Tag Archives: HIV

Most HIV-Positive Americans Lack Regular Medical Care

by D Gregory Smith
English: Enterprise Performance Life Cycle

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)

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. 

English: IPSF HIV/AIDS Campaign Logo

English: IPSF HIV/AIDS Campaign Logo (Photo credit: Wikipedia)

 

 

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ADAP Watch 7.19.12

by D Gregory Smith

From NAPWA:

The Administration has pledged new money to end the waiting lists, but they will linger for some time. Making sure that everyone who needs ART drugs can get them is an obvious first step towards ending this country’s HIV/AIDS epidemic, but when the waiting lists are gone, we’ll have to move on to the hard work of changing attitudes towards people with HIV and ensuring access to health care for all Americans, not just those living with HIV.

It was grimly entertaining, explaining to Conference delegates from Canada and Germany what ADAP is and why we have waiting lists, when it’s so obviously better public health policy and so obviously more fiscally prudent to treat everyone with HIV who wants treatment. After she got past her initial disbelief, a German delegate gently suggested that there are better ways to handle this sort of thing. We wouldn’t need ADAPs, let alone have ADAP waiting lists, if we had a rationally designed national health care system.

Here are the latest numbers from our friends at NASTAD:

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HIV In Prison

by D Gregory Smith

FYI:

  • More than 2 million people are incarcerated in jails and prisons in the United States.
  • People who are incarcerated are at increased risk for acquiring and transmitting HIV.
  • The correctional setting is often the first place incarcerated men and women are diagnosed with HIV and provided treatment.

People who are incarcerated are at increased risk for acquiring and transmitting HIV and other infections. Correctional health, public health, and community-based organizations need to improve HIV prevention and care for incarcerated populations through 1) routine HIV screening and voluntary HIV testing within prisons and jails and 2) other effective prevention strategies, including those that address inmates’ transition back into the community. Correctional institutions can be important partners in preventing and treating HIV to protect and improve inmate and community health.

More here.

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Let’s Talk About Sex

by D Gregory Smith

“Sex Is the Question,” is an engaging and important survey regarding the sexual practices of gay and bisexual men. This entirely confidential survey is sponsored by the Center for Disease Control, and will be used by state and local health departments to better understand the HIV epidemic among gay and bisexual men and potentially create new techniques to reverse the trend. “Sex Is the Question” is the largest survey ever attempted by a US federal agency for gay and bisexual men, and it will only take you a few minutes to complete. Do you want another great reason to take the survey? For every completed survey, “Sex Is the Question” will make a monetary donation to the It Gets Better Project.

How can you take the survey? Just click on this link. After you complete the survey, you will also have the opportunity to invite your friends to participate, and a donation will be made to the It Gets Better Project for each of your friends who completes the survey too. In addition, “Sex is the Question” is not just a survey. It is the first study of its kind to provide immediate feedback to its participants by incorporating videos and other interactive tools. At the end of the survey, you will be presented with personalized insight and comparisons based on your answers. Thank you for your consideration! With you support, we can help put an end to HIV once and for all, and in doing so, support a terrific organization.

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Olympic Rings Inspire Artist To Illustrate Inequality

by D Gregory Smith

Need some help visualizing global issues? Here’s an amazing idea:

Oceania: blue. Europe: black. Americas: red. Africa: yellow. Asia: green.

 

Powerful. Also illustrations for homicide, obesity, military spending and billionaires. Click graphic for source and story.

 

 

Gay Men’s Wives, Homophobia and HIV

by D Gregory Smith

(click for source)

Discrimination and homophobia are often more prevalent in rural areas. Outreach workers in Montana know that there are certainly barriers for men to being tested for HIV. One of the most significant is the fear of being harshly judged, labelled and dismissed. It’s one of the reasons some gay/bi men get married to women and start families- they want to be ‘normal’- even though they already are. The sense of shame and guilt can be overpowering- and it’s adding fuel to the fire as far as HIV is concerned.

Rural outreach workers have known this for years- it may be one of the reasons that HIV is spreading so rapidly in the south. It’s almost certainly one of the reasons that HIV is spreading in the African American population. But we haven’t paid much attention- at least scientifically- to this issue. Now it looks as if science is actually catching up to reality. From The Sobering Truth About HIV Among MSM by Gregory Trotter, Chicago AIDS Foundation blog (July 25):

The idea of “turning the tide” against the AIDS epidemic will prove to be no more than a slogan if more is not done to address the growing number of gay/bisexual men infected with HIV worldwide, experts said today.

Speaking at an afternoon press conference today, a panel of experts presented new research – recently published in a series in the medical journal, The Lancet – that confronted the reality of HIV prevalence among MSM (men who have sex with me).  The series concluded that, in addition to medical and scientific advances, more must be done to eradicate the cultural and societal impediments of homophobia and discrimination. Until that happens, ending the AIDS epidemic is unlikely, said Chris Beyrer, a professor at Johns Hopkins Bloomberg School of Public Health. (emphasis mine)

We routinely encounter discrimination in dealing with MSM in Montana- some of whom do not openly identify as gay. In fact, some are married- with children- and do not plan on leaving their families. But they’re having sex with other men- and some are not using condoms with their wives. “If I did, she’d know I was having sex with someone else,” one client told me.

The fear of being exposed for these men is great. One man told me, “I can’t afford to be seen as gay. It would kill me- it would kill my wife.”  Shame from society, churches and social groups abut being gay have forced men to create false lives. But they haven’t stopped sexual behavior. This type of internalized shame is not uncommon here- and the wives of these men could be put at risk as a result.

Shame, homophobia and discrimination are fueling the epidemic- so are apathy and denial (see my essay Gay Men Are Flunking The Test). Part of me wonders when we’re going to start seeing a rise in HIV infection among rural women- the wives of gay/bi men. Back to Mr Trotter:

On average, MSM are 19 times more likely to be infected with HIV than the general population in low- and middle-class countries, according to Dr. Kevin Fenton, director of the National Center for HIV/AIDS.

Many African countries do not accurately report numbers of MSM and some do not even acknowledge they have MSM among their population, said Paul Semugoma,  Uganda physician who serves on the steering committee for the Global Forum on MSM &HIV (MSMGF).

Homophobia is rampant in such countries, he said.

“If we don’t start solving these impediments for MSM, we’re not going to do much about the epidemic,” Semugoma said.

In a recent study in Jamaica, 82% of Jamaicans self-identified as homophobic, largely out of fear of HIV prevalence among gay/bi men, said Maurice Tomlinson, legal advisor on marginalized groups for AIDS-Free World, an international advocacy group.

Such homophobia has engendered a climate where gay men are afraid to buy condoms for themselves, Tomlinson said. Their female friends often buy condoms for them, he said, but refuse to buy lube, as that would imply a female “deficiency.”

And so many gay/bisexual Jamaicans use petroleum jelly, saliva or even hairspray as a lubricant, he said.

“In those cases, it would be better if they used nothing at all,” Tomlinson said.

To learn more about how HIV affects MSM throughout the world and possible solutions to problem, read the full series in The Lancet titled “HIV in Men Who Have Sex with Men.”

Related article:

Gay Men Are Flunking The Test

by D Gregory Smith

Also published on Bilerico.com

Yesterday, I posted an article about  a press release by the Journal Of The American Medical Association:

“…all adult patients, regardless of CD4 cell count, should be offered antiretroviral therapy (ART), according to an article in the July 25 issue of JAMA, a theme issue on HIV/AIDS. Other new recommendations include changes in therapeutic options and modifications in the timing and choice of ART for patients with an opportunistic illness such as tuberculosis.”

This follows the “treatment as prevention” model, based on the scientific research that people with HIV on antiretroviral therapy- with an undetectable viral load- are 96% less likely to pass on the virus.
us-statistics-2.jpgThis seems to be very good news. If you have HIV, you should find out early, get on meds and you’ll have a better chance of living a longer healthier life.

So what’s the problem? The problem is twofold:

  1. People at risk aren’t being tested: 20-25% of all HIV-infected people don’t know they have it.
  2. People at risk are still not being tested: Gay and Bisexual men of all races are the most severely affected by HIV

That’s not a typo- they’re basically the same reason, but there’s a difference. Any guesses?

Hint: It’s probably why most gay men won’t even read this article.

20-25% of all people with HIV don’t know they have it. Why not?

Here’s my take: Denial is one of the strongest mechanisms in the human psyche. It is fed by lack of information, by avoidance and by a strong desire for an alternative reality. If you’ve had unprotected sex, you’ve probably engaged in the process of denial. You’ve probably downplayed the risk, probably lied to yourself a little. You may have even gone over and over it in your mind, seizing every opportunity to deny the possibility of trouble.

“He looked okay”; “He didn’t seem sick”; “He pulled out”; “He would have told me if he had HIV”, etc, etc, and etc.

Well, we all know where that goes…. As individuals, we’re not facing facts. If we were, we’d be getting tested.

us-statistics-1.jpgGay and Bi men of all races are the most severely affected by HIV. Of course. We know that. Don’t we?

Again, denial applies. Gay and Bi men aren’t talking about HIV anymore. Our friends aren’t dying, so there’s no reason to be concerned. People with HIV aren’t out- aren’t well-known in our communities. Why? I was once told “You don’t need to harp about HIV all the time- it’s not that big of a deal.” Except that it is.

HIV has complicated my life in ways many people can’t believe. I am on catastrophic health insurance through the state- almost three times as expensive as my partner’s insurance. I get assistance for my meds- which cost about $25,000 a year- but (crazily), I can’t make more than $30,300 and still qualify for the program. I have joint pain, sleep issues, battles with depression, fatigue and a body that is aging at several times the normal rate– most probably due to inflammation- the hallmark of HIV disease. And yet, if I talk about this to friends or family, I’m seen as a whiner or someone trying unnecessarily to worry people I care about. It’s the “shut up- at least you’re not dying” defense. I know several HIV+ people who haven’t told anyone of their status, mostly because it’s “uncomfortable”.

No shit.

As a community, we’re not facing facts. If we were, we’d be talking to our friends about the importance of maintaining our health. We’d be talking about the hard reality of HIV.

But we’re not. Denial still holds sway, both individually and as a community. We’re lying to ourselves- we’re lying to each other- and infection rates stay the same.

We have a chance to change this trend. But only if everyone with HIV starts treatment, gets into care. This recommendation of the AMA may help with that. But it’s not up to doctors, nurses and social workers, it’s up to us.

We’re being tested, both as individuals and as a community. The problem is, we’re flunking.

Because we’re not showing up.

(Images source)

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“All Adult HIV Patients Should Be Offered Antiretroviral Therapy”

by D Gregory Smith

From Science Daily:

Included in the 2012 International Antiviral Society-USA panel recommendations for human immunodeficiency virus (HIV) patient care is that all adult patients, regardless of CD4 cell count, should be offered antiretroviral therapy (ART), according to an article in the July 25 issue of JAMA, a theme issue on HIV/AIDS. Other new recommendations include changes in therapeutic options and modifications in the timing and choice of ART for patients with an opportunistic illness such as tuberculosis.

Melanie A. Thompson, M.D., of the AIDS Research Consortium of Atlanta, presented the findings of the article at a JAMA media briefing at the International AIDS Conference.

Journal of the American Medical Association

Journal of the American Medical Association (Photo credit: Wikipedia)

“Since the first antiretroviral drug was approved 25 years ago, improvements in the potency, tolerability, simplicity, and availability of ART have resulted in dramatically reduced numbers of opportunistic diseases and deaths where ART is accessible,” according to background information in the article. “New trial data and drug regimens that have become available in the last 2 years warrant an update to guidelines for ART in HIV-infected adults in resource-rich settings.”

The benefit of suppressing the virus, in my opinion, is greater than the possible toxicity of medication and navigating possible side effects. We know that as long as HIV is in the body, unchecked, it’s doing damage. It’s more likely than possible that people who start antiretroviral therapy early will have less problems with secondary conditions (joint pain, arthritis, memory problems) as they progress in their lives. I think this is tremendous news.

Full Story Here.

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President’s Welcome Video To International AIDS Conference 2012

by D Gregory Smith

Some history and a commitment to continue progress:

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HIV Treatment Breakthrough: Weekly Injection Could Replace Daily Pill Regimen

by D Gregory Smith
HIV-1 Gag

HIV-1 Gag (Photo credit: AJC1)

For a number of people with HIV, treatment can be troublesome because medicine should be taken at the same time every day- sometimes more than once a day. Some medications must be taken with food, some without. Some can only be taken near bedtime because they cause drowsiness.

Science Daily reports a treatment breakthrough:

(A) University of Nebraska Medical Center research team’s progress toward developing weekly or twice-monthly injectable antiretroviral therapy (ART) nanomedicines for patients with human immunodeficiency virus (HIV) infection will be highlighted as the cover story in the Journal of Infectious Diseases.

A long-acting, nanoformulated ART (nanoART) would be a substantive improvement over daily and sometimes more complex regimen of pills, said Howard Gendelman, M.D., the lead investigator on the development of nanoART for HIV/AIDS and professor and chairman of the department of pharmacology and experimental neuroscience (PEN) at UNMC.

The journal article hails the successful testing of UNMC’s ART injectables as treatment of HIV-infected mice and in preventing new infections.

“We actually followed the process exactly as we would with a person — and it worked,” Dr. Gendelman said. “This is all very exciting. Although there are clear pitfalls ahead and the medicines are not yet ready for human use, the progress is undeniable.”

This could prove to be helpful- most especially in the developing world- where people have trouble managing a regimen of pills or have low access to long-term medication treatments. But it may have significant impact everywhere, changing the way HIV is treated….

Full article here.

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