WISCONSIN: Area Inmates Part of HIV Rapid-Test Study
Dani McClain
Milwaukee Journal Sentinel (08.07.06) - Wednesday, August 09, 2006
Inmates in Wisconsin, Florida, New York, and Louisiana recently took part in a CDC-funded study to determine the
merits of rapid-result HIV testing in jails. In Wisconsin, the tests were made available at Milwaukee House of Correction in Franklin and Rock
County Jail in Janesville. More than 31,000 inmates in the four states were tested, said Robin MacGowan, a CDC project officer.
Testing in short-stay jails may help find undiagnosed HIV cases, experts say. According to a study by Ted Hammett
of the research firm ABT Associates, almost 25 percent of people with HIV will pass through a correctional facility at some point.
Twelve of the 4,500 inmates tested in Milwaukee and Rock counties were HIV-positive, for a rate of 0.27 percent -
well below the rate of 1.1 percent found in the combined results for the 13 testing sites in all four states.
The Wisconsin Division of Public Health received a $389,000 grant from CDC to run the testing outreach at the two
facilities, said Jim Vergeront, director of the state AIDS program. Wisconsin hired STD Specialties, which has performed traditional HIV
testing in the Milwaukee County Jail since 2000, to run the outreach. Staff provided counseling and follow-up during inmates' incarceration and
offered case management services to HIV-positive persons upon release. Inmates' written consent was required for the testing, which was
voluntary and confidential but not anonymous.
Upon release, HIV-positive persons received a $50 stipend to cover transportation expenses associated with
seeking treatment. STD Specialties' personnel met with HIV-positive clients three and six months after diagnosis, and the state Health
Department surveyed patients to assess their ability to access care.
"It's gotten much easier for the patient," STD Specialties Executive Director, Casey Reilly, said of rapid-result
versus conventional HIV testing. "Some people wouldn't get tested because they couldn't stand the anxiety."
INTERNATIONAL NEWS
AFRICA; NORTH AMERICA: Africans Better at Taking AIDS Drugs
Bloomberg News
Newsday (New York) (08.09.06) - Wednesday, August 09, 2006
A new study examining data from almost 30,000 HIV patients found 77 percent treatment adherence among African
patients versus 59 percent adherence among North American patients. Initially, doctors worried patients in limited resource settings would be
more likely to skip doses of the demanding treatment regimens. Missing drugs that target different parts of the virus could lead to viral
resistance.
The new study refutes this premise, said David Bangsberg, senior study author and an associate professor at the
University of California-San Francisco. "Over the last several years, bits of information have trickled out suggesting that adherence to
antiretroviral therapy is really quite excellent in resource-poor countries," he said. "This takes all those pieces of information and puts
them together in a systematic way."
Patients' initial adherence is usually high since it noticeably improves their health and adverse effects have
yet to develop, said Bangsberg. While that may partly explain the adherence rates on the two continents, the differences observed were so
significant, it suggests other factors were also involved, he said.
In both Africa and North America, doctors need to assist patients in proper adherence, said researchers. The full
report, "Adherence to Antiretroviral Therapy in Sub-Saharan Africa and North America: A Meta-analysis," was published in the Journal of the
American Medical Association (2006;296(6):679-690).
GLOBAL: AIDS and TB Team Up to Kill Even More, Group Says
Maggie Fox
Reuters (08.08.06) - Wednesday, August 09, 2006
On Tuesday, the Open Society Institute released a report highlighting the prevalence of co-infection with HIV and
tuberculosis. Each year, TB kills 2 million people, and 9 million more become infected, said the report. It noted, however, that doctors often
fail to diagnose TB in AIDS patients.
In a telephone briefing with reporters, Stephen Lewis, UN special envoy for AIDS in Africa, called for more
action against the "double plague." Co-infection with the two diseases, Lewis said, is almost "always an irreversible formula, cause for
death." "TB is in fact the most common cause of death for people living with AIDS. Ninety-nine percent of those infections and deaths are in
the developing world."
"When people have AIDS, it is difficult to diagnose TB," said Ezio Santos Filho, a Brazilian lawyer and activist
who contracted HIV in 1985 and became infected with TB in 1992. "Normally, they don't have all the symptoms, all the typical characteristics
that people without AIDS would have. People cough less and people have less sputum when they have AIDS."
According to the report, only one-third of all TB smear tests in HIV patients produce an accurate positive
result. Lewis said, "You could do it with a chest x-ray, but obviously that kind of technology is not readily available to the developing
world."
"And for people living with AIDS," the report said, "even a short delay in accessing TB treatment can be fatal."
Lewis and Open Society staffers hope to use the report to raise the issue of HIV/TB co-infection at the 16th
International AIDS Conference in Toronto next week.
INDIA: Rural India in Big HIV-AIDS Push
BBC News (08.08.06) - Wednesday, August 09, 2006
At a conference held in Delhi on Tuesday, India and UNAIDS launched an initiative to involve hundreds of local
village leaders in helping prevent HIV/AIDS. Nearly 60 percent of Indians with HIV live in villages, a proportion that officials blame on rural
poverty, migration and limited health care access.
"AIDS is a disease of intimacy and has a lot to do with things that are personal, such as sex and death," said
Denis Broun, the country's coordinator for UNAIDS. "The local-level bodies are the closest to the people, hence their cooperation is very
important." Some 500 village council leaders attended the event.
Village councils oversee rural development planning, community services, public health and welfare. These members
belong to the community and usually have direct access to all the families in their area, a wide reach invaluable to stopping HIV's spread.
Migrant laborers and truck drivers have already been identified as primary groups involved in the growth of rural
HIV infections, said Sujatha Rao, head of the National AIDS Control Organization. Locally, NACO will help train leaders to assist women with
AIDS facing discrimination, encourage the promotion of condom access, and introduce AIDS education in schools.
Most awareness and prevention efforts in India have focused on high-risk groups. The rural initiative will began
encouraging village council leaders to incorporate HIV/AIDS into local planning and to address disease myths. Women's low social status in
India makes them vulnerable to STDs, and they have a low awareness about HIV transmission and prevention.
SAUDI ARABIA: Saudi Arabia Begins to Face Its Hidden AIDS Problem
Hassan M. Fattah
New York Times (08.08.06) - Wednesday, August 09, 2006
After years of keeping quiet about its AIDS epidemic, the government of Saudi Arabia is opening up. In June, the
Ministry of Health acknowledged that more than 10,000 people in the nation are HIV-positive, including almost 600 children. The number of cases
is up significantly from 2004 (7,800) and 2003 (6,700). Still, the actual number may be much greater: According to a doctor who treats HIV
patients, the nation's real caseload could be as high as 80,000.
Legislation enacted some years ago that guards the privacy of patients and guarantees their right to work offers
some protection for AIDS patients. And the nation's health care system provides free medical care and distributes antiretrovirals to those who
need them.
These rights and benefits, however, extend only to Saudi citizens. Non-Saudis - who comprise three-fourths of the
nation's reported HIV cases - are typically locked up, then sent home.
Cultural barriers that forbid the discussion of sex and condoms make HIV prevention a challenge. "The main
problem here is not the disease itself," said Muneera al-Dahhan, a clinical counselor at King Faisal Specialist Hospital and Research Center.
"It is the tough view of society. People see this as the result of sexual behavior that is unacceptable in our society and [they] are unable to
accept it."
But on this front, too, there is evidence of progress. A growing number of doctors, social workers and AIDS
patients themselves are working to teach Saudis about the disease and to help infected persons live more normal lives. Regular public sessions
at King Faisal Hospital are helping educate patients and the public. And doctors frequently appear on Saudi TV to talk about HIV/AIDS and how
to prevent it.
MEDICAL NEWS
ASIA: Study: Millions of TB Deaths Could Be Averted with Shorter Therapy
Jessica Berman
Voice of America News (08.02.06) - Wednesday, August 09, 2006
A study by Harvard University International Health's Joshua Salomon and colleagues found that a two-month course
of Directly Observed Therapy, in which social workers watch patients take their pills, was just as effective as a six-month course of DOT for
treating tuberculosis. Patients often fail to take all their antibiotics during the standard six-month TB treatment, which can result in drug-
resistant strains of the disease.
Salomon and colleagues conducted their study in Southeast Asia, where one-third of TB cases and deaths occur.
They used a model to project what the epidemic would look like using a two-month treatment course and the standard six-month course, and found
the two-month course to be superior.
"If we get them to the finish line in two months instead of six months, we're likely to see more patients cured,
fewer patients forming a pool of infectious cases that can pass on the infection to others," Salomon said. "And when we translate that into
benefits in terms of reduced new cases at the population level and reduced deaths, we see quite an enormous impact."
If the two-month course of DOT is adopted, it could double or even triple the decline in new TB cases and deaths.
The model predicts benefits would be seen between 2012 and 2030. However, the calculation assumes development of a new anti-TB drug that would
be in wide use by 2012.
The study, "Cost-Effectiveness of Treating Multidrug-Resistant Tuberculosis," was published in Public Library of
Science Medicine (2006;3(7):e241).
LOCAL AND COMMUNITY NEWS
TEXAS: AIDS Services Feel Cuts
Kim Horner
Dallas Morning News (08.07.06) - Wednesday, August 09, 2006
In the Dallas area, HIV social service organizations supported by federal Ryan White money are increasingly being
sidelined as local and federal governments shift priority to HIV medical treatment. Local AIDS service officials believe the cuts could mean
their clients - increasingly minority and female - could get sicker and be left without child support, nutritional programs or transportation
to medical appointments.
In Congress, a proposed reauthorization of Ryan White would require that 75 percent of funds go to medical
services. Administered locally by Dallas County, Ryan White funds have an increased medical care emphasis: from 62 percent last year to 77
percent this year.
Bryan's House, a local agency providing services to about 800 kids a year affected by HIV/AIDS, lost $70,000 in
Ryan White funding for the fiscal year starting in July. The nonprofit AIDS Interfaith Network recently lost $260,000 for services including
adult day care, for which hours have been cut.
Cuts of $25,000 and $44,600 to, respectively, AIDS Services of Dallas and Dallas Legal Hospice mean legal and
food services will have to be reduced if not supported by private donations, said officials. The legal services agency expects to lose all its
federal funding eventually, said Roger Wedell, executive director.
Parkland Memorial Hospital, which operates clinics serving 5,000 HIV/AIDS patients, received $571,161 more than
it did the previous year, said Sylvia Moreno, its director of HIV services. That still does not cover PMH's expenses, with AIDS drugs costing
more than $13,000 per patient annually, she added. "This is a huge expense, and it's mostly uncovered" for PMH's mostly uninsured patients,
Moreno said.
The shift toward treatment is needed because thousands of US HIV/AIDS patients still are not receiving medical
care, said Michael Weinstein, president of Los Angeles-based AIDS Healthcare Foundation. "The response in the '80s with organizations springing
up to care for people was very heroic and useful," he said. "On the other hand, we now have the tools to treat AIDS as we would any other
illness."
NEW YORK: Group Teaches Immigrants About AIDS, Hoping to Head Off a Crisis
Sarah Garland
New York Times (08.08.06) - Wednesday, August 09, 2006
Javier Soriano is director of Mexicanos Unidos, a nonprofit he launched to help educate New York's Mexican
community about AIDS. He got the idea several years ago while counseling HIV patients, including a growing number of Mexicans, at New York
Presbyterian Columbia Hospital. Chief among his concerns was that language and cultural barriers were preventing the organizations that
traditionally do outreach to Hispanics from reaching these recent arrivals from Mexico, many of whom speak local dialects. Limited education
and taboos against condoms are also issues, said Soriano, who is himself from a small town in the Mexican state of Puebla.
Ten years ago, HIV was virtually nonexistent in the Mexican states from which many immigrants come to New York,
said Dr. Michele Shedlin, a health professor at the University of Texas-El Paso who has studied this population and the HIV risk it faces in
the city. Now, she said, "Migrants are bringing HIV back to the villages. We're very worried about the future."
Soriano takes his outreach around the city to church basements and Mexican festivals. He talks with men, who may
patronize prostitutes while working far from home, and with Mexican women, who as Hispanics are statistically four times more likely to die of
AIDS than are white women. He distributes condoms and passes out fliers he designed that combine traditional images like the Virgin of
Guadalupe with messages about AIDS. He holds Thursday night meetings at Our Lady of Refuge Roman Catholic Church in the Bronx. This month,
Soriano is organizing an art fair with free HIV testing at an East Harlem Catholic church. In addition, he tries to make connections with
grassroots Mexican groups that may not have AIDS as a part of their mission.
NEWS BRIEFS
INDIA: AIDS May Kill 11 Million in India over 20 Years
Reuters (08.09.06) - Wednesday, August 09, 2006
HIV/AIDS could kill 11 million Indians over the next 20 years, the Times of India reported today, citing an
official census forecasting its 2026 population as 1.4 billion - a 1.2 percent loss. The figure assumes 5 million children unborn to women lost
to AIDS. "If we do not stop [the AIDS epidemic] now, the fate of South Africa will overtake us," Mani Shankar Aiyar, the country's minister for
local self-government, told a conference of rural political leaders Wednesday. UNAIDS estimates India's HIV caseload is the world's highest, at
5.7 million people, surpassing South Africa, where more than one-ninth of its 45 million population is infected. Nonetheless, Indian officials
continue to cite their Health Ministry's estimate of 5.2 million infections.
RUSSIA: Health Agency: Nearly 12,000 People Died of AIDS in Russia Since 1987
Associated Press (08.08.06) - Wednesday, August 09, 2006
Since Russia recorded its first case in 1987, 11,968 people have died of AIDS, a higher figure than most previous
government estimates, the Federal Service for Supervision of Consumer Rights and Human Welfare (Rospotrebnadzor) reported Tuesday on its
website. The report, dated July 25, found most of Russia's 362,000 registered HIV cases were acquired from intravenous drug use. However,
Rospotrebnadzor said sexually transmitted HIV infections have jumped from 6 percent to 45 percent in the past five years.
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