Hospital officials at Cedars-Sinai Medical Center in West Hollywood, Calif., have confirmed “some cutbacks” to the Infectious Diseases Division (IDD), which were originally announced internally in December 2012. These cuts will include HIV specialists Dr. Paula Gaut and Dr. David Hardy, who is also IDD’s director. Dr. Yoko Miyasak, an infectious disease researcher and HIV specialist, also will lose her hospital position unless she receives grant funding. Hardy warned that, while HIV/AIDS patients will continue to receive medical attention at the hospital, they will not have the expertise of “full-time, credentialed HIV specialists.” Patients also will not get the benefit of the hospital’s coordinated HIV care and research program.
Dr. Zab Mosenifar, executive vice chairman of Cedars-Sinai’s Department of Medicine, which includes the IDD, and Sally Stewart, the media relations manager, accused Hardy of spreading erroneous information. Their public statements disagree with Hardy’s on the number of positions that will be eliminated. Mosenifar emphasized that IDD is not closing. So far, no one has told patients where they should go for care, as HIV/AIDS patients usually see a doctor every three months. Hardy said he has been informing patients of the cutbacks as he wants them to be prepared, and he is encouraging them to get their medical records. According to Mosenifar, IDD’s fellowship training program will remain with Dr. Phillip Zakowski, a private practitioner and volunteer teacher who will assume Hardy’s responsibilities as part-time coordinator of the fellowship program.
One year ago, when the hospital closed its psychiatric division due to budget cuts, patients scrambled to find care and local mental health providers became overwhelmed. Jimmy Palmieri, West Hollywood human services commissioner, is worried that the situation will be repeated with HIV/AIDS providers. Palmieri is concerned about the patients and where they will find an immunologist for treatment. Since West Hollywood does not contract for services with Cedars-Sinai, the hospital was not required to notify the city of the cutbacks in its IDD. However, West Hollywood contracts with other organizations whose budgets may be affected if many of Cedars’ patients turn to them. Cedars-Sinai is required to offer a “community benefit program” under California law (SB 697) in exchange for nonprofit status. The hospital states on its Web site that one of the benefits it offers is “need.” In light of this statement, Hardy criticized the decision to reduce HIV/AIDS services, as West Hollywood is highly impacted by HIV/AIDS.]]>
MONTREAL — To put it bluntly, talking to teenagers about sex is awkward.
But one Montreal group will try to engage the city’s youth in a serious discussion about sexuality — not in a classroom or through the use of a grainy VHS tape. AIDS Community Care Montreal is asking sexually curious teenagers to send them their questions about sex via text message.
“Sext ed” is the latest community-based initiative to try to fill the void left by Quebec’s ministry of education, which removed mandatory sex ed programs from public high schools in 2005. Project founders say they decided to upend traditional teaching models and reach out to youth directly on their cellphones.
“The obvious advantage of this is that it provides the person with anonymity and maybe makes it easier for them to ask a question without feeling judged or ashamed,” said Melissa Fuller, one of the project’s coordinators. “Often, youth have questions they don’t want to talk to an adult about. I mean, I’m now an adult and I don’t want to talk to adults (about sex). Also, people feel like they should know things already or they’ll be made fun of for the questions they ask.”
The project “soft launched” last month after contacting several high schools and community organizations. A wider launch is set for May 14 at ACCM’s headquarters on Plessis St. near Parc Lafontaine.
The questions people text to the service are reviewed by a volunteer, who researches the ACCM’s database and consults with sex ed professionals before sending a reply. Because the reply can only be 160 characters long, it includes a hyperlink to a more detailed response that allows users to access educational tools and resources on their own.
To ensure anonymity, the user’s cellphone number is scrambled and given a random number so that the person fielding questions can’t know where the message came from.
Fuller says the ACCM has been working on getting the Sext ed project off the ground for about a year. The lion’s share of the work has been assembling a guide of more than 1,000 frequently asked questions about sex that volunteers and users can consult at sexted.org.
“We went on a lot of Internet forums to see what people are asking and we used a lot of the questions people ask us when we do workshops,” said Fuller, also a sex columnist and former councillor at the Concordia Student Union. “For the questions we didn’t anticipate, we do more research and we add it to our database. It’s a constantly evolving process.”
Answers deal with subjects like where and when to get tested for sexually transmitted infections as well as safe sex practices. They can address pregnancy and other medical questions, but also the emotional side of sexuality, which Fuller says is too often overlooked by traditional sex ed courses.
“A big issue about not being educated about sex is that most people don’t know how to recognize unhealthy physical and emotional relationships,” Fuller said. “So we’re ready for questions about consent and we know that the questions may reveal themselves in subtle ways … It’s really important for us that the people texting us know there’s a caring person on the other end of that message. They need to feel supported.”
Experts say the need for comprehensive sex ed is backed up by a dramatic spike in certain types of STIs observed in Quebec and Canada over the last 10 years. For instance, a 2012 study conducted by Quebec’s Health Department found that the rate of chlamydia among young adults rose by 60 per cent between 2001 and 2011. Instances of syphilis and gonorrhea also saw a significant surge during this period.
Perhaps the most telling detail the study revealed is that the majority of teenagers in Quebec are having sex, and not all of them are using condoms. In the case of CEGEP students, the study found that about 67 per cent of respondents don’t always use a condom during sex with a “regular” partner, and about half said they don’t always use condoms with “occasional” partners.
Fuller says the ACCM has already been dealing with a handful of Montreal high schools and community groups and will expand its outreach program when it officially launches the service next week. Sext ed will also provide school teachers with tool kits on how to talk about sex with their students and what resources are available.
The organization has also been in touch with CEGEPs as well as Concordia and McGill University.
“The goal is to be in as many high schools as possible but also to be available for older students as well,” Fuller said. “People still have questions when they get to university. In fact, they may be even more shy to ask them because they feel ashamed for not knowing. We’ve been in touch with the resident advisers at Concordia University and they’re very receptive.”
Contacted by The Gazette on Tuesday, a spokesperson for Quebec’s Health Department said the government is working on implementing new, more comprehensive sex ed programs in the future. But the official could not say when details of the plan would be announced or give a rough estimate as to the amount of funds set aside to pay for it.
“I don’t think the government is malicious or anything; I think this is a conversation that’s difficult to have so that makes it easier to forget about,” Fuller said. “We wish there was better sex ed in high schools but we’re also happy to do what we can to help.”
To reach a Sext ed volunteer with a question, send a text message to 514-700-0445 or visit sexted.org
Read more: http://www.montrealgazette.com/health/Program+allows+teens+text+their+questions/8351263/story.html#ixzz2TIfnoi83]]>
“We found no evidence of risk compensation among at-risk MSM [men who have sex with men] initiating PrEP,” comment the authors. “Mean numbers of partners and the proportion of men reporting UAS [unprotected anal sex] decreased significantly from baseline during 24 months of follow-up.”
PrEP is an emerging HIV prevention technology. It involves HIV-negative individuals taking daily antiretroviral therapy to reduce their risk of infection with the virus. In 2010, results of the iPrEx trial involving gay and other MSM showed that daily PrEP with Truvada (FTC and tenofovir) reduced the risk of infection with HIV by 44% overall, with high efficacy seen in people with the best treatment adherence. Although the results of PrEP studies involving heterosexuals have been mixed, the United States Food and Drug Administration approved Truvada for use as PrEP by adults with a high risk of HIV infection.
However, there is concern in some quarters that use of PrEP may lead to increases in sexual risk behaviour. Mathematical models suggest that even modest increases in the proportion of gay men reporting unprotected sex could wipe out the beneficial effect of PrEP at a community level. However, the precise impact of PrEP on sexual risk taking is highly controversial.
Data gathered during a PrEP safety study allowed investigators to explore the impact of PrEP on the sexual risk behaviour of HIV-negative gay men with a high risk of infection with HIV.
A total of 400 men were recruited to the study between 2005 and 2007. All reported anal sex with another man in the preceding twelve months. The study was double blind and placebo controlled. Participants were randomised either to start treatment immediately or to wait for nine months. The men were interviewed at baseline and then every three months about their sexual risk behaviour and use of recreational and erectile dysfunction drugs. The study lasted 24 months.
At baseline, the men reported a mean of 7.25 sexual partners in the previous three months. This fell significantly during follow-up to a mean of 6 partners between months 3 and 9 and a mean of 5.71 partners between months 12 and 24 (p < 0.001). These declines were similar in the immediate- and delayed-treatment arms.
The mean number of reported HIV-positive partners or partners of an unknown status fell from 4.17 at baseline to 3.51 partners between months 3 and 9 and 3.37 partners between months 12 and 24 (p = 0.01). There was also a significant fall in the number of reported partners believed to be HIV negative.
Use of poppers (p < 0.001), erectile dysfunction drugs (p < 0.001) and a higher perception of the efficacy of PrEP (p = 0.04) were all associated with reporting higher numbers of sexual partners during follow-up.
At the start of the study, 57% of men reported unprotected anal sex in the previous three months. The proportion fell to 48% between months 3 and 9 (p = 0.001) and to 52% between months 12 and 24 (p = 0.03).
The proportion of men reporting unprotected sex between months 3 and 9 was similar between the immediate- and delayed-treatment arms.
There was also a fall in the proportion of men reporting unprotected sex with an HIV-positive partner, from 29% at baseline to 21% between months 3 and 9 and 22% between months 12 and 24 (p < 0.001). Declines in unprotected sex with HIV-positive partners were seen in both the immediate- and delayed-treatment arms.
Factors associated with reporting unprotected sex during follow-up included younger age (p = 0.01), use of poppers (p = 0.02), erectile dysfunction treatments (p < 0.001) and methamphetamine (p < 0.001).
Participation in the study did not lead to an increase in the number of reported episodes of unprotected anal sex, which remained steady between months 3 and 9 and months 12 and 24 in both the immediate- and delayed-treatment arms.
There was a fall in reported episodes of unprotected sex with HIV-positive partners from two in the previous three-month period at baseline to 1.37 between months 12 and 24 (p = 0.05). This was the case for both the immediate- and delayed-treatment study arms.
In contrast, the number of episodes of unprotected anal sex with partners thought to be HIV negative increased between baseline and months 12 and 24 (2.75 Vs. 4; p = 0.01).
“These changes may represent a possible increase in seroadaptive practices, in which men preferentially have more episodes of UAS with assumed HIV-negative partners,” comment the authors.
They also note “men in this study received risk-reduction counseling, condoms and lubricants, regular HIV/STI testing, and linkage to prevention services…which may explain the observed risk reduction and could explain the observed risk declines and could mitigate any potential for risk compensation.”
Despite this, the investigators were encouraged by their results, which they believe “provide important information on changes in risk practices among MSM in the US initiating PrEP in a clinical trial setting”.
CLICK HERE to view study abstract.]]>
http://www.unodc.org/unodc/en/prevention/prevention-standards.html. Below is the introductory statement.
Prevention strategies based on scientific evidence working with families, schools, and communities can ensure that children and youth, especially the most marginalized and poor, grow and stay healthy and safe into adulthood and old age. For every dollar spent on prevention, at least ten can be saved in future health, social and crime costs.
These global International Standards summarize the currently available scientific evidence, describing interventions and policies that have been found to result in positive prevention outcomes and their characteristics. Concurrently, the global International Standards identify the major components and features of an effective national drug prevention system. It is our hope that the International Standards will assist policy makers worldwide to develop programmes, policies and systems that are a truly effective investment in the future of children, youth, families and communities. This work builds on and recognizes the work of many other organizations (e.g. EMCDDA, CCSA, CICAD, Mentor, NIDA, WHO) which have previously developed standards and guidelines on various aspects of drug prevention.]]>
The initiative includes a package of new investments worth more than US $120 million which will be used to expedite progress against TB and HIV in the next 1000 days. The initiatvie will work with South African Development Community (SADC) countries to achieve the international targets of cutting deaths from TB and HIV-associated TB by half by 2015.
Mr Sidibé and other health leaders will sign the Swaziland Statement in Mbabane at tomorrow’s formal launch of the initiative.
” TB and HIV have combined together in the SADC region in a perfect storm and what we need to mobilize is an emergency response to this storm.”
- Benedict Xaba, Minister of Health of Swaziland
”We must prioritise action in the hot spots, and one of the hottest of these is TB in the mining industry. The new partnerships that we are witnessing today between government, the corporate sector and global agencies can and must drive our renewed effort in the next 1000 days.”
- Dr Aaron Motsoaledi, Minister of Health of South Africa
” We have the power to stop TB and HIV in their tracks. We must adopt Zero tolerance for parallel systems for TB and HIV. If we don’t close the funding gap and focus on HIV and TB hotspots, sub-Saharan Africa could face a worsening disaster of HIV and drug resistant TB.”
- Michel Sidibé, UNAIDS Executive Director
”We have 1000 days to achieve the international targets of 50% reductions in TB mortality and TB/HIV deaths by 2015. Together, we are building momentum towards ending the TB and TB/HIV co-epidemic in SADC.”
- Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership
All the presentations from the conference are now available ONLINE
To find a specific talk, the agenda is HERE ]]>
National Youth HIV & AIDS Awareness Day (NYHAAD) is a HIV testing and treatment community mobilization initiative designed to raise awareness of HIV/AIDS prevention, care and treatment among youth ages 12-25 in the United States.
This campaign has four main objectives:
April 10, 2013 (This is also the first year of observance)
About 1 in 4 (26%) of all new HIV infections are among youth ages 13 to 24 years. About 60% of youth with HIV do not know they are infected and don’t receive treatment. This puts them at risk for sickness and early death. These youth can also unknowingly pass HIV to others.
NYHAAD is a nationwide movement with organizers planning activities and events in thousands of locales. In Los Angeles, we are making a Call to Action utilizing social media for youth to share their stories and help raise awareness. But that’s just the beginning. You can plan your own individual events to observe the day as well.
What can I or my agency do? Support youth in telling their stories on Twitter, Facebook, Instagram, and YouTube. Please remember to review your agency’s social media policy before participating, if applicable. Sponsor a youth-led event that raises awareness in your community. Promote NYHAAD in your community through events and online activities.
NYHAAD is a national initiative of Advocates for Youth. Contact Sulava Gautam-Adhikary, program coordinator, Advocates for Youth: email@example.com.
Contact Maria Sipin, health communications specialist, SYPP Center at Children’s Hospital Los Angeles: firstname.lastname@example.org.
A 26-month-old infant girl born in Mississippi has been functionally cured of HIV, according to results presented at CROI 2013 in Atlanta.
According to lead author Deborah Persaud, M.D., the infant was treated very early, within 31 hours of life, with zidovudine/lamivudine (AZT/3TC, Combivir) and nevirapine (Viramune). After a week, the nevirapine was switched out for lopinavir/ritonavir (Kaletra).
While HIV testing and prenatal treatment is standard for pregnant women in the U.S., the infant’s mother was not in care during her pregnancy.
The mother, who was unaware of her HIV status, was confirmed infected using standard rapid tests during labor and delivery. Within 30 hours, the baby was transferred to the University of Mississippi Medical Center, where Hannah Gay, M.D., administered two separate HIV tests: a nucleic acid test at 30 hours and a viral load test at 31 hours.
The test results didn’t come back until days later, but based on the mother’s prior lack of HIV care, Gay decided the risk of mother-to-child HIV transmission was too great, and made the highly unusual decision to start the child on a full antiretroviral regimen immediately.
Within a week, the nucleic acid test came back positive and the viral load test revealed the child had a viral load of about 20,000 copies/mL. Persaud noted that the two positive tests are the standard definition of HIV infection in a perinatally exposed child and therefore justified the decision to start the infant on HIV treatment.
Within a month, the baby’s viral load had lowered to undetectable levels. After 18 months of treatment, the mother decided to take the child off treatment. Despite this treatment discontinuation, the infant has continued to have an undetectable viral load through 26 months of age. Although HIV DNA fragments have been found in the baby’s blood in extremely small amounts, there has been no sign of any actively replicating virus.
“Plasma viral load, PBMC (peripheral blood mononuclear cells) DNA, and HIV-specific antibodies remained undetectable with standard clinical assays, confirming a state of functional HIV cure,” the researchers state in the study abstract. They theorize that very early treatment could have stopped the virus from forming reservoirs that cannot be eliminated with existing antiretrovirals; the existence of those reservoirs has thus far proven to be the primary roadblock to HIV eradication in chronically HIV-infected patients.
Dr. Persaud noted that this case appeared to be different from post-exposure prophylaxis (PEP) because the infant showed detectable levels of virus prior to treatment initiation, thus suggesting she was probably infected in the womb rather than during delivery.
For thoughtful analyses of the importance of this study and its significance for the HIV community, read this reaction article by Paul Sax, M.D., as well as this op-ed by Jim Merrell of the HIV Prevention Justice Alliance on the questions this story raises about the U.S. health care system.]]>