AIDS Drug Assistance Program (ADAP) Watch 7/1/12

From NAPWA:

The waiting list numbers continue steady, just over 2,000, down from 9,000 in September of last year.

Coming off another National HIV Testing Day, we have to wonder how some states can encourage their citizens to get tested but not help them get lifesaving medicines if they test positive.

We also wonder what kind of cost analyses the waiting list states are doing. The cost of clearing the waiting lists completely just isn’t that great. Virginia has just under 600 PLWHA on its waiting list. If drugs cost $15,000 for one ADAP beneficiary for one year, drugs for 600 will cost $9 million – and we just don’t believe $9 million can’t be found in an $85 billion fiscal 2013 Virginia state budget. PLWHA on Virginia’s and other states’ waiting lists will cost the public sector a lot more if they don’t get drugs that can keep them from progressing to AIDS.

Here are the latest numbers from our friends at NASTAD:

ADAP Watch

From NAPWA: Recently released supplemental federal funding is slowly bringing state waiting lists down – 2,552 this week. Regional disparities are troubling, though. Ninety percent of Americans on ADAP waiting lists are in the South. The only non-Southern state with comparable numbers is Nebraska. The South is where HIV is spreading fastest, and providing HIV drugs to those who need them would help prevent new infections.

Here are the latest numbers from our friends at NASTAD:

Some Startling HIV Facts

…from The CDC’s Annual Report from the Division of HIV/AIDS Prevention (DHAP), Accelerating Progress, Investing for Impact. This report provides an overview of some of the HIV prevention activities conducted and supported by the Centers for Disease Control and Prevention (CDC) during late 2010 to the end of 2011.

Too few Americans with HIV are getting the testing, treatment, and care they need to stay healthy and prevent transmission to others.

Surprisingly, only 28% of all HIV-infected persons are considered to have HIV under control ( viral load less than 200/ml). That’s not enough.

Percentage of HIV-infected Individuals Engaged in Selected Stages of the Continuum of HIV Care, 2010-11

All HIV positive individuals- 100%

Aware of their infection- 80%

Linked to HIV care- 62%

Retained in HIV care- 41%

Receive antiretroviral therapy- 36%

Have their virus under control*- 28%

*Plasma viral load < 200 cells/ml

Source: MMWR  60(47);1618-1623

 

 

Missoula County Sees Spike In HIV Infection

HIV infection has increased unexpectedly in Missoula County- 12 new cases in five months- almost half the number of all reported cases in Montana last year.

From The Missoulian:

“We tend to see small numbers of new cases every year, but to have this many new cases – at this count 12 – documented in a five-month period is an unusually high number,” Missoula City-County Health Department Director Ellen Leahy said on Wednesday. “Twelve cases in one county in five months is an outbreak.”

HIV causes acquired immune deficiency syndrome or AIDS, a debilitating and sometimes fatal disease. It is spread by unprotected sexual contact or infected blood transfer, such as sharing infected hypodermic needles. Leahy said all the Missoula cases appeared to stem from sexual activity.

The announcement was made after consulting with many community groups, including Partnership Health Center, the Montana Gay Men’s Task Force and the Open Aid Alliance. Open Aid director Christa Weathers said the decision to publicize the outbreak was a hard one, because health officials depend on people self-reporting their condition to track the disease’s spread.

“It’s hard to issue a public health risk without creating alarm, or without pointing fingers at any group of people,” Weathers said. “It’s a great opportunity to remind people this is a risk and why testing is so important. But we don’t want to discourage anyone who may know they may need to get tested, but they’re afraid to come in and then this hits the media and they’re gone.”

So far, all the confirmed cases are adult males. But Leahy warned that women who don’t consider themselves members of a high-risk group for HIV infection have also been exposed.

“It’s sexually spread, but it’s time to remind ourselves – you really cannot know if you’re infected unless you’ve been tested,” Leahy said. “We recommend health clinics regularly offer HIV testing to sexually active patients. Rather than presume someone is in a risk group, it’s risk behavior, not membership in any group, that they need to think about.”

Several of my sources say the newly-infected persons are young men who simply didn’t practice safe sex, thinking “It’s Montana- I’m not at risk”. These men, mostly in their twenties, I’m told, will now have a lifetime of medication, stigma and health issues to deal with. It saddens me.

Today is a good day to be tested. For a list of Montana free Rapid HIV Testing sites, click here.

If you’re in Bozeman, call AIDS Outreach 406-451-5718 (the number in the link above is incorrect) or go to AIDSOutreachMT.org

HIV Diminishes Lung Function

We know that uncontrolled HIV can lead to a host of problems (see illustration). You can now count breathing among them.

English: Main symptoms of acute HIV infection....

Image via Wikipedia

A new study has shown that if you have untreated HIV, you are much more prone to a rapid decline in lung function. Because we know that smoking negatively affects lung function, this finding adds urgency to the message that persons with HIV will benefit greatly from not smoking.

The study seems to corroborate soft-tissue organ damage by unchecked HIV, and is yet another argument buttressing early treatment and lowering viral levels among persons with HIV disease. From AIDSMEDS:

Though the study results from a Johns Hopkins University School of Medicine team note that people living with HIV—particularly those with viral loads not being kept in check with antiretroviral (ARV) therapy—have reduced lung strength and a more rapid loss of pulmonary function compared with HIV-negative controls, the researchers also point out that cigarette smoking was very common in the cohort studies and remains an important risk factor to contend with.

As explained by Michael Drummond, MD, of Johns Hopkins during his introductory remarks, HIV infection has been shown to increase the risk of obstructive lung diseases (OLD), such as emphysema and chronic bronchitis—both under the umbrella of chronic obstructive pulmonary disease (COPD)—and asthma.

According to a study reported in 2000, there was a greater prevalence of emphysema—documented using chest X-rays—in smokers living with HIV. And in a 2006 study, HIV infection was found to independently increase the risk of a COPD diagnosis by 47 percent.

More recently, in a study authored by Drummond and his colleagues in 2011, an HIV viral load in excess of 200,000 copies was associated with a 3.4-fold increase in the odds of having an OLD diagnosis using gold-standard pulmonary function tests. The cohort has enrolled more than 4,000 injection drug users, roughly a quarter of whom are people living with HIV.

People with uncontrolled HIV infection had a loss in lung function at a sharply higher rate than both HIV-negative people and those with good viral control. It means that if you smoke, you’re just going to make that loss of lung function happen faster. I quit smoking almost three years ago. In fact, I wrote about it right here.

There were a lot of reasons. But mostly,  I quit because I wanted to consciously choose a healthy life. And I wanted to be able to credibly help others to do that, too. These facts from Nancy Reynolds study on HIV and smoking helped bring me out of the smokers’ corner for good:

  • The lungs of a person with HIV are more susceptible to cancer, emphysema, pneumonia,acute bronchitis and tuberculosis. This risk increases dramatically among HIV+ smokers.
  • The incidence of cancers, especially lung and cervical cancer are higher among HIV+ smokers and develop at a significantly younger age than the general population.
  • And the biggie: Smokers with HIV negate some of the effects of antiretroviaral medications by smoking. Thus, HIV+ smokers had a 36% greater chance of developing an AIDS-defining condition and a 53% higher risk of dying than HIV+ persons who did not smoke.

In the last few years after I quit smoking, my health has steadily improved. My cardiac function increased. My CD4 counts went up. My bilirubin counts went down- so did my bad cholesterol. All good things. I can exercise more without gasping, and I look good (if I do say so myself).

So, again, I’ll make a plea: I don’t want to be one of those newly-converted who scowls every time somebody lights up a cigarette. I really don’t. I understand how much fun smoking is, and how complicated. I just want you to have the facts. The very disturbing facts.

And maybe, if you’re a Person With HIV, they’ll hit you like they did me and you’ll improve the quality and length of your life. Just maybe.

And if you know someone who’s HIV+ who still smokes, show them this article- and ask them if they need support to quit. There are a lot of resources out there- and a lot of good reasons to choose from.

Even more now.

ZZZZZZZZ- You Need More Sleep

In my role as a therapist, I hear people complain about lack of sleep inability to fall asleep, fatigue and mental grogginess. It’s simple- we’re not getting enough sleep. Persons with chronic illness- including HIV- are especially susceptible and will benefit greatly from enhanced sleep hygiene.
Below is a helpful infographic Ken found on sleep:

You Need More Sleep
Created by: MedicalBillingAnd CodingCertification.net

AIDS: “The Unnecessary Epidemic”

This eloquent, excellent article is from The National Association Of People With AIDS/HIV (NAPWA) newsletter, Positive Voice. It outlines many of the challenges we face as a country- including homophobia, stigma, and stinginess- in getting HIV under control:

This is an exciting time for all of us who live with HIV or are affected by it. Theoretical models predicted for years that treatment-as-prevention could work, and the last year confirmed it. In the elegantly designed HPTN 052 trial, results showed that serodiscordant heterosexual couples had a drastically reduced risk of infection for the HIV-negative partner when the positive partner was receiving effective treatment with antiretroviral drugs.British Columbia didn’t wait for trial results. For several years, the province has aggressively sought to find and treat as many HIV-infected people as possible, and the numbers of AIDS deaths and new HIV infections are now coming down. Dr. Julio Montaner, father of the B.C. program, remarked recently that the falling number of (known) new infections was not the result of less testing, or of safer sex. That leaves only one plausible explanation: reduced community viral load.

So we can end this epidemic. It’s time to start calling it The Unnecessary Epidemic.

As NAPWA President and CEO told us in the previous issue of Positive Voice, ending the epidemic will take resources, resources, resources. Resources for high-impact prevention programs. Resources for treatment and support services for all who need them. Resources to fix an unfair health care system.

But it’s also going to take more than resources. It will take changes in public attitudes. Twenty percent of Americans living with HIV don’t know it. Some of them don’t because prevention and testing programs haven’t reached them. Other don’t because having HIV can be so stigmatizing that they would really rather die slowly than know their status.

So let’s look at some public drivers of HIV stigma, and then look at the consequences.

The evils of “second-hand sodomy”

On the site Conservapedia.com – think of it as Wikipedia for the “right”-minded – Americans for Truth (!) president Peter LaBarbera writes, Why isn’t there a concerted government effort – akin to the current anti-smoking campaigns – to reign in homosexual promiscuity – beginning with closing down all sex businesses (bathhouses) that facilitate homosexual perversion? (Of course, we favor closing down straight prostitution businesses as well.) We know that bisexual behavior (men on the “down low”) help spread dangerous diseases to the general population: how many deaths and illnesses have to result from “second-hand sodomy” before authorities take corrective action?

Translation: it’s all the gays’ fault. If we could just shut down all gay sex, the epidemic would go away. Never mind that a majority of African Americans living with HIV are women, in numbers that could not possibly be accounted for by some partners’ “down low” adventures, and HIV in Africa was a heterosexual disease from day one. LaBarbera is saying that sex he disapproves of is perversion, perversion leads to disease, and “second-hand disease” is tantamount to murder.

Just as bizarrely, Dr. Peter Duesberg continues to contend that HIV is harmless and AIDS is caused by gay sex and drug use. Somehow, we just don’t think most of the African American women living with AIDS have been having gay sex and sniffing poppers…. And never mind the experience of people with HIV who were on the ropes in 1996, when drug cocktails based on protease inhibitors were just coming into use, and eight weeks after we started our new drug regimens our viral loads were down, our T cells were up, and our dermatologists were telling us we didn’t have to come back anymore for our every-two-weeks appointment to zap new KS lesions. Practical lesson: control the HIV and the AIDS symptoms go away. Conclusion: the virus causes the symptoms. Discussion over, Dr. D.

Not victim-free expressions of opinion

We can laugh at these extreme opinions, but publishing them is not a victimless crime. Duesberg’s opinions delayed wide use of antiretroviral drugs (ARVs) in South Africa for years, and people died. The shame about non-majority sexual orientation spread by Conservapedia and others keeps people who know they should get tested from doing so and having to live with a positive result. Using criminal law as a (failed) tool to prevent new infections drives infected people and injection drug users underground, where prevention and treatment services can’t reach them.

How the Grinch stole your needle exchange

The 2013 federal budget just passed reinstates the former ban on federal funding for one of the most targeted, cost-effective HIV programs ever conceived: injection needle exchanges. The ban was one of many prices, just before Christmas, for passing any budget at all. The underlying thinking may have had something in common with Conservapedia’s panacea of outlawing gay sex: just say “there ought to be a law,” whether it’s a matter law can deal with effectively or not. It can’t, and we wonder whether many members of Congress demanding the ban knew that. Certainly those with competent health policy staffers did.

Naming stigma – and praising constructive action

As a community of people who live with HIV or serve those who do, we have a responsibility to call out stigma wherever we see – HIV stigma, homophobia, unease with transgendered people, the cruel expectation that people trapped in sex work or drug use are in control and should just go cold turkey and quit. This is more important than any quarrels we may have among ourselves about PrEP, condoms, or whether to concentrate on developing a preventive or therapeutic vaccine first (scientific accident will decide that for us).

 To join the National Association Of People with AIDS/HIV, click here.