Vancouver's Gritty Close-Up

Working with students from UBC's Graduate School of Journalism, former CBS anchor Dan Rather takes an unflinching look at the drug-riddled Downtown Eastside for his newsmagazine show

February 19, 2008

Vancouver - When Dan Rather arrived in Vancouver last fall to do a story about the notoriously troubled Downtown Eastside, he was armed with piles of research provided by journalism students at the University of British Columbia.

"This was not a case where the school lent its name to it and we did most of the work," Rather said during an interview last week from New York. "[The students] did a lot of the work."

The result of that collaboration, A Safe Place to Shoot Up, profiles the not-so-photogenic side of Vancouver with visuals you won't see in any tourism brochure or Olympic marketing campaign. Rather greets viewers at the show's opening, "Good evening from beautiful Vancouver, Canada," but the initial shots of scenic English Bay, the North Shore mountains and sandy beaches quickly give way to scenes from the streets and alleyways of the Downtown Eastside, where syringes litter sidewalks, sex workers await customers and drug addicts shoot up in broad daylight.

Rather calls it "a city of contrasts" in his report, describing "a landscape studded with snow-capped mountains and multimillion-dollar condos cradling a downtown that's home to one of the worst urban blights in North America." He cites stunning statistics from the United Nations: One in three residents of the Downtown Eastside is HIV-positive, and the rate of hepatitis C infection is 70 per cent.

The plight of the Downtown Eastside is not exactly news to Vancouverites. The area, in fact, is often a first stop for journalists – or journalism students – new to the city, and looking for a good story to tell.

But this time, the story is being fronted by a celebrity journalist and will get international airplay on HDNet, a television network based in Dallas, which also streams already-aired stories online. So Vancouver's reputation as the most livable city in the world (a title, the story notes, the city has earned repeatedly) may be in for a little tarnishing.

Rather, 76, is a veteran journalist who has covered events ranging from wars and elections to the John F. Kennedy assassination. He joined HDNet in 2006, a year after his bitter departure from long-time employer CBS.

Rather is now suing CBS, arguing the network and its executives made him a scapegoat for a questionable story that aired about President George W. Bush's military service. He is expecting a ruling to be made soon – possibly this week – in CBS's move to have the case dismissed. At the same time, the legal discovery process is continuing.

"I have no illusions about this," Rather says. "I knew going into it that it would be a long, hard, expensive road [with] odds against."

Rather said he's focusing not on the lawsuit but on his new show, which launched on HDNet three months ago.

The idea for A Safe Place to Shoot Up came from the advanced TV class at the UBC Graduate School of Journalism. Hoping to introduce his second-year masters students to the real world of working journalism, associate professor (and long-time 60 Minutes producer) Peter Klein developed a course in which students would spend a semester producing an item for Dan Rather Reports. The students were each asked to come up with a story idea for the show.

Ten pitches were whittled down to three, and those were presented to Rather and his producers. They chose to tell the story of Vancouver's Downtown Eastside. The students then got to work – doing research, lining up interviews, writing questions for Rather to ask.

"A number of them have said it was the highlight of their journalism education experience," says Klein. "I think initially there was that star quality, anticipating working with a star journalist … [but] there was a wonderful rapport between them and I think they lost that sort of starry-eyed thing really quickly."

To the students, "Mr. Rather" became "Dan" and eventually they felt comfortable making suggestions to the highly experienced reporter. "He was really like the farthest from a prima donna – really easy going," Klein says.

The half-hour of television focuses heavily on the safe-injection site for drug addicts, but also touches on homelessness, a plan by sex workers to open a prostitute-run brothel, the trial of mass-murderer Robert Pickton and the proposal being touted by Vancouver Mayor Sam Sullivan known as CAST (Chronic Addiction Substitute Treatment) that would see addicts get their drugs from pharmacies rather than on the street. Lurking in the background is the spectre of the Winter Olympics, two years away.

Before shooting this story, Rather had been to Vancouver many times. But he had never before walked the streets of the Downtown Eastside. When he did last November, even after extensive research, he was still surprised by what he saw – in particular how far the squalid neighbourhood stretches.

"It's impossible to spend time [in the Downtown Eastside] and not wonder to oneself how such a crime-ridden, poverty-devastated area could exist side by side and literally right in the midst of what is clearly a wealthy community," Rather says. "Very few places in the world would … have those contrasts, literally cheek by jowl."

He was impressed, though, with the thinking-outside-the-box attempts at solutions, and by the idealism displayed by those trying to clean up the city's problems – from the volunteers at the safe injection site all the way up to the mayor's office.

"As a journalist, I try hard not to be cynical, but part of my job is to be skeptical.… Do I think the problems can be addressed in the main and overall and substantially between now and Olympic time? I have my doubts," he says. "I'd love to be proven wrong."

A Safe Place to Shoot Up on Dan Rather Reports airs on HDNet Tuesday at 8 p.m. ET and 8 p.m. PT.

By Marsha Lederman, Globe and Mail

Conservatives Give Lobby Group Same Weight as Scientists

February 18, 2008

In the latest salvo in the battle over Vancouver's controversial safe drug injection site, leading researchers are criticizing the Harper government for not differentiating between legitimate science and a report endorsed by a U.S. law-and-order lobby group.

"Alarmingly", they say, Health Minister Tony Clement has been citing the lobby group report as evidence of growing "academic debate" over the safe injection site.

In a report published Monday in a British medical journal, they say advancing evidence-based public health in Canada "will now require that politicians are able to tell the difference between valid peer-reviewed science and essays posted on the websites of lobby groups."

The lobby group, the Drug Free America Foundation, is dedicated to strengthening laws to hold drug users and dealers criminally accountable for their actions. The group's online journal, "which to the untrained eye could easily be mistaken for a scientific journal," disseminates material and essays that oppose the concept of harm reduction, researchers Drs. Evan Wood, Julio Montaner and Thomas Kerr say in an article published Monday in The Lancet Infectious Diseases, a British medical journal.

Wood, Montaner and Kerr of the B.C. Centre for Excellence in HIV/AIDS are principal investigators at INSITE, an experimental safe injection site in Vancouver's troubled Downtown Eastside. Since September 2003, heroin and cocaine addicts have been injecting street-bought drugs at the site staffed by a small team of government-paid nurses and drug counsellors.

The researchers' two dozen reports, published in top-level peer-reviewed journals, conclude that INSITE has reduced the number of syringes on the street, reduced syringe-sharing that can spread infection, increased entry into detox and treatment, and reduced drug-overdose deaths. The findings have been widely backed by other investigators.

Drug Free America and its online journal prefer to highlight a critique of the injection site that concludes the experiment has had little success. It also says drug policy in Canada has become so "politicized" that the true results are being "ignored."

The critique was written by former academic and Canadian anti-harm reduction activist Colin Mangham, and was, according to Wood and his colleagues, funded by the RCMP.  Mangham says INSITE has resulted in "little or no reduction in transmission of blood-borne diseases or public disorder, no impact on overdose deaths in Vancouver" and has lacked impact and success.

The federal government has recently announced a new anti-drug strategy that redoubles law enforcement efforts while leaving the future of INSITE in doubt. Health Canada announced in October it would extend the drug-law exemption that allows the facility to operate, and the Harper government has given it a reprieve until June.

Wood and his colleagues say they were alarmed when Clement recently alluded to Mangham's report and suggested there is growing academic debate about safe injection sites.

"If the health minister equates a report from an RCMP-funded, advocacy group to 24 peer-reviewed scientific papers including articles in the New England Journal of Medicine, then Canadians need to be worried about the person who is in charge of public health in this country," Wood said in an interview Monday.

Clement could not be reached for comment.

By Margaret Munro, http://www.canada.com

B.C. Study Shows 40 Per Cent of HIV Sufferers Died without Getting Treatment

February 22, 2008

Vancouver - Forty per cent of the people who died of HIV-AIDS in British Columbia never accessed life-saving treatment even though it was free, according to a new study released Friday.

The study by the B.C. Centre for Excellence in HIV-AIDS looked into more than 1,400 HIV-related deaths in the province between 1997 and 2005.

In that period of time, a total of 567 people died without ever receiving the highly effective antiretroviral treatment.

"We have a problem," said Dr. Julio Montaner, director of the centre. "The treatments are available for free but something is wrong because the people that most need the treatment, they're not always accessing the treatment."

Low income was strongly associated with the delay in starting therapy and the ensuing high mortality rate.

Residence in a poor neighbourhood was associated with an increased risk of mortality among HIV patients, Montaner said.

"Factors such as a lack of housing or transportation, mental illness, illegal activity and language barriers play a role in an individual's ability to access treatment," he said.

Twenty-five per cent of those infected with HIV in Canada are not aware of their infection, according to the centre.

The centre distributes the cocktail of antiretroviral medications to all eligible British Columbians, free of charge, through the province-wide Drug Treatment Program, funded by Pharmacare.

Yet ensuring access to the treatment remains an elusive goal, he said.

"We have found that over the last several years there is a persistent number of people dying with HIV in our midst, where treatment and health care is supposed to be readily available," Montaner said.

Typical examples are single mothers who don't have the resources to get a babysitter or a homeless, mentally ill drug addict who lives on the Downtown Eastside and doesn't even know he's HIV-positive, he said.

And it's not just Vancouver, Montaner said. It's a problem right across the country and the percentage could even be worse in smaller communities where fewer resources are available.

Ann Livingston, spokeswoman for the Vancouver Area Network of Drug Users, called the study shocking.

Four in 10 people in Vancouver's Downtown Eastside live outside and many among them are sick with AIDS, she said.

Some live in substandard hotels that are often infested with cockroaches and unsafe but people stay there because welfare payments don't provide enough money for decent housing for those who are too ill to work, Livingston said.

"And they have no general practitioner. That's another nightmare," she said.

Ken Buchanan, of the British Columbia Persons with AIDS Society, said the long-term solution is to bring some stability to the lives of HIV-AIDS sufferers.

"For a person who is homeless, taking medications, even free medications, is pretty low in their priorities," he said.

Buchanan warned that access to medication isn't enough. A person who begins treatment and doesn't maintain the proper dose regime will build up a resistance to the drugs and end up more likely to die.

"You can't take them for a few days and then stop for a few days," he said. "If your life is chaotic ... you don't have the ability or the need or the desire to take your meds."

The centre has a proposal before the provincial government to form outreach teams that would take rapid-response testing to the most vulnerable and offer treatment.

But "free health care is not necessarily enough to address this problem," he said.

"We need to bring the treatments to the people and we need to create the programs that are going to help these individuals to take the treatment," he said.

It is not only the ethical and human thing to do, he said, it's also better for society at large because it reduces HIV-related illnesses that drain the health care system.

"By treating these people we're doing what is right for them, we're doing what is right for the system and we're also going to decrease HIV transmission," Montaner said.

"This is the right thing to do both in an ethical sense and also in a business sense."

Previous research by the centre and by researchers in Taiwan showed a 50 per cent reduction in new HIV cases that they felt was due to access to the highly active antiretroviral therapy.

The treatment consists of three or more antiretroviral drugs on a daily basis for life and it requires a very high level of adherence in order to be fully effective.

It has been the standard of care for the treatment of HIV-AIDS since 1996.

The Canadian Press

Gay Jamaican Officer Seeks Asylum

'My life is in great, great jeopardy' in a country where violence against homosexuals is pervasive

February 25, 2008

A Jamaican police officer says he's living in fear after coming out as a gay man and hopes to come to Canada where he can safely speak up on behalf of other gay Jamaicans.

Michael Hayden, who has been on the police force for four years, said other officers routinely attacked and abused him after becoming suspicious of his sexual orientation.

But after speaking out publicly about the problem in The Jamaica Star newspaper this month, the 24-year-old Hayden said he began receiving death threats.

"I want to stay here and fight," Hayden said in a telephone interview from Jamaica yesterday. "But it's not safe for me. My life is in great, great jeopardy."

Human rights groups say Hayden's case is the latest in a series of disturbing anti-gay incidents in the Caribbean tourist destination.

The Jamaican police force declined to comment on Hayden's situation. Sodomy is a criminal offence in Jamaica, which carries a maximum penalty of 10 years.

"We have no comment at this time," Karl Angell, a spokesperson for the Jamaican Constabulary Police Force, said in a telephone interview from Jamaica yesterday.

Hayden is not the first gay Jamaican to seek asylum out of fear for his life, said Rebecca Schleifer, a researcher with Human Rights Watch in New York and author of Hated to Death, a report on gay bashing and its impact on the fight against HIV/AIDS in Jamaica.

Jamaica lost a key leader in the HIV/AIDS battle, she said, when gay activist Gareth Henry fled the country last month and sought refugee status in Canada. Henry had been co-chair of the Jamaican Forum for Lesbians and Gays and also a volunteer with Jamaican AIDS Support for Life.

Henry, 30, told the Star yesterday that he started thinking about leaving Jamaica after being beaten by police a year ago on Feb. 14 in a drugstore in Kingston, Jamaica. He says police deny beating him.

He said he's lost 13 gay friends since 2004, yet police refuse to acknowledge there's a problem, often blaming the dead victim's lover or other gay men.

"The situation for gays and lesbians in Jamaica is getting worse," Henry said in a telephone interview in Toronto, where he's now living.

Henry said he feels for Hayden. "He's unsafe. They're hunting him daily. It's one of those very sad cases. For him coming out, he didn't want to be another person who died before he got to tell his story."

Hayden is now on a leave of absence from his job and is in hiding while his allegations against his fellow officers are being investigated.

Violence against men who have sex with men, ranging from verbal harassment to beatings, armed attacks, and murder, is pervasive in Jamaica, according to Schleifer's report for Human Rights Watch.

The church denounces gay sex, popular music reinforces prejudices against gays and lesbians and police do little to stop violence against them, she noted.

By Dana Flavell, Toronto Star

Bono’s $42.5M Valentine to the Global Fund

February 18, 2008

An art auction organized by Sotheby’s, U2 front man Bono and artist Damien Hirst raised $42.5 million Valentine’s Day evening. The funds were donated to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Associated Press reports (ap.google.com, 2/15). The star-studded auction was held at the Gagosian Gallery in Manhattan.

The priciest piece auctioned was Hirst’s work entitled "Where There’s a Will, There’s a Way," which sold for $7.15 million, the AP reports. The piece is a cabinet filled with painted antiretroviral pill bottles. Hirst was among 17 artists—including Howard Hodgkin, Keith Tyson and Marc Quinn—to donate work for the event.

Bono proclaimed in a Sotheby’s press release, "Tonight we got serious about love, and not just the love of art, but the love of our brothers and sisters suffering from AIDS in the poorest places on the planet."

AP, http://www.poz.com


Also: Elton John Foundation's Activist Works Behind Scenes at Oscars

February 22, 2008

While Elton John performs with Mary J. Blige for 700 guests Sunday night at his annual Academy Awards party in West Hollywood, Scott Campbell will be offstage leading the pop singer's war against AIDS.

Since it started in 1992, the party has evolved from a small, glamorous gathering that raised $200,000 for the Elton John AIDS Foundation to a huge, star-studded affair that took in $4.3 million last year. The party, where tables cost as much as $100,000, begins even before the stars walk the red carpet. Huge screens broadcast the show live and the party continues into the early morning.

The organization has made a big push forward in recent years with the help of Campbell, a 45-year-old Montana native who took over as executive director three years ago. In that time, he has nearly tripled the foundation's budget to $12 million and expanded the organization's reach to the Caribbean by funding a program that publicizes awareness of the disease.

John's name attracts celebrities to the party. Among those invited this year include actors Sean Penn, Eva Longoria, Ellen DeGeneres, Tim Allen, Sharon Stone, singer Ozzy Osbourne and film director John Waters.

Yet it's the lanky and affable Campbell who pushed to get big corporate backers on board. Jewelry and watch maker Chopard & Cie SA is the party's largest sponsor. He also lured American Airlines and VH-1, Viacom Inc.'s cable television music channel, as top sponsors.

"Laser-Focused"

"Scott is laser-focused on his job as the fundraiser," said Kandy Ferree, president of the National AIDS Fund in Washington, whose organization received $2.8 million in funding from the foundation last year. "He's someone who is committed to follow-up and will be on the phone with deep-pocketed donors."

When the party under the tents at the Pacific Design Center in West Hollywood is over and guests have had their fill of steamed sole, risotto and long-winded Oscar speeches, the nonprofit is expected to raise $5 million. The foundation, with offices in New York and London, has funded 4,000 AIDS treatment, prevention and research programs in 55 countries since its founding.

Grant recipients are approved by the 12-member board, which includes John, who is the chairman, his partner, David Furnish, and tennis player Billie Jean King.

Last year, the foundation made 58 grants to AIDS organizations, including $350,000 to the New York-based Syringe Access Fund, which distributes clean syringes.


Reduce the Stigma

"We know that they (needle exchanges) have been effective, in cutting down the transmission of HIV from one person to another," he said.

Campbell was instrumental in the foundation's funding of the Caribbean Broadcast Media Partnership on HIV/AIDS, which uses newspapers and broadcasting to encourage people in that region to get AIDS tests. "The purpose of it is to reduce the stigma of AIDS and to make people aware of the disease," Campbell said.

Last year, about 11,000 people died of AIDS in the Caribbean and only an estimated 10 percent of people who are HIV-positive know they're infected, according to the foundation on its Web site.

A native of Bozeman, Montana, who was raised in California, Campbell worked for fundraising consultant J.C. Geever Inc. after college. As the AIDS epidemic grew in the 1980s, he became interested in raising money to combat the disease and joined the Foundation for AIDS Research, or amfAR, in 1992.

During his 13 years at amfAR -- where he eventually became vice president of development -- the organization funded early studies that were important to the development of protease inhibitors that reduced deaths.

"AIDS was very often thought of as a death sentence,'' he said. ``Part of that was due to the stigma that surrounds it and society's slow response to it."

Campbell said he hopes eventually there won't be a need to collect donations to fight AIDS.

"I don't think people are thrilled that they're still here 16 years later having to support this event," he said. "But people remain supportive because they know that AIDS is an urgent problem."

By Patrick Cole, www.Bloomberg.net


And: Record Bequest To Support Gay Rights, HIV/AIDS Groups

Seattle - The estate of Ric Weiland, a high school classmate of Microsoft Corp. founders Bill Gates and Paul Allen and one of the first five people to work at the software giant, has left $65 million to gay rights and HIV/AIDS organizations.

The bequests were announced Sunday by the Pride Foundation of Seattle, where Weiland was a board member for several years. The foundation called it the largest single bequest ever given to gay, lesbian, bisexual and transgender causes.

Gates and Allen hired Weiland in 1975, the year they founded Microsoft. He worked as a project leader for the Microsoft Works word processing and spreadsheet software, and was a lead programmer and developer for the company's BASIC and COBOL systems, two of the first personal computing interfaces. He left Microsoft in 1988.

Weiland donated tens of millions to various organizations — from gay rights groups to environmental and education organizations — before he died in 2006. He committed suicide at age 53 after a long battle with depression, and survivors include his partner, Mike Schaefer.

The $65 million is among bequests totaling about $160 million — the bulk of Weiland's estate_ to various charities and Stanford University, his undergraduate alma mater, according to an estimate provided by the Pride Foundation.

In the latest bequest, the Pride Foundation said Weiland's estate had established a fund at the foundation that would give $46 million over the next eight years to 10 national gay rights and HIV/AIDS groups, including Lambda Legal; the National Gay and Lesbian Task Force; Parents, Families and Friends of Lesbians and Gays; the Gay & Lesbian Alliance Against Defamation; and amfAR, the Foundation for AIDS Research.

His estate also bequeathed $19 million directly to the Pride Foundation for scholarships and grants supporting the gay, lesbian, bisexual and transgender community in the Pacific Northwest.

The Associated Press.

One in Five HIV Patients in New York Say They Never Use Condoms

February 21, 2008

Approximately one-fifth of HIV-positive patients report never using condoms with regular or casual partners in a study conducted in New York and published in the February edition of AIDS Patient Care and STDs. Inconsistent use of condoms was associated with the presence of symptoms of depression, and most of the patients reporting unprotected sex had a detectable viral load.

Although the investigators found no link between use of antiretroviral treatment and inconsistent or non-existent condom use in their multivariate analysis, they did find that patients who reported poor adherence to antiretroviral therapy were more likely to never or inconsistently use condoms.

Patients in the study were asked about their sexual behaviour and adherence using an audio computer-assisted self-interview and the results of this interview were made available to their doctors. The investigators suggest that these interviews could be used to identify "a core group of non-adherent patients who do not consistently use condoms, and then deliver targeted intensive psychosocial services and prevention interventions to them."

Thanks to the success of antiretroviral therapy people with HIV can live, longer, healthier lives. This good health means that individuals with HIV are likely to remain sexually active. Therefore HIV prevention efforts are being focused on people with diagnosed HIV infection and in 2003 the US Centers for Disease Control and Prevention announced an initiative to screen for sexual risk behaviour during HIV clinic appointments.

Investigators wanted to see if audio computer assisted interviews were a successful means of obtaining information about issues including sexual risk behaviour, adherence to antiretroviral therapy, and the presence of depressive symptoms.

A total of 198 patients at two HIV clinics with a predominately Latino population were recruited to the study in 2004. The patients were told that their answers during the computer-assisted interview would be provided to their HIV doctor.

Three quarters of the patients were Latino, 36% were gay/men who have sex with men, and 25% were women.

In the four weeks before the study, 65% reported being sexually active, with 24% reporting a regular partner only, 5% a casual partner only and 35% both a regular and a casual partner.

Of the patients who reported sex with a regular partner, 34% said they didn’t always use condoms and 18% said they never used condoms. Of the patients who said they had had sex with a casual partner, 26% reported not using condoms every time and 15% said they never used condoms. Overall 35% of sexually active individuals reported inconsistent condom use and 19% reported never using condoms.

Women were more likely than men to report never using condoms (32% vs, 15%, p = 0.047), and heterosexuals were more likely than gay men to report not using a condom every time with a regular partner (p = 0.04).

Taking antiretroviral therapy was associated with inconsistent condom use with regular partners in univariate analysis (p= 0.05). But this association disappeared in multivariate analysis that adjusted for age, race, gender and HIV transmission category. In multivariate analysis, the only factors significantly associated with not using condoms were self-reported depression (p = 0.03) and self-reported poor adherence to antiretroviral therapy (p = 0.02).

Of the patients who reported never using condoms with regular partners, 76% had a viral load above 400 copies/ml. All the patients who reported never using condoms with casual partners had a viral load above 400 copies/ml.

"We found that almost one fifth of those who had been sexually active in the past four weeks reported never using condoms with their regular or casual sex partners. Over one third of these patients reported not using condoms every time", comment the investigators.

"Most patients with recent HIV RNA results who reported unprotected sex…had detectable HIV RNA", the researchers observe, adding, "the fact that a substantial number of patients with detectable HIV RNA are practicing unprotected sex is a serious concern."

The investigators acknowledge that their study had some limitations, including the lack of diversity in the population. Nor were the investigators able to say if patients were having unprotected sex with partners of the same HIV status, or if men were adopting "strategic positioning" (assuming the receptive role with men who were HIV-negative or of unknown HIV infection status).

Reference:

Schackman BR et al. Sexually active HIV-positive patients frequently report never using condoms in audio computer-assisted self-interviews conducted at routine clinical visits. AIDS Patient Care and STDs 22: 123 – 129, 2008.

By Michael Carter, www.aidsmap.com

Further to this: New York City Health Department Conducts Review of Bathhouses, Considers Changes Aimed at Reducing Spread of HIV

February 20, 2008

The New York City Department of Health and Mental Hygiene last fall began a review of bathhouses in the city after it recorded between 2001 and 2006 a 33% increase in new HIV diagnoses among men younger than age 30 who have sex with men, the New York Times reports. The review also includes sex clubs and "sex parties," which charge an admission fee and have regular locations and hours, according to the Times.

City health inspectors for 20 years have enforced a provision in the state's sanitary code that prohibits bathhouses and other businesses from providing facilities for sex; however, some businesses avoid the rule by providing private rooms that inspectors do not enter, according to the Times. A weekly newspaper for MSM last month published an internal health department memo that listed possible ways the agency could handle bathhouses and other "commercial sex venues" -- including increasing efforts to close such businesses or mandating that they comply with safer-sex regulations -- in an effort to reduce the spread of HIV among MSM.

The memo angered many people in the MSM community, who have said that closing such businesses will not prevent the spread of HIV, the Times reports. Sean Cahill, managing director of the Gay Men's Health Crisis, said that closing bathhouses would "driv[e] the activity underground," adding, "By knowing where these places are, we can go in and engage people and move them in healthier directions."

Demetre Daskalakis -- assistant professor at the New York University School of Medicine, who runs HIV testing programs at two bathhouses in the city -- said that people who meet in such businesses to have sex "are going to have sex on their terms no matter where it is," adding that the city should work with the businesses to offer HIV prevention and testing programs.

A forum scheduled for Thursday at the Lesbian, Gay, Bisexual and Transgender Community Center will address issues surrounding HIV prevention and sex businesses (Angelos, New York Times, 2/17).

http://www.kaisernetwork.org

Glaxo Cuts HIV Drug Prices for Poor Countries

February 19, 2008

London - GlaxoSmithKline Plc <GSK.L> cut the prices on its range of HIV drugs offered to developing countries, marking the fifth such discount since 1997.

The most significant reduction is an almost 40 percent cut on Ziagen, a pill the World Health Organisation recommends as a first- and second-line treatment particularly for children. The average discount across its 14 not-for-profit HIV medicines was 21 percent, the company said on Tuesday.

More than 33 million people globally are infected with HIV, which is incurable and deadly. There is no vaccine and drugs that help control the infection do not stop its spread and are not available to most people.

"These prices will take effect immediately for public sector customers and not-for-profit organisations in the least developed countries and sub-Saharan Africa (as well as other eligible countries)," the company said in a statement.

The decision comes after Thailand stunned drug makers in late 2006 when it overrode the patent on Merck's AIDS drug Efavirenz, arguing it could not afford patented drugs for its national healthcare scheme.

Months later it did the same on a Sanofi-Aventis <SASY.PA> heart medicine and an AIDS drug made by Abbott Laboratories <ABT.N>, which refused to register several new medicines in Thailand.

Drugmakers themselves say they are doing more than ever to help the world's poor with a raft of initiatives designed to get healthcare to millions who cannot afford to pay Western prices. 

By Michael Kahn; Editing by David Holmes, Reuters


Also: Antiretrovirals Becoming More Profitable for Pharmaceutical Industry, Los Angeles Times Reports

February 22, 2008

Antiretroviral drugs are becoming a "growing profit center" for the pharmaceutical industry as treatment for HIV-positive people worldwide improves, the Los Angeles Times reports.

According to the Times, sales of antiretrovirals for Gilead Sciences, which sells antiretrovirals to about one half of all HIV-positive people taking drugs nationwide, reached $3.14 billion in 2007, an increase of 48% from 2006. Sales of all antiretrovirals are expected to increase from $6 billion in 2007 to $11 billion by 2015, according to Datamonitor.

The increase in antiretroviral profits is fueled in part by longer life expectancies for people living with HIV/AIDS and earlier treatment of the virus. HIV vaccine development has stalled and HIV/AIDS rates are increasing in some communities after being stabilized for years, the Times reports. In addition, once-daily antiretrovirals such as Truvada and Atripla have made the virus easier to treat and have helped increase treatment adherence.

According to the Times, Gilead's success in the antiretroviral market in part is because of its "foresight" in developing once-daily medications. Atripla -- which was introduced in 2006 and combines Gilead's antiretrovirals Viread and Emtriva with GlaxoSmithKline's antiretroviral Sustiva -- is the most prescribed medication for HIV-positive people beginning treatment in the U.S. The drug -- which costs about $1,300 monthly -- is expected to reach $1 billion in sales this year.

Gilead CEO John Martin said that many pharmaceutical companies were "scared off" from developing HIV treatment because of "political and assumed financial pressure." In addition, many companies did not believe antiretrovirals would be profitable because two-thirds of HIV-positive people live in developing countries in Africa, the Times reports. Homayoon Khanlou, a Los Angeles-based HIV expert, said once-daily antiretrovirals are a "milestone because of how easy they are to use." Martin added that Gilead "recognized" a "significant unmet medical need" in making HIV treatments easier to follow.

Some doctors have expressed concern that once-daily antiretrovirals could be responsible for a recent increase in cases as more people begin to view HIV/AIDS as a manageable, chronic illness. Khanlou said public health experts and the pharmaceutical industry should continue to warn people about the virus, adding, "We've made too much progress to start going back" (Costello, Los Angeles Times, 2/21).

http://www.kaisernetwork.org

Top Doctors Association Says "YES" to Medical Marijuana in Historic Endorsement

February 20, 2008

In a position paper, a leading American medical association has endorsed the medicinal use of marijuana, called for more studies of its medical uses, and urged the US government to get out of the way. The position paper from the American College of Physicians was released last Friday after being approved by the group's governing body.

The American College of Physicians (ACP) is the nation's second largest doctors' organization, behind only the American Medical Association. It is made up of some 124,000 internal medicine specialists dealing primarily with adults.

The college pointed to strong evidence that marijuana has proven useful in treating AIDS wasting syndrome, glaucoma, and the nausea and vomiting associated with cancer chemotherapy treatments. The college also noted that there is anecdotal evidence for many other medical uses of marijuana, but that research had been stymied by "a complicated federal approval process, limited availability of research grade marijuana, and the debate over legalization." The science of medical marijuana should not be "hindered or obscured" by the controversy over legalizing the plant for personal, non-medical use, the group said.

"This is a historic statement by one of the world's most respected physician groups, and shows the growing scientific consensus that marijuana is a safe, effective medicine for some patients, including many battling life-threatening illnesses like cancer and AIDS," said former US Surgeon General Dr. Joycelyn Elders in a press release from the Marijuana Policy Project. "Large medical associations move cautiously, and for the American College of Physicians to note 'a clear discord' between scientific opinion and government policy on medical marijuana is a stinging rebuke to our government. It's time for politicians and bureaucrats to get out of the way of good medicine and solid research."

"This statement by the American College of Physicians recognizes what clinicians and researchers have been seeing for years, that for some patients medical marijuana works when conventional drugs fail," said Dr. Michael Saag, director of the Center for AIDS Research at the University of Alabama-Birmingham. "One of the challenges in HIV/AIDS treatment is helping patients to adhere to drug regimens that may cause nausea and other noxious side effects. The relief of these side effects that marijuana provides can help patients stay on life-extending therapies."

"This statement by America's second largest doctors' group demolishes the myth that the medical community doesn't support medical marijuana," said Marijuana Policy Project executive director Rob Kampia. "The ACP's statement smashes a number of other myths, including the claims that adequate substitutes are available or that marijuana is unsafe for medical use. 124,000 doctors have just said what our government refuses to hear, that it makes no medical or moral sense to arrest the sick and suffering for using medical marijuana."

While the ACP position paper consists of 13 closely reasoned pages, the group summarizes its medical marijuana positions thusly:

Position 1: ACP supports programs and funding for rigorous scientific evaluation of the potential therapeutic benefits of medical marijuana and the publication of such findings.

Position 1a: ACP supports increased research for conditions where the efficacy of marijuana has been established to determine optimal dosage and route of delivery.

Position 1b: Medical marijuana research should not only focus on determining drug efficacy and safety but also on determining efficacy in comparison with other available treatments.

Position 2: ACP encourages the use of non-smoked forms of THC that have proven therapeutic value.

Position 3: ACP supports the current process for obtaining federal research-grade cannabis.

Position 4: ACP urges review of marijuana's status as a schedule I controlled substance and its reclassification into a more appropriate schedule, given the scientific evidence regarding marijuana's safety and efficacy in some clinical conditions.

Position 5: ACP strongly supports exemption from federal criminal prosecution; civil liability; or professional sanctioning, such as loss of licensure or credentialing, for physicians who prescribe or dispense medical marijuana in accordance with state law.

Similarly, ACP strongly urges protection from criminal or civil penalties for patients who use medical marijuana as permitted under state laws.

"The richness of modern medicine is to carefully evaluate new treatments. Marijuana has been in a special category because of, I suppose, its abuses and other concerns," Dr. David Dale, the group's president and a University of Washington professor of medicine, told Reuters in a phone interview.

An uncharacteristically terse David Murray, chief scientist for the White House Office of National Drug Control Policy, could only appeal to science in an interview with Reuters. "The science should be kept open. There should be more research. We should continue to investigate," he said.

Dale Gieringer, executive director of California NORML had a few nits to pick with the ACP's statement, but approved overall. "This is an important step," he said. "But when they say they support the existing federal supply system, it suggests they are unaware of all the systematic blockage of independent research caused by the NIDA monopoly and DEA interference."

Similarly, said Gieringer, while government licensing and regulation of medical marijuana makes sense, that doesn't mean we have to maintain the existing NIDA monopoly. "It just doesn't make sense to do that," he said.

Where Gieringer was pleasantly surprised was with the ACP's call to end the criminal persecution of medical marijuana patients, providers, and doctors. "They came out really forcefully against criminalization," he noted. "That's very impressive. No one else has been willing to address that. All of these apologists for the government run around saying you can't have unregulated medical marijuana, but that doesn't mean you need to throw patients and doctors in jail."

The medical community's embrace of medical marijuana has been timid and hesitant, with a number of important organizations, including the American Medical Association, lagging behind. This policy statement by the nation's second largest medical association should give that process an important boost.

http://stopthedrugwar.org

Egypt: Taking Aim at Ignorance about HIV/AIDS

February 22, 2008

Cairo - Eight Egyptian men who were arrested and forced to undergo HIV tests, and the subsequent torture of the two who tested HIV-positive, has unleashed a storm of controversy in a country where people still know very little about HIV.

"You can find people who know what you are talking about when you talk about AIDS, but I could say that most people who live here don't know the difference between a person with HIV and a person with AIDS," said UNAIDS Country Officer Wessam El-Beih. "They will say that this is not something that exists in Egypt."

In late 2007, eight men in the capital, Cairo, were charged with debauchery after allegedly accepting money for sex. They were subjected to mandatory HIV tests, and the two who had tested positive were taken to a Cairo hospital for treatment and initially chained to their beds, according to the rights lobby group, Human Rights Watch.

"The hospital is not a prison, it is an open place and they could escape, so at first they actually were chained down so that they would not get away," said Zein El-Taher, director of the National AIDS Programme (NAP). "We asked that they be uncuffed, and they were. We even said we would be held accountable [should they escape] ... I did this so no one would say that they [the authorities] discriminate against people with HIV in Egypt."

UNAIDS estimates that about 13,000 people were living with the virus in 2005 - an HIV prevalence rate of less than 0.1 percent in a population of 80 million - so most Egyptians believe HIV/AIDS does not affect their lives, El-Beih told IRIN/PlusNews.


Even Doctors Don't Know

While many Egyptians are indifferent, even more lack knowledge about HIV/AIDS. Although educational HIV/AIDS programmes are part of the curriculum for junior high school students, NAP's Zein El-Taher admitted that these courses were inadequate.

Medical schools fared even worse. A survey by the International Federation of Medical Students Association revealed shocking levels of ignorance about HIV among the country's medical students. Iman Ewais, a national Federation officer for reproductive health, including HIV, said some students thought bathing more often prevented HIV, and swimming in a pool or sharing food with someone with HIV could bring on infection.

Medical students get only two hours of HIV training during their six years of medical school, and their ignorance reflected prevailing myths and misconceptions in Egypt, Ewais added.

"The doctor is considered to be of a very high status, and if the doctor doesn't know, the students won't know," she said, recalling that a professor of microbiology had once told her HIV might be transferred through sweat. "What will a doctor like that tell his students?"

El-Beih said medical students have misconceptions about how HIV is transmitted because not much emphasis is put on teaching HIV as a subject in medical schools. For example, some students believed HIV could be transmitted through insect bites.

The survey findings prompted the National AIDS Programme to develop a programme to raise awareness of HIV/AIDS in all Egypt's medical schools. "Medical school is six years long, and HIV/AIDS training would normally come in the last two years, meaning the student goes on for four years without HIV/AIDS training or knowledge," El-Taher said. "The programme is aimed at making students learn this from the beginning."


No Room For Complacency

Given the low official prevalence rate, the government has so far focused solely on highly vulnerable population groups like commercial sex workers, men who have sex with men, street children and injecting drug users. But UN agencies have raised the alarm over trends revealing that the number of newly reported HIV cases in Egypt is on the rise.

El-Beih warned that Egyptians could not afford to continue stigmatising infected people, nor could they keep ignoring the virus. "There is still a low perception of related risks ... 80 percent of infected women in Egypt have been infected through monogamous relations with their husbands; more women and children are being affected by it."

The National AIDS Programme provides free antiretroviral drugs to those who need them, holds regular support group meetings for HIV-positive Egyptians and offers services to prevent mother-to-child transmission of HIV. UNAIDS has been in Egypt for over five years, and has set up an HIV/AIDS hotline. In 2004 it opened the first of 20 voluntary counselling and testing centres.

"Before 2004, the only way people got tested was if they needed to go to the Gulf and needed a blood test, or if they were to be blood donors. It was not done on a voluntary basis," El-Beih said. "Now there are more facilities, so more people are testing for HIV."

Reuters

Spotlight on Women in New Study

February 19, 2008

Women make up more than 40 per cent of all HIV cases globally and 27 per cent of new cases in Canada. While the number of women living with HIV continues to climb worldwide, little research is available on the way the virus and HIV drugs affect women differently than men. To generate more evidence for this field of research, the Canadian HIV Trials Network (CTN) is supporting a new study observing HIV positive women on combination antiretroviral therapy (CTN 233).

"Understanding the reasons for the differences of adverse events between HIV positive men and women is critical and needs to be evaluated within a large cohort. We don't know whether these differences relate to hormonal influences, drug metabolism, adherence, fat distribution, or other factors," says Principal Investigator Dr. Mona Loutfy of the Women's College Research Institute in Toronto.

CTN 233 will examine levels of antiretrovirals in the blood and how these drugs are processed in HIV positive women. Loutfy and her research team will also be determining if drug levels are higher in women compared to men - with information regarding HIV positive men obtained from historical data. The study will investigate whether antiretroviral drug levels are associated with body weight in women, as well as higher frequency and severity of adverse events such as nausea, diarrhea, liver toxicity and lipodystrophy. Findings could help guide treatment for HIV positive women.
 
This study is recruiting 80 participants at eight sites in Hamilton, Montreal, Ottawa, Toronto, Vancouver and Quebec City.
 
For more information on this study and other CTN trials, please visit the CTN/CATIE co-sponsored clinical trials database, or http://www.hivnet.ubc.ca/.

You may also call the CTN’s information line:1-800-661-4664.

By Jennifer Chung, Canadian HIV Trials Network, CATIE


Also: Both 3TC And Tenofovir Have High Concentrations In Female Genital Tract: Potential To Prevent Sexual Transmission Of HIV

February 18, 2008

Drugs from the nucleoside reverse transcriptase inhibitor (NRTI) class of antiretrovirals achieve good concentrations in the female genital tract and may have the potential to reduce the risk of sexual transmission of HIV, US researchers report in the March 1st edition of Clinical Infectious Diseases. Particularly high concentrations of 3TC (lamivudine, Epivir) and tenofovir (Viread) in the genital tract were observed.

But the investigators found that protease inhibitors and non-nucleoside reverse transcriptase inhibitors achieved concentrations in the female genital tract that were between 1% - 33% of those observed in the blood. Nevertheless, viral load remained suppressed in the genital tract of women with good adherence.

This latest research may further fuel the debate about the infectiousness, or otherwise, of patients taking successful anti-HIV therapy. Swiss HIV doctors issued a statement in late January stating that HIV-positive individuals who were adherent to their anti-HIV therapy, achieving an undetectable viral load for at least six months, and who were free of sexually transmitted infections should not be considered infectious.

Anti-HIV treatment reduces the risk of mother-to-child transmission of HIV. There is also evidence from some studies that it reduces the risk of sexual transmission of the virus. This is likely to be because antiretroviral therapy lowers viral load in the genital tract. Research has shown that reductions in viral load during HIV therapy in cervicovaginal fluids parallel those in blood. But, viral load can diverge in these two compartments and the development of drug-resistant HIV in the genital tract, but not blood, has been observed in some patients.

It is currently unclear if differences in viral load in the female genital tract and blood are due to differing concentrations of antiretroviral drugs in the two compartments. Some studies do suggest that concentrations of protease inhibitors and NNRTIs are lower in the genital tract than in blood, but there has been little research describing concentrations of NRTI drugs in cervicovaginal fluid.

Investigators from the US state of Rhode Island therefore obtained paired blood and cervicovaginal fluid samples from HIV-positive women receiving antiretroviral therapy. All the women had a blood viral load below 80 copies/ml for at least six months.

A total of 34 women were included in the study, median age was 44 years, and 44% of the patients were black. CD4 cell counts were between 200 – 500 cells/mm3 in 20 patients (59%), and twelve individuals (35%) had a CD4 cell count above 500 cells/mm3.

Nearly all the patients had antibodies to the genital herpes virus, HSV-2, and all 34 women had test results that were positive for bacterial vaginosis at baseline.

Antiretroviral therapy consisted of two NRTIs with either an NNRTI or protease inhibitor in 30 women, with three of the women taking a three or four drug NRTI combination and one woman a regimen that did not include any NRTIs.

All but three women were receiving either therapy that included 3TC or tenofovoir.

A total of four paired blood and cervicovaginal fluid samples were obtained from the women over a twelve month period. There was considerable divergence in concentrations of drugs in the blood and the genital tract.

Concentrations of tenofovir in cervicovaginal fluid were five times those in the blood. High concentrations of 3TC in cervicovaginal fluids were also observed, with levels of the drug in the genital tract being three times higher than those seen in the blood. In addition, levels of FTC (emtricitabine, Emtriva) were 50% higher in the genital tract than blood and those of ddI some nine times higher.

But concentrations in the genital tract of efavirenz (Sustiva) were only 1% of those achieved in the blood, and concentrations of protease inhibitors in cervicovaginal fluid were between 3% - 33% of those in the blood.

Nevertheless, good suppression of viral load in the genital tract was maintained by all women with good adherence to antiretroviral therapy. Seven women experienced a rebound in their blood viral load between 100 – 1400 copies/ml during the study. But in only one woman did viral load become detectable in the genital tract. This patient was noted for her poor adherence to her anti-HIV treatment and had extremely undetectable concentrations of some antiretroviral drugs in both her blood and cervicovaginal fluids.

"This study examined the concentrations of components of [antiretroviral therapy] in the cervicovaginal fluid of women who had achieved excellent viral suppression in blood plasma and sought to correlate local drug concentrations with subsequent virologic rebound," write the investigators.

They emphasise the particularly good penetration of 3TC and tenofovir into the genital tract and suggest "the excellent accumulation of these agents in the cervicovaginal fluid may be beneficial for the prevention of HIV transmission during [antiretroviral therapy] and for pre- and post-sexual exposure antiretroviral prophylaxis."

Although both NNRTIs and protease inhibitors had poor concentrations in the genital tract compared to blood "sustained suppression of HIV RNA levels were observed in the genital tract compartment."

The investigators suggest that their findings should be interpreted with caution, particularly given the small number of patients in the study.

Reference:

Kwara A et al. Antiretroviral drug concentrations and HIV RNA in the genital tract of HIV-infected women receiving long-term highly active antiretroviral therapy. Clin Infect Dis 46: (Online edition), 2008.

By Michael Carter, www.aidsmap.com

Key Test Of Kidney Function Has Poor Accuracy In Patients With HIV

February 18, 2008

Urine dipsticks may be a poor way of telling if HIV-positive patients have protein in their urine, an important marker of kidney disease, according to US research published in the February 1st edition of the Journal of Acquired Immune Deficiency Syndromes.

The investigators paired dipstick tests with protein-to-creatinine ratio tests obtained from the same patient within 24 hours and found that over a fifth of dipstick tests were failing to detect significant levels of protein in urine. They call for further research to find the best method of screening for kidney disease in HIV-positive patients.

Kidney disease is an increasingly important cause of illness and death in patients with HIV. A number of factors are responsible for this, including the general aging of patients with HIV and a high prevalence amongst HIV-positive patients of other conditions capable of causing kidney disease.

Many individuals with kidney disease have protein in their urine, and this is often called proteinuria.

Compared with the general population, patients with HIV are significantly more likely to have proteinuria. A study conducted in HIV-positive women before effective anti-HIV treatment became available, found that significant levels of proteinuria (dipstick > 1+) were associated with a doubling in the risk of death. Another study found that proteinuria increased HIV-positive individuals’ risk of hospitalisation by 50% and their risk of cardiovascular illness by 40%.

Guidelines for the management of chronic kidney disease in patients with HIV issued by the Infectious Diseases Society of America recommend that urine dipstick tests should be used to detect kidney abnormalities in this population. This test should have the ability to detect kidney disease with a threshold of 1+ proteinuria.

But dipstick tests measure levels of albumin, and if urine is diluted the accuracy of these tests is affected. Furthermore, some forms of kidney disease, including tubular disorders, cannot be accurately diagnosed using dipstick tests.

Early detection is vital to the appropriate management of kidney disease in HIV-positive patients. It is therefore essential that healthcare staff are using the most accurate tests to detect such disorders.

Investigators from Johns Hopkins University compared the accuracy of two tests to measure protein in urine: a urine dipstick test and a protein-to-creatinine ratio test.

Their study included 165 HIV-positive patients who were receiving care at the Johns Hopkins Nephrology Clinic between 1995 and 2005. The patients included in the study had these two tests within the space of 24 hours.

The dipstick tests had a sensitivity to detect proteinuria of above 1+. The protein-to-creatinine ratio selected for comparison was 0.30 to 0.99.

Patients had a mean age of 45 years, 59% were male and 94% were African American.

Results showed that 13 of 64 patients (21%) with abnormally low protein-to-creatinine ratios had normal urine dipstick results.

"The results of our study suggest that the urine dipstick may not be an adequate tool for screening proteinuria in HIV-positive patients", comments the investigators.

They add, "at clinically relevant lower levels of proteinuria…a threshold of >1+ proteinuria had a false-negative rate of 21%."

This could have serious clinical consequences for a significant number of patients. The investigators write, "as many as one in five patients with proteinuria in this range may not be recognised and may be subject to delayed workup and treatment."

The investigators conclude, "in sum, despite recommendations to use urine dipsticks for screening of renal disease in the HIV-positive population, poor validity of qualitative testing prevents any reliable single cutoff from serving as a reliable marker for predicting proteinuria at ranges where HIV providers may consider further workup of renal involvement."

They therefore recommend, "it might be prudent to revisit guidelines that recommend using the dipstick as a screening tool. Further investigation of protein measurements, including comparison of random and 24-hour protein measurements, may help to determine the best method for screening and monitoring renal disease in HIV-infected patients."

Reference:

Siedner MJ et al. Poor validity of urine dipstick as a screening tool for proteinuria in HIV-positive patients. J Acquir Immune Defic Syndr 47: 261 – 263, 2008.

By Michael Carter, www.aidsmap.com


Related: Suppressing HIV Improves Kidney Function

February 14, 2008

Reducing viral load using antiretroviral therapy can greatly improve renal function in people with HIV and kidney disease, according to a new study published in the February 19 issue of AIDS. These results provide further evidence that uncontrolled HIV replication is a major cause of HIV-associated nephropathy, a form of kidney disease seen in HIV-positive people, notably black men with low CD4 counts.

Robert Kalayjian, MD, of the department of medicine at MetroHealth Medical Center in Cleveland, and his colleagues evaluated data involving 1,776 individuals participating in the AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trials (ALLRT) study. The average age of the participants was 38 years; 82 percent were male and 30 percent were black. At baseline—when participants first entered the study—4 percent had diabetes, 11 percent had stage 1 (mild) chronic kidney disease (CKD), and 7 percent had stage 2 or greater CKD (moderate to severe).

Kidney function and stage of kidney disease was assessed using patients’ glomerular filtration rates (GFRs), which measure how quickly their kidneys can filter substances like drugs from fluids. A reduction in GFR is synonymous with a reduction in kidney function.

In the cohort as a whole, there was a slight decrease in GFR, over time. This was true in people who began the study with normal kidney function or stage 1 CKD. The opposite was true, however, in people with stage 2 or greater CKD who began treatment with low CD4 counts—they experienced significant GFR improvements upon suppressing their viral loads by at least 1 log or reducing them to less than 400 copies. In fact, 28 percent of people with stage 2 or greater CKD at baseline saw their GFR increase to the normal range after suppressing their viral loads with the use of antiretroviral treatment.

The authors caution that a variety of antiretrovirals were used by the study participants, and that at least two of those antiretrovirals, indinavir (Crixivan) and tenofovir (found in Viread, Truvada and Atripla) have been associated with decreased kidney function, and this may have affected the results to some degree. They point out, however, that the size and design of the study should give people with low CD4 cells and kidney disease confidence that controlling HIV through the use of antiretrovirals can significantly improve kidney function

http://www.poz.com

Offer Gay Men Screens For Anal STIs Regardless Of Reported Risk

February 19, 2008

Rubbing of the penis against the anus without a condom, or brief insertion of the penis without a condom into the anus followed by withdrawal, are sexual activities reported by some gay men visiting commercial sex venues in Melbourne, Australia, according to a study published on February 6th in the online edition of Sexually Transmitted Infections.

The investigators suggest that these activities could explain the large number of anal sexually transmitted infections diagnosed in gay men who did not report unprotected anal sex. They therefore recommend that all gay men, regardless of their reported risk behaviour, should be offered screens for anal infections during visits to sexual health clinics.

Studies in many industrialised countries have shown a high prevalence of sexually transmitted infections amongst gay men, including those who visit commercial venues where there is sex on the premises. There is some evidence that men who visit such venues are more likely to engage in risky sexual practices, and that sex on premises venues can be the focus for outbreaks of sexually transmitted infections.

No recent study has looked at the full range and frequency of sexual activities in gay sex on premises venues. Therefore investigators in Melbourne recruited 200 men in late 2006/early 2007 who used sex on premises venues and asked them about the type and frequency of sex they had in such venues.

The median number of visits to a sex on premises venue in the previous month was three. A wide range of sexual activities were reported, with 83% reporting oral sex and 42% anal sex.

But other forms of sexual activities that involved penile-anal contact without intercourse were also widely reported. For example, 40 men (27%) reported receptive "nudging" (touching or rubbing of the penis against the anus) and 20 men these men reported no anal intercourse. Furthermore, ten men (5%) reported receptive "dipping" (transient, unprotected insertion of the penis into the anus), and of these two (1%) reported no other form of receptive anal sex.

Unprotected insertive anal sex with ejaculation in a sex in premises venue was reported by four men (2%), with three individuals (1.5%) telling investigators that they had had unprotected receptive anal sex with ejaculation in a sex on premises venue.

Almost half the men (93, 47% had a regular partner). Sexual activity with a casual male partner outside of the sex on premises venues was reported by 49% of men.

Sex with casual partners in sex on premises venues was significantly less likely than sex with casual partners outside these venues to involve oral sex (p < 0.01), unprotected insertive anal sex (p = 0.04), unprotected receptive anal sex (p = 0.01), and rimming (p = 0.01). However, men were significantly more likely to have group sex at sex on premises venues (p = 0.03). The investigators call for further research to determine why there was less reported risk behaviour in sex on premises venues.

"Substantial penile-anal contact that did not involve anal intercourse occurred at sex on premises venues", comment the investigators.

They note that approximately a third of gay men diagnosed with anal sexually transmitted infections reported no unprotected anal sex. The investigators suggest that activities like nudging and dipping "may explain anal infections in the absence of anal sex."

On the basis of their findings the investigators recommend that "screening for anal infections should be offered to all men who have sex with men, including those who do not report anal intercourse."


Reference:

Wun Phang C et al. More than just anal sex: the potential for STI transmission amon men visiting sex on premises venues. Sex Transm Inf (online edition), 2008.

By Michael Carter, www.aidsmap.com

Gene Associated with Efavirenz and Nevirapine Rash Identified

February 19, 2008

Investigators have identified a gene that is associated with the development of allergic rashes in patients taking the non-nucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz (Sustiva) and nevirapine (Viramune).

In a study published in the February 19th edition of AIDS, French investigators report a statistically significant association between the presence of the HLA-DRB1*01 gene and rashes in patients treated with the two NNRTIs. There was no association between the appearance of rashes and other potential risk factors such as age, gender, CD4 cell count or viral load.

They hope that the identification of the association between the gene and allergic rashes during NNRTI treatment could lead to the development of diagnostic tests to identify patients at risk of the side-effect.

Both efavirenz and nevirapine are widely used in anti-HIV drugs, often in first-line therapy. They have relatively few side-effects, but both drugs are associated with allergic rashes. About 20 – 35% of patients taking nevirapine develop such reactions, as do a third of patients treated with efavirenz.

There is increasing evidence that allergy to medicines is influenced by genetics. The HLA-B*5701 gene is strongly associated with a hypersensitivity reaction to the nucleoside reverse transcriptase inhibitor abacavir (Ziagen, also in the combination pills, Kivexa and Trizivir). Patients who are considering treatment with abacavir should have a test to screen for the presence of this gene prior to starting treatment with the drug. Furthermore, nevirapine liver-associated side-effects have been linked to the presence of the HLA-DRB*0101 gene and CD4 cell count.

French investigators conducted a small cohort study to see if there was an association with the HLA-DRB1 gene and allergy to efavirenz and nevirapine, manifested in skin rashes. They also wanted to see if factors such as age, gender, CD4 cell count and viral load were important factors in the development of such an allergic reaction.

Their study involved 21 adult, Caucasian, HIV-positive patients, who started anti-HIV therapy between 2002 and 2004 with a combination of drugs that included efavirenz (seven patients) or nevirapine (14 patients).

A total of six patients developed rashes. None of these patients had liver-related side-effects. The investigators compared the characteristics of these six patients with the other 15 individuals.

All 21 patients were tested for the presence of the HLA-DRB1 gene. They found that five of the six patients (85%) with rashes had the HLA-DRB1*01 gene compared to just one of the patients (15%) who did not develop a rash, a statistically significant difference (p = 0.004).

No other factors were associated with the development of a rash.

"The results of our study suggest that the mechanism of nevirapine/efavirenz-related isolated rash is different from the mechanism in cases with hepatic/systemic reactions", write the investigators. They add, "the isolated rash risk appears to depend on the presence of the predisposing allele HLA-DRB1*01 alone, whereas the risk of hepatic/systemic reactions is associated with an interaction between genetic and immunological factors."

They call for further examination of this association in larger cohort studies which could lead "to the development of a diagnostic test, and help decrease or eliminate the incidence of nevirapine/efavirenz hypersensitive reactions."

Reference:

Vitezica ZG et al. HLA-DRB1*01 associated with cutaneous hypersensitivity induced by nevirapine and efavirenz. AIDS 22: 540 – 541, 2008.

By Michael Carter, www.aidsmap.com


Also in related gene studies: Imitating Monkey's 'Jumping Genes' Could Lead To New Treatments for HIV

February 19, 2008

UCL (University College London) scientists have taken a significant step in understanding how retroviruses such as HIV can move between species and the biological mechanisms behind the 'jumping genes' which make some monkeys immune. They will now use this knowledge to develop a gene therapy treatment for HIV/AIDS in humans.

The international team of researchers, coordinated by Professor Greg Towers, UCL Infection and Immunity, and funded by the Wellcome Trust, have identified a combination of genes in a species of monkey that protects against retroviruses a particularly opportunistic family of viruses that can integrate into the host's genome and replicate as part of the cell's DNA. The team's findings are published today in Proceedings of the National Academy of Sciences (PNAS).

Professor Towers explained: "HIV causes AIDS and affects around 40 million people worldwide. Research has shown that HIV entered the human population from a chimpanzee retrovirus called SIV early in the 20th century. In order for a virus to successfully cross the species barrier and jump into a new species, it first has to bypass the new host's innate immune system, mediated by a combination of genes and proteins. One such gene, called TRIM5, has been shown to protect certain species from retroviruses but unfortunately the human TRIM5 gene does not protect against HIV infection."

The team found that a species of Asian monkey called Rhesus Macaques have a sophisticated 'antiviral arsenal' that can protect them against retroviruses. By closely examining TRIM5 in this species, they demonstrate that in some monkeys another gene called Cyclophilin has been joined to the TRIM5 gene, generating a TRIMCyp fusion.

Dr Sam Wilson, the paper's first author, said: "Cyclophilin is very good at grabbing viruses as they enter cells. By fusing Cyclophilin to TRIM5, a gene is made that is good at grabbing viruses and good at destroying them.

This is the second time that this fusion has been identified a TRIMCyp gene also exists in South American Owl Monkeys and, until now, this was thought to be an evolutionary one-off.

"This new research shows that a TRIMCyp has evolved independently in two separate species it's like lightening has struck twice. It's a remarkable example of convergent evolution, where organisms independently evolve similar traits as a result of having to adapt to similar environments. It also highlights the evolutionary selection pressure that viruses like HIV can apply."

Professor Greg Towers explained further: "The discovery is a compelling example of how 'jumping genes' can shuffle an organism's genetic makeup, generating useful new genes, and it is an exciting possibility for novel treatments for HIV/AIDS.

"About 25 per cent of Rhesus Macaques have the TRIM5 and a TRIMCyp gene, greatly expanding their antiviral arsenal. The others have an immunity, based around TRIM5, that protects them against a different combination of viruses. The gene seems to be evolving to protect the individual species from a range of different virus sequences."

Professor Towers and his team now aim to develop humanised TRIMCyp that blocks HIV infection by artificially fusing human Cyclophilin and human TRIM5. Professor Towers said: "We can then introduce the TRIMCyp into stem cells, using gene therapy technologies, and the stem cells could repopulate the patient with blood cells that are immune to HIV. This work, already underway, could offer a real possibility of novel treatments for HIV/AIDS."

UNIVERSITY COLLEGE LONDON - UCL
Gower Street
London
http://www.ucl.ac.uk

http://www.medicalnewstoday.com

Maraviroc Used Successfully In PEP

February 21, 2008

Accidental exposure to HIV can occur in a medical setting such as hospitals and clinics, usually involving needle-stick injuries. In such cases, taking medicines to suppress and limit the spread of HIV within the body is necessary. This use of medication is called PEP—post-exposure prophylaxis.

When a new drug becomes licensed, there is often great temptation to use it as part of PEP. This arises because new drugs have generally not been widely used and so the risk of HIV being able to resist a new medication should generally be low.

Maraviroc (Celsentri, Selzentry) is a relatively new anti-HIV medication that belongs to a family of drugs called entry inhibitors. It was recently approved in Canada, the European Union and the United States as part of combination therapy in cases where HIV positive people have virus that can resist other anti-HIV therapies. Now doctors in Paris, France, have reported a novel and unapproved use of maraviroc: PEP.

Decision time
Because clinical trials have not been undertaken to assess the effectiveness of PEP, the ideal regimen for this use is not clear. Recommendations for PEP can therefore vary from one region to another. In addition, when considering a PEP regimen it is important to take into account the following information from the potential source of exposure:
* viral load
* CD4+ cell count
* treatment history
* resistance test results


Case details

According to the Paris physicians, a medical student injured herself with a needle that had been used on a "heavily treatment-experienced" HIV positive man. At the time of her injury, he had been hospitalized because of HIV-related neurological problems. His basic profile was as follows:
* age – 52
* viral load – 200,000 copies
* CD4+ count – 121 cells
* since 1990 he had been exposed to 13 different anti-HIV drugs
* results of resistance testing suggested that many treatments would not work for him

His current therapy was as follows:
* lopinavir/ritonavir (Kaletra)
* fosamprenavir (Telzir, Lexiva)
* enfurvirtide (T-20, Fuzeon)
* tenofovir (Viread)

Taking all of this information into account, doctors prescribed the following regimen for the medical student:
* lopinavir/ritonavir
* fosamprenavir
* tenofovir
* 3TC (lamivudine)

She began taking these medications 15 minutes after her possible exposure. Ideally, her physicians would have preferred to include maraviroc in her regimen. However, at the time her injury occurred mararaviroc was not approved in France and her doctors had to request access to this drug. Fortunately, their request was quickly approved and the next day lopinavir/r was discontinued and replaced with maraviroc. She took PEP for a total of 28 days.

The doctors reported that the regimen was well tolerated. Moreover, laboratory testing of her blood did not detect any toxicity from the medications. Importantly, six months after her needle-stick injury, testing revealed that she was HIV negative.

The report from France is the first published case in which maraviroc was used as PEP. It underscores the value of new drugs and their potential for PEP. As needle-stick injuries are relatively common in healthcare settings, in the future we expect to see more reports of maraviroc and other new drugs, such as raltegravir (Isentress), used as part of PEP.

References:

1. Lalezari J, Goodrich J, DeJesus E, et al. Efficacy and safety of maraviroc in antiretroviral experienced patients infected with CCR5-tropic HIV-1: 48-week results of MOTIVATE-1. Program and abstracts of the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy, 17-20 September 2007, Chicago, USA. Oral presentation H-718a.

2. Grinzstejn B, Nguyen B-Y, Katlama C, et al. Forty-eight-week efficacy and safety of MK-0518, a novel HIV-1 integrase inhibitor, in patients with triple class resistant virus. Program and abstracts of the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy, 17-20 September 2007, Chicago, USA. Abstract H-713.

3. Markowitz M, Nguyen BY, Gotuzzo E, et al. Rapid and durable antiretroviral effect of the HIV-1 integrase inhibitor raltegravir as part of combination therapy in treatment-naive patients with HIV-1 infection: results of a 48-week controlled study. Journal of Acquired Immune Deficiency Syndromes 2007 Oct 1;46(2):125-33.

4. Méchai F, Quertainmont Y, Sahali S, et al. Post-exposure prophylaxis with a maraviroc-containing regimen after occupational exposure to a multi-resistant HIV-infected source person. Journal of Medical Virology 2008 Jan;80(1):9-10.

By Sean R. Hosein, CATIE

Stimulating Thymus Reactivates T-Cell Production

February 22, 2008

It's possible to stimulate the thymus gland to produce new immune system T-cells in adults infected with HIV, U.S. researchers say.

HIV infection destroys T-cells, which leads to the collapse of the immune system and severe infection. The thymus gland produces T-cells early in life but gradually loses function and becomes mostly inactive in adulthood. That means it's difficult for HIV-infected adults to produce new T-cells to rebuild their depleted immune systems.

It has long been believed that it wasn't possible to reactivate T-cell production in the thymus. The new study, by researchers at the Gladstone Institute of Virology and Immunology and the University of California, San Francisco (UCSF), is the first to show that therapy can help boost thymus function in adults.

The two-year study of 22 HIV-infected adults found that treatment with growth hormone (GH) increased thymus mass and more than doubled the number of newly made T-cells. The results are published in the March issue of the Journal of Clinical Investigation.

"These results represent new proof-of-principle findings that thymic involution can be reversed in humans," study author Dr. Laura Napolitano, an assistant investigator at Gladstone and an assistant professor of medicine at UCSF, said in a prepared statement.

"Improved T-cell production may be helpful for some medical conditions such as HIV disease or bone marrow transplantation. These findings contribute new information to our understanding of T-cell production and are also an important step to determine whether immune therapies might someday benefit patients who need more T-cells," Napolitano said.

However, much more research is needed to determine whether stimulating production of new T-cells actually provides a health benefit for HIV patients or anyone else, the researchers said.

By Robert Preidt, Gladstone Institute, http://www.kold.com

New Edition of CATIE’s Practical Guide to Nutrition For People Living With HIV

The completely revised edition, written by Diana Johansen, one of Canada's leading experts in HIV and nutrition, contains sections on meal planning, vitamins and supplements, managing side effects and more.

To order, please fill out our publications order form: http://www.catie.ca/eng/Publications/PublicationsIndex.shtml

Decriminalise Reckless HIV Transmission, Argues HIV Legal Expert

February 22, 2008

A new book on the criminalisation of HIV transmission by Dr Matthew Weait, senior lecturer in law and legal studies at Birkbeck College, University of London, argues that current English law has "the potential to do more harm than good" if "its primary purpose is to prevent onward transmission."

The book, Intimacy and Responsibility: The Criminalisation of HIV Transmission, was welcomed by HIV clinicians and advocates at last week’s central London launch, which highlighted the impact of criminal prosecutions on the ability of doctors and researchers to work effectively.

Dr Jane Anderson, consultant physician at Homerton Hospital, and lead author of the British HIV Association’s (BHIVA) briefing paper on HIV transmission, the law and the work of the clinical team said that the spectre of criminal prosecutions had affected the way the NHS provided services to HIV-positive patients "in terms of care, advice and confidentiality" and had created "a great deal of anxiety and concern."

She said that many healthcare staff working with HIV-positive patients felt that "the law was looking over people’s shoulders" and that it had significantly affected the doctor-patient relationship since doctors could potentially be asked to testify as expert witnesses for either prosecution or defence.

Dr Anderson also highlighted the impact recent prosecutions have had on research. "The rigour of our research has been coloured by prosecutions," she said. "We have had to reconsider whether we ask certain questions whilst researching sexual behaviour in the current climate."

Also speaking at the launch was Dr Catherine Dodds, a research fellow at Sigma research, University of Portsmouth, who has studied the impact of criminal prosecutions in affected communities. She said that in his book, Dr Weait "asks us to engage actively as citizens who think about how our criminal justice system works, and who ask if it should be the place to resolve all of the issues in our complicated, intimate, messy, sloppy, passionate, tangled, painful human lives."

Dr Weait’s book critically examines and deconstructs the English criminal law’s approach to criminal prosecutions for reckless HIV transmission. In one of the book’s most revelatory chapters, he uses transcripts from the trial of Feston Konzani to show how the English criminal law reduces complex human thoughts, feelings and interactions to "over-simplified accounts of responsibility and irresponsibility, of guilt and innocence."

The book also examines concepts of harm, risk, recklessness, consent, and responsibility and strongly suggests that the criminal law is ill-equipped to understand these concepts pragmatically. If the primary purpose of the criminal law is to prevent onward transmission, he argues, then it "has the potential to do more harm than good."

Edwin Cameron, Justice of the South African Supreme Court of Appeal, and one of the world’s leading figures on HIV and AIDS and the law, writes in the book’s preface that "Weait’s premise is that criminal law and criminal justice should be used for the public good rather than as means of securing reparation for particular individuals."

"If his argument is correct," he continues, "then we must question criminal laws that may discourage people from HIV testing, or from being candid about their sexual history when confiding in health care workers. We must question whether it is good to impose criminal liability when media coverage is often sensational and inaccurate – with the effect of demonising all with HIV, and marking them as potential aggressors. We must question whether such laws acknowledge the difficulties that some living with HIV – particularly women, who may risk violence and expulsion from the home – have in negotiating safer sex."

"And we must question the public ‘good’ that comes from ascribing sole responsibility for transmission (as such laws do) to the person with HIV, thus attenuating the partner’s responsibility for avoiding transmission – especially in an epidemic when all should be aware of the risks of unprotected sex," writes Mr Justice Cameron.

The best way to promote "a more authentic and socially beneficial approach to the meaning, practice and expression of responsibility than that which the law constructs and reinforces," concludes Dr Weait "is to decriminalise the reckless transmission of HIV."

Reference:
Weait M. Intimacy and Responsibility: The criminalisation of HIV transmission ISBN 978-1-904385-70-7; Routledge-Cavendish, 2007.

By Edwin J Bernard, www.aidsmap.com