Underscoring its efforts to increase HIV testing nationwide, the U.S. Centers for Disease Control and Prevention (CDC), through its ambitious Act Against AIDS Initiative, has launched the Razones/Reasons campaign targeted at at-risk Latino gay and bisexual men.
The bilingual, mass-media campaign focuses attention on a community that is among the hardest hit by HIV in the U.S. Overall, Latinos account for nearly 22% of all new infections, despite representing only 17% of the population.
Of this group, the largest number of new infections has occurred among gay and bisexual men between the ages of 24 and 35. Even more concerning is the fact that 70% of HIV-positive Latino gay and bisexual men between the ages of 18 and 24 are wholly unaware of their status.
The Razones/Reasons campaign aims to redress this disparity by confronting many of the emotional, cultural and social barriers that keep many for being tested. Combining easy-to-understand facts with compelling, first-person testimonies, the initiative affirms many of the "reasons" why HIV testing is of such benefit to this at-risk population -- emphasizing not only personal health and well-being, but community, family and pride.
The Razone/Reasons campaign highlights the increased multidisciplinary coordination seen in recent years between governmental and local health authorities. By actively promoting universal testing, earlier treatment intervention, and stronger linkage to appropriate care, the CDC and others are aiming to reverse infections rates in vulnerable ethic, youth and MSM (men who have sex with men) populations.
The Razones/Reasons campaign was officially launched in Los Angeles on June 6, with an additional launch planned for Miami to coincide with National HIV Testing Day on June 27. Other launches are planned throughout the summer -- with targeted mobile and online advertising, as well as local print and outdoor/transit advertising slated for major U.S. cities.
More on HIV Testing
- Find an HIV Testing Center Near You
- Understanding Your HIV Test
- What is "Treatment as Prevention" (TasP)?
Image provided by the Act Against AIDS Initiative.
While much focus has been placed in recent months on issues ranging from therapeutic vaccines to the possibility of a "functional cure," there have been just as many advances in the development of next-generation antiretroviral drugs.
The most promising candidates are those that offer better tolerance, easier dosing, greater penetration of viral reservoirs, and novel mechanisms that can more effectively suppress drug-resistant viruses.
Here are a few of the agents we're keeping a close eye on:
Dolutegravir - Currently under review by the FDA, dolutegravir is a once-daily integrase inhibitor that performed impressively in clinical trials. Results thus far have shown that it is statistically superior to the twice-daily Isentress (raltegravir), with fewer resistance mutations, fewer virological non-responders (15% versus 24%), and fewer adverse event discontinuations (2% versus 4%) after 24 weeks of use.
Clinical trials are underway to explore the use of dolutegravir in a once-daily, fixed dose combination with abacavir and lamivudine. Expect dolutegravir on our shelves sometime in late-2013.
It may not seem like such a big thing, but news that case workers in New York City were able to locate 689 HIV-positive people "lost to follow up" signals a significant shift in the public health policy in the U.S.'s most populated city.
The New York City Department of Health and Mental Hygiene had identified 797 people on its database who had tested positive, but thereafter dropped off the radar with no follow-up visits or lab tests. Early investigation revealed that five percent of these patients had moved outside of the department's jurisdiction, while two percent had died.
In intensifying their search (which included home visits and internet searches), case workers were eventually able to re-connect 77% to the appropriate medical care, while identifying three additional infections linked to the cases.
Reason for the disappearances included:
- Patients felt well and didn't believe they needed treatment.
- Lack of trust in the public healthcare system.
- Being uninsured.
- Not wanting to think about being HIV-positive.
Medscape, the New York-based healthcare information provider, recently released their annual Physician's Compensation Report, which analyses the earnings, practices and job satisfaction of over 22,000 physicians in the U.S.
The report provides some surprising insights about HIV specialists in particular, shedding some light on a profession (and professionals) that we often take for granted.
Fact # 1: HIV doctors make less than any other medical specialty in the U.S.
Of the 25 specialties listed in the survey, HIV physicians were at the very bottom of the pay scale, averaging around $170,000 per annum. That's nearly $100,000 per year less than the average physician salary in the U.S. ($264,000), and more than 200% less than the top earner (orthopedics at $405,000).
Fact #2: Less than half of HIV doctors believe that they are fairly compensated.
On average, 48% of all physicians believe that they are fairly compensated, according to the survey. HIV doctors fall more-or-less in line with that figure at 46%. Ironically, only 39% of orthopedic doctors feel that they are properly compensated.
Fact #3: Despite this, HIV doctors rank number two in overall satisfaction with the profession they've chosen.
With a 53% overall satisfaction rating, HIV doctors rank only second to dermatologists at 59% (a profession for which averages $306,000 per year).
Research has shown that unprotected sex (also known as "barebacking") has risen in many at-risk communities as perceptions -- and misperceptions -- about HIV has led some to abandon condom use altogether. The fact that many people don't particularly like them (either because they reduce sexual sensation, or imply distrust or infidelity) only adds fuel to the fire.
The Marina del Rey-based Origami Condoms decided that it was time to completely re-think the condom model and find a design that might actually enhance the sexual experience rather than diminish it. Led by Daniel Resnic, a former-principle investigator with the National Institute of Health (NIH), the company has developed a silicone-based, unrolled condom that unfurls around the penis like an accordion, with folded ridges that actively expand and collapse during intercourse.
The loose-fitting silicone sheath reportedly glides up and down the shaft of the penis, while simultaneously massaging the vagina or rectum. On paper, the design to us sounds absolutely brilliant -- one of those slam-dunk, "gee-why-hasn't-anyone-ever-thought-of-this-before" concepts that, well... frankly, excites us. A lot.
To put the issue to rest from the start, yes, I have watched Tyler Perry movies. A couple of them I have even liked. Sure, they are pretty clunky and sometimes wincingly heavy-handed, but who doesn't like a 6' 5" tall, African-American man channeling his foul-mouthed grandmother?
That said, one can't help be but taken aback by Tyler's frequent lapses into fire-and-brimstone moralizing, whereby those who "fall from grace" get their all-too-rightful comeuppance and then some. Few films highlight this more than Perry's latest, Temptation: Confessions of a Marriage Counselor, which has already grossed well in excess of $50 million in its U.S. release.
In the film, the lead character Judith (played by Jurnee Smollett-Bell) strays from a deadly dull marriage to have a series of sexual trysts with a charismatic, billionaire drug-addict. Despite being repelled by their first sexual encounter, in which the lothario forces himself upon her, Judith comes back for more and more in an increasingly aestheticized display of carnal abandon.
And then she gets HIV. And then she learns from the errors of her ways. And then, by film's end, we see poor Judith literally limping (?) her way to church to atone for her sins, having aged considerably compared to her good-hearted, former spouse.
As much as one might like to dismiss the film as puerile nonsense, Temptation does seem to reinforce a long-held-but-largely-unspoken belief that AIDS is somehow a punishment from God. That in straying from a lifeless marriage to enjoy the pleasures of the flesh, we literally and metaphorically "get what we deserve."
On May 7, Representative Barbara Lee of California introduced the REPEAL ("Repeal Existing Policies that Encourage and Allow Legal") HIV Discrimination Act to Congress, calling for the review of federal and state laws regarding the criminal prosecution of individuals for HIV-related offenses. Currently, 34 states have enacted laws that make exposure to (or the non-disclosure of) HIV a crime.
One recent case in Iowa, Rhoades v. State, resulted in a 25-year sentence for an HIV-positive man who had one-time sexual encounter, in which a condom was used and no transmission occurred. Another case before the Minnesota Supreme Court, State v. Rick, questions the sentencing of another HIV-positive man who had consensual, unprotected sex after fully disclosing his status.
Meanwhile, 13 states have made biting a prosecutable offense, even though the risk of transmission from saliva is essentially zero. And in perhaps the most logic-defying case, an HIV-negative Texas man was sentenced in May to 10 years imprisonment for spitting on police officers while claiming he was HIV-positive.
Now we're the first to admit that HIV non-disclosure is an incredibly thorny issue -- one that is often highly charged and emotional. Still, at the heart of the debate is the on-going struggle between the issues of personal responsibility and assignment of blame. Where does one end and the other begin?
Attention-grabbing headlines are the name of the game in news business. The advent of search engine analytics has somehow made the practice all the more absurd, bordering on desperate, as media outlets and bloggists (like us) vie for your valuable page views.
But when does the practice become a problem?
The revision of a recent article in the U.K.'s Telegraph newspaper, claiming that a Danish HIV cure was expected "within months," highlights an increasingly worrying trend in mainstream reporting. Dozens of top news outlets jumped on the original story when it was first released, apparently unconcerned as to whether the claims were accurate. The fact that the research was not (and still has yet to be) published makes the matter all the more troubling.
The revised Telegraph headline now states (correctly) that the "first results are expected 'within months.'" Meanwhile, the lead researcher of the Danish, Dr. Ole Søgaard, issued a press statement, insisting:
"We are not on the brink of an HIV cure... We are making good progress, but there is still a long way to go."
It's sound like something out of a Star Trek movie. Imagine this for a second:
You swallow a pill. Digestive juices activate a sand grain-sized sensor inside the pill. A remote signal is then sent to an adhesive patch on the surface of your skin. The patch sends a digital confirmation to your healthcare provider, who can track and record your adherence. The sensor (made of trace copper and magnesium) is then safely expelled from your body.
Believe it or not, technology like this may not be all that far away. Developers at Proteus Digital Health in Redwood City, California have just submitted the world's first ingestible microchip to the U.S. Food and Drug Administration (FDA) for approval. The FDA has already given the product its pre-market clearance, paving the way for full approval should the device pass final safety and effectiveness testing.
It is envisioned that devices such as these may not only be able to track the adherence to chronic medications such as antiretrovirals (ARVs)and TB drugs, but that they might also find use as diagnostic tools. Imagine swallowing a pill that can remotely monitor your kidney function (for patients on tenofovir-based regimens) or indicate the development of lactic acidosis, a side effect associated with certain ARVs.
Proteus believes that digital devices like these will help prevent the development of drug resistant virus due to suboptimal adherence (something frequently seen in Africa with the proliferation of multidrug-resistant TB).
That's not to say the device doesn't stir some ethical concerns -- bringing to mind questions about medical privacy, or what other types information might be potential captured without a person's knowledge or consent.
Sci-fi speculations aside, investor response to the devise has been strong in light of the FDA's pre-market approval. Earlier this month, Proteus announced that it had raised just over $62 million in its latest round of funding.
More on HIV Adherence
Photograph © Evan Sharboneau is used under a Creative Commons license at www.flickr.com/photos/thevlue/4839060646/
On the face of things, the strategy makes perfect sense.
With the patent expiring on one of the three drugs in Atripla (the once-daily, single-pill antiretroviral used in first-line therapy in the U.S.), why not save money by using a cheap generic version of first drug (Sustiva), replacing the second (Emtriva) with a suitable generic (Epivir), and offering the branded drug component (Viread) on its own? Drug coverage providers in the U.S. could potentially save up to $1 billion per year, said an investigative team from Harvard Medical School this past July.
While we admit that this is hardly "new" news, the expiry this month of Sustiva's composition patent does raise the specter of such an approach. And while there's little doubt that a Sustiva generic would be enthusiastically received by the public, particularly private payers and commercial insurers who would benefit the most, the study does raise a few important questions.
In their mathematical modelling, the Harvard researchers justified the approach by stating that a switch from one pill to three would result in a "modest survival loss" of 4.5 months (meaning that you would decrease your life expectancy by about 18-20 weeks). While we don't doubt the veracity of these figures, they largely conflict with what other research has shown.