Wednesday, December 08, 2004

The FDA on generic drugs

The FDA says that:
Generic drugs are safe, effective and FDA approved. Generic drugs account for about 50 percent of all prescription drug purchases in the United States, therefore, consumers should be well informed and confident when taking generic drug products.

To obtain printed copies of any of these materials, please email your request by title to: dpapubs@cder.fda.gov. You can also call 301-827-1243 or 1-888-INFO-FDA.

For more information about generic drug products, visit the Office of Generic Drugs Web site .

Infection increases among young gay males

Thanks to JS for sending this link to an essay by Nate Lippens about the increase in infection among young gay males: "All that for nothing."
Gay men used to risk friendships, offend drinking buddies, and piss people off to stop the spread of HIV. Now the only thing we're willing to risk is our health.




Tuesday, December 07, 2004

FDA approves first generic drug for HIV/AIDS

On December 3, the Food and Drug Administration (FDA) approved a generic formulation of Didanosine (ddI) Delayed Release capsules, 200 mg, 250 mg, and 400 mg for use in combination with other antiretroviral agents in the treatment of HIV-1 infection in adults. The product, manufactured by Barr Laboratories, Inc. of Pomona, NY will be available for use within the United States and foreign countries.

It is the first approval in the United States of a generic antiretroviral product to treat HIV/AIDS.

Didanosine (ddI) is the a generic version of the already approved Videx EC Delayed-Release Capsules manufactured by Bristol Myers Squibb. It is a delayed-release capsule, taken once daily.

Monday, December 06, 2004

National Perinatal HIV Consultation and Referral Service

The National Perinatal HIV Consultation and Referral Service (Perinatal Hotline) at 888-448-8765, provides free 24-hour clinical consultation and advice on treating HIV-infected pregnant women and their infants as well as indications and interpretations of rapid and standard HIV testing in pregnancy.

The Perinatal Hotline is an expansion of the HRSA National HIV/AIDS Clinicians’ Consultation Center (NCCC) at San Francisco General Hospital, which currently operates the National HIV Telephone Consultation Service (Warmline) and the National Clinicians’ Post-Exposure Prophylaxis Hotline (PEPline).

The Perinatal Hotline (888-448-8765) and the PEPline (888-448-4911) are both available 24 hours, seven days per week. The Warmline (800-933-3413) is available 8 a.m. to 8 p.m. (EST) Monday through Friday. All consultations are free and confidential.

See the NCCC Web site for more information.

Thursday, December 02, 2004

Pediatric guidelines updated

The Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection have been updated. The Pediatric Guidelines, developed by the Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children, now include Supplement II, titled "Managing Complications of HIV Infection in HIV-Infected Children on Antiretroviral Therapy, "and Supplement III, titled "Adverse Drug Effects." Also included in the new version are updates to the atazanavir, indinavir, and enfuvirtide sections in Supplement I, "Pediatric Antiretroviral Drug Information."

All new information is highlighted in yellow in the main document. Supplements II and III are new to the guidelines and are highlighted in title only. The updated guidelines document is available in the Pediatric Guidelines section of the Guidelines page on the AIDSinfo Web site.

Wednesday, December 01, 2004

World AIDS Day

Abilene

Big Country AIDS Resources will sponsor a World AIDS Day community worship service at the First Baptist Church chapel, 1333 N. 3rd at Orange St. (use Orange St. entry) on Wednesday, December 1 at 7pm. Please call Larry Holmes at 325-691-1300 for more information.

Austin

The seventh annual Austin area World AIDS Day Interfaith Service of Rememberance and Hope will be held Wednesday, December 1 at 7pm at the Unity Center, 9600 Dessau Road. This service provides a vivid reminder of the need for renewed awareness of the extent of the HIV/AIDS pandemic in Central Texas. AIDS quilts will be displayed in memory of those who have died from AIDS complications. For more information, please contact Roger Temme, Interfaith Care Alliance, at 512-459-5883.

Beaumont

The P.A.L.M. Center will be at the Lamar University Student Center in Beaumont. They will have a booth for testing, education and pamphlets. There will also be a candle light ceremony starting around 6:30 that night for anyone who wishes to attend. Contact Carla Baker at CBaker@landmanor.org for details.

Dallas

Skillful Living Center, Inc. presents its fourth Teen Summit on Thursday, December 2, 2004 from 9:30am-2:30pm at the Oak Cliff Bible Fellowship Church, 1808 W. Camp Wisdom Rd., in Dallas. The Teen Summit 2004 theme is, "Empowering the Hip Hop Generation with Healthy Sexuality & Relationship Skills". Expected attendance is 600 teens from approximately four schools. Hip Hop Promoters will share the "History of Hip Hop." There will be food, fun, prizes, speakers and entertainment. Please contact Mary Tavares at 214-330-8468 or slc2mary@aol.com for more information.

AIDS Arms, Inc. will present a World AIDS Day musical memorial on Wednesday, December 1 at 7:30pm at the Sara Ellen & Samuel Weisfeld Center, 1508 Cadiz at Browder by Dallas City Hall. The musical will feature the Turtle Creek Chorale, the Women's Chorus, Beckles Dance Company, Denise Lee, and Gary Floyd. Call 972-530-9253 for tickets or additional information. Tickets can be purchased on behalf of clients to enjoy the event.

The Micheal Maddison Children's Fund will hold a silent auction benefiting children affected by HIV/AIDS that includes a gallery showing of artistic photo journalism by Malek entitled "A Celebration of Life". Food and drinks will be offered. Hosted by International fashion photographer, A O. Matesun (a.k.a. Malek), Myriam Guerrero and 97.9 The BEAT's Action Jaxon. For additional information, please visit www.mmcfund.org.

The Dallas County Health & Human Services Department Testing and Counseling Clinic will be offering free testing on Wednesday, December 1. Please contact Kay Caddell at KCaddell@dallascounty.org for more information.

Denton

ExHALE Services is having several free HIV testing sites on Wednesday, December 1. Sites include the University of North Texas Health Clinic from 10am-12pm, the Texas Women's University Wellness Clinic from 10:30am-2pm, and ExHALE Services, 405 S. Elm St., Ste. 102 in Denton, from 3-7pm. Please call 940-484-2617 or 817-781-0523 with any questions.

World AIDS Day will be recognized at the University of North Texas (UNT) on Tuesday, November 30 and Wednesday, December 1. The free events are open to the public and feature UNT faculty, staff and students as well as representatives from Metroplex AIDS organizations and UNT organizations, who will share program and educational information. UNT's University Union is located at 410 Avenue A in Denton. Participating organizations include various Metroplex AIDS organizations and UNT groups, including the Ally Program, Center for Psychosocial Health, Division of Equity and Diversity, University Union, Student Health and Wellness Center, Feminist Majority Leadership Alliance and Pan African Students' Association. On November 30 from 6-8pm in the University Union Golden Eagle Suite, UNT faculty and students will give presentations on HIV/AIDS research. There will also be a panel discussion with persons with HIV infection. On December 1 from 10am-2pm in the University Union Courtyard, there will be displays of community resources, as well as poster displays of faculty and student research. UNT faculty representing academic departments across campus have authored poster presentations on HIV and AIDS research. From 12-3pm, UNT's Center for Psychosocial Health will host an open house in Terrill Hall, room 284. The website for the Center is www.unt.edu/cph. HIV testing and results will be given at UNT Student Health and Wellness Center for UNT students on December 1st. An evening World AIDS Day candlelight vigil will begin at 6pm, with location to be announced by UNT's Feminist Majority Leadership Alliance (FMLA). For more information, contact Dr. Dan Emenheiser or Rebeca Perfecto, Division of Equity and Diversity, at 940-565-2456, or check www.unt.edu/ally.

Fort Worth

Tarrant County AIDS Interfaith Network will have two significant activities on World AIDS Day. A Physician Lecture will take place Wednesday, December 1 from 12-2pm at Celebration Community Church, 908 Pennsylvania Av. in Fort Worth. This is a free program with catered lunch for persons living with HIV/AIDS, social workers and medical professionals, sponsored by Abbott Labs. Later that day, an Interfaith Commemorative Service will take place at 6:30pm at Texas Christian University's Carr Chapel, 2855 South University. For more information, please contact Curtis L. Smith at 817-923-2800, ext. 22.

Galveston

MotherLand, Inc. cast members will be presenting the HIV/AIDS awareness play, "That's Why We're Here" at the AIDS Coalition of Coastal Texas World AIDS day event at 1405 39th Street in Galveston. MotherLand will also be conducting testing on December 1 in collaboration with ELOES Center. For testing times and locations, please contact Victor Ndando-Ngoo or Ifeoma Adegun at 713-290-0001.

Planned Parenthood of Houston and Southeast Texas (PPHSET) will provide free HIV testing at the World AIDS Day event sponsored by the AIDS Coalition of Coastal Texas (ACCT) in Galveston on Wednesday, December 1. A memorial march begins at Galveston City Hall at 11am, ending at the Saengerfest Park on the Strand, where PPHSET will be offering HIV tests. Contact ACCT at 409-763-2437 for information.

Houston

The Harris County Hospital District's Thomas Street Health Center, in conjunction with the Houston Department of Health and Human Services, will host a day of recognition on Wednesday, December 1 from 12-4pm at 2015 Thomas St. The day of recognition will include this year's dedication of the Tree of Remembrance and a health and information fair. This will be an opportunity for the public to come to Thomas Street Health Center and honor a loved one who has passed away due to HIV/AIDS. They will also be able to attend a health and information fair highlighting HIV/AIDS services available in the Houston/Harris County area. For more information, please contact Jeff Benavides at 713-873-4026.

On December 1, 2004, the University of Houston will be commemorating World AIDS Day. Following is a list of activities:
  • Two panels of the AIDS Quilt will be on display in the University Center.
  • The Wall of Tears will be displayed in the UC Arbor, with an opportunity to write messages of support and comfort
  • The UH AIDS Quilt will be on display. This quilt was made from messages students and employees contributed over the past three years. An opportunity to add messages to the next UH Quilt will be available.
  • There will be music from 11:30am-1pm in the Arbor.
  • A health fair will be held on the first level of the UC from 11am-1pm.
  • Information and red ribbons will be available at the UC and in the Towers Commons.
  • 10,000 red ribbons will have been distributed across campus the week preceding World AIDS Day.
  • The UH Health Center will be doing free HIV testing all day.
  • There will be a candlelight vigil held at 5pm in the UC Arbor.

For more information about these activities, please contact Gail Gillan, Director, UH Wellness, at 713-743-5461.

To observe World AIDS Day 2004, the Texas Children's Hospital Allergy and Immunology Department will set up a booth to offer HIV information/education for the staff, volunteers and families at the hospital. Up-to-date facts and information about HIV prevention, medical care and research for infants, children, adolescents and pregnant women will be available for everyone. The event will be held from 11:30am-1pm on the Clinical Care Center Bridge. For further information, contact Gloria Sierra or Sherri Henry at 832-824-1319.

Planned Parenthood of Houston and Southeast Texas (PPHSET) will be conducting free HIV testing in collaboration with Fundatión Latino Americana Contra El Sida (FLAS), Inc. at the Mexican Consulate's Office, 4506 Caroline Street, 1st Floor, in Houston, 10am-2pm. Contact FLAS at 713-772-2366 for additional information.

In honor of World AIDS Day, Rice University will host a display of the NAMES Project AIDS Memorial Quilt in the Grand Hall at Rice Memorial Center. Making up 10 quilts total, 80 panels will be on display at the following times: Wednesday, December 1, 11am-11pm; Thursday, December 2, 11am-11pm; Friday, December 3, 11am-5pm. In addition to the display, there will be a variety of educational, academic, and artistic programs. For a full schedule of events, visit www.rice.edu/service.

The Houston GLBT Community Center, 3400 Montrose Blvd., Ste. 207, will have a tree of remembrance, celebrating the annual tradition it took over from NAMES Project Houston in 2002. The center invites people to bring memorial ornaments throughout the month of December. For more information, call 713-524-3818.

AVES (Amigos Volunteers in Education and Services) has arranged a World AIDS Day Mass to be celebrated in Spanish at All Saints Catholic Church, 215 E. 10th St. in the Heights. The mass takes place Wednesday, December 1 at 7pm. People wishing to bring photos of loved ones are invited to do so, and they will be placed on a table near the altar during the Mass. For more information, call 713-626-2837.

The Illumination Project takes place Wednesday, December 1 at 7:30pm at the Hobby Center for Performing Arts, 800 Bagby. Presented by the Dominic Walsh Dance Theater, the Hobby Center, and Hope Stone, Inc., this performance benefits Baylor International Pediatric AIDS Initiative and Bering Omega Community Services. For tickets or more information, call 713-526-1907.

There will be a ecumenical, interfaith Community World AIDS Day service on Wednesday, December 1 at 7pm at the Grace Lutheran Church, 2515 Waugh Dr. A reception will follow. Please call the Rev. Todd Williams at 832-723-6948 for more information.

A World AIDS Day luncheon honoring Bracewell & Patterson, LLP and benefiting AIDS Foundation Houston will take place Thursday, December 2 at 11:30am at the Houstonian Hotel, 111 N. Post Oak Ln. Call Annisa Hill at 713-623-6796, ext. 224 for tickets and additional information.

The Living Water-Annual Mass of Remembrance will take place Friday, December 4 at 11am at St. Mary of the Purification Catholic Church, 3006 Rosedale. A reception will follow at the Parish Hall. For more information, call 713-626-2837.

Longview

Special Health Resources of Texas (SHRT) will host a candlelight service on Wednesday, December 1 at St. Andrews Presbyterian Church, McCann Rd. and Hampton St., 7-8pm. SHRT Board Chairman Griff Hubbard will emcee the event and State Representative Tommy Merritt will speak. For more information, please call 903-234-0776.

Lufkin

On December 1, World AIDS Day, Planned Parenthood of Houston and Southeast Texas (PPHSET) will be hosting a free HIV testing day at their Lufkin Clinic, 1404 Frank, from 1-7pm. The event will be announced on the four Clear Channel radio stations and on Lufkin's Spanish radio station. We will also be offering urine gonorrhea and chlamydia testing at a reduced rate. This free HIV testing day will follow the annual education program conducted by the Community Coalition for AIDS Education, of which PPHSET is a partner, at the Pitser Garrison Civic Center from 8:30a-11:30am. For more information please contact Bonnie Lee at 936-634-8446 ext. 223.

Plano

AIDS Services of North Texas will be hosting a World AIDS Day ceremony on Wednesday, December 1. The ceremony will be at the Plano Centre, Plano, Texas and will begin at 7:30pm. Mayor Pat Evans will be the guest speaker as well as Mr. Glenn Kopanski, Retired Naval Petty Officer. Kopanski is known to be one of the longest surviving AIDS patients in the country. AIDS Services of North Texas will be displaying 20 Quilts of the internationally acclaimed AIDS Memorial Quilt and will be dedicating over 20 new panels to the Memorial. Eighteen panels are for young South African children who have lost their lives to AIDS. Over 100 Plano students will be participating in the evening ceremony. Local youth from Collin County will perform in the ceremony. For more information, go to www.aidsntx.org and click on "upcoming events."

San Antonio

The San Antonio AIDS Foundation (SAAF) and the Partnership for Education, Empowerment, Resources and Support (PEERS) For Women are presenting an evening community activity for World AIDS Day. Featured speakers include:

  • Ann Paddie, Bank of America - Topic: Women and Business
  • Crystal Stone, ClearChannel Radio - Topic: Women and Radio Broadcasting -Linda Hook, RNC, MSHP, San Antonio Metropolitan Health District -
  • Topic: Women and Health -Patti Radle, San Antonio Councilwoman
  • Topic: Women and Community Activism -Patti Wetzel, MD - Topic: Women and AIDS

The evening program begins at 6pm on Wednesday, December 1 at the SAAF facility located at 818 E. Grayson. Speakers will present from 6-6:30pm followed by a few testimonials from women of PEERS. The community activity will end with a candlelight ceremony to remember those we have lost to AIDS. The program is open to the entire community. For more information regarding the speakers and/or program, please contact Ramiro Sanchez at 210-225-4715.

Tuesday, November 30, 2004

Moral Plunder

Kathy Pollitt's recent column for The Nation argues that a number of policies implemented by the current national administration represent a quid pro quo for the political support of the Religious Right. Her column begins:

Sitting alone in a classroom at a Catholic all-boys high school this weekend (don't ask), I passed the time by browsing through the health textbooks stacked on the window sill. Sure enough: no discussion of contraception (condoms are mentioned, but not described, in connection with people who have HIV); abortion, still legal here in the United States, isn't even listed in the glossary. Sex itself is discussed only in the vaguest terms, with emphasis on how to avoid it. This wasn't a special Catholic-boy textbook, either -- "Health: Skills for Wellness" is one of the bestselling health texts in the country.
Pollit's discussion continues through a long list of changes that she attributes to political payback for the Religious Right. Her conclusion is basically that "this, too, shall pass," and reason and enlightenment will eventually return to the land of the free and the home of the brave. Until then, however, she asks:
How many young people will suffer STDs and HIV and pregnancy because they learned in school that condoms "don't work" -- or didn't hear about them at all?

One may agree with her conclusion or disagree with her thesis, but Pollit still points to troubling examples of disinformation which seem likely to have some effect on HIV prevention. When effective prevention information is withheld from those at high risk to engage in high risk activities, then their likelihood for exposure to HIV increases simply because they will not have the information they need to avoid such exposure. Giving incorrect information is at least just as bad.

It's true. Condoms don't make a very good sandwich wrap. They are useless for holding the trunk closed when you want to haul an oversized load. They simply don't work as a hotpad. But condoms are effective at preventing the transmission of HIV.

Sunday, November 21, 2004

The Short End of the Stick

Roy Appleton, Dallas Morning News, has written an interesting profile/update about Retractable Technologies, the manufacturer of retractable syringes which were specifically designed by Texan Thomas Shaw to eliminate needle stick injuries and reduce the spread of HIV and other infectious diseases in the health care setting. Appleton's article details the legal battles and financial struggles that resulted from Shaw's attempt to break into the closed world of medical suppliers.

Interestingly, Appleton makes no mention of current Texas law, which requires public entities whose employees are at risk of exposure to bloodborne pathogens through sharps injuries, including needle stick injuries, to provide safety engineered medical devices for their employees' use. This would be the Health and Safety Code, Chapter 81, Subchapter H: Bloodborne Pathogen Control (paragraphs 81.301-307).

This section of the law has a more or less interesting legislative history. In the 76th Regular Session (1999), Rep. Harryette Ehrhardt (D-Dallas) introduced HB 1646, which successfully passed through the Public Health Committee and was sent to the House floor as part of the Local & Consent Calendar. The companion bill, SB 905, by Sen. David Bernsen (D-Beaumont), moved similarly smoothly through the Senate. Both bills, however, ran up against the end of session crunch. Rather than lose them entirely, the authors decided to append them to another bill (HB 2085), the reauthorization of the Texas Department of Health, which was sure to pass.

As a result of this legislation, the then Texas Department of Health produced its Bloodborne Pathogen Exposure Control Plan, which includes the following procedures:

All publicly owned or financed institutions that provide health services, even if health services are not their primary purpose, shall comply with the state and federal laws concerning bloodborne pathogen exposure. Providers such as public hospitals, school clinics, home health agencies, local agencies (LAs), EMS providers etc are covered by these laws. Under the law, these providers are required to:
A. Use needleless systems and sharps with engineered sharps injury protection for all venous/arterial access, body fluid withdrawal, and all fluid administrations and injections.
B. Develop an Bloodborne Exposure Control Plan, modeled after and equal to the plan mandated by TDH, that monitors employee exposure determinations, addresses training and education, establishes safer work practices and procedures, provides employee vaccination, specifies use of personal protective equipment, and addresses housekeeping and laundry safety, post-exposure evaluation, followup and documentation. The BPECP shall be submitted to the state agency (SA) for approval prior to each fiscal contract period.
C. Record and report employee bloodborne exposure incidents to TDH. Keep a sharps injury log to record date, time, and related incident information as mandated by law. Sharps injuries shall be reported to TDH within 10 working days of the end of the calendar month in which the exposure occurred.
D. Employee medical records regarding vaccination, needlestick exposures, and treatment shall be retained for the term of employment plus 30 years. (Hard copy records may be converted to electronic storage formats.) Additionally, training records shall be retained for 3 years from the date of the training.
E. Review and update the exposure control plan - at least annually, or more frequently if safer work practices or devices are available or if further workplace guidelines, rules or regulations are issued.

Although early analysis of the legislation predicted that up to 25 safety-engineered devices would be registered with the state in any given year, only three are on the current list. Two of them are manufactured by Retractable Technologies.

Friday, November 12, 2004

Texas headed the wrong way

Mitch Mitchell, Fort Worth Star Telegram, writes about the decline in health-related rankings for the state. Texans are worse off in number of uninsured, child poverty, infant mortality, and infectious disease, among other things. There was one bit of good news, according to Mitchell:

Infectious disease was another category that depressed the state's health rankings, which saw the state drop from 39th in the nation to 43rd.

But some good news about HIV and AIDS was hidden in the numbers.

"About a decade ago, every year we had about 40,000 new AIDS cases and about 20,000 deaths," said Elvin Adams, the health authority for Tarrant County Public Health. "Now, people don't die from AIDS because we've found ways to treat them. We're doing such a good job treating people that our infectious disease rates are going up."

I guess that's one way of looking at it.

Monday, November 08, 2004

Update on Amarillo case

I was looking for more information about what the final outcome might have been in the case of the alleged prostitute in Amarillo, who is HIV positive and who was being sued by the City of Amarillo under the "recalcitrant transmission" policy of the Department of State Health Services. While I still haven't found more recent news (see the link above), I did run across an editorial written by the Amarillo Globe News and published in the midst of things on September 30 (there were other developments a few days later).

The editorial begins by pointing out:

Well, Amarillo city officials appear to have gotten someone's attention with the threat of a lawsuit.

Whatever it takes.


The editorial includes a stern shaking of fingers:

The city's get-tough initiative against T.T. should send a wakeup call to those who fail to heed all the warning signals associated with high-risk behavior. It should warn the men who seek sexual gratification from women who might be infected with the virus. It should warn women who put themselves at risk by engaging in sex with men who themselves are infected. It should warn young people who believe mistakenly that they are invincible, that they cannot possibly fall victim to the tragic consequences of unsafe sex.

My only question is: Warn them about what?

The best information in this vague and threatening paragraph is the acknowledgement of "the tragic consequences of unsafe sex" on which they might have said a bit more. However, there is no "get tough" policy going on in Texas or Amarillo that works as effective prevention for broad groups of people. The lawsuit tool is available for specific individual situations where counseling has failed. When there is no counseling--or adequate funding for prevention messages to convince the broader public that HIV is an equal opportunity virus for men and women both--"get tough" just may get in the way.

Still looking for more current information . . .

Mandatory testing for Texas inmates

Representative Yvonne Davis (D-Dallas-District 111) has pre-filed HB 43, "relating to requiring the Texas Department of Criminal Justice to conduct a mandatory human immunodeficiency virus test on certain inmates and jail felons." Current law allows for this testing (using "may test"), but Davis bill requires that the institutional division of TDCJ "must test" an inmate who is eligible for release prior to release. In addition, the bill mandates that the state jail division "shall test" in the same manner and subject to the same conditions as apply to the institutional division.

Representative Norma Chavez (D-El Paso-District 76) filed a similar bill in the 77th legislative session (2001). Chavez' bill (HB 2583) required education and testing for both Hepatitis C and HIV, but restricted the requirement to inmates aged 22 or over and who had been sentenced for a term of at least two years. Chavez' bill was not related to release from incarceration. Chavez' bill was scheduled for a hearing but was pulled from the schedule at the last minute. The high fiscal note was a likely problem as well as the fact that Chavez' staff was unaware that HIV testing was not already mandatory in the prison system.

The Network is now reviewing Davis' bill and will contact her office for more background information.

Note that Chavez' bill was referred to the House Corrections Committee (not Public Health). It's a fair bet that Davis' bill will also be referred to that committee.

Texas legislature begins pre-filing bills

Shortly after elections for members of the Texas legislature, members of both houses can begin "pre"-filing bills. These are bills that legislators have been working on over the interim between sessions. They are not technically filed until the legislature comes into session in January, but pre-filing gets the bills through Legislative Council (for legal review) and acquires a bill number. This means that bills stand a better chance of getting quickly referred to committees and potentially having hearings. In other words, the early bird gets the worm.

Today was the first day for pre-filing legislation. House and Senate members filed a total of 135 bills and resolutions.

To see a list of all the bills filed on a particular day, Texas Legislature Online provides this resource. Just click on the date for which you wish to see all of the filings. To search for a particular phrase in the text of all of the bills filed, use this link.

When you see a bill number highlighted as a web link, you can click on the link to find out more about the bill. You can also click on the author's name to find out more about him or her and the other bills that he/she has filed.

Friday, November 05, 2004

World AIDS Day Memorial

This year, the international theme for World AIDS Day (December 1) is "Women, Girls, HIV and AIDS." Googling "World AIDS Day" will net a large number of web sites, some with current information. Today's mailbox, however, brought a message about an annual memorial event in which all of us can participate:

World AIDS Day is fast approaching. In Los Angeles on the Adelphia cable system we will once again present AIDS Watch. In this 24 hour program, midnight to midnight, we computer generate names of people that have died from HIV/AIDS. Every name, every person is treated equally. Rock Hudson and Freddy Mercury are on screen the same scant three and a half seconds that David Cartwright and Chris Blauman are. The names fade in and fade out. Black screen, white letters. This is very pointedly an awareness project, no funds are solicited. We hope only to touch people and remind them of this plague. In the 24 hours we have space for over 26,000 names.
26,000 memories. But yet in our best year (this will be the ninth time we have done this) only 14,000 names have been submitted. We need more memories, we need more names. In order for the names to reach the roster they must be submitted through the website. That's how the computer works, I didn't write the program. PLEASE visit the website and submit names for the memorial. AND please send this along to everyone you know that might have someone they want remembered. There is no cost involved. Just a moment of your time. Remember your friends. www.aidswatch.org
The interface is simple to use. I added three names, two of them members of my family. Doing so made me think about others who have been lost along the way--people who fought hard for AIDS funding and progressive policy, who didn't die of AIDS but gave their lives to it. I added three names to the World AIDS Day memorial, but I also thought of David and Sharon.

Tuesday, November 02, 2004

The Hidden Epidemic

Slate writer, Jon Cohen, provides more follow up on Gwen Ifill's question for the vice presidential candidates regarding the devastating effect of AIDS on black women in America. He recapitulates the non-answers of both candidates and then explores reasons why HIV so disproportionately affects black women in the U.S. He ends with quotes from Ifill about her own reaction to the candidates' lack of knowledge.

As Cohen lists the possible reasons for this situation, he adds a more fulsome response from Phill Wilson, executive director of the Black AIDS Institute in Los Angeles:

And there's one more factor to consider, says Wilson: Politicians ignore this population. "It's both a cause and a symptom of the problem that our government really is not interested in the health and well-being of black people and in particular black women," says Wilson. "How is it that Dick Cheney can tell you how many machine guns are in Baghdad, but doesn't have a clue about issues that are killing black women a stone's throw from his office?"

I have often opined that the AIDS epidemic casts a harsh light on the cracks that divide our society showing us, among other things, that HIV most affects those that our society is most willing to "throw away." Whether such neglect is willful or not, it remains a lasting condemnation that policy makers can continue to turn their backs on this situation.

ICAAC news

The 44th International Conference on Antomicrobial Agents and Chemotherapy concludes today in Washington, DC. AIDSmap provides an update on research reported at the conference.

The Puzzling Origins of AIDS

Red Nova, which appears to be a popular science website, presents an article by Jim Moore, an anthropologist on the faculty of the University of California at San Diego, who has done some research on the question of where/how AIDS might have originated. The article, which may first have been published in Scientific American, outlines four competing theories of the origin of AIDS:
  • Tainted polio vaccine - chimpanzee or monkey tissue used to cultivate early polio vaccines in Africa may have allowed species crossover;
  • Cut hunter - indigenous hunters of various primates, especially chimpanzees, may have been exposed to a virus that crossed species;
  • Contaminated needles - inadequate health facilities may have spread a crossover virus in local populations;
  • Heart of darkness - labor and health practices in the former Belgian Congo may have spread a debilitating virus in forced labor camps.

Moore's conclusions do not point to the greater validity of one theory over another. Rather, he looks at the "lessons" to be drawn from them:

Given the precarious status of each of the current theories, it seems more reasonable to try to keep an open mind until better evidence emerges and, in the meantime, to consider the literature on each of these origin stories as representing a highly refined simulation scenario. Insofar as there is any material benefit to come from understanding the origin of HIV in terms of cautionary tales, each model can and should be considered plausible-and worrisome. After all, unsterile needles do transmit diseases, contaminated polio vaccine did spread a simian virus (one called SV40) to millions of people, doctors do sometimes conduct risky research, colonial policies did have major health consequences, and contact with wild animals can introduce pathogens into humans.

An obvious general lesson can be drawn from all four theories: For some very puzzling reason, the origin of HFV was not fundamentally natural, given that humans apparently failed to acquire an immunodeficiency virus from simians during thousands of years of exposure. Instead, the emergence of HIV involved social change in one form or another: the abuses carried out at the hand of an invading foreign power; abrupt urbanization overwhelming the ability of medical and political authorities to manage the process; the undersupervised transfer of medical technology and half- measures in development programs; doctors taking liberties in distributing medicines without adequate precautions. It is worth noting that three of the four theories postulate an origin for AIDS that involves the inadvertent results of medical efforts, with what were then state-of-the-art health programs and technologies carrying with them unforeseen dangers.

Whether understanding the origin of HIV and AIDS is useful for evaluating risks associated with present-day concerns (say, the consumption of wildlife that might be the natural reservoir for emerging diseases like SARS, or evaluating the likelihood that the transplantation of animal organs into people will unleash a dangerous new virus) is a matter of opinion. My own view is that a firmer grasp of what happened in the past-and what might easily have happened had circumstances been slightly different-helps society to understand these dangers and to minimize the risk of sparking the next global scourge. [Emphasis added.]

The article itself is interesting reading. Its conclusions might prod us into thinking more about the ways in which social and healthcare practices in the current environment promote the spread of HIV in the U.S.

Cholesterol Pills and Grapefruit Don't Mix

. . . especially in combination with protease inhibitors, it would appear.

Monday, November 01, 2004

Catching up is hard to do

That's the new song I've started singing. Just back from a wee bit of sick leave with a bunch things to blog. Here goes:

* Innovative Health Solutions is offering a health insurance policy and life insurance for people who are HIV positive. There's no information about rates in the press release. The life insurance policy can be issued up to $10,000 in coverage.

* One Earth Foundation has announced that:

their national HIV/AIDS prevention initiatives will include the launch of Living for a Cure® Wristbands. The red Living for a Cure® Wristband symbolizes awareness among humankind in promoting a consciousness about the devastating AIDS disease. The foundation’s mission is to reduce the number of individuals infected daily by raising the nation’s level of awareness of the HIV/AIDS epidemic.

The wristbands will sell for $2.00. Proceeds will be used for HIV/AIDS prevention and research programs.

The Austin American Statesman provides another take on wristbands as a marketing tool.

* The Houston Chronicle added Disease Intervention Specialist to the list of "worst jobs" in the Houston area. While the article may have been a tongue-in-cheek attempt to localize the recent Popular Science "Ten Worst Jobs" list, but it makes the worthy point that:

The annual list is an important reminder that improving public health or adding to scientific understanding is not always easy or glamorous.

An interview with a Houston DIS provides some background on the necessary but neither easy nor glamorous work performed on behalf of public health.

* The National Latino AIDS Awareness Day (October 15) marked the beginning of a national push to increase awareness and boost HIV prevention in the Latino community. The U.S. Department of Health and Human Services has been sponsoring health fairs with a tie-in to NLAAD. A fair was held in McAllen on October 24. Fairs will also be held in Dallas (November 14) and Houston (November 21).

More catching up when I catch up!

Tuesday, October 19, 2004

Comic book tackles HIV

Mia, a teenage runaway featured in the Green Arrow comic book series, discovers that she has HIV. She wants to become a crime-fighter, too, so Green Arrow allows her to become his new sidekick, with the new name, Speedy.

One-on-One counseling stems spread of AIDS

This article is a week or so old, but I have had some technical difficulties in getting a working link. It comes from HealthDayNews regarding an HIV prevention study for young HIV-positive drug users. While this particular version of the report was published in the Atlanta Journal Constitution on October 8, several other news outlets carried this and other HealthDayNews stories. Links to those articles were difficult to include here, for some reason I don't quite understand.

One other problem is that the article is based on a study that was published in "the Journal of Acquired Immune Disorders." When I find a news story like this, I like to link to the original study, if possible. In this case, I spent quite a bit of time looking for the journal cited in the article to no avail. Either the name of the journal is misidentified, or the journal is not available on the web, or my search skills need some improvement.

To make matters worse, I couldn't find any other news stories about this research that weren't a repetition of the HealthDayNews article.

All of that being said, the article does report some interesting research:

Convincing HIV-positive young adults to avoid infecting others is one of the biggest challenges in the fight against AIDS.

But in a new study, American researchers contend the solution may lie in one-on-one counseling that encourages people to make better decisions by understanding their own personal values.

The rates of one kind of unprotected sex dropped by more than 30 percent among HIV-positive drug users who underwent an intensive counseling program. "You shore up a person's ability to control their life and change their behavior," said Lee Klosinski, director of programs at AIDS Project Los Angeles, which hopes to replicate the study's findings. The counseling "equips them to make healthy choices in their life."

An estimated 110,000 Americans under the age of 23 are infected with the AIDS virus. Studies suggest that many of them aren't aware they're sick; those who know they're infected don't always take the expensive drugs that have revolutionized the treatment of AIDS over the past eight years.

Researchers offered a choice of three infection-prevention programs to 175 HIV-positive young people in Los Angeles, San Francisco, and New York City. The subjects, aged 16 to 29, were regular users of methamphetamine or intravenous drugs; more than two-thirds were gay men.

The participants, for the most part, had been very sexually active before the study: They reported a median of 50 sexual partners over their lifetime, and 21 said they'd had sex with 1,000 or more people. The risk is that they will continue to have unprotected sex and infect others.

Some of the subjects had as many as 18 sessions with a counselor over the phone. Another group attended one-on-one sessions, while a third group was assigned to get counseling at a later date. All participants received $20 to $25 for attending each of four meetings with counselors to measure their progress.

The goal of the counseling was to bring out an inner sense of responsibility in the participants, said study co-author Mary Jane Rotheram, director of the Center for Community Health at the University of California at Los Angeles. "Most people want to be good people," she said. "Our program helps people remember what's joyful and happy in their lives, and helps them figure out how to maintain that on a daily basis."
The findings appear in the October issue of the Journal of Acquired Immune Disorders.

The study suggested the one-on-one counseling convinced more than a third of participants to cut down on unprotected sex with partners whose HIV status -- positive or negative -- was unknown. "They had the same amount of sex, but it was either protected or they went to HIV-positive people," Rotheram said.

The telephone counseling wasn't as successful.

The findings are encouraging because they show that the federal emphasis on counseling is a good idea, said Steve Morin, director of the AIDS Policy Research Center at the University of California at San Francisco. "What this study illustrates is that it works."

Previous research has suggested that the counseling approach works in groups. But counseling several young people at once isn't feasible in many parts of the country, such as rural areas, Rotheram said. "This showed that you could also work with kids individually."

The next step is to expand the counseling program, Rotheram said. "We're being funded by the CDC [U.S. Centers for Disease Control and Prevention] to train providers so we can make this a routine part of medical care."
It almost makes you wish that news stories had footnotes, doesn't it. ;)

Monday, October 18, 2004

Planned Changes to AIDS Prevention Funds Draw Fire

As we have noted before, the CDC is proposing new guidelines for HIV prevention. The agency received more than 4700 comments on the proposal, including many from knowledgeable folks who are concerned that the new guidelines will do more harm than good. The number of comments may cause a delay in issuing the final version of the new guidelines, originally expected to be issued in mid-December.

Thursday, October 14, 2004

The HHSC budget briefing--in brief

Tom Suehs, Deputy Executive Director for Financial Services, provided a briefing this morning regarding the Texas Health and Human Services Commission's (HHSC) Legislative Appropriations Request (LAR) for the upcoming biennium (FY 2006-2007). The most critical point for the Texas HIV/AIDS community is that the current version of the HHSC LAR does not include the budgets of the component state agencies, so HIV is not addressed at this point. Suehs said that a consolidated budget for all five agencies and the HHSC would be ready by November 1.

Talking from a 20-page handout that detailed the FY2006-2007 HHSC LAR for baseline budget needs and exceptional items, Suehs pointed out that, of the $3.6 billion in new state funds requested, $2.7 billion would maintain current services. He also pointed out that the combined budget would be requesting about $6 billion total in new general revenue. This, he agreed, would be a substantial request, but he expected that the exceptional item requests would place the focus on specific policy issues that need to be discussed by legislators, and, it seems, it was just the right thing to do. [Note: We really haven't heard that "right thing to do" justification for budget requests very much from bureaucrats in the past few years.]

Key Dates:
  • October 18--HHSC presentation to Senate Finance Committee
  • October 20--HHSC public hearing before Legislative Budget Board
  • November 1--Consolidated budget available

Points of Interest:

  • HHSC is proposing an actual plan to eliminate waiting lists for state services across all component agencies over the next 10 years.
  • There are no funds for the expansion of STAR+PLUS in the current LAR.
  • TIERS is (finally) expected to begin in mid to late 2005.
  • The state will begin paying premiums to Medicare in 2006 to cover the cost of prescription drug coverage for dual eligibles (who formerly received medications through Medicaid). [My crystal ball says this debate ain't over.]
  • The Medicaid VendorDrug Program, despite some significant changes that were supposed to save money, is expected to grow by about 25%. [That's a rough estimate, not an exact calculation.] The $1.8 billion increase is, however, hard to find in the exceptional item requests, and it's even harder to figure out how much of that amount is general revenue (state dollars) versus federal Medicaid matching funds. Exceptional Item 3, Maintain Medicaid Cost and Utilization Trends, appears the most likely place for this issue, but other costs are combined in the item.

Wednesday, October 13, 2004

What's Next? Treatment Options When the First Antiretroviral Regimen Fails

From The AIDS Reader ® -- on Medscape (free registration required)

What's Next? Treatment Options When the First Antiretroviral Regimen Fails Virologically or Is Not Tolerated, Part 1
Posted 10/05/2004

Peter J. Ruane, MB, MRCP; Eric S. Daar, MD

Abstract

There are many choices for the initial treatment of HIV infection. However, a change may be required if drug resistance or intolerance occurs. Thus, the selection of an initial regimen is important not only because of its immediate effects but also because of its potential influence on subsequent treatment options. HIV clinicians should be aware of the resistance and safety profiles of the regimens they prescribe as initial therapy and be ready with a strategy for subsequent treatment in the event of virologic failure or drug toxicity. This article suggests treatment algorithms for those experiencing adverse events or the emergence of drug resistance with commonly used antiretroviral regimens.


Monday, October 11, 2004

Briefing on HHSC Legislative Appropriation Request

As I noted earlier, the next hearing in the state budget cycle for HIV will be on October 20. However, the HHSC will be giving a briefing on their budget request--which should include HIV--on Thursday. Here are the details:

The Texas Health and Human Services Commission will conduct a briefing on Oct. 14 to provide information about the agency's legislative appropriations request for fiscal years 2006-2007. The briefing will provide consumers, advocates, providers and others with an opportunity to learn more about the HHSC budget request. No public comment will be taken during the meeting. However, there will be an opportunity for public comment on HHSC's legislative appropriations request during a joint meeting of the Legislative Budget Board and the Governor's Office of Budget, Planning and Policy. [Hearing schedule]

What: Briefing on HHSC's legislative appropriations request

When: 10 a.m. Oct. 14, 2004

Where: Public Hearing Room at HHSC headquarters, 4900 N. Lamar in Austin

Contact for special accommodations: Sandra Conzemius at 512-424-6648 or Sandra.conzemius@hhsc.state.tx.us


Thursday, October 07, 2004

More reactions to Cheney & Edwards on AIDS

The Advocate gathers responses from AIDS and advocacy groups around the country:

AIDS groups and activists tell Advocate.com they are disappointed the candidates avoided talking about domestic AIDS issues, particularly the Bush administration's flat-funding of Ryan White spending, the financial crisis faced by the nation's AIDS Drug Assistance Programs, and President Bush's push for abstinence-only sex and HIV prevention education programs.

AIDSVote.org says "Democrats and Republicans still need AIDS 101 education":

AIDSVote.org urges the audience participants and moderators of the two final presidential debates to demand specific and detailed answers from the candidates about their HIV/AIDS policies. The group's model presidential platform contains a detailed plan on effective strategies to combat HIV/AIDSin the U.S. and abroad. Hundreds of organizations and thousands of individuals have endorsed this platform, generating emails to the candidates encouraging them to do more in the fight against HIV/AIDS.

Note: Texas AIDS Network has endorsed the AIDSVote platform.

The CAEAR Coalition issued a call for national action in response the failure of the candidates to answer Gwen Ifill's question adequately:

It is time for a wake-up call to all of our leaders. It is time to increase funds for the Ryan White CARE Act with an additional $425 million. Congress has the appropriations legislation before it now, it should act now, and the administration should call for this action immediately.

At the same time, we will redouble our efforts to educate the nations leaders and decision makers about the appalling statistics regarding the prevalence of HIV/AIDS among African American women and other severely impacted communities, and the need to support the CARE Act, which is the foundation of the nation's ability to meet the needs of these communities.


Developing, as they say.


Study: AIDS Drug Effective Vs. Hepatitis B

Stephanie Nano recaps a report published in the latest issue of the New England Journal of Medicine for the Associated Press:

A long-used AIDS drug appears to be the first effective, long-term treatment for hepatitis B in those with advanced liver disease caused by the virus.

The drug lamivudine, also known as 3TC, has been available for the treatment of
hepatitis B since 1998, but the consequences of using it for years in those with serious liver disease or cirrhosis were unknown.

Researchers tested the drug for almost three years in 651 people, mostly Asians, and found it cut in half the risk of liver failure and the chances that the disease would develop into liver cancer.

About 8 percent of those who got lamivudine saw their liver disease get worse, compared with 18 percent of those who were given a dummy pill. The study was ended early because of the difference in the groups, and everyone was offered lamivudine.


Wednesday, October 06, 2004

LBB hearing rescheduled

The Legislative Budget Board has rescheduled its hearing on the Legislative Appropriation Request of the Health and Human Services Commission. The hearing is now scheduled for October 20, at 9:00 AM in the Capitol Extension, Room E2.028.

Get your flu shot

The U.S. supply for flu vaccine has been cut in half since a British manufacturer failed to pass some critical inspections. Now the Centers for Disease Control is recommending voluntary rationing of the vaccine so that people in the highest risk categories can be assured of vaccination. Persons living with HIV or AIDS fall into that high risk category. Now is the time to get your shot!

Post-Debate Background Information on Domestic AIDS Epidemic

Woohoo! AIDS Alliance for Children, Youth & Families is johnny-on-the-spot for getting this press release out so quickly. It provides some context for Ifill's AIDS question, gives the media some additional aspects of the story, and helps keep the issue alive. Way to go!

Contact: Mark Del Monte of the AIDS Alliance for Children, Youth & Families . . .

WASHINGTON, Oct. 5 /U.S. Newswire/ -- Tonight, Vice President Cheney and Senator John Edwards were asked about the domestic AIDS epidemic. Gwenn Ifill, cited a statistic on the HIV infection rates of African-American women with HIV/AIDS. Vice President Cheney stated he was unaware of the statistic.

The following facts are background information:

-- According to the CDC, African American women represent a grossly disproportionate percentage of new HIV infections among women. In 2002, African American women made up 64 percent of reported new HIV infections, Hispanic women made up about 17 percent, and white women made up 17 percent.

-- According to the Centers for Disease Control and Prevention young women account for 58 percent of new HIV cases among people ages 13 to 19. Furthermore, these young women are largely racial and ethnic minorities. Young African American and Hispanic women account for 75 percent of HIV infections among women ages 13 to 24.

-- While the Bush Administration has increased funding for global AIDS programs to $2.8 billion this year, the Administration has proposed no increases in domestic HIV/AIDS prevention programs. These programs have remained level funded over the past 4 years at $700 million per year.

-- The Bush Administration has requested no new funding for the HIV/AIDS care programs in the Ryan White CARE Act the past 4 years while funding minimal and inadequate increases for AIDS drugs. One program that targets African American women and their families, Title IV of the CARE Act, has remained level funded at $73.5 million despite double digit increases in patients served each year.


Tuesday, October 05, 2004

Ifill's Question on AIDS

Ok, I know I'm supposed to be working on a presentation, but I just had to take time out to listen to the debate between Vice President Dick Cheney and Senator John Edwards. I imagine that we are all surprised (and grateful) that the moderator, Gwen Ifill, addressed them with a question about AIDS in the U.S.

Here's her question:

IFILL: I will talk to you about health care, Mr. Vice President. You have two minutes. But in particular, I want to talk to you about AIDS, and not about AIDS in China or Africa, but AIDS right here in this country, where black women between the ages of 25 and 44 are 13 times more likely to die of the disease than their counterparts.

What should the government's role be in helping to end the growth of this epidemic?


Here's Vice President Cheney's response:

CHENEY: Well, this is a great tragedy, Gwen, when you think about the enormous cost here in the United States and around the world of the AIDS epidemic--pandemic, really. Millions of lives lost, millions more infected and facing a very bleak future.

In some parts of the world, we've got the entire, sort of, productive generation has been eliminated as a result of AIDS, all except for old folks and kids--nobody to do the basic work that runs an economy.

The president has been deeply concerned about it. He has moved and proposed and gotten through the Congress authorization for $15 billion to help in the international effort, to be targeted in those places where we need to do everything we can, through a combination of education as well as providing the kinds of medicines that will help people control the infection.

Here in the United States, we've made significant progress. I have not heard those numbers with respect to African- American women. I was not aware that it was--that they're in epidemic there, because we have made progress in terms of the overall rate of AIDS infection, and I think primarily through a combination of education and public awareness as well as the development, as a result of research, of drugs that allow people to live longer lives even though they are infected--obviously we need to do more of that.


Here's Senator Edwards' response:

EDWARDS: Well, first, with respect to what's happening in Africa and Russia and in other places around the world, the vice president spoke about the $15 billion for AIDS. John Kerry and I believe that needs to be doubled.

And I might add, on the first year of their commitment, they came up significantly short of what they had promised.

And we probably won't get a chance to talk about Africa. Let me just say a couple of things.

The AIDS epidemic in Africa, which is killing millions and millions of people and is a frightening thing not just for the people of Africa but also for the rest of the world, that, combined with the genocide that we're now seeing in Sudan, are two huge moral issues for the United States of America, which John Kerry spoke about eloquently last Thursday night.

Here at home we need to do much more. And the vice president spoke about doing research, making sure we have the drugs available, making sure that we do everything possible to have prevention. But it's a bigger question than that.

You know, we have 5 million Americans who've lost their health care coverage in the last four years; 45 million Americans without health care coverage. We have children who don't have health care coverage.

If kids and adults don't have access to preventative care, if they're not getting the health care that they need day after day after day, the possibility of not only developing AIDS and having a problem--having a problem--a life-threatening problem, but the problem of developing other life-threatening diseases is there every day of their lives.


Here's some reactions from the (corporate) blogosphere. First, Paul Begala, at CNN:

How many African-American women with AIDS?
Posted: 10:27 p.m.
Gwen Ifill just asked Cheney to talk about AIDS in America.

She specifically asked Cheney not to talk about AIDS overseas. But all Cheney's talking about is AIDS overseas. He hasn't been programmed on it, and candidly told Gwen he didn't know about how African-American women have been hurt by the disease.

One of the downsides of the Bush-Cheney record is the sense that they care more about the rest of the world than America.

But Edwards is responding in terms of Africa -- first AIDS, and now genocide. Come on, guys, bring it home.


Jessi Klein, also blogging for CNN:

AIDS is infecting who?
10:19 p.m. ET
Did Cheney just admit that he was not aware of an AIDS statistic that Gwen brought up? I think for Cheney to say he doesn't know about something in this forum, he has to truly, truly not know about it.

That's pretty disturbing, no matter how you slice it. Wonder if he did the same thing with the AIDS statistics memo that Condi did with that silly "Al Qaeda Plans On Attacking US Inside the Country Using Airplanes" memo in August 2001?


Keith Olberman at MSNBC blogs the debate as a boxing match (which explains the "score" at the end of his post:

Round sixteen: Cheney receives about AIDS affecting women in America.
Cheney flinches, talks globally, cites $15B for international aid. Minus one point to Cheney. Says he had not heard numbers about African-American women. Startling admission. Minus one point to Cheney. Cheney wounded badly. Edwards misses easy opening on Cheney's unfamiliarity, goes back to Africa. Minus one point to Edwards. Opens up towards Sudan, says "here, we need to do much more." Broadens out ineffectively to American health care coverage. Subject completely avoided. Minus one point to Edwards. Round -- Draw, -2 to -2.

I couldn't find any blogs or mention of the AIDS question and responses at FOX, CBS, or ABC. It is gratifying, however, that two major media outlets, albeit cable rather than network, did pick up on the question and respond. I know that the issue is cropping up on some of the political blogs that are not funded by the corporate media--and that will be quite helpful now in raising some awareness of the issue. The importance of the corporate media, however, is that these are the outlets that will reach the broadest audience. How--and whether--this question is covered in these media outlets will help increase awareness and understanding of the issue.

The only way this is likely to happen is for folks in the HIV/AIDS community to follow up on the opening that Ifill has given us to provide the answers that neither candidate provided:

  • The Senate needs to increase the proposed appropriation for AIDS Drug Assistance Program from $35 million to $217 million.
  • The CDC needs to rescind its requirement to provide confusing information about the effectiveness of condoms in preventing the spread of HIV so that prevention workers can do a more effective job in outreach.
  • The Administration must make sure that the changes in Medicare that provide for a prescription benefit does not decrease access to HIV medications.

Monday, October 04, 2004

Erratic blogging for a while

I have a couple of blog items that I am developing right now, but, over the next few days, I may not be able to publish as often as I have been. I will be presenting an exhibit for the Texas Higher Education Coordinating Board all day tomorrow. Wednesday brings another budget hearing. Then I have a major (for me) workshop to present for the City of Houston Department of Health and Human Services next week. This might take some preparation, I'm thinking.

I will, however, post as much as possible during this time. This would really be a good time to have a co-moderator, hunh?

Fact sheets on Medicaid and Medicare

In the mail . . .

Together, Medicaid and Medicare represent nearly three quarters of all federal spending on HIV/AIDS care in the U.S., and provide health insurance coverage to an estimated half of all people living with HIV/AIDS who are receiving care. These programs are likely to play an even greater role as people live longer with HIV/AIDS and continue to rely on these programs for care and treatment, including access to prescription drugs.

As part of the Kaiser Family Foundation's ongoing effort to provide information on the key programs that provide care and services to people living with HIV/AIDS, we are releasing two new fact sheets on the role of Medicaid and Medicare. Most people with HIV/AIDS who qualify for Medicaid are Supplemental Security Income (SSI) beneficiaries, meaning they are both disabled and low income. The majority of Medicare beneficiaries with HIV/AIDS are under the age of 65 and disabled, and most also rely on Medicaid.

These fact sheets provide an overview of the role of these programs for people with HIV/AIDS including federal funding estimates, eligibility criteria and services, profile of beneficiaries, and future outlook. The fact sheets are available at http://www.kff.org/hivaids/hiv100104pkg.cfm.

Recalcitrant transmission in Amarillo

A current court case in Amarillo relates to an HIV-positive woman being sued by the City of Amarillo to stop her from engaging in high risk behaviors which could transmit HIV to others.

The Amarillo Globe-News has published three articles on the case over the past week or so. The first, published on September 25 and written by Greg Cunningham, is headlined "City sues prostitute to get HIV treatment; issue pits public safety against civil rights." The second, published on September 28, was also written by Cunningham and is headlined "Prostitute may agree to treatment; Officials won't go through with lawsuit if woman cooperates." The third, published on October 2, was written by Jim McBride. The headline: "HIV-infected woman denies suits claims."

This case is important because it appears to be the first time that the Texas Department of State Health Service's rules on recalcitrant transmission have been applied. How they are applied should be of great concern to all in the HIV/AIDS community. And a big caveat to this is the question of whether those rules have been followed in the case at all, since the news reports only cite the statutory authority for the city to sue and not the DSHS rules.

The statutory authority to bring this suit derives from Chapter 81 of the Health and Safety Code (The Communicable Disease Prevention andControl Act). The specific section in operation appears to be 81.083, Application of Control Measures to Individual, which gives the local health authority the power to issue a written order regarding control measures and to back it up with a court order if necessary:
If the department or a health authority has reasonable cause to believe that an individual is ill with, has been exposed to, or is the carrier of a communicable disease, the department or health authority may order the individual, or the individual's parent, legal guardian, or managing conservator if the individual is a minor, to implement control measures that are reasonable and necessary to prevent the introduction, transmission, and spread of the disease in this state.
The rules are departmental policy, not formal rules that have been promulgated as part of the Texas Administrative Code. This particular policy (HIV/STD Policy No. 410.003) is called the "Accelerated HIV Intervention Program, Addressing the Potential for Recalcitrant Transmission of HIV in Texas." It begins by saying:

This policy establishes the Accelerated HIV Intervention Program, a program developed by the Bureau of HIV and STD Prevention (Bureau) to address the public health concerns of potential HIV transmission to unsuspecting persons by an individual who is known to have HIV. Any HIV positive individual found to be practicing recurrent behaviors which are known to transmit the virus and who engages in those behaviors with limited regard for the health of another person is considered a threat to public health.

When this policy was under review in 2001, Texas AIDS Network expressed a number of concerns about its wording, its purpose, and its eventual implementation. We were concerned, among other things, about the possibility of community witch hunts to label persons living with HIV "recalcitrant." The need to apply the rules would ordinarily come up in the course of contact tracing and partner notification, a standard part of disease prevention practices, when a single contact might be identified as the partner allegedly "responsible" for one or more other cases. An overzealous or biased investigator, we thought, might be able to use the rules to harass or penalize an HIV-positive person for any sexual activity. (There was some reason to worry about this in some parts of Texas at the time.)

In the Amarillo case, the HIV-positive woman, identified only as "T.T.," was indeed identified in the course of contact tracing and partner notification related to a recently reported case of HIV. T.T. was allegedly the source of that infection. Further investigation appears to have revealed that T.T. knew her status, had been informed of methods to prevent the spread of HIV, and allegedly engaged in prostitution while knowing that unprotected sexual intercourse could spread the virus. As it happens, these are key protections for the accused person: knowing their status and having received counseling about HIV prevention. If either of these things did not obtain, then the person would not need to be hauled through the courts but simply educated about prevention.

What is remarkable about the Amarillo case is that no criminal charges for prostitution or drug use are being brought against T.T. The concern stated by all appears to be getting T.T. into treatment coupled with the belief that all other means for gaining T.T.'s cooperation in preventing the spread of HIV have failed. And it does appear that the case is following the guidelines of the recalcitrant transmission policy, since T.T. received additional counseling about high risk behaviors and allegedly refused to avoid them, due, it would seem, to possible addiction to cocaine. The court case is being used as a "last resort."

Another concern that Texas AIDS Network had with the recalcitrant transmission policy was the potential for this policy to become the springboard for criminalization of HIV transmission. That very issue was raised by Cunningham in his second article. There is some comfort that both public health officials and the legal authorities are treating the case as a public health issue and not a criminal case, but the possibility that criminalization will be introduced in the Texas Legislature now looms large. Texas legislators are well known for legislation by headline, and this story has generated a lot of headlines in Texas.

We should all keep a weather eye out for developments in this case. How it is handled can have important consequences for others besides T.T.

Friday, October 01, 2004

LBB hearing on DSHS HIV budget

Staff members from the Legislative Budget Board (LBB) held a hearing today regarding the Texas Department of State Health Services budget request for FY 2006-2007. Additional folks on the dais included representatives of the Speaker's Office, legislative staff, and Rep. John Davis, who serves on the House Appropriations and State Affairs Committees.

Commissioner Eduardo Sanchez laid out the department's budget request by talking about the state of health in Texas, emphasizing that it includes concern for both a sound mind and sound body. Two points of concern to the Texas HIV/AIDS community came in his discussion of exceptional items. The first was a request to restore the 5% reduction in general revenue. The second was a request for $5.7 million in new funding for the Texas HIV Medication Program (THMP).

In regard to the first, Dr. Sanchez was responding to the mandate that all state agencies have been instructed to follow in making their budget requests for the coming biennium: Make the budget request for 5 percent less that was appropriated for FY 2003 and make any additional funding requests as an exceptional item. Dr. Sanchez requested that the 5% funding cut be restored for the sake of the health of the people of Texas. He pointed out that, if the 5% was not restored, 400 people would have to be cut from the Texas HIV Medication Program's current client load.

In regard to the second, Dr. Sanchez discussed the exceptional item request for the Texas HIV Medication Program, pointing to a $5.7 million shortfall projected for FY 2007. He told the LBB that access to medications was important because the medications prolonged lives, reduced transmission, and allowed people to live productive lives.

Rep. Davis asked Dr. Sanchez whether there were any waiting lists for THMP. Dr. Sanchez pointed out that there were no waiting lists and that the Department had rules in place to move to cost containment procedures if the program ever began to run out of money. Waiting lists, he said, would be the last step in that process.

When it came time for public testimony, I spoke on behalf of Texas AIDS Network. I pointed out that a new actuarial report showed that THMP would experience an $8.3 million shortfall in FY 2007. The Network, therefore, supported both the restoration of the 5% funding cut and an increase in the exceptional item request from $5.7 million to $8.3 million. I emphasized the importance of THMP as our "safety net for the safety net."

Rep. Davis asked me about Fuzeon and its presence on the THMP formulary. I responded that Fuzeon was on the formulary but limited to 50 clients. An expensive drug, Fuzeon is partially responsible for the increased funding need for FY 2007. Rep. Davis asked about criteria for eligibility for the drug, and I agreed to provide additional information.

The next hearing on the budget will be on October 6 when the LBB hears the combined budget request for the Commission on Health and Human Services.

Thursday, September 30, 2004

Status of federal HIV/AIDS appropriations

The U.S. government is operating under a continuing resolution through November 20.

On July 15, the U.S. House passed the Labor, HHS, Education appropriation bill for FY 2005. According to a committee press release, the following appropriations were recommended by the House for medical research and health programs:

  • Centers for Disease Control funding is $4.48 billion, $101 million below last year and $15 million above the budget request.
  • Community Health Centers are expanded - fourth year of the President’s proposed expansion of health services through the Community Health Centers Program. Total funding $1.8 billion, $219 million over last year and the same as the President’s request.
  • National Institutes of Health continues our commitment to the NIH by providing $28.5 billion, $727 million more than last year.
  • International HIV/AIDS, TB and Malaria programs are funded at $ 624 million, the
    same as the President’s request.
  • Infectious disease- Enhances CDC’s resources for preventing and controlling emerging infectious disease threats, such as SARS, West Nile Virus, and Monkeypox. ($ 398 million - +$ 29 million)
  • Homeland Security/Biodefense programs are supported at $ 1.694 billion in NIH, $1.638 in CDC and $543 million in hospital preparedness.
  • Ryan White AIDS program is increased by $35 million over FY04 with total funding of $2.1 billion.
  • Children’s Graduate Medical Education (GME) is funded at $303 million, the same as the President’s request and roughly the same as last year.
  • Low Income Home Energy Assistance Program (LIHEAP) is funded at $2.2 billion, an increase of $122 over last year.
  • Faith- and Community-Based Initiatives are increased including the Compassion Capital Fund at $55 million.
  • Abstinence- Provides $110 million for the discretionary abstinence education program, an
    increase of $35 million over FY04.
  • Social Security - Provides a 6% increase to the Social Security Administration to improve service delivery of Social Security benefits and accelerate the time it takes to process disability claims.
On September 15, the Senate Appropriations Committee voted out its bill for Labor, HHS, and Education. The committee provides the following highlights of appropriations for HHS programs:

  • Community Health Centers -- $1.867 billion, which is $31 million above the request and $250 million over last year. These centers provide critical health care services to underserved and uninsured people throughout America.
  • Pediatric Graduate Medical Education -- $303 million, the same as the President’s request.
  • Health Professions – The bill includes $465 million for Health Professions programs, which restores many of these programs which were eliminated in the President’s budget.
  • National Institutes of Health -- The Senate bill includes $28.9 billion, an increase of $1.1 billion over the FY’04 appropriation and $380 million over the President’s budget request.
  • Centers for Disease Control & Prevention -- The Senate bill includes an increase of $345 million over the budget request, for a total of $4.8 billion.
  • Pandemic Flu --The bill includes $75 million in new funding to ensure that an adequate supply of vaccine would be available in the event of a severe flu outbreak.
  • Global AIDS -- The bill includes $660 million for global HIV/AIDS activities. Within this total, $149 million is included for the Global Fund for HIV/AIDS/TB, which is $50 million over the budget request and the same as last year. In addition, $118.8 million is included in CDC for global HIV/AIDS/TB activities.
  • Family Planning -- $308 million, an increase of $30 million over the budget request and $30 million over FY’04.
  • Low Income Home Energy Assistance Program (LIHEAP) -- The Senate bill includes $2 billion for LIHEAP, the same total as the budget request. Of the funds provided $99.4 million was included for the contingency emergency fund.
  • Ryan White AIDS Programs -- $2.080 billion for the Ryan White AIDS programs, $35 million more than last year's budget.
  • Family Caregivers -- The Senate bill includes $157 million for family caregivers, an increase of $4.3 million above last year.
  • Head Start -- $6.935 billion for Head Start, an increase of $160.5 million over last year.
    Abstinence Education Programs -- $138 million, an increase of $36.5 million over the FY’04 appropriation.
  • Substance Abuse & Mental Health Services -- The bill provides $3.5 billion, an increase of $133.8 million over last year. SAMHSA is responsible for supporting mental health programs and alcohol and other drug abuse prevention and treatment services throughout the country.

If I read the congressional table giving the status of appropriations correctly, the full Senate has not yet voted on this appropriations bill, so the issue has not yet gone to conference committee. It makes sense, then, point out that $35 million for the Ryan White CARE Act will not cut the mustard.

The National Organizations Responding to AIDS (NORA) recommends a $217 million increase in funding for AIDS Drug Assistance Programs (ADAPs) alone. But there are other needs for funding in the Ryan White CARE Act, including early intervention services, case management, etc. The appropriations process for FY 2005 is pretty far along to have much of an impact on the final numbers we can expect out of the conference committee (and there is no disagreement about those numbers so far between the House and the Senate anyway), but it's still worth it to let our representatives in Congress know what is being missed in this appropriation cycle.

The new federal appropriation cycle gets underway in February, 2005.


NYT Supports Reimportation

The New York Times editorial page opines that it's high time that the Senate majority leader, Sen Bill Frist, allow a vote on a bill that would allow reimportation of drugs from Canada.



September 29, 2004
The Senate's Chance on Drug Costs

If Dr. Bill Frist, the Senate majority leader, knows what's good for the body politic, he will allow a quick floor vote on the drug reimportation bill he has been bottling up for the benefit of President Bush and the pharmaceutical industry. A large majority - up to 75 members, by some estimates - would easily pass the bill and delight the organized older voters who have been clamoring for lower-priced Canadian drugs. American consumers are increasingly aware that their average drug prices are 67 percent higher than what Canadians pay for comparable prescriptions. Bipartisan Senate pressure is growing on Dr. Frist, along with threats of the sort of floor rebellion that saw the Republican House rise up last year to pass a drug reimportation plan over Mr. Bush's opposition.

Mr. Bush continues to express concern about potential safety risks from imported drugs while insisting that the new Medicare subsidy for prescription drugs will eventually ease the pocketbook pain of dissatisfied retirees. Dr. Frist also continues to express concern about the need to weigh the benefits of lower prices against possible safety risks.

But this concern is addressed in the pending bipartisan bill, which mandates that the bargain drugs would come from licensed Canadian pharmacists and wholesalers registered with the federal Food and Drug Administration. [emphasis added.]
The Times joins an increasingly large bandwagon that supports the reimportation of U.S. manufactured drugs from Canada, because Canada's universal health care program has negotiated (or mandated) lower consumer prices for these drugs. Regardless of the politics involved, the U.S. Food and Drug Administration has--for years--expressed concerns about the importation of drugs from foreign sources, including the reimportation of U.S. manufactured drugs. (The pharmaceutical industry seems only lately to have jumped on the bandwagon, presumably for their own reasons.) Moreover, Congress has already passed laws allowing for reimportation if the safety concerns can be addressed.

If this bill does indeed address the safety concerns, then reimportation may become a viable--and safe--alternative to the high costs of medications in this country. However, setting standards for safety will not be enough if the FDA is not also given adequate funds for inspections and the personnel to conduct them. FDA must also be given authority to prohibit certain pharmacies from doing business with U.S. customers if their activities are deemed unsafe.

The bill in question appears to be S.2137, which has sponsors from both parties and a version of which has already passed the House as HR.2427. S.2137 is called the "Pharmaceutical Access Act of 2003." It has passed on second reading and now sits on the Senate calendar, awaiting action.

The bill lists some interesting findings (note the repetition of findings on safety):
Congress finds that--
(1) Americans unjustly pay up to 1000 percent more to fill their prescriptions than consumers in other countries;
(2) the United States is the largest market for pharmaceuticals in the world, yet American consumers pay the highest prices for pharmaceuticals in the world;
(3) an unaffordable drug is neither safe nor effective;
(4) allowing and structuring the importation of prescription drugs ensures access to affordable drugs, thus providing a level of safety to American consumers that consumers do not currently enjoy;
(5) according to the Congressional Budget Office, American seniors alone will spend $1,800,000,000,000 on pharmaceuticals over the next 10 years; and
(6) allowing open pharmaceutical markets could save American consumers at least $635,000,000,000 each year.
The purpose of the bill is stated to be:
(1) to give all Americans immediate relief from the outrageously high cost of pharmaceuticals;
(2) to reverse the perverse economics of American pharmaceutical markets;
(3) to allow the importation of drugs (excluding pharmaceutical narcotics) only if the drugs and the facilities in which the drugs are manufactured are approved by the Food and Drug Administration; and
(4) to require that imported prescription drugs be packaged and shipped using counterfeit-resistant technologies approved by the Bureau of Engraving and Printing, similar to the technologies used to secure United States currency.

Another Senate bill (S.2307) on the same subject has only one sponsor (Sen. Grassley) and has been referred to committee. This bill is much broader and includes financial incentives for "taxpayers" not to oppose reimportation from foreign supplies.





Additional Information

We've now added a blogroll, or list of links, under the heading called "Additional Information." As we discover and get to know other sites, especially other blogs, we'll be adding them to the list.

At the top of the list, of course, is Texas AIDS Network's own website. If you didn't arrive at this blog through the website, we hope you'll visit the site to learn more about the programs and activities of the Network.

A comparatively new AIDS blog is AIDS Matters. This blog was established in March and is a project of Forum One Communications. Jim Cashel and staff members of Forum One run the blog. AIDS Matters is described as a web resource for global AIDS professionals. The blog includes recent articles about AIDS funding, international discussion boards, media coverage of the global pandemic, and other stories about the big picture.

Developing . . . as they say.

Wednesday, September 29, 2004

HIV and Poverty

The good folks at the Kaiser Family Foundation provide a daily collection of HIV/AIDS-related news summaries, called the "Daily HIV/AIDS Report." In addition, KFF provides daily reports on health policy and reproductive health.

Today's report includes a brief summary of an opinion piece in the Lancet. In the essay, Lynda Fenton talks about the link between HIV and poverty. She suggests that poverty itself is a co-factor in HIV infection, since persons living in poverty often have poor access to health care and often suffer from malnutrition. The ill effects of poverty on health can break down the body's defenses against HIV.

Fenton talks about the cycle of the epidemic, beginning with folks who have greater economic means, who contract and then spread the epidemic because of their ability to travel. However, since greater economic means often correlates with better educational opportunities, at some point these same groups of folks are in a better position to receive information about HIV and its prevention. Poor folks, on the other hand, are in a worse position to receive those messages, and so the epidemic concentrates in that population.

Fenton was talking about the cycles and causes of the global pandemic and thinking in terms of whole countries, and she was careful not to limit her concept of the root causes of the epidemic to poverty alone. However, there is some value in applying her thoughts to the situation in the U.S.

We talk about the changing face of AIDS because the new infections, while still largely occurring in the gay community, are rapidly increasing among women and people of color in this country. There are statistics all over the place that correlate women and people of color with poor access to health care and lower quality education, especially when combined with poor economic circumstances. It is reasonable to ask whether HIV infection in the U.S. correlates in these populations with those circumstances.

Fenton makes two policy recommendations: (1) end poverty, but (2) don't neglect effective prevention efforts while you're ending poverty.

That sounds like a good plan, even in the U.S.

Tuesday, September 28, 2004

The war on condoms

The War on Condoms is rather more like a campaign in the larger War on Science now being waged in the United States. HIV/AIDS prevention relies, in part, on correct and consistent use of condoms, and can be seriously undermined if doubts about the effectiveness of condoms encourages people to opt for unprotected sex.

The latest issue of Science includes an opinion piece about the current state of science and public policy at the U.S. Centers for Disease Control:


Scientific Decisions, Including HIV/AIDS Policies, 'Subjected to Political Tests' by Bush Administration


The scientific community -- both in the United States and abroad -- has "expressed concern" over the fact that scientific decisions, including those concerning HIV/AIDS policies, are "subjected to political tests" by the Bush administration, David Baltimore, president of the California Institute of Technology, writes in a Science opinion piece.

The administration's "pattern of behavior ... is becoming clear," including its "abandon[ment]" of scientific rationale in favor of political policies influenced by "religious conservatism or economically based political caution," Baltimore says. Current U.S. HIV/AIDS policy is a "case in point," Baltimore says, adding that "[s]topping the spread [of HIV/AIDS] should be the highest international priority," because the disease is spreading at an "alarming rate" in Africa and Asia.

However, the Bush administration has prioritized abstinence as the most effective method of HIV prevention and has given "scant recognition to the protective value of condom use," despite the fact that "under most circumstances the only safe and effective protection is condoms," Baltimore says.

Although "complaints" led CDC to include a "positive statement" about the effectiveness of condoms in an online fact sheet and USAID now promotes condom use, the administration does not promote widespread use of condoms in HIV prevention, according to Baltimore.

Although complaints from the Union of Concerned Scientists and other individuals in the field have resulted in a "new posture" in the administration that is more "honest" about scientific facts, the implications of policy decisions are "still being ignored," Baltimore writes, concluding, "Our goal now should be to have the policies track the science" (Baltimore, Science, 9/24).

The War on Condoms is not just being fought abroad. There are battles in the U.S., as this excerpt from Scientific Integrity in Policymaking notes:

Cases: Public Health
Scientific Knowledge on HIV/AIDS Prevention Distorted

At the instigation of higher-ups in the George W. Bush administration, fact-based information on the Centers for Disease Control's (CDC) website has been altered to raise scientifically questionable doubt about the efficacy of condoms in preventing the spread of HIV/AIDS.

A fact sheet on the CDC website that included information on proper condom use, the effectiveness of different types of condoms, and studies showing that condom education does not promote sexual activity was replaced in October 2002 with a document that emphasizes condom failure rates and the effectiveness of abstinence.52 When a source inside the CDC questioned the actions, she was told that the changes were directed by Bush administration officials at the Department of Health and Human Services.53

[Footnote]52. A. Clymer, “U.S. Revises Sex Information, and a Fight Goes On,” New York Times, December 27, 2002. A comparison of the two versions of the CDC website about condoms can be seen online. The original website, CDC, Condoms and Their Use in Preventing HIV Infection and Other STDS (September 1999) is available at [broken link]; the current CDC fact sheet, CDC; Male Latex Condoms and Sexually Transmitted Diseases (October 2003) is available at www.cdc.gov/nchstp/od/latex.htm.

[Footnote]53. Author interview with current CDC staffer, name withheld on request, November 2003.

We've also noted here that the CDC is changing some of its policies regarding contract guidelines for prevention education. This will bring the War on Condoms down to the local level.

Not that we're not used to the War on Science in Texas. Any time the State Board of Education considers new textbooks, another battle (also here, here and here) ensues.

But here's the deal.

According to the Texas Department of State Health Services, on December 31, 2003, 48, 368 Texans were living with HIV or AIDS. In 2003, 4,802 new cases of HIV were reported. That's more than 13 new cases each day. In addition, 3,689 cases of AIDS were reported. While those reported cases showed a decline between 2002 and 2003 in the number of new infections by means of male-to-male sex, there was a slight increase in the number of new infections by means of heterosexual sex. The number of new HIV infections by means of heterosexual sex is comparatively low; however, they still constituted about 30 percent of new infections in 2003.

Moreover, talking about HIV infections doesn't include the other sexually transmitted infections that could have been prevented by correct and consistent use of condoms nor does it include the fact that Texas has the highest teen pregnancy rate in the nation.

The domino effect of the War on Condoms affects quality of life for families, not just individuals. It ultimately affects the cost of health care to the state and community, which translates to increased pressure on property and other taxes. For want of a nail, the shoe was lost . . .