped because I was too ashamed of myself. I didn't tell the police. I didn't tell the people in the hospital. I didn't tell my own family," explained the soft-spoken man, who took advantage of the 2006 HIV/AIDS conference in Toronto as a way out.

"How could I go to the same people and ask them to protect me when it's the same people who did this to me?" asked Ramirez, before he started crying and had to stop the interview.

Unlike most of the estimated 160 AIDS conference delegates who successfully sought asylum in Canada in 2006, Ramirez is believed to be among a minority turned down, said Francisco Rico-Martinez, executive director of Toronto's FCJ Refugee Centre.

"What we found shocking in Joaquin's case is that the risk of being a gay person in El Salvador was not properly assessed in these decisions," Rico-Martinez said.

Ramirez, a clothing and shoe vendor from San Salvador, was a volunteer outreach worker with the Young Men's Christian Association and the Salvadoran Network of People Living with HIV/AIDS, with a mission to educate the public on safe sex and give out free condoms.

He said he was picked on by three drunken officers at an Aguilares restaurant on Jan. 13, 2006, and driven to a plantation field where the alleged assault took place.

"I took out some condoms in my bag and asked them to put them on because I was HIV-positive.

``They just laughed and said I lied so they wouldn't rape me," recalled Ramirez, who has had a long history of sexual abuse by his relatives. "They just pushed me to the ground, ripped off my clothes off, beat me and raped me."

The police officers took off with Ramirez's money and a phone book, he said, leaving him bleeding and bruised in the empty field.

Five months later, Ramirez said, a stranger called his sister for his whereabouts and threatened to kill him for infecting him with HIV. A group of men fitting the attackers' descriptions have also visited her home several times looking for him, he claimed. That's about the same time the AIDS conference organizer responded to the application Ramirez sent in the year before – and prior to the alleged rape.

In his decision last May, refugee board adjudicator Chimbo Mutuma said he didn't believe Ramirez left El Salvador because of the alleged assault as he had already planned to leave in November 2005.

By Nicholas Keung, The Globe and Mail

Stephen Harper's Government Has No Love of Science

April 17, 2008

The principal role of science in society is to advance human understanding. Unfortunately, in modern times a host of political masters have invested considerable energy and resources in an effort to cloud science. The primary goal of such efforts is to manufacture uncertainty about the world we live in.

The politicization of science is not a new problem. Junk science was used to justify and then deny the Holocaust, and with Stalin, scientists were under strict ideological control. In more recent times, science has taken a beating at the hands of various industries, special-interest groups, and politicians. Instances deserving of special mention include the tobacco industry’s efforts to misrepresent and politicize the science showing that smoking is harmful and Exxon Mobil’s donation of more than $16 million to various organizations working to refute the science specific to climate change.

The Bush administration has also been singled out for its poor treatment of science. According to a survey by the Union of Concerned Scientists, one-fifth of U.S. Food and Drug Administration scientists reported being asked, for nonscientific reasons, to exclude or alter information or conclusions in an FDA scientific document. The Union of Concerned Scientists has been so outraged by the Bush administration’s treatment of science that it dedicated a full report to the topic. According to the report, the administration has repeatedly placed unqualified individuals or individuals with conflicts of interest in official posts, censored and suppressed government reports, and misrepresented scientific knowledge in an effort to mislead the public.

Although this problem has been evident for some time and has been seen in countries throughout the world, it has been less well publicized in Canada. However, with the rise of the Stephen Harper government, Canada too has been singled out for its mistreatment of science. For example, a February editorial in the prestigious journal Nature slammed the Harper government for muzzling Environment Canada scientists and for closing the office of the national science adviser.

The scientific evaluation of Insite, Vancouver’s supervised injection site, has also been challenging for the Harper government. The Tories clearly favour a get-tough, U.S.–style, "war on drugs" approach, and in their new "anti-drug strategy" there is no room for public-health-based strategies such as supervised injection sites that fall under the rubric of "harm reduction"—despite the wealth of scientific evidence to support these interventions.

As scientists, we were contracted by Vancouver Coastal Health to conduct an arm’s-length evaluation of Insite. After three years of evaluation, we published 22 studies that described the impacts of Insite. These studies appeared in various peer-reviewed medical journals—including the New England Journal of Medicine, the Lancet, and the British Medical Journal—and showed that Insite was doing exactly what it was set up to do. This fairly small and simple public-health program was contributing to reductions in the number of people injecting in public and the number of discarded syringes on city streets. Insite was also helping to reduce HIV-risk behaviour and likely saving lives that might otherwise have been lost to fatal overdose. We also found a 30-percent increase in the use of detoxification programs among Insite users in the year after the site opened. Potential harms were ruled out as research showed that the opening of Insite did not increase crime or lead more vulnerable citizens to take up injection-drug use.

Despite this large body of scientific evidence, the Harper government remained unconvinced of the merits of Insite. Harper stated publicly that he would look to the RCMP for their evaluation of Insite, and when asked to renew the federal exemption that allows Insite to operate legally, Health Minister Tony Clement gave a brief extension and called for more research. The RCMP did end up paying SFU criminology professor Ray Corrado to conduct an external evaluation of our research. Although Corrado fully agreed with our findings, Clement was unconvinced. He gave Insite another brief extension, called for yet more research, and formed a national "expert advisory committee" to commission new research and comment on the state of the evidence pertaining to Insite.

Last week, the expert advisory committee released its report. It stated that Insite is helping to reduce public disorder, HIV-risk behaviour, and overdose risks, and is helping people get into addiction treatment. The committee also stated that Insite is not increasing crime and/or encouraging people to start injecting drugs. Sound familiar? But that is not all. The committee also added that the site appears to be cost-effective and is popular among the public, including among local police officers.

The next chapter in this story should be an interesting one. Will Harper and Clement continue their call for more research on Insite? Will they dismiss the findings of their handpicked committee and start over? Perhaps they will give up and let those crazy West Coast folks do what they want when it comes to protecting the health of Vancouver’s most marginalized citizens. Maybe they will remain tight-lipped, wait for a majority, and then try to close Insite. Whatever their next move, it will not go unnoticed, as this government may already have garnered a reputation for being the most anti-science government in Canadian history.

Thomas Kerr and Evan Wood are research scientists at the British Columbia Centre for Excellence in HIV/AIDS and assistant professors in the UBC department of medicine.

Georgia Straight

Overdoses, Disease Cause of Half the Deaths of B.C. Homeless People

April 18, 2008

Overdoses and chronic diseases were the cause of half the deaths among homeless people in B.C. over the last two years.

According to figures released by the B.C. coroner's office, 27 of the 56 people who had been living on the street or in shelters died of either "natural disease processes" or poisoning from alcohol or drugs. Other causes of death included being hit by blunt objects (which includes car accidents), suicide, and stabbing.

The report, like many studies done of homeless deaths in North America and Europe, showed that people who are homeless died younger than people in the general population. The average age of death ranges from 41 to 48 in various studies.

"That's not surprising," said University of B.C. professor Jim Frankish, whose research specialty is homelessness. "If you're older and you have congestive heart failure, being on the street would not be helpful."

Most studies estimate that the homeless die at three or four times the rate of the general population for their age group.

That's not only because they're homeless. Many homeless people suffer from the effects of drug use, may have an HIV or AIDS infection, and might also be mentally ill, which compromises their ability to take care of their health.

Chris Giroux, a Vancouver binner, died in April last year after he overdosed on heroin -- his friends think it was a mistake, since Giroux generally used crystal meth or crack -- and then fell forward into a dumpster and suffocated. He was 41.

Frankish said that's why it's important for policy makers and the public not to fool themselves into thinking that just getting people indoors is going to solve the problem.

"Just putting them in housing, they'll live a little longer than they would if they were outside but they will still die prematurely," said Frankish. To increase the quality of their health and the length of their lives, people who are homeless or at risk of homelessness need a lot of support to help them avoid infections, minimize the impact of addictions and take care of their health.

The B.C. statistics, which were produced at the request of another media outlet, indicated that homeless people were only 20 per cent more likely to die than those of their age in the general population.

The number is lower than in most studies because the 56 deaths were compared to a larger sample. In this case, the deaths were compared to 12,000 people who were not just homeless, but at risk of homelessness.

Most other studies compare the number of deaths only to the population of homeless people who have been in contact with a health agency or homeless service.

Homeless people in the United States have higher death rates than those in Canada, which studies have attributed to three different causes: There are fewer homicides in Canada (the prime cause of death among homeless young people). Canada has fewer war veterans, a group that has more complicated health problems and that tends to show up in high numbers among the homeless. And Canada has a better health care system.

Seattle had 110 deaths among homeless people in 2006, the last year for which figures are available.

By Frances Bula, Vancouver Sun

Help Sought for Ukraine's AIDS Epidemic
Experts to discuss strategy

April 17, 2008

Ukraine's AIDS epidemic -- one of the fastest-growing in the world -- has brought experts to Winnipeg looking for help.

"This is the first time organizations fighting HIV/AIDS in Ukraine have gathered to talk about how to stem the tide," said Terry Duguid, president and CEO of the International Centre for Infectious Diseases, which organized the event.

Of Ukraine's 46 million residents, an estimated 344,000 are living with HIV/AIDS. The former Soviet state has reported more annual AIDS deaths than any other European country. Injection drug use is still driving the spread of HIV but, more and more often, mothers are passing it on to their babies and younger people are spreading the virus through unprotected sex. Close to 80 per cent of those infected are young.

The spread of the disease hits too close to home for Canadians with strong ties to Ukraine.

"It's a growing pandemic that's on the cusp of becoming a major outbreak," said Yarko Petryshyn, national vice-president of the Ukrainian Canadian Students Union. He's attending the forum to get more information and find ways local grassroots groups can help.

Winnipeg is the logical location for the gathering, Duguid said. "Winnipeg is blessed with some of the finest infectious disease specialists in the world."

Manitoba is home to the largest Ukrainian community in Canada, numbering 130,000 people. Many have strong ties to and a tradition of helping Ukraine, said the head of the Ukrainian Canadian Congress.

"When the Soviet Union fell apart, government-run health-care budgets went through the floor," Ostap Skrypnyk said. "A lot of community groups got involved in projects helping hospitals with getting pharmaceuticals and old equipment like hospital beds."

By: Carol Sanders Skrypnyk said he thinks some older and church-related groups might be uncomfortable addressing the issue of AIDS in Ukraine. He's confident younger and more-educated Ukrainian Canadians will step up to help out.

"There are horrible examples of how this can go through a population very quickly," Skrypnyk said. He pointed to countries in Africa where the HIV/AIDS epidemic unchecked became a crisis that decimated populations, in contrast to countries that were able to take action.

"In North America and Western Europe, it's not the death sentence it used to be. That's what makes it hopeful for Ukraine," Skrypnyk said. "Part of the work is preparing the groundwork for a counter-offensive to HIV/AIDS in Ukraine."

Experts from Ukraine like Dr. Alla Scherbynska will tell the forum today about the challenges Ukraine faces in dealing with the epidemic. Dr. Jamie Blanchard, a University of Manitoba researcher with international expertise, will talk about possible prevention strategies.

"Canada has a major role to play in this," Petryshyn said. "This is what Canada is known for."

By Carol.Sanders, www.freepress.mb.ca

Manitoba Introduces Forced HIV Testing Bill
Legislation violates human rights, says group

April 17, 2008

Manitoba's forced HIV testing legislation is "flawed" and "ill-conceived" charges the Canadian HIV/AIDS Legal Network.

The bill would allow paramedics and firefighters to apply for a testing order if they have come into contact with bodily fluid of another person while on the job. Health Minister Theresa Oswald, introduced the bill in the Manitoban legislature Apr 16.

Oswald touted the bill as providing emergency workers with "peace of mind" when responding to an incident. Yet, the risk of contracting an infection such as HIV from an occupational exposure is extremely low, says the Legal Network.

In fact, the group says that there has been only one confirmed case of occupational HIV infection in Canada since the early 1980s.

"Forcing someone to undergo blood tests, and then to disclose the results of those tests, is a serious violation of their human rights," says the Legal Network's executive director Richard Elliott.

The group notes that forced testing violates a person's right to privacy, because the results are revealed to others without consent. The process of forced testing could involve public court hearings and there is no way to stop the exposed person from telling others about the results of the test.

Still, at least four provinces now have laws on forced HIV testing: Ontario, Alberta, Nova Scotia and Saskatchewan. Manitoban legislators have introduced private members' bills since 2006 that have sought to get forced testing in the province. Those failed, but the difference now is that the government has brought forward this legislation.

The Legal Network says alternatives should be examined.

"To provide real peace of mind, the Ministry of Health should be taking measures to protect the confidentiality of all test results, provide accurate information and protective equipment to emergency responders and ensure access to voluntary testing and treatment to everyone in the province who needs it," says Elliott.

By Brent Creelman, Xtra West

Brazil: Full Frontal Attack On AIDS Among Gays

April 15, 2008

Rio de Janeiro - The poster, reminiscent of the film "American Beauty," features a nude young man in a sensual pose lying on (and partly covered by) masses of pink condoms, with the legend "Do whatever you want but do it with a condom." It is part of a new Brazilian campaign against HIV/AIDS aimed at gays.

The Health Ministry’s Epidemiological Bulletin indicates that in 1996, in the 13 to 24-year-old age group, men who have sex with men made up 24 percent of all AIDS cases, compared to 41 percent in 2006. In the 25 to 29-year-old age group, 26 percent of those living with HIV were men who have sex with men in 1996, and 37 percent in 2006.

In contrast, in the 30 to 39-year-old age group, the proportion of AIDS cases represented by men who have sex with men fell slightly, from 30 percent to 28 percent, over the same period.

The difference between these indicators is attributed to behaviour changes in younger men, according to Julio Moreira, head of HIV prevention programmes in the non-governmental organisation Arco-Íris (Rainbow), which defends gay rights.

"With the availability of the anti-retroviral AIDS drug cocktails and the longer survival of people with AIDS, the new generation have not seen their friends die and haven’t experienced the pain of the loss of someone very close, so they have become careless about using condoms," the expert told IPS.

He also links the expansion of AIDS to increased consumption of drugs and alcohol. "Substance abuse also leads to carelessness and the failure to use condoms," he said.

But Alexandre Chieppe, the coordinator of the AIDS and sexually transmitted diseases programme of the health department of the government of Rio de Janeiro, clarified that the figures do not indicate that the number of cases of HIV/AIDS have increased more rapidly among gays.

"Actually, the trend towards more AIDS cases in the young gay population is generally the same as is seen among heterosexual men of the same generation," he said.

"Among the general population the AIDS epidemic is stabilising, but cases are still increasing among young men in general and, within that group, gays," he said.

Although the epidemic is behaving similarly among heterosexuals and homosexuals, its consequences are different, according to a study of sexual behaviour quoted by the Brazilian Health Ministry.

The survey of sexual knowledge, attitudes and behaviour carried out in 2004 estimated that in Brazil there were almost 1.5 million gays and men who have sex with other men, including transvestites and bisexuals, aged between 15 and 49.

Based on this estimate, the incidence of HIV/AIDS in this population group was calculated to be 226.5 cases per 100,000 people. This was more than 11 times higher than the incidence in the general population, which was 19.5 cases per 100,000 population in this country of 188 million.

Gay men "are 18 times more likely to develop AIDS than the heterosexual population," Moreira said, explaining why a campaign aimed specifically at homosexuals is necessary.

"I think the state had a long-standing obligation to respond to this need, and there is also a concrete demand," Claudio Nascimento, human rights secretary for the Rio de Janeiro state government, said in an interview with IPS, referring to the new focus of the campaign.

Nascimento said that, from the didactic point of view, "a target audience can be reached by segmenting the population and very directly addressing the target group."

For example, the campaign makes itself perfectly clear when it gives advice such as "always use a water-based lubricant gel."

"The gay community was the first to act against HIV infections in this country, and in practice there hasn’t been a specific campaign to recognise its efforts," added Nascimento, one of the country’s best known gay rights activists.

Anthropologist Sérgio Carrara, a professor at the Institute of Social Medicine in the State University of Rio de Janeiro (UERJ), agrees.

"We had a certain moralism and homophobia that prevented AIDS campaigns from being directed specifically at gays," he said.

Similarly, according to Carrara, "it is necessary" to refer directly to transvestites, who are "ordinarily invisible" in campaigns against AIDS and other sexually transmitted diseases.

Homophobia is one of the key targets of this government campaign. In the public system, said Nascimento, "homophobia is still one of the largest causes of violations of the rights of the gay, lesbian and transvestite community."

In public hospitals, anti-gay prejudice is shown "in lack of respect, poor care, negligence, and taking decisions not to give differentiated care," he complained.

"The public service, which ought to offer care without any kind of discrimination, ends up reproducing social homophobia," he said.

These prejudices, according to the activist, "increase the gay population’s vulnerability to HIV."

Factors like rejection by their family, social prejudice and violence are reflected in "low self-esteem among gays," and consequently they are less able to look after themselves, he said.

"Treating AIDS as a public health issue is extremely important, so that people go back to regarding it as a chronic disease, which doesn’t kill as much as it used to, but which continues to be a serious problem," said Chieppe.

As part of the campaign, the government will distribute some 100,000 posters, stickers and 500,000 leaflets with information about AIDS, other sexually transmitted diseases, and instructions for the correct use of condoms.

Posters and leaflets will be placed in public health institutions, but they will also be distributed to bars, night clubs, parties and other places frequented by gays, and to civil society organisations.

Other strategies will be discussed in Brasilia in June, at the First National Conference of Gays, Lesbians, Bisexuals, Transvestites and Transsexuals

By Fabiana Frayssinet, http://www.ipsnews.net

Quiet Sexual Revolution Forces Beijing to Admit Dangers of AIDS

April 18 2008

Beijing - When HIV patients in Hebei heard the Chinese premier was visiting they thought their chance had come. For years they had fought in vain for compensation from hospitals which they allege spread the virus through blood transfusions.

"They knew that premier Wen [Jiabao] liked to listen to the ordinary people's voices, so they wanted to tell him about their problems," said Jiang Tianyong, a lawyer for their families.

Instead, 11 patients and relatives were detained by police as they sought Wen on his visit to Shahe, in the south of the province. A week and a half later eight are still being held. Police have refused to tell Jiang what charges could be lodged, but described it as a case of "national security".

The incident says a lot about China's fight against HIV. After years of inaction and denial, the government has begun to address the problem. High profile meetings between HIV patients and political leaders are one solution, intended to address the stigma and educate the public about the issue.

Just as significant is the hefty increase in funding for prevention programmes and antiretrovirals for patients. There are public information films and the first strategy addressing the needs of men who have sex with men - one of the highest risk groups.

"There's been a lot of change," said Wan Yanhai, director of the Aizhixing Institute and one of the country's leading AIDS/HIV activists. "This generation of leaders - Hu Jintao, Wen Jiabao and Wu Yi - have met people with AIDS. They have increased the national budget, opened up to international donors and they tolerate some civil society involvement in provision."

But when it comes to addressing difficult questions, when activists embarrass officials, or when it comes to implementing policy, the shortcomings of this zeal are clear. Experts fear that leaves China at risk of an epidemic if further improvements are not made.

The Joint United Nations Programme on HIV/AIDS estimates there were around 700,000 HIV positive people in China at the end of 2007.

The provinces of Yunnan, Henan, Guangxi, Guangdong and Sichuan and the region of Xinjiang each have more than 10,000 affected residents.

Wan believes that the true figure is far higher and warns - as international experts have - that the virus is spreading from high-risk groups such as prostitutes, drug users, migrant workers and the gay community to the wider population. Last year saw around 50,000 new cases. Increasingly liberal attitudes to sex - yet ignorance about the risk of STDs - and a growing sex trade are adding to the problem.

"There has been a sort of sexual revolution since the market reforms," said Dr Heather Xiaoquan Zhang, a senior lecturer in Chinese studies at the University of Leeds.

"People are more open about sex - but in most cases that's in urban areas among the better educated sections of the population.

"The Confucian tradition means most people still feel embarrassed to openly talk about sex. Their knowledge of risks and vulnerabilities is quite limited."

The government has backed landmark programmes, which range from educating migrant workers on the use of condoms to commissioning public information films featuring stars such as Jackie Chan.

Yet, as Wan points out, some subjects remain beyond bounds. UNAIDS estimates that 41% of those with HIV in China were infected through heterosexual sex, 38% through intravenous drug use, 11% through homosexual sex - and almost 10% through selling or receiving blood and blood products.

The scandal over the blood-driven epidemic that spread through rural China, and particularly Henan province, was one of the factors which propelled HIV up the political agenda.

Peasants who sold their blood for money discovered they had also sacrificed their health as blood-collection services reused dirty needles.

But Wan believes that officials will not admit that transfusion was a problem - as in the Shahe case - because they are reluctant to admit to failings in the system.

"The government has admitted there's an epidemic among people who sold blood - but not among those who received it. It has not informed the public of the risk from blood transfusions and doesn't suggest people are tested," he said.

He warns that the government's top-down approach also makes it hard to tailor services to different needs, makes it easier for corrupt officials along the way to pocket cash, and offers little space for grassroots work.

The organisations which get cash focus on meeting government needs rather than those of the public: building capacity and educating but not engaging in enough direct work.

"The government is supporting work in the gay community, and that's good.

"You have more than 100 organisations working in that sector now. But you go to a bathhouse and there aren't any condoms," he said.

That leaves the essential work of engaging with high risk groups to NGOs - when they are allowed to do so. Those working in civil society argue that security preparations for the Olympics have made officials much more suspicious in their dealing with NGOs.

This week the Aizhixing Institute announced an emergency protocol to protect its staff, volunteers, colleagues and clients in the run-up to the Olympic Games.

By way of explanation it offers a tally of recent incidents, including the house arrest or surveillance of more than 100 HIV positive people and activists in the first half of March. The list begins last December, when Wan himself was briefly detained. It ends with the detention at Shahe.

Officials in Hebei did not respond to the Guardian's calls about the case.

But Jiang, who maintains that the detentions are illegal, says the Public Security Bureau has told him it needs at least a month to "execute the law".

"It is their right to want to see the premier," he added.

"The HIV/AIDS sufferers and their families are innocent victims: they face pain, poverty, and prejudices against them."


By Tania Branigan, www.guardian.co.uk

Members of Scottish Parliament Ask for More Information on Gay Blood Ban

April 16, 2008

A committee of the Scottish parliament is to ask the country's government and various blood and tissue donation organisations to explain why men who have sex with men are barred from donating.

The petitions committee met yesterday afternoon at Holyrood to consider a submission from Mr Rob McDowall calling on the Scottish Parliament to urge the Scottish Government to review existing guidelines and risk assessment procedures to allow healthy gay and bisexual men to donate blood.

The Committee agreed to seek responses to the issues raised in the petition from the Scottish Government, the Scottish National Blood Transfusion Service, Joint United Kingdom Blood Transfusion Services and National Institute of Biological Standards and Control Professional Advisory Committee, Advisory Committee for Safety and Blood, Tissues and Organs, Bloodban, Terrence Higgins Trust and the Equality Network.

Mr McDowall told MSPs: "People are being asked about their individual risk, rather than being told it's because it's a lifestyle choice they are making." He claimed that in Spain and Italy the number of people contracting HIV from blood donations has fallen since a blanket ban on gay men donating was lifted.

Liberal Democrat Health spokesperson Ross Finnie MSP said: "I'm pleased that the Scottish Government admits that "advances in blood transfusion safety procedures may allow gay and bisexual male donors to donate."

"But Ministers have so far refused to do anything to introduce new and improved testing mechanisms that could make it safe to lift the blanket ban on gay men donating blood.

"I urge the Minister for Public Health to reconsider this position and examine the case for introducing a testing regime that would provide good grounds for the relevant bodies to look again at the current restrictions."

The Scottish National Blood Transfusion Service (SNBTS) maintains that it is not a question of being gay or bisexual but the risk involved.

It does not recognise safe sex practices among men who have sex with men (MSM) as safe, despite the rapidly rising HIV infections among heterosexuals.

UK's National Blood Service (NBS) also bars men who have had sex with other men from donating blood, even if they used a condom.

A statement on their website says: "It is specific behaviours, rather than being gay, which places gay men at increased risk of HIV infection.

"Safer sex will keep most gay men free from infection, however research shows that allowing gay men as a group to donate blood would increase the risk of HIV infected blood entering the blood supply.

"Abolishing the rule for gay men would increase the risk of HIV infected donations entering the blood supply by about five times, and changing the rule to allow gay men to donate one year after they last had sex with another man would increase the risk by 60 per cent."

According to Section 28 of the Equality Act (Sexual Orientation) Regulations "it is not unlawful for a blood service to refuse to accept a donation of a person's blood where that refusal is determined by an assessment of risk to the public based on - clinical, epidemiological data obtained from a source on which it was reasonable to rely."

A Scottish government spokeswoman told The Times: "It is sometimes necessary to exclude people whose blood would probably be safe because they are from part of a group that carries a high risk."

http://www.pinknews.co.uk

SMART Study Reaffirms That HIV Replication Is Harmful, Even At CD4 Counts Above 350

April 14, 2008

Uncontrolled HIV replication is associated with a higher risk of serious illness and death even when the CD4 cell count is above the currently recommended threshold for starting treatment - 350 cells/mm3 - according to a new analysis of the SMART study of structured treatment interruption published in the April 15th edition of the Journal of Infectious Diseases.

In addition, the analysis showed that the greater risk of serious illness and death in the treatment interruption was also associated with a greater period spent living with a CD4 cell count below 350 cells/mm3.

Taken together, say the authors, the findings "support consideration of initiating ART before even moderate levels of immunodeficiency develop," although they recommend that a large randomised trial still needs to be conducted to answer the question of when is the optimal time to start antiretroviral treatment.

The SMART study compared two antiretroviral treatment (ART) strategies in HIV-infected adults with CD4 counts > 350 cells/mm3. The viral suppression (VS) strategy entailed continuous use of ART to maximally suppress HIV replication. By contrast, the CD4 count-guided ART interruption strategy, also designated drug conservation (DC), involved stopping ART when CD4 counts was above 350 cells/mm3 and re-initiating ART when CD4 counts fell below 250 cells cells/mm3.

The study reported an increased risk of serious opportunistic diseases (OD) and all-cause mortality in HIV-infected patients on CD4 count-guided ART interruption by comparison with HIV-infected patients on continuous ART.

The majority of the excess risk of disease or death in SMART was associated with lower CD4 counts and higher HIV RNA loads during follow-up in patients on ART interruption. However the reasons or mechanisms underlying this effect remained unknown. In order to address this issue, the SMART study group has now assessed the rates and predictors of OD/death and the relative risk (RR) in DC versus VS groups as a function of the latest CD4 cell count and HIV RNA level.

Details of the study design and study participants have already been reported by the SMART study group (New England Journal of Medicine 355: 2283-2296, 2006). During a mean of 16 months of follow-up, DC patients spent more time with a latest CD4 cell count <350 cells/mm3 (for DC vs. VS, 31% vs. 8%) and with a latest HIV RNA level > 400 copies/ml (71% vs. 28%) and had a higher rate of OD/death (3.4 vs. 1.3/100 person-years) than VS patients.

For periods of follow-up with a CD4 cell count above 350 cells/mm3, rates of OD/death were similar in the two groups (5.7 vs. 4.6/100 person-years). The rates of OD/death were higher in DC versus VS patients (2.3 vs. 1.0/100 person-years; RR, 2.3 [95% confidence interval, 1.5–3.4]) for periods with the latest CD4 cell count of 350 cells/mm3 or greater. This increased risk of disease or death is explained by the higher HIV RNA levels in the DC group despite the higher CD4 counts.

These findings are significant for two reasons. First, uncontrolled HIV replication even at higher CD4 cell counts appears to be an important cause of pathology which has not been hitherto appreciated. Second, the current treatment guidelines which emphasise deferring ART at higher CD4 counts are probably resulting in an unnecessary burden of disease and death on the fragile public health systems in resource-poor countries. This probably compromises the ability of these countries to confront other challenges due to malaria, tuberculosis, and a legion of other diseases.

A companion paper in the same issue by the SMART study group reports on the lower relative risk of serious illness or death in those who started treatment with a CD4 cell count above 350 cells/mm3.

Reference
The Strategies for Management of Antiretroviral Therapy (SMART) Study Group. Inferior clinical outcome of the CD4 cell count–guided antiretroviral treatment interruption strategy in the SMART Study: role of CD4 cell counts and HIV RNA levels during follow-up. Journal of Infectious Diseases 197:1145–1155, 2008.

By Tom Egwang, www.aidsmap.com

Benefit of Starting HIV Treatment Early Outweighs the Risk of Toxicities, SMART Study Shows

April 14, 2008

Starting antiretroviral therapy at a CD4 cell count above 350 - the current threshold for starting treatment - reduced the risk of serious illness and death compared to later treatment, according to the findings of a subgroup analysis of the SMART treatment interruption trial published in the 15th April edition of the Journal of Infectious Diseases.

Current treatment guidelines in Europe and the United States recommend deferring antiretroviral therapy (ART) in asymptomatic adult patients until the CD4 count falls below 350 cells/mm3 or has reached less than 200 cells/mm3 in resource-poor countries. These recommendations were based on the results of nonrandomised studies and expert opinions.

The guidelines were formulated based on earlier concerns about the risk/benefit ratio of starting ART earlier and the fact that AIDS-defining clinical events were rare at higher CD4 counts. There were fears that any benefits of early ART could be compromised by toxicities, cost-effectiveness, quality of life issues, adherence, and drug resistance.

An increasing body of evidence now suggests that these guidelines must be revisited. First, data from clinical studies indicate that the risk of AIDS persists at CD4 counts >500 cells/mm3. Second, even in patients with high CD4 counts, the risk of AIDS or death decreases with the initiation of ART by comparison with those who are not on ART. Finally, the risk of serious non-AIDS-related diseases and cancers is lower at higher CD4 counts.

The Strategies for Management of Antiretroviral Therapy (SMART) Study Group conducted in 318 international sites in 33 countries has addressed this issue. Its primary finding - that treatment interruption was associated with an increased risk of serious illness and death - was published in the New England Journal of Medicine in 2006, and a range of other findings have been presented at international conferences over the past five years.

The SMART study randomised participants with CD4 cell counts above 350 cells/mm3 to continuous use of ART (the viral suppression, or VS, strategy) or to discontinue treatment until the CD4 cell count fell below 250 cells/mm3. Some participants were antiretroviral-naive when they entered the study.

For the present study, the SMART Study Group undertook a subgroup analysis of the larger trial in which clinical outcomes were compared between participants who initiated ART in the trial with CD4 counts above 350 cells/mm3 and HIV-infected patients who deferred ART until the CD4 counts had declined to <250 cells/mm3.

The sub-study analysed 477 patients, 249 of them treatment-naive on entry to the study. The patients were followed for a mean of 18 months with periodic clinical and laboratory monitoring for CD4 counts and HIV-1 RNA loads.

The following clinical outcomes were assessed: (i) opportunistic disease (OD) or death from any cause (OD/death); (ii) OD (fatal or nonfatal); (iii) serious non-AIDS events (cardiovascular, renal, and hepatic disease plus non–AIDS-defining cancers) and non-OD deaths; and (iv) the composite outcomes of OD and serious non-AID events.

Twenty one and 6 OD and non-AIDS events occurred in the DC and VS groups, respectively. Hazard ratios for DC versus VS by outcome category were as follows: OD/death, 3.47 (P = 0.02); OD (fatal or nonfatal), 3.26 (P = 0.04); serious non-AIDS events, 7.02 (P = 0.01); and the composite outcomes, 4.19 (P = 0.002). Thus, early initiation of ART at CD4 cell counts > 350 cells/mm3 reduced HIV-related deaths and disease.

The authors say these findings require urgent validation in a large, randomised clinical trial. An accompanying editorial makes the point that such a study should unequivocally establish that the benefit of early ART initiation is large enough to justify the costs. Such a study would also provide unique opportunities to unravel the mechanisms underlying the beneficial effects of early ART initiation on non-AIDS events.

A companion report in the same edition of the journal provides further evidence to support earlier treatment. The analysis shows that even at CD4 cell counts above 350 cells/mm3, uncontrolled viral replication in individuals who had interrupted therapy was associated with an increased risk of serious illness or death, as was a greater duration of time spent living with a CD4 cell count below 350 cells/mm3.

Reference
The Strategies for Management of Antiretroviral Therapy (SMART) Study Group. Major clinical outcomes in antiretroviral therapy (ART)–naive participants and in those not receiving ART at baseline in the SMART study. Journal of Infectious Diseases 197:1133 - 1144, 2008.

Hughes MD, Ribaudo HR. The search for data on when to start treatment for HIV infection. Journal of Infectious Diseases 197:1084-1086, 2008.

By Tom Egwang, www.aidsmap.com

Tesamorelin for Lipo: More Data Expected

April 14, 2008

Montreal-based Theratechnologies announced today that the last patient enrolled in its confirmatory Phase III clinical trial of tesamorelin for HIV-associated lipodystrophy has completed 26 weeks of treatment. The press release from the company also suggests that data from the first six months of the yearlong study will be released within the next few months.

The clinical trial currently under way was designed to confirm the results of the first Phase III study by examining the safety and efficacy of daily injections of 2 mg tesamorelin for 26 weeks. Data from the first study, reported in a December 2007 issue of The New England Journal of Medicine, indicated that tesamorelin treatment for six months decreased visceral adipose tissue (VAT)—deep belly fat—by 15 percent, compared with a 5 percent increase in VAT among those who received placebo injections.

Improvements in triglyceride and cholesterol levels were also reported in the first Phase III study.

"We are extremely pleased to have completed our confirmatory Phase III trial on schedule," Dr. Christian Marsolais, vice president of clinical research at Theratechnologies, is quoted as saying in the press release. "These data will allow us to move forward with the preparation of the documentation required to submit a New Drug Application for tesamorelin [for the treatment of] HIV-associated lipodystrophy to the U.S. Food and Drug Administration by year end."

Allowing for a standard 10-month review period, tesamorelin could be available for commercial use in the U.S. by mid-2009.

http://www.poz.com

Indirect Effects on Immune Activation May Partially Account For Lingering Benefits of Failed Antiretroviral Therapy in the Brain

April 16, 2008

The intriguing finding that anti-HIV therapy continues to provide protective benefit in the brains of HIV-positive people who have failed therapy may be explained by an indirect effect of therapy on immune activation, say researchers in a report in the April 15th issue of Journal of Acquired Immune Deficiency Syndromes.

What’s more, they suggest that this newly characterised effect on immune activation may help to explain why antiretroviral therapy often performs better than expected in reducing the amount of HIV in the brain.

A 2006 study by Dr Richard Price, University of California, San Francisco, reported that among 123 people with HIV who were failing treatment, the HIV viral load in the cerebrospinal fluid (CSF) was about 10-fold lower than that in plasma. In the current follow-up study, Price and colleagues tested the hypothesis that this difference in therapeutic effect is due to the reduced immune activation often associated with the replication of drug-resistant virus.

In the cross-sectional study, the researchers placed the participants into four groups: 53 people who had been off treatment for at least three months (‘offs’), 30 people who were on treatment but with a viral load above 500 copies/ml (‘failures’), 40 people who were on treatment and with a viral load below 500 copies/ml (‘successes’) and 14 HIV-negative controls.

For each group, the researchers measured viral load in blood plasma and CSF. They also measured the level of activation of CD8 cells and CD4 cells in both compartments, as well as two markers of CSF immune response, white blood cell counts and neopterin levels.

Median blood CD8 cell activation was highest in offs (47.1%) and decreased in failures (34.2%), successes (21.5%) and HIV-negative controls (9.2%).

Overall, CD8 cell activation in CSF was strongly correlated with that in the blood, with median levels of CD8 cell activation being somewhat higher in the CSF samples: 61.3% for offs, 39.1% for failures, 26.7% for successes and 23.9% for controls. CD4 cell activation in the different groups was similar, but not as clearly correlated as CD8 cell activation. CD8 cell activation also correlated with the two other markers of CSF immune response, white blood cell counts and neopterin.

In their previous work, the researchers had found that plasma viral load was not significantly different between failures and offs, but CSF viral load was significantly higher in offs than failures (1.65 log10 difference in medians).

Noting that this difference in CSF viral load between the failures and offs coincided with a difference in CD8 cell activation levels, researchers then evaluated the interaction between three factors: 1) viral load in plasma and CSF, 2) CD8 cell activation in blood and CSF and 3) status as failure or off.

Across the range of plasma viral loads, blood and CSF CD8 cell activation were significantly lower in failures than in offs. This suggests that CD8 cell activation differed depending on the type of virus: wildtype virus (off group) led to high activation while resistant virus (failure group) led to muted activation in the blood and CSF.

Across the range of CSF viral load, blood and CSF CD8 cell activation were not different between the failure group and the off group. From this the authors suggest that CD8 activation in the CSF is the same regardless of whether the virus is wildtype (off group) or resistant (failure group).

Further statistical analysis revealed that plasma viral load, blood CD8 cell activation and neopterin levels predicted CSF viral load across the three groups (off, failure and success). CSF CD8 cell activation, which was significant in univariate analysis, lost significance after blood CD8 cell activation was included.

The researchers assert that these data support a model of HIV replication (and antiretroviral suppression) in the blood and CSF that includes both direct and indirect effects. Briefly, HIV infection in the blood increases plasma viral load and activates blood immune cells. These activated blood immune cells travel through the blood–CSF barrier, populate the CSF and become a primed target for HIV replication in the CSF. In fact, the researchers propose that the bulk of virus detected in the CSF is due to these systemically activated immune cells. (The CSF can also be populated by immune cells derived from long-standing sources in the brain.)

Antiretroviral treatment decreases plasma viral load and CSF viral load, though the direct effect on the latter may be weakened due to the blood–CSF barrier. Treatment also dampens activation of immune cells in the blood. These dampened cells cross into the CSF, but due to their less activated state will lead to lower HIV amplification in the CSF and thus a lower CSF viral load.

In cases of treatment failure due to resistance, plasma viral load will rise due to resumed HIV amplification in the blood. However, due to some unknown mechanism, blood immune cell activation is muted. When these muted immune cells cross the blood–CSF barrier, they provide poor targets for HIV and so lead to reduced amplification in the CSF and a lower than expected CSF viral load.

As a final remark, the researchers write, "these studies suggest that the level of systemic immune activation is an important modulator of this infection and that its downregulation by ART [antiretroviral therapy] may contribute to controlling HIV-1 in this compartment and explain the better-than-predicted responses of CSF HIV-1 to ART." While not conclusive, these findings by Price and colleagues add to the mounting evidence that that brain-penetrating antiretrovirals are not always necessary for control of HIV in the CSF.

Reference
Sinclair E et al. Antiretroviral treatment effect on immune activation reduces cerebrospinal fluid HIV-1 infection. J Acquir Immune Syndr 47:544–552, 2008.

By David McLay, www.aidsmap.com

N.C. Becomes Center of HIV Fight
The International AIDS Vaccine Initiative joins the Center for HIV/AIDS Vaccine Immunology at Duke in the search for a vaccine

April 19, 2008

The world's hope of beating HIV centers on a team of Triangle-based scientists.

The Center for HIV/AIDS Vaccine Immunology, headquartered at Duke University and drawing on researchers at Duke, UNC-Chapel Hill and more than 30 other universities, formed in 2005. This week, the center announced it will add even more brainpower with the addition of an international research consortium, signaling the mounting pressure to discover a vaccine.

The center and a privately funded research group, International AIDS Vaccine Initiative, agreed to cooperate, saying that the moral obligation to find a vaccine is too pressing for anyone to work alone.

"Competition retards work in this field," said Dr. Barton Haynes, the center's director and professor of medicine at Duke University Medical Center. "It's no longer ethical to do anything but move forward on this disease as fast as we possibly can because of the human cost."

The groups agreed to share virus samples and laboratories, and launch parallel studies. The center is particularly anxious to gain access to the Vaccine Initiative's large sample pool of the virus to get better reads on its mutations.

Such collaboration is unprecedented. It's also imperative, Haynes said.

"The science is daunting," said Haynes. "The bug had escaped and eluded us so many times. It's pretty audacious."

For nearly 25 years, HIV has outwitted scientists trying to stop the spread of the virus that causes AIDS. The latest setback: a vaccine that not only didn't work, it appeared to make otherwise healthy patients more likely to contract HIV.

Two trials tested the vaccine, drawing on participants in North and South America, the Caribbean, Australia and South Africa.

Each was to have 3,000 participants. When researchers noticed the troubling results in one of the trials last fall, clinicians halted the other study.

Back To Basics
Haynes said the new mission is an old one: Tackle basic questions about the virus, which killed 2.1 million people worldwide last year.

Scientists at the center are working to better understand what's happening in the initial hours when HIV invades a healthy person. They are exploring genetic differences between those whose immune systems thwart the virus and those infected. Scientists have tried to get a picture of the virus in its native form so they can create antibodies to spot it.

Dr. Myron Cohen, a center leader and director of the Center for Infectious Diseases at UNC-CH, said the scientific work being done now is essential for breakthroughs to come. "It's been like putting glasses on," Cohen said. "We can finally see the face of our challenge specifically."

Even before Merck & Co. announced last month it would halt its vaccine trial, many HIV researchers were aware of the drug's shortcomings. Yet the failure still stung. Researchers mourned the money spent and the lives lost while scientists chased medicine that didn't work.

"The HIV vaccine is our holy grail," Cohen said. "We spend $1.3 billion a year. It hurts when it doesn't work."

The research community formed Center for HIV/AIDS Vaccine Immunology in 2005 after scientists realized that colleagues were refusing to share their research out of fear they'd lose funding, Haynes said.

The center, and now the new alliance with the Vaccine Initiative, forces collaboration by funneling large government, foundation and private donor block grants into a single consortium.

'Mortgaging Our Future'
All the while, HIV marches on. Since AIDS appeared in the early 1980s, more than 25 million have died. Last year, the virus infected another 2.5 million, according to UNAIDS, a United Nations group.

"We're scrambling," said Catherine Hankins, chief scientific adviser to UNAIDS. "We're mortgaging our future here."

In North Carolina, the number of new cases started to climb again in 2002. Last year, nearly 2,000 North Carolinians got the disease.

No one is more interested in a vaccine breakthrough than those already infected. "We don't want anyone else to go through this," said Steve Kueny, a Durham resident who has battled HIV since the early 1990s.

Over the past decade, antiviral therapies have transformed a deadly disease into a survivable one. But the same mutations that have made a vaccine so elusive also plague treatments.

Kueny relies on a combination of pills to survive. Any day, though, he could grow resistant to one or experience a debilitating side effect.

"The point is to stay alive until there's a new drug," Kueny said.

By Mandy Locke, http://www.newsobserver.com

Heart Health Concerns? You Can Still Get Cracking
An egg a day doesn't boost the risk of heart attack or stroke in healthy men, but diabetics may want to think twice

April 16, 2008

It's a misconception that almost 75 per cent of Canadians believe to be true: The amount of cholesterol you eat boosts blood cholesterol. It's also a belief that keeps many people, especially those worried about heart disease, from eating eggs.

According to a new study from Harvard University's medical school, eating an egg a day does not increase the risk of heart attack or stroke in healthy men. But the findings suggest that if you have diabetes, you may want to swap sunny side up for a whites-only omelette.

The concern with eggs has to do with their high cholesterol content - 190 milligrams in each egg. Nutrition guidelines to keep LDL blood cholesterol in the desirable range have emphasized limiting dietary cholesterol, which is abundant in egg yolks, shrimp, liver and duck, to less than 300 mg a day. (Elevated LDL cholesterol in the bloodstream is a major risk factor for heart disease.) If you have high blood cholesterol, the American Heart Association advises consuming less than 200 mg of cholesterol a day.

The Heart and Stroke Foundation of Canada does not recommend a specific cholesterol intake for healthy people, but rather stresses the importance of limiting saturated and trans fats to help control blood cholesterol.

That's because higher intakes of saturated fat (found in meats, poultry and dairy products) and trans fats (found in baked goods, snacks and fried foods made with partially hydrogenated vegetable oil) raise LDL cholesterol much more than do higher amounts of dietary cholesterol.

While there is compelling evidence that high cholesterol intakes can cause hardening of the arteries in rabbits, pigs and mice, there's little evidence that this is so in humans. For most people, only a small amount of cholesterol in food passes into the bloodstream.

In the current study, published in this month's issue of the American Journal of Clinical Nutrition, researchers followed 21,327 male physicians for 20 years and found that consuming eggs - up to six a week - was not linked with a greater risk of heart attack, stroke or death from all causes.

The results were different for men with diabetes. Those who ate seven or more eggs a week compared with less than one had double the risk for all-cause mortality, presumably from heart disease.

This isn't the first study to find no connection between egg intake and heart disease in healthy people. An earlier study from Harvard's school of public health determined that eating one egg a day had no overall impact on the risk of heart disease or stroke in men and women.

Interestingly, that study also reported a relationship between egg consumption and risk of heart disease in people with diabetes. Among those with diabetes, egg-a-day eaters were a bit more likely to develop heart disease than those who rarely ate eggs.

Scientists speculate that individuals with diabetes absorb higher amounts of cholesterol from foods. Dietary cholesterol may also lead to the formation of smaller and denser LDL cholesterol particles in people with diabetes. (Small, dense LDL particles are more often associated with hardening of the arteries than large, "fluffy" LDL particles.)

How many eggs can a person concerned about heart disease safely eat? If you're healthy, one whole egg a day seems perfectly safe. If you're a man with diabetes, it's prudent to limit egg yolks to four a week. Instead of a three-egg omelette packed with 570 mg of cholesterol, try a whites-only omelette for a good source of protein, riboflavin and selenium.

Some eggs may actually offer protection from heart disease. Research has demonstrated that eating eggs enriched with DHA from fish oil helps lower triglycerides, a blood fat linked to heart disease.

While evidence that eating eggs boosts heart disease risk is lacking, there is plenty of scientific support for making other dietary modifications.

Numerous studies have shown that reducing saturated and trans fats, limiting sodium intake and increasing consumption of fish, whole grains and fibre guard against heart disease.

Eggs 101

Brown Eggs
Produced by Rhode Island Red hens. Egg shell colour does not affect the flavour or nutrients.

Free-Run Eggs
Produced by hens free to roam in open-concept barns equipped with nests and perches. Nutrient content is the same as regular eggs.

Free-Range Eggs
Produced by hens that have outdoor access as well as space for nesting and perching. Nutrient content is the same as regular eggs.

Liquid Eggs
Contain pasteurized egg whites, a small amount of pasteurized egg yolk, beta carotene and natural flavour. Four tablespoons (50 millilitres) are equivalent to one large egg. Burnbrae Farms Naturegg Break-Free liquid eggs contain 80 per cent less cholesterol than one regular egg.

Liquid Egg Whites
Pasteurized egg whites that contain no fat or cholesterol. One carton (250 ml) is equivalent to eight large egg whites.

Omega-3 Eggs
Laid by hens fed a diet enriched with flaxseed or fish oil, sources of the omega-3 fatty acids ALA and DHA, respectively. These eggs are good sources of ALA or DHA, both linked with protection from heart disease.

Organic Eggs
Laid by hens fed certified-organic grains grown without the use of synthetic chemicals or genetically modified crops. Nutrient content is the same as regular eggs.

Egg Substitutes
Found in the freezer section, these products contain egg whites, corn oil, colouring, additives and preservatives.

By Leslie Beck, a Toronto-based dietitian at the Medcan Clinic, is on CTV's Canada AM every Wednesday. www.esliebeck.com . The Globe and Mail