Opinion: Rapid home tests stem HIV spread

By Dr. Mary Jane Rotheram,, Dr. Arleen Leibowitz
 and Kevin Farrell
 

August 24, 2009 
Atlanta Journal Constitution
 
In Atlanta this week, the nation’s public health strategy to eliminate HIV is being hotly debated.

Our public health leaders have strongly endorsed a strategy to test and treat all Americans: everyone is encouraged to get tested once for HIV as an adult; adults in communities with a high prevalence of HIV may need to be tested multiple times; and access to HIV treatment is to be guaranteed to all HIV-infected persons.

Decisions about who gets tested, where, when and how they get tested will have a major impact on the effectiveness of this strategy.

Universal testing would identify the 25 percent of HIV-infected persons who do not now know their HIV status and allow them to enter treatment.

This would be a great benefit, both to the individual and to society.

Adults who know they are HIV-positive usually protect their partners from acquiring HIV by stopping unprotected sex and needle sharing.

Furthermore, once HIV-infected persons take anti-retroviral medications, risky acts are far less likely to transmit the virus. The test and treat rationale makes common sense.
However, significant and dramatic shifts in where and how we conduct HIV testing may be necessary to reach the most affected populations.

Gay and bisexual men, who may be hiding their sexual orientation from loved ones, are the most likely to avoid HIV testing in a physician’s office.

In communities of color, HIV-infected persons typically do not find out they are infected until they are already showing symptoms of HIV, often 10 years after becoming infected.

To make HIV testing more accessible, cheaper and less stigmatized, we endorse wide availability of HIV rapid tests that the consumer can self-administer using a sample of tissue from the cheek or a sample of blood from a finger stick.

Screening oneself for HIV could be similar to testing oneself to find out about pregnancy.
Home-administered HIV antibody screening tests could be made available at a pharmacy for a cost substantially below the current $40 price for home HIV tests.

Read in the privacy of one’s own home, without the need to send samples to a laboratory and without the need to have another person read the test, home tests can maintain confidentiality.

Two rapid screening tests can confirm whether or not it is necessary to seek confirmation of HIV status from a physician.

Persons who test at doctor’s offices or community-based organizations today usually wait a year to start getting services.

With a home test, at least these persons will stop transmitting the virus when learning their HIV status.

To date, the FDA has required a third party to administer and/or interpret the HIV test results.
Perhaps these policies reflect pressure from groups with vested interests in maintaining the status quo: laboratories, community-based HIV testing sites or pharmaceutical agencies. In China, rapid tests cost less than $2.

Rapid, consumer-controlled HIV testing strategies have been blocked, similar to the way in which consumer-controlled pregnancy tests were blocked in the 1970s.

Pregnancy was considered too traumatic to learn without the support of their doctor. Today home, consumer-controlled pregnancy testing is routine.

Buying rapid HIV screening tests at your local drugstore may succeed in achieving broad use in urban inner cities and allow couples and families to find out their HIV status in the privacy of their home.

To have the greatest impact on HIV infection, let persons who are frequently exposed to HIV have an easy way to protect others, by finding out quickly that they are infected.

Health care reform, at every level, is going to require greater individual responsibility for maintaining our own health.

Let’s start with providing tools to those most likely to get HIV to take personal responsibility to protect themselves and others.

Dr. Mary Jane Rotheram, Dr. Arleen Leibowitz and Kevin Farrell are researchers at the Center for HIV Identification, Prevention and Treatments Services at UCLA.

Magic Johnson addresses National HIV Prevention Conference

Magic Johnson addresses National HIV Prevention Conference
Being face of disease both blessing and curse, former NBA star says
From an article by DYANA BAGBY, Southern Voice | Aug 24 2009

Former NBA star Earvin “Magic” Johnson wowed hundreds of attendees Sunday at the opening plenary of the 2009 HIV Prevention Conference in Atlanta, as he spoke frankly about being HIV positive for nearly 20 years.

“They said I wouldn’t be here, but last Friday I celebrated my 50th birthday,” said Johnson, who announced he was HIV positive in November 1991.

“A lot has changed since I announced. We now have a major problem in urban American, in inner cities — the face of AIDS has changed from a gay white man’s disease to a black and Latino disease. And if we don’t get the black church involved, there is no way we can bring these numbers [of new HIV cases] down," he said.

Johnson, who played with the Los Angeles Lakers and helped carry the team to five championships, walked among the crowd in the Centennial Ball Room of the Hyatt Regency in downtown Atlanta as he spoke, shaking hands with attendees as well as stopping to pose for pictures.

After announcing he was HIV positive, Johnson founded the Magic Johnson Foundation to combat the spread of HIV and educate people about safer sex. He has said he is not gay but contracted the disease through having numerous sexual partners during his NBA career.

His foundation is working to partner with black churches, he said Sunday, because African Americans are disproportionately impacted by the disease.

According to a 2006 report from the Centers for Disease Control & Prevention, a sponsor of the conference, while African Americans make up 12 percent of the U.S. population, blacks account for 45 percent of new infections and 46 percent of those living with HIV. Also, gay and bisexual black men accounted for 63 percent of new infections among black men in 2006, the CDC reported.

“We have talked to pastors to get involved in any way,” Johnson said to cheers from the crowd.

Churches can be involved, for example, by using their vans and buses to transport those with HIV/AIDS to doctors’ appointments and pharmacies to pick up their medication. Johnson said pastors are also being asked to get in the pulpit and tell their congregations to get tested for HIV — and then go back and get the results.

“We all have to get black churches involved. If we do, we will see change quickly,” Johnson said. “One constant in the black community is the church.”

Johnson said young black gay men are also at serious risk.

“Now young black gay men are more open than before, they are more accepted by their peers. In Atlanta, you see a lot of that,” he said. “That was never accepted when I grew up. We need to teach them about safe sex and tell them what can happen — because when you’re young, you think you are invincible.”

Johnson also acknowledged him being HIV positive has been good for the movement to stop the spread of HIV by being able to raise awareness, but it also has been a “curse.”

“Because people can say, well, if I get HIV, I can be like Magic,” he said. "But there is also someone dying from AIDS every day in the U.S. On our historically black college campuses, numbers are rising. We have to get the sororities and fraternities involved. This is so, so important.

“I love being the face of the disease, but I have not enjoyed where we are headed. We still have numbers that are not far down enough."

More than 3,000 public health, medical and AIDS community leaders are in Atlanta through Aug. 26 for the National HIV Prevention Conference.

“This conference is a reminder that HIV prevention can and does save lives,” said Kevin Fenton in a statement.

Fenton is the conference co-chair and director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention. “However, the HIV crisis is far from over. Too many people remain at risk, and too few people have access to proven HIV prevention programs.”

More than 1 million people in the U.S. are living with HIV and the CDC estimates more than 56,000 Americans contract the disease each year — that’s one person every nine and a half minutes. Gay and bisexual men of all races as well as African Americans and Latinos are most severely impacted by HIV.

California: HIV & AIDS Programs Face State Budget Cuts

KION News
8/21/09

SALINAS, Calif. - Governor Arnold Schwarzenegger has just signed off on $52 million in budget cuts, affecting state-run HIV and AIDS programs. That concerns non-profits like Salinas-based John XXIII, who provide services to clients in Monterey County.

The organization provides not only education and prevention, but housing, HIV and Hepatitis C testing as well as a needle exchange program.

While they aren't clear how much they'll lose, Supervisor Jim Smith says, their anticipating drastic cuts of at least $150,000 in just their education and prevention program alone.

They're now planning to limit the amount of testing they do. In the past, they were been able to provide free HIV testing to everyone, but will now only offer it to high-risk individuals.

Also, they plan to decrease their hours. They used to be open five days a week, now they're cutting back to three days a week. Not to mention they've already let go of a handful of employees.

"If people can't get tested for HIV, and they don't have the money to pay for it, where are they going to go?," says Smith. "Just because the money has stopped, doesn't mean HIV is going to slow down. It's still a disease. It's still out there. It affects everybody."

Despite the cuts in state funding, they will continue to offer services and seek out other sources of funding, including private donors and grants.

Last year, Smith says, eight people tested positive with HIV out of 700 tests they did.

AIDS in the U.S.A.

AIDS in the U.S.A.

How to give President Obama your advice on combating the epidemic here at home.


The Washington Post
Tuesday, August 25, 2009

WE CANNOT write often enough about the terrible toll that HIV/AIDS is exacting on the United States. More than 56,000 Americans become infected with HIV every year. In the District of Columbia, the epidemic rages on with more than 3 percent of the total population living with the disease that has no cure. The "generalized and severe epidemic" threshold is crossed when 1 percent of a local population is living with HIV/AIDS. And African Americans, just 12 percent of the population, account for 46 percent of those living with the disease. These are the statistics that motivate a White House push for a desperately needed national AIDS strategy.

On Friday, President Obama announced the first in a series of national community discussions meant to inform and provide input as the White House Office of National AIDS Policy (ONAP) puts together that strategy. According to ONAP, Tuesday's meeting in Atlanta will seek views from participants on how to reduce HIV infections, increase access to care and reduce "HIV-related health disparities." Other cities on the itinerary include New York, Los Angeles, Jackson, Miss., and, yes, the District. Dates for those discussions will be announced later.

If you can't make it to one of the impending discussions, you can still let the White House know how you think it can achieve Mr. Obama's three goals. Go to http://www.aids.gov. Not only will you be able to leave your comment or idea, but you will also have access to the latest information on the epidemic, prevention, testing and treatment.

Lake Zurich teacher fired for showing AIDS video back on job

Last time I heard, the Archdiocese of Chicago had an age-appropriate curriculum on AIDS prevention education. I wonder if the director of St. Francis de Sales school is aware of it.
-Brenda



Lake Zurich teacher fired for showing AIDS video back on job

Daily Herald
8/21/2009

By Bob Susnjara

CHICAGO -- A teacher has regained his job about four months after he was fired for showing an educational AIDS prevention video to his eighth-grade science class at a Lake Zurich Catholic school.

Patrick Szady, 60, of Lake in the Hills, is working again for St. Francis de Sales Parish's elementary school. He had been at St. Francis for about 32 years when he was suddenly ousted in April.

Numerous parents and former students rallied for Szady and demanded his return, saying he's a kind, enthusiastic instructor who was committed to St. Francis de Sales. They even held a party in his honor at the Hawthorn Woods village barn and a picnic in Lake Zurich.

Public pressure didn't drive the decision to return Szady to the classroom, said Sister Mary Paul McCaughey, the Archdiocese of Chicago's superintendent of Catholic schools.

"He's been reinstated by the archdiocese," McCaughey said. "We just felt it was the best thing for everyone involved."

Szady was sacked toward the end of the last school year after showing the video "Time Out: The Truth About HIV, AIDS and You", which features entertainer Arsenio Hall and former basketball star Earvin "Magic" Johnson. Szady said he had used the video in class during several previous years, but did not know why it suddenly cost him his job.

McCaughey said Szady has agreed to be in accordance with Catholic school teachings and will no longer show the AIDS-prevention video to St. Francis students. She said the video's content isn't the issue.

"Educationally," McCaughey said, "it's too long and it's dated."

Szady said he appreciated the parents and former students who stepped up publicly on his behalf after he was fired. His backers even sent a letter to Cardinal Francis George seeking consideration of his reinstatement.

"I'm thrilled it turned out the way it did," Szady said. "I'm glad to be back at work."

Classes at St. Francis resume with a half day for grades one through eight on Tuesday, Aug. 25. Szady teaches science to pupils in grades six through eight.

Researchers decode HIV genome

8/06/2009
Popular Science


Using special techniques developed to sequence RNA, researchers at the University of North Carolina, Chapel Hill, have published the first complete genome of HIV. Laying bare the complete genetic make up of the virus opens up a new era of research, drastically widens the possible experiments that scientists can perform on the virus, and may significantly accelerate our understanding of how HIV infects humans and evades our immune system.

While it may seem odd that scientists decoded the genomes of the guinea pig, the nine-banded armadillo and the Western European hedgehog before one of the world's most deadly diseases, one must note the byzantine complexity of the AIDS-causing virus.
 Unlike those animals, and other viruses like influenza, the HIV genome is composed of RNA, not DNA. And unlike DNA, which orders itself into a neat, simple double helix, RNA twists into a wide range of intricate knots. Not only does that complicate sequencing the genome, but it also makes understanding the role of each gene more difficult, as the various twists and turns of RNA knots influences how and when different genes are expressed. For this study, the UNC researchers went beyond simply listing each component of the genome, and completely reconstructed the architecture of the RNA knots down to the finest resolution possible.

Aside from helping scientists understand how the geometry of HIV's RNA affects its life cycle, decoding the genome also enables scientists to probe HIV one gene at a time. Those so-called "knock out" experiments, where a single gene is deactivated, are crucial to deciphering how HIV hides from the human immune system.

This is not an end, but a beginning. Developing a cure for HIV will still require a great deal of time and effort, but providing a complete genome for the virus is a vital step towards that goal. 

[via Nature and Research and Development] 

SECCAM '08 Conference Recap - En español