Drug-Resistant Gonorrhea: New Facts

“WARNING – VENEREAL DISEASES” – NARA – 516044 (Photo credit: Wikipedia)

From The National Association of STD Directors (NASTAD) comes a new fact sheet, which begins with this:

For several decades, the Centers for Disease Control and Prevention (CDC) has closely monitored gonorrhea and its potential to become resistant to available antibiotics. Gonorrhea is one of the most commonly reported communicable diseases in the United States. In 2011, there were 321,849 reported cases and another 400,000 estimated unreported cases. If left untreated, the illness can cause infertility in both women and men, dangerous pregnancy complications and can be passed on to newborns, possibly causing blindness or pneumonia. Gonorrhea can also facilitate HIV transmission.

The CDC now reports that gonorrhea has become resistant to all but one of the antibiotics recommended to treat it, and resistance to the remaining antibiotic is increasing. If no new antibiotics become available, gonorrhea has the potential to become a serious epidemic. However, by increasing public health infrastructure investment and encouraging pharmaceutical companies to create new antibiotics, we can prevent a public health emergency.

Read the full fact sheet here: ncsd.astho_antibiotic_sheet

New gonorrhea strain could kill you in a matter of days (deathandtaxesmag.com)
‘Worse than AIDS’ – sex ‘superbug’ discovered in Japan called disaster in waiting (rt.com)
Gonorrhea Superbug Said To Be More Dangerous Than AIDS (insidesurgery.com)
The Gonorrhea Doomsday Is Nigh (theatlanticwire.com)
Sex ‘Superbug’ Worse Than AIDS? 2 Reports Of Resistant Gonorrhea In Hawaii Are False (latinospost.com)

Montana LGBT Youth At Increased Risk for Suicide

Mar3 by D Gregory Smith

Today, a groundbreaking piece in the Billings Gazette:

Icon for Wikimedia project´s LGBT portal (Portal:LGBT). (Photo credit: Wikipedia)

Getting through adolescence is hard enough.

There’s the agony of puberty, the mood swings and the withering self-consciousness. Then comes the clumsiness of emerging sexuality.

It can be overwhelming.

For some young people, the passage can be even more daunting. For a few Montana kids coming to terms with their attraction to the same gender — in a religious and rural culture that doesn’t always know what to make of them — the challenge can be deadly.

A 2009 survey of more than 7,000 lesbian, gay, bisexual and transgender middle and high school students aged 13 to 21 found that in the past year, at least eight of 10 students had been verbally harassed at school; four of 10 had been physically harassed; six of 10 felt unsafe at school; and one of five had been the victim of a physical assault, according to the Centers for Disease Control and Prevention.

LGBT youth also are at far greater risk for suicide. A national study of adolescents in grades seven to 12 found that LGBT youth were more than twice as likely to have attempted suicide as their heterosexual peers.

There is little specific research in Montana concerning how much of a role sexual orientation plays in youth suicides, said Karl Rosston, Montana’s suicide prevention coordinator. However, national studies have shown about 15 percent of youth who reported suicide attempts also reported same-sex attraction or relationships.

In Montana between 1999 and 2009, suicide was the second-leading cause of death for young people ages 10 to 24, behind unintentional injuries like auto and farm accidents.

In the two years between 2010 and 2011, at least 57 youth ages 15 to 24 killed themselves in Montana.

It’s difficult to figure the current number of gays and lesbians in Montana. However, according to a report from the Williams Institute, a national think tank at UCLA researching sexual orientation issues, there were 1,600 same-sex couples in Montana as of 2005, up from 1,200 in 2000. This number is almost certainly higher, especially since the study didn’t include youth. The number of male couples and female couples were nearly evenly split, with 806 men and 853 women.

About 2.6 percent of Montana’s population — around 26,000 people — is gay, lesbian or bisexual, according to the report.

Teen suicide is a microcosm of what’s happening throughout the state, which has had one of the highest rates of suicide in the nation for more than 30 years. Consider that during 2010, at least 227 Montanans took their own lives. Another 225 people committed suicide in 2011.

D Gregory Smith, a Bozeman-based licensed mental health counselor and executive director of AIDS Outreach, counsels LGBT high school and college students, gay men and a handful of heterosexual men and women. He also counsels parents wondering if their child’s sexual preference can be changed, although he doesn’t believe that’s possible. He counsels parents on how they can better understand their child’s sexuality.

Most of his youth and young adult clients have contemplated suicide.

“Their biggest fear is believing they cannot have a good life,” said Smith, a former Catholic priest who is gay and HIV-positive. “They believe they cannot stay in Montana, be who they are and be happy.”
There’s so much more here: http://billingsgazette.com/news/state-and-regional/montana/lgbt-youth-at-increased-risk-for-suicide/article_d7e8360a-f437-5ba6-8d03-8aeb2d67d701.html#ixzz2MVkAw1EE

LGBT youth at increased risk for suicide (billingsgazette.com)
Former Priest: “I got the cue he’s falling in love with me” (Billingsgazette.com
Musical Nun Sings: ‘You Are Not Alone’ (dgsmith.org)

CDC: HIV Cases Decline for Black Women, Increase for Gay Men

Dec21 by D Gregory Smith

Some disturbing news. From Reuters:

The CDC reported that the number of new cases of HIV among black women declined 21 percent between 2008 and 2010, while the incidence of HIV among young gay and bisexual men rose by 22 percent in the same time frame. The rate of HIV infections among black women remains 20 times higher than the number of new cases in white women, and HIV-infected black women account for 70 percent of HIV incidence among all women. Men who have sex with men comprised almost two-thirds of all new HIV infections in 2010.

Joseph Prejean, chief of the Behavioral and Clinical Surveillance Branch in CDC’s Division of HIV/AIDS Prevention, attributed the decline in new HIV cases among black women to HIV testing and the success of HIV

Drugs (Photo credit: Images_of_Money)

awareness campaigns. “Treatment advances” for AIDS may have caused young men to underestimate their risk and the health threat posed by HIV”, said Prejean. Although anti-retroviral treatment prolongs life, HIV-infected individuals can expect to take medicine for the rest of their lives, at an estimated lifetime cost of $400,000. (emphasis mine)

Young black men who have sex with men have the highest HIV incidence of any population group within the United States. An earlier CDC report stated that 26 percent of new HIV cases occurred among young people age 13 to 24. Half of HIV-infected young people do not know their HIV status, reported CDC Director Thomas Frieden, MD.

Read the full article here.

HIV Patients Lose More Years To Smoking Than HIV (dgsmith.org)
CDC: Half of young people with HIV don’t know it (thechart.blogs.cnn.com)
Breaking News: Young Gay, Bisexual Black Males Hit Hardest By HIV Infection (thebuzzcincy.com)
CDC Reports Troubling Rise in HIV Infections Among Young People (pbs.org)

Clinicians Asked To Screen All Patients For HIV

Nov26 by D Gregory Smith

The US Preventive Services Task Force (USPSTF) strongly recommends that clinicians screen all people aged 15 to 65 years for HIV infection, according to a draft recommendation statement posted online November 20. The statement also recommends HIV screening for all pregnant women, including those who present at the time of labor, and for younger adolescents and older adults who are at increased risk.

“The draft recommendation reflects new evidence that demonstrates the benefits of both screening for and earlier treatment of HIV,” task force member Douglas K. Owens, MD, said in a USPSTF news release. “Because HIV infection usually does not cause symptoms in the early stages, people need to be screened to learn if they are infected. People who are feeling well and learn they are infected with HIV can begin treatment earlier, reduce their chances of developing AIDS and live longer and healthier lives.”

Although US prevalence of HIV infection is nearly 1.2 million and annual incidence is about 50,000, nearly one quarter of those infected are unaware that they are HIV-positive. Since the first reports of AIDS in 1981, more than 1.1 million people have been diagnosed with AIDS and nearly 595,000 have died from it.

Combined antiretroviral therapy (ART) has been shown to reduce the likelihood of HIV transmission, and earlier initiation of treatment lowers the risk for AIDS-related complications.

In issuing this recommendation, the task force hopes to improve and maintain the health of persons who are already infected with HIV, to delay the onset of AIDS, and to lower the risk for HIV transmission.

U.S. Task Force Backs HIV Screening for All 15 to 65 (news.health.com)
Life-saving HIV tests (toledoblade.com)
Specifics: Obamacare and HIV (dgsmith.org)

Why HIV Testing and Treatment Are Still Issues

Sep28 by D Gregory Smith

A key concept for anyone considering the success of anti-HIV treatment in improving the health of individuals and in preventing onward transmission in their communities is the ‘treatment cascade’ or ‘care continuum’. This shows how, at every stage, patients are not retained in the healthcare system or are unable to access the medical care they need.

(Source)

Specifics: Obamacare and HIV (dgsmith.org)
Oral Health and HIV (topdentists.com)
San Francisco Thwarts HIV With Wide Testing, Universal Treatment (npr.org)

Specifics: Obamacare and HIV

Sep27 by D Gregory Smith

click for more info

From Think Progress By Tara Culp-Ressler

A new brief from the Kaiser Family Foundation reports that President Obama’s health care reform represents a significant step forward for Americans with HIV, helping to expand health insurance to many HIV-positive individuals who would be “otherwise unable to access affordable and stable health care coverage.” Representing hugely important tactics to continue addressing the HIV/AIDS epidemic, several of Obamacare’s provisions will have a directly positive impact on the estimated 1.1 million Americans who live with the HIV virus:

Obamacare will prevent insurance companies from denying HIV-positive Americans coverage simply based on their HIV status. The health care reform law prohibits insurance companies from discriminating based on pre-existing conditions, including HIV. Before Obamacare, Americans living with HIV often struggled to find insurance companies willing to take them on — according to the Kaiser Family Foundation, just 13 percent of HIV-positive individuals were covered under private insurance in 2010.
Obamacare’s expansion of the Medicaid program helps low-income Americans with HIV who otherwise wouldn’t qualify for coverage. Over 40 percent of HIV-positive Americans accessed their health insurance through the Medicaid program in 2010, and expanding Medicaid even further will extend additional coverage to this community. Furthermore, under Obamacare, HIV-positive individuals do not have to have to be diagnosed with AIDS as a precursor to qualifying for Medicaid coverage. Although this was an old eligibility requirement for the program, the health reform law ensures the states that accept Obamacare’s Medicaid expansion will not have to impose this restriction on Americans living with the HIV virus.
HIV-positive Americans will no longer reach limits on the amount of treatment their insurance companies are willing to cover. Obamacare eliminates lifetime coverage caps and phases out annual limits, which will help all Americans with chronic conditions — including the Americans who rely on treatment for HIV infections — continue to be able to afford the care they need without reaching an arbitrary cut-off set by their insurance companies.
HIV testing will likely be covered under Obamacare. This year, the U.S. Preventive Services Task Force is expected to recommend routine HIV screenings as a part of regular preventative care, similar to a routine blood pressure test. Since the health reform law requires insurers to cover the preventive services recommended by the Preventative Services Task Force, a new standard for HIV testing could ensure that it becomes a standard part of annual check-ups. The Centers for Disease Control estimates that about 20 percentof the total population of Americans who are infected with HIV don’t know they have the virus, so regular tests that don’t incur an out-of-pocket expense could help encourage more Americans to learn their status.
Since Obamacare helps close the prescription drug coverage gap for Medicare beneficiaries, HIV-positive individuals will be more likely to afford their drug treatments for the virus. By closing the “donut hole,” or the gap in coverage for expensive prescription drugs under the Medicare program, Obamacare will help ensure that older Americans living with HIV aren’t unable to afford any of the 26 antiretroviral drug treatments that can be used to combat HIV infections. Twelve percent of Americans with HIV relied on Medicare for their health coverage in 2010, and that number may rise significantly as the population of HIV-positive Americans continues to age.
Obamacare increases resources for HIV research and prevention. The health care reform law allocates $10 billion over ten years for a new fund that focuses on prevention, wellness, and public health activities. In 2010, $30 million from that fund was awarded to the Centers for Disease Control for HIV prevention activities, including new investments in HIV surveillance and testing among high-risk populations.

How Obamacare Helps Americans Living With HIV (thinkprogress.org)
Most HIV-Positive Americans Lack Regular Medical Care (dgsmith.org)
By 2015, Half Of HIV-Positive Americans Will Be Over The Age Of 50 (thinkprogress.org)
Health Department Warns of HIV-Positive Prostitute (stlouis.cbslocal.com)
A Guide to Oral Care and HIV/AIDS (topdentists.com)

Red Ribbons And Mosquitos

Aug23 by D Gregory Smith

Yesterday, a friend sent me the following:

“Today I saw this headline:

West Nile Outbreak Largest Ever, 41 dead

and it made me think of this:

Rare Cancer Seen In 41 Homosexuals

…and wondering about what makes a disease a crisis versus a judgment. The number of victims was the same.”

Indeed.

And to further the irony, the famous speech given by Mary Fisher to the Republican National Convention in 1992- 11 years after the rise of “gay cancer” was highlighted in a feature by the New York Times today:

TWENTY years ago this month, Mary Fisher took the stage of the Republican National Convention at the Houston Astrodome and delivered a 13-minute prime-time speech that was seen by many as a sharp rebuke of her party’s negligence in the face of the growing AIDS epidemic.

Mary Fisher in 1992 made what is considered one of the best American speeches of the 20th century.

Ms. Fisher, a mother of two young children who had worked in Gerald Ford’s White House, addressed the delegates as someone who was H.I.V. positive herself. “Tonight, I represent an AIDS community whose members have been reluctantly drafted from every segment of American society,” she said. “I am one with a black infant struggling with tubes in a Philadelphia hospital.” She added, “I am one with the lonely gay man sheltering a flickering candle from the cold wind of his family’s rejection.”

It was a speech that was both surprising and poignant. Few, including Ms. Fisher herself, expected that she would survive a disease that had already killed more than 150,000 Americans by the summer of 1992.

But Mary Fisher is still alive — and still taking issue with her political party.

As she should. The discrimination and loathing that prevented government intervention is still with us. It’s made itself known in issues of women’s health, gender inequity, transgender rights and the House defense of DOMA.

However, West Nile will probably not become the epidemic that AIDS did. Because mosquitos don’t discriminate.

They bite everyone.

AIDS Activist Mary Fisher Is Defined by Words, Not Disease (nytimes.com)
West Nile spreads in Colo., outbreak becomes largest in U.S. history (kdvr.com)

With Resistance to Treatment Rising, CDC Updates Gonorrhea Treatment Guidelines

Aug9 by D Gregory Smith

From The National Coalition Of STD Directors:

Today, the Centers for Disease Control and Prevention (CDC) released updated guidelines for the treatment of the sexually transmitted disease gonorrhea, which is a major cause of pelvic inflammatory disease, ectopic pregnancy, and infertility and can facilitate HIV transmission.[i] CDC estimates there are more than 700,000 gonorrhea infections each year in the United States. The updated guidelines were published in CDC’s Morbidity and Mortality Weekly Report.

The change marks an end to CDC exclusively recommending oral antibiotic treatment as the first line of defense for gonorrhea, and now instead recommends that infections be treated with the injectable antibiotic ceftriaxone in combination with one of two other oral antibiotics, either doxycycline or azithromycin. This change in treatment has significant implications for clinical service delivery and infected patients alike, as the simple act of taking pills is replaced by an administered injection by a certified health professional.

“We applaud the CDC’s preemptive strike of changing recommended treatment and with the intention of extending the life of the last effective drug,” said William Smith, Executive Director of the National Coalition of STD Directors (NCSD). “However, the rising resistance of gonorrhea to our last line of defense against it must be a clarion call to policymakers and private industry alike to invest in the research and development pipeline for new antibiotics and more sophisticated diagnostics…and quickly. We desperately need additional options to meet the challenges of this infection,” continued Smith.

Last summer, the CDC sounded the alarm on gonorrhea’s rising resistance to antimicrobials. This report outlined that we are on the verge of a highly untreatable gonorrhea epidemic as gonorrhea has developed resistance to every class of antibiotics put up against it and there is no new drug in the pipeline. Documented increases in resistance throughout the U.S. are what has prompted the CDC to make the current recommended treatment change.

Full presser here.

Gonorrhea growing resistant to drugs that stopped it’s spread… (washingtontimes.com)
Untreatable gonorrhea worries health officials (cbsnews.com)

Join NAPWA (and me) For Free

Jul31 by D Gregory Smith

Infected/Affected by HIV/AIDS?

Join the National Association of People With AIDS (NAPWA). NAPWA is doing amazing work advocating for people HIV infected- and affected. It’s important that they have people from rural areas in their membership, so if you are HIV+ and live in Montana (or other rural areas) I would encourage you to join. From their mission statement:

Founded as a 501(c)(3) charitable organization in 1983, NAPWA advocates for the lives and dignity of all people living with HIV/AIDS, especially the more than a million Americans who live with it today. We want the epidemic to end, and we want life to be better for people with HIV until it does.

They are offering- for the first time ever- a free one year membership. To join me as a NAPWA member, click here: http://www.napwa.org/freemembership

ADAP Watch 7.19.12 (dgsmith.org)
‘Take The Test, Take Control’ On National HIV Testing Day (huffingtonpost.com)
More antivirals would stem HIV spread (bigpondnews.com)

Most HIV-Positive Americans Lack Regular Medical Care

Jul30 by D Gregory Smith

English: Enterprise Performance Life Cycle (Photo credit: Wikipedia)

From Betsy McKay of the Wall Street Journal comes this from the recently concluded International AIDS Conference in Washington DC:

HIV Data (1990, 2000, 2010) (Photo credit: cmdelaserna)

More than half of the people diagnosed with the HIV virus in the U.S. aren’t getting treatment for their infection, the U.S government said (Friday).

African-Americans and younger people are least likely to be receiving regular treatment, meaning that programs to keep them under a doctor’s care aren’t working or aren’t plentiful enough, according to a report by the Centers for Disease Control and Prevention.

While 81% of those African Americans estimated to be infected are diagnosed, only 29% get ongoing care, and just 21% are “virally suppressed,” or have their virus controlled by a regular regimen of antiretroviral, or ARV, drugs. Among Americans ages 25 to 34, 72% of those infected are diagnosed, but 28% get care and a mere 15% are virally suppressed.

Overall, an estimated 1.1 million Americans are infected with HIV. Only 46% of those who are diagnosed with HIV get regular treatment, while a quarter of all those estimated to be infected are virally suppressed.

“We’ve got to do better,” says Jonathan Mermin, director of the CDC’s division of HIV/AIDS Prevention.

The data were released at the XIX International AIDS Conference in Washington, D.C.

The challenge is to find ways to make HIV testing more widespread, and then make it easier to link those who are diagnosed directly into care — and to make sure they stay there, says Mermin. “I want to make the healthy choice the easy choice,” he says.

And therein lies the challenge. The easy choice is sometimes pretending the choices don’t even exist….

Read the rest here.