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!