Tuesday, September 26, 2006

More money for FDA!

Diedtra Henderson writes for the Boston Globe about a new coalition that has formed to lobby for a bigger appropriation for the FDA. Yea, verily. As federal agencies go, the FDA is one of the most important for the health and safety of the American people, yet it is chronically underfunded. A little e coli in the vegetable supply goes a long way toward reminding folks that the "F" in FDA stands for food, and this is the agency that sets standards and conducts inspections. There's also the "D" in FDA, which makes one wonder about this:
Pharmaceutical Research and Manufacturers of America, the pharmaceutical industry's trade association, said in a statement that a decision whether to join the Coalition for a Stronger FDA is ``still under consideration." It also has not decided whether to endorse redirecting user fees to help improve drug safety.

Yo, PhRMA! It's a no brainer.

The public face of AIDS (U.S.A.)

The Washington Post writer Michael A. Fleischer reports that the First Lady is now being touted as the public face of AIDS for this administration:
"She's been the face of, as far as the public face of, the U.S. government commitment on AIDS, on human rights, on democracy," McBride [Mrs. Bush's chief of staff] said. "So I think he's seen what all of you have seen -- she's been a voice for the commitments that the U.S. government is making on these issues."

Oh, dear. Is that the same face that forced the withdrawal of a WHO resolution on AIDS treatment?

AUCKLAND, New Zealand A resolution calling for universal access to HIV/AIDS treatment has been withdrawn from the World Health Organization's Asia-Pacific conference because the United States insisted on changing it, senior officials said Friday.

American officials submitted a series of last-minute amendments to remove expressions of support in the resolution for items such as needle exchange programs for drug addicts, said officials at the meeting in Auckland, New Zealand's largest city.

New Zealand Health Minister Pete Hodgson, who chaired WHO's annual weeklong conference of officials from the Western Pacific region, said the U.S. amendments would have watered down the resolution.
Or was the real face of US policy on HIV meant to be hidden while the public face smiles . . . vacuously?

Friday, September 15, 2006

Honor killing on the installment plan

I went back to an old favorite news source today: newsmap. In the Health section, I found a link to a news article from the Phillipines about the HPV vaccine: "How many women will have to die?" I'm interested in the subject (we are expecting to see legislation on this matter in the next session of the Texas Legislature), but it may not be immediately obvious why the vaccine might matter in the context of HIV/AIDS.

The parallels to HIV prevention are, however, quite obvious. The same age groups are important for early prevention activities. Both have a significant time lag between risky behavior, infection, and the appearance of life-threatening consequences. The same moral issues have been raised as reasons not to use effective prevention interventions.

The Phillipine article gives a nice run down of the issues surrounding the full utilization of the HPV vaccine at the recommended time with the recommended population, especially the economic and regulatory issues. The "morals issue" got rather short shrift, however:

ANOTHER issue that has emerged in the controversy is that of “morals.” “Giving the HPV vaccine to young women could be potentially harmful,” Bridget Maher of the Family Research Council told the British magazine New Scientist, “because they may see it as a license to engage in premarital sex.”

Katha Pollitt, writing in The Nation, comments with tongue firmly in cheek: “Just as it’s better for gays to get AIDS than use condoms, it’s better for a woman to get cancer than have sex before marriage. It’s honor killing on the installment plan.”

(a) I somehow doubt we'd ever see such short shrift given to the issue in a U.S. publication. Instead what we tend to see is a lot of reportorial vapors over the concern for the morals of young girls and the parental right to make life and death decisions for the future adults that they will become. (b) I think we've found the right description for opposition to effective prevention, whether it's prevention of HIV or HPV infection: honor killing.

Thursday, September 14, 2006

Talking point: Texas health workforce

The Statewide Health Coordinating Council is in the process of finalizing its report on healthcare workforce issues in Texas through its 2007-2008 State Health Plan Update. If you're interested, the stats and graphs showing number, distribution, education, and even age (they are so getting older) are included in Chapter 2: Status of the Health Workforce in TX. SHCC's recommendations to the legislature are included in Appendix A: 2005-2010 Texas State Health Plan Recommendations. On page 6 of those recommendations, under "Primary Care Recommendations," we find this little gem:


1. The Legislature should support initiatives that will support public health prevention and education programs in an effort to decrease the incidence and severity of chronic disease in the population by enabling individuals to take personal responsibility for their health.
Yes, I know there are some code words in here, most notably the infamous "personal responsibility," but, used carefully, this can serve as a talking point in support of the legislative appropriation request for increased funding for HIV services and prevention.

The health workforce is going to be an issue of significant concern to the Texas Legislature when it convenes in January. Aligning the request for increased funding for HIV prevention and services with this concern can be useful in creating a more positive reception for the request.

I do not, however, see this as the whole burden of one's argument in support of this funding, but rather as a passing reference that "appeals" to authority of the SHCC. For example, "Senator So-and-So, this request is precisely the sort of initiative that is included by the Statewide Health Coordinating Council in its recommendations for improving primary care in Texas." Then move on to your other points. If there's any question, you have the reference to the original and can quote it.

Wednesday, September 13, 2006

Condom ad

A friend sent me a video of a condom ad from East Africa. I tracked it down to at least one web site. Go see it. It's fun.

The caption at the end is "Maisha iko sawa na Trust." There may be some double meanings here as well. My first reading was that it meant "Life is the same as Trust," i.e., life = Trust. A second reading made me think that the phrase was somewhat more idiomatic and might mean "Life is good with Trust."

Trust is the condom brand. The phrase seems to have been their ad slogan for some years. The video and discussions of it have been viral, showing up in web discussions in several languages. The consensus seems to go with my second translation, but I kinda like the first, since it focuses so clearly on the prevention concept rather than a more hedonistic ethic. Still, it's a clever ad. Look for the old baba in the car.

Texas HIV/STD Infoline . . . going . . . but not gone

The latest issue of the Texas HIV/STD eUpdate from the DSHS HIV/STD Program carries the story (emphasis added):

InfoLine Callers Now Forwarded to CDC-INFO

The Texas HIV/STD InfoLine you know so well (800-299-2437) is undergoing some changes.

Until recently, callers who wanted to speak to an information specialist would get a DSHS employee. Callers who request to speak with an information specialist are now automatically forwarded to 1-800-CDC-INFO. This new hotline, which replaces the National AIDS Hotline, provides English, Spanish, and TTY service 24 hours a day, seven days a week. Callers can speak to a live information specialist and receive HIV/STD testing and services referrals for Texas or any other state. The Texas HIV/STD InfoLine will continue to be forwarded to CDC-INFO through the end of 2006.

All callers are still greeted with a menu of informational audio tapes in English and
Spanish. Callers wishing to connect with the Texas HIV Medication Program (THMP) or file a complaint are still connected to DSHS employees.

If you have any questions regarding the InfoLine, please contact Jean Gibson at jean.gibson@dshs.state.tx.us or 512-533-3023.

Calling the InfoLine seems only to net that one change: if you want to talk to an information specialist about HIV or STDs, you get a referral to the CDC Infoline. Otherwise, it's all the same, at least until the end of 2006.

This all came about because the person who managed the InfoLine retired, and the Program has made the decision not to rehire. Instead, there are ongoing discussions with the folks at the 211 program and some thinking about rerecording the info messages, etc. Further changes are not likely before 2007, but we have been reassured that there will be an InfoLine for the foreseeable future.

Condoms at DSHS

Well, not exactly at DSHS. On their new website.

I was looking to see what educational resources related to condoms were still available on the HIV/STD program's new website--and couldn't find it! Naturally, I couldn't stop myself from being just a tad . . . well . . . paranoid about the possibility of the change from one web address to another being used as an opportunity to scrub some things from the website. Condoms have been a central battleground, so to speak, in the culture wars. As I recall, there had been some rather useful information about condoms on the old website. Did it make it to the new one?

Most of it did indeed make it, but finding it takes some effort. The obvious place to look is under Publications and from there under "Publications and Brochures." That will net you references to two brochures: (6-23) "How to Use a Condom" and its Spanish companion (6-23a). The asterisk after each, however, asserts that you must be a "professional" in order to order the brochure. (I'm pretty sure that the humor was unintended.)

I had to have help from a DSHS employee to find the next links. A search of the site assured me that two fact sheets on condoms did in fact exist on the site, but where were they? How would a member of the public find them? With a little help, we managed to locate them in the section: "What are HIV and STDs?" Under the heading: "Information about STD transmssion (sic) and testing." Not under "Information about HIV transmission and testing." And not under anything that would point you to the concept of prevention.

I suspect that there will be some reworking of the new site so that things are easier to find, especially for the general public looking for prevention information. I'm also thinking it may be time to mirror some of these things on Texas AIDS Net . . .

Tuesday, September 12, 2006

Checking out the new Blogger

Spent some time yesterday dinking around with the new version of Blogger, called, cleverly enough, Blogger Beta. I'm with Peggy Lee on this: is that all there is? I was, as you can guess, underwhelmed.

I'm normally a BIG fan of just about anything Google does (well, except for that China thing), but they've missed the boat on this one. It really is a "beta," and not much of one at that.

Why am I kvetching about this on an AIDS blog? Well, it's a blog--and Blogger is what we have to work with right now. Either I learn a lot more about CSS and HTML than I ever wanted to know so we can have a better interface here, or the Blogger team (which already knows this stuff) makes it work for us.

Here's what's missing:
  • Better templates (the instructions are not clear to a novice, the options are too limited, where are the new ones?)
  • More features (it's nice that Blogger is finally going to add categories and blog rolls, but where is the connection to Google Earth or Calendar or all those other features?)
  • Privacy issues (I'm blogging with my real name because this is an "official" blog; what about folks who want some pseudonymity in their blogging? what about folks who have both official and personal blogs? linking everything to your Gmail account makes it hard to keep those separate)
  • Three columns (duh!)
  • Statistics (duh!)

There are probably more issues, but these are the ones that popped up on the first pass. I think we'll wait until the "beta" goes away before looking at it again.

/rant

Routine testing on its way?

Todays' CDC Prevention News included a clip from the Fort Wayne (IN) Journal-Gazette regarding the possibility of a recommendation for routine HIV testing in the U.S. The story was a nicely done "local take" on a national issue. I'm guessing that the CDC included this item in its news roundup because overall reporting on the issue is comparatively slim, and this story helps keep the issue floating about in the HIV community.

Even though the article includes a caveat from "CDC spokesperson" Tammy Nunnally that the policy is only under consideration, I fully expect that the next few months will bring it to reality. If so, we'll see something like a quasi-voluntary testing policy (you will be tested unless you refuse) that "offers" the test to every person between the ages of 16 and 60 (or thereabouts) when they enter the health care system. Presumably this would include private as well as public health elements of the system.

The reasons being offered for shifting to routine testing seem to boil down to two things: simplifying testing (by removing mandatory counseling components) and the hope that this policy will duplicate the success of routine testing for pregnant women in reducing new HIV infections. And, of course, the possibility of offering routine testing is assisted by the availability of new tests which provide results in a matter of minutes rather than the wait of two weeks needed in the past.

The results expected include an overall "social desensitization" to HIV testing. Right now, there is sufficient stigma associated with HIV testing, that many who are at risk do not get tested for fear of that stigma. Given that such tests are supposed to be confidential, that whole issue speaks ill of our health care system that it cannot be trusted to keep the mere fact of being tested for HIV confidential. If HIV testing becomes routine, perhaps there will be a concomitant effort to increase the sensitivity of health care providers, especially in the private sector, to handle the results more discreetly.

There is nothing in this proposal, however, that would help with "social desensitization" to an HIV diagnosis. We still remain a society that will judge a person for his/her health status before we are moved to compassion regarding that same health status.

Thursday, September 07, 2006

New web site for Texas HIV Bureau

The HIV Bureau (yeah, that's not it's name anymore, w/e) has a new website with a new look. Three years after the Department of State Health Services arose from the ashes (thanks, Arlene) of the old Texas Department of Health, the HIV Bureau is now being added to the Department's website as a full-fledged section rather than as a link to a legacy site. (That probably doesn't matter to the rest of the world, but I always found it curious that it HIV managed to hang out in limbo so long.)

The new web address: http://www.dshs.state.tx.us/hivstd/default.shtm.

The "home page" shows the new look--which is just like the (bland) DSHS look--with links to other sections of the department's web site. The left side of the page holds the HIV Bureau's links, and I have to say that they are now much easier for me to read and to distinguish one from another. I am more familiar with some sections of the old site than with others.

In those cases where I have some familiarity, it looks like nothing has been lost in the transition. I'd be curious to know what you find in looking at the site.

America is Africa?

So says Patrick Moore in his op ed for Long Island Newsday, and I couldn't agree more. He makes his comparison thusly:
But, in large parts of this country, America is Africa. With skyrocketing infection rates, poverty, lack of health insurance and a paucity of doctors, people with AIDS in the American rural South face prospects almost as grim as people living with AIDS in Africa.

The Kaiser Daily HIV/AIDS Report gives this summary of his op ed (emphasis added):
Over the last few years, the U.S. increasingly has "turned its attention" to the HIV/AIDS "crisis" in Africa even though in "large parts of this country, America is Africa," Patrick Moore, author of "Tweaked: A Crystal Meth Memoir," writes in a Long Island Newsday opinion piece. "With skyrocketing infection rates, poverty, lack of health insurance and a paucity of doctors, people with AIDS in the American rural South face prospects almost as grim as people living with AIDS in Africa," Moore writes. According to Moore, the "deeper story" of how HIV/AIDS in parts of the U.S. compares to the situation in developing countries "involves not just racism but our national character as a whole." The U.S. tends to "bounce along from one crisis to another, without addressing underlying, persistent problems," such as injection drug use, poverty and the "failure of the American health care system," Moore writes. According to Moore, the "solution" to fighting domestic HIV/AIDS is "not to reapportion a shrinking pool of existing funds but to increase the funding to appropriate levels for the entire country." Moore writes, "None of this is to argue that we should decrease funding to AIDS programs in Africa," concluding, "In fact, we can have greater compassion for Africa if we understand that this disease remains a crisis at home as well. When that awareness is achieved, we can be proud to say America is Africa" (Moore, Long Island Newsday, 9/6).

I could have highlighted several other phrases, but I focused on the funding issue because that one seems to be the easiest and simplest to deal with. Issues of national character (bouncing along the surface of crises without dealing with underlying causes) and chronic infrastructural probems (failure of the health care system) are neither attractive to policy makers nor amenable to solution in the near term. Full funding for the Ryan White CARE Act is. Doing so should take nothing, of course, from concern and support for dealing with HIV in Africa. That's a serious issue and really is in our national interest to address--completely apart from the humanitarian issues there. We should not, however, allow the media or policymakers to distract us--or themselves--from the serious issue of HIV at home by focusing more attention on Africa than on America when there are waiting lists for medications in this country, when people on those waiting lists die for lack of medication, when AIDS drug assistance programs cannot provide all of the medications that are needed to meet the standard of care for this nation in this nation.

Wednesday, September 06, 2006

Where the epidemic is now

CDC Prevention News cites the following research study:

"Epidemiology of HIV and AIDS Among Adolescents and Young Adults in the United States" Journal of Adolescent Health Vol. 39; No. 2: P. 156-163 (08..06):: MarĂ­a C. Rangel, MD, PhD; Loretta Gavin, MPH, PhD: Christie Reed, MD, MPH, FAAP; Mary G. Fowler, MD; Lisa M. Lee, PhD

The study's conclusion:
National case surveillance data for people ages 13-24 revealed that the burden of HIV/AIDS falls most heavily on the Southern region of the country and disproportionately on black and Hispanic youth, the study found. "The observed increases in the number of HIV cases among men who have sex with men are congruent with recent reports that suggest a resurgence of HIV among these young men," the authors noted. "Our findings highlight the need for intensified HIV prevention efforts within minority communities and among men who have sex with men as well as strengthened efforts to encourage at-risk youth to get tested for
HIV," the researchers concluded.

The epidemic is now hitting young people, especially young men who have sex with men, especially black and hispanic youth. Trends show a decline in reported HIV cases among women. In some ways, there might be a tendency to say "we're back where we started." I, however, am thinking that the whole thing is rather like whack-a-mole. You hit it here, and it pops up there. Without a comprehensive approach to prevention, one that goes beyond "just say no," any strong emphasis on one demographic group may lead another group to think that it is not at risk.

Maybe we shouldn't talk about where the epidemic is now, but emphasize that the epidemic shifts. It gains a foothold in one social network and spreads there; awareness and prevention may reduce or eliminate (we can wish) the infection rate in that community, but the virus can easily spread to another where individuals have been less vigilent. Just a thought.

RWCA: Reauthorization vs. funding

CDC's Prevention News includes the following story from the Washington Blade:

UNITED STATES: "Congress Poised to Renew Ryan White Act" Washington Blade (09.01.06):: Joshua Lynsen

A revised formula for the Ryan White CARE Act is expected to be unveiled in the House in the next week, one year after the act that provides more than $2 billion in federal funding for people living with HIV/AIDS expired. Renewal of Ryan White has been hampered by political infighting and bureaucratic procedures. Revisions to the act will likely see money distributed based on a state's total number of HIV cases, not just AIDS cases. Activists fear such a change, combined with the act's flat funding, could take money away from states and cities that have had longtime epidemics. "A certain amount of redistribution has to be done," said Edward Hopkins, director of federal affairs for the San Francisco AIDS Foundation. "But it can't be done in a way that dismantles the systems of care that already exist." Some legislators were aiming to pass the act by the end of the month, said Hopkins. Critics worry the revised formula will benefit rural regions at the expense of metropolitan areas. The new plan is widely expected to be a reworked version of a Senate plan offered earlier this year by Tom Coburn (R-Okla.). Hillary Clinton (D-N.Y.) in May cast the lone dissenting vote to approve that version in the Senate Committee on Health, Education, Labor and Pensions, arguing her state could lose $20 million under the proposed revisions. Dr. Patricia Hawkins, associate director for policy and external affairs at the Whitman-Walker Clinic in Washington, D.C., said the House plan includes a "hold harmless provision" to limit jurisdictions from losing more than 10 percent of their previous allocation. "That might protect us to some degree," she said. "But the next year, you lose more money, and the next year you lose more money, and so on," she suggested. Activists agree that what is needed is increased funding for the act. While current Ryan White allocations may appear impressive, said AIDS Action Council Executive Director Rebecca Haag, they remain insufficient. "The reality is that we need additional funding to meet that unmet need."


And so it goes. Every time the Ryan White CARE Act comes up for reauthorization, there is a battle over the funding formula. In one of the most unseemly legislative battles one can imagine, people who care for people are forced to fight each other so that they can continue to take care of the people that they care for. Notice that I didn't say "take better care" of those people, just "continue to take care" of them.

The issue is not really whether the Title I cities are getting too much money or the Title II areas getting too little. It's whether Congress ever really wanted to care for those same people and provide the funding necessary to do so. Twenty-five years ago, people really did die on the streets of America--from AIDS. For all of the commitment that Congress has shown these past five years to preventing that from recurring, we may see it again.

Tuesday, September 05, 2006

A little metablogging

I'm looking back over the month of August (yes, I didn't post much; no, I'm probably not going to back post; yes, it was an awful month) and checking up on user stats.

  • It was nice to see Texas folks drop by the site. They came from Austin, McKinney, DeSoto, Dallas, Plano, San Antonio, Duncanville, Houston, and Tyler last month.
  • It's interesting to see how the ClustrMap is developing. I haven't gotten around to finding another mapping service; this one may or may not redeem itself. The date on the current map doesn't coordinate with the numbers. I'm pretty sure that that lone dot off on the right side of Africa is supposed to be in Tanzania, not Uganda (hi, Jen). But it's always nice to see lots of dots from lots of places, and another tracking service (Tracksy) is telling me that people really are coming from from various parts of the world for one reason or another. Brazil may show up on the map eventually (at least, Tracksy suggests that it will), giving us (at last) "full coverage" of the continents.
  • We noticed that a couple of people tried to sign up as email subscribers in the past few weeks and then didn't show up on the subscriber list. I contacted FeedBlitz about this, wondering if there was some glitch with the feed (or their software). The problem seems to be that signing up is a two-step process. You enter your email address to subscribe and then you confirm your subscription when a confirmation email is sent to that address. If this is not the problem, please let me know.
  • ZoomClouds, who provides our current tag cloud is now definitely a keeper. I am tinkering with the format a bit, trying to change the background and setting things up so that the search results that come from clicking on a link pop up in a new window (so you don't lose your place on the blog), but we can only wait and see how well my tinkering works. The good news (for me, at least) is that ZoomClouds has added statistics to its service. I'm sure that I will eventually learn a great deal from these stats about the things that readers are looking for and how to provide more of it. One thing that I have learned already is that you are using the tag cloud to get around the site. In June, for example, you used the tag cloud 273 times to find information on the site. Cool beans. One thing that I can already see from the links that you have clicked is that there are some really weird tags showing up. What I long for is the day that Blogger actually allows for creating tags on each post. Won't that be fun?

And that's it for this month's meta. Unless I think of something else or decide to do more tinkering.