Pouring Tea:Black Gay Men of the South Tell Their Tales by E. Patrick Johnson
March 6, 2010
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MANILA, Philippines – The Philippine General Hospital on Wednesday said the number of Filipinos infected with HIV rose dramatically in the past 10 months and now includes young urban professionals such as call center agents.
Doctors at the PGH Infectious Disease Treatment Complex said the number of human immuno-deficiency virus (HIV) cases in the hospital rose to 100 in the past 10 months.
Records from the Department of Health showed that the number of HIV cases rose to 709 last year, compared to 528 in 2008.
Dr. Edsel Savana of the PGH Infectious Disease Treatment Complex said 80 HIV cases were recorded for November alone.
“The spread of AIDS in the country is already an epidemic. We should be on the lookout because AIDS spreads fast,” he said.
Savana said most of those who contract HIV are sex workers, gays and drug addicts.
Dr. Katerina Leyritana, however, said hospitals have also recorded HIV cases among young urban professionals such as call center agents.
She said majority of the recent HIV cases tend to be younger, mostly from ages 15-29, who are well educated.
Some of those infected said they got the illness after engaging in casual or group sex, which they discovered through social networking sites on the Internet.
“There are a lot of sites right now that can organize orgies quickly. A lot of young people believe in casual sex,” she said.
If current trends hold, the health department said HIV patients in the country could balloon to 20,000 cases by 2020.
The PGH said it will conduct a massive information drive to warn people about the possible dangers of unsafe sex. With a report from Jay Ruiz, ABS-CBN News.
by Alex Schoenfeld
A recent study has found that individuals who test positive for HIV may suffer from premature aging of the brain, either due to the infection itself or the treatment used to control it.
Researchers at the Washington University School of Medicine used magnetic resonance imaging scanners to study the brain of 26 patients with HIV and 25 uninfected subjects. They found that brain blood flow values were considerably reduced in HIV patients compared to control respondents.
The cognitive function of subjects infected with the virus was equivalent to readings seen in uninfected individuals who were 15 to 20 years older.
“Brain blood flow levels decline naturally as we age, but HIV, the medications we use to control it or some combination of the two appear to be accelerating this process independent of aging,” said lead author Beau Ances.
Researchers discovered that declining brain function was perceptible in young, newly infected patients as well as older individuals who have been dealing with the virus for some time. Previous studies related to the long-term health of HIV patients have indicated that the virus adversely affects the liver, heart, kidneys and endocrine system.
ScienceDaily (Jan. 25, 2010) — A five-year international multi-center clinical trial has found that acyclovir, a drug widely used as a safe and effective treatment taken twice daily to suppress herpes simplex virus-2 (HSV-2), which is the most common cause of genital herpes, does not reduce the risk of HIV transmission when taken by people infected with both HIV and HSV-2.
The results of the study are published in the New England Journal of Medicine.
Up to 90% of people with HIV infection also have HSV-2 infection. Most people who are infected with HSV-2 do not know they have the virus because symptoms can be mild or absent. HSV-2 infection can cause recurrent sores and breaks in the skin of the genital region, which can be mild and often go unnoticed. HSV-2 infection also attracts immune cells called CD4 T-cells to the genital region, which HIV uses to establish or pass infection.
Multiple studies have shown that frequent genital herpes recurrences increase the amount of HIV in the blood and genital tract. The HIV virus is also shed from genital herpes ulcers and persons with such ulcers transmit HIV to others more efficiently. Five preliminary studies showed that it is possible to decrease the amount of HIV in the blood and genital tract through treatment to suppress HSV-2, but these studies did not measure whether this translated into a reduction in HIV transmission. Researchers had hoped that acyclovir’s ability to suppress the herpes virus, which causes symptomatic genital sores and breaks in the skin but also frequently is active without symptoms, could reduce the likelihood of sexual transmission of HIV from a person with HIV and HSV-2. The study is the first to determine whether twice daily use of acyclovir by individuals who are infected with both HSV-2 and HIV reduced the transmission of HIV to their sexual partners. The authors conclude that daily acyclovir therapy did not reduce the risk of transmission of HIV, in spite of the fact that acyclovir reduced plasma HIV RNA by a ¼ log and the occurrence of genital ulcers due to HSV-2 by 73%.
Led by the University of Washington in Seattle and funded by the Bill & Melinda Gates Foundation, the Partners in Prevention HSV/HIV Transmission Study was conducted among 3,408 African HIV serodiscordant couples, in which one partner had HIV and the other did not. In all the couples, the partner who had HIV also had HSV-2 infection. The study took place at 14 sites in seven countries in eastern and southern Africa (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia). In sub-Saharan Africa, the majority of new HIV infections occur among heterosexual HIV discordant couples, many of whom are in stable partnerships and unaware that one partner has HIV and the other does not. Genital herpes is thought to be a factor in a substantial proportion of new HIV infections in Africa.
The study began recruitment in Nov. 2004 and ended follow-up of participants in Oct. 2008. Results were first announced in May 2009 and were presented at the International AIDS Society (IAS) meeting in Cape Town, South Africa, on July 22, 2009.
In the primary analysis of HIV transmissions determined by laboratory testing to have occurred within the couple and not acquired from an outside partner, there were 41 infections in the acyclovir arm and 43 in the placebo arm — not a significant difference. Of the partners who were infected with HIV, 68 % were women. Acyclovir suppressive treatment did show significant reductions in the frequency of genital ulcers (by 73%) and the average amount of HIV in the blood (by 0.25 log10 copies/milliliter, a reduction of 40%), compared to the placebo arm.
“As is often the case with large efficacy trials, you learn to expect surprises,” said Dr. Connie Celum, the leader of the study and a UW professor of Global Health and Medicine in the Division of Allergy and Infectious Diseases. “We found that, in spite of a significant reduction in plasma HIV levels and genital ulcer disease with acyclovir suppressive therapy, there was no reduction in HIV transmission. This was a disappointing finding, but a critical outcome of this study is the understanding that interventions must achieve a bigger reduction in HIV levels in order to reduce HIV transmission, especially among persons with high HIV levels. This will be important in informing future interventions to reduce HIV infectiousness.”
Celum said the study is a direct assessment of the impact of herpes suppression on HIV transmission and is the most direct way to see if it’s possible to make a person less infectious and less likely to transmit HIV to their partner. Although the primary outcome of reducing HIV transmission was not observed, Celum said the study achieved many significant mile¬stones that will help to inform HIV prevention research in a number of ways. Among these were HIV testing of approximately 55,000 couples of unknown HIV serostatus, screening of more than 6,500 HIV serodiscordant couples, and enroll¬ment of 3,408 couples in which the HIV- infected partner was dually infected with HSV-2 and not eligible for antiretroviral therapy, based on national guidelines. Adherence to twice daily acyclovir was high, with 88% of doses dispensed (the drug was not dispensed during pregnancy or if visits were missed), and 96% of dispensed doses taken, as measured by pill counts. Retention of study participants at 24 months of follow-up was 92% for HIV infected partners and 84% for HIV uninfected partners.
The Partners in Prevention HSV/HIV Transmission Study is the first clinical trial to directly test whether suppressing HSV-2 infection in HIV-infected persons could reduce rates of HIV transmission and HIV disease progression. The study was randomized, placebo-controlled and double-blinded, meaning that both participants and the care providers did not know which treatment the participants were receiving. Both the placebo and treatment groups received standard HIV prevention services, which included being supplied with condoms, treated for other sexually transmitted infections, and provided care for HIV infection. All participants received extensive counseling, both individually and as a couple, throughout the study period, on how to reduce the risk of HIV infection.
“This was an ambitious study, and I applaud our collaborators at the University of Washington, the investigators and study teams in Africa, the study participants, and the communities where the study was done, for their dedication over the past five years,” Celum said. “We will continue to learn from this study about risk factors for HIV transmission, which will bear fruit for both the HIV prevention and the vaccine fields for years to come.”
SENIOR Citizens Association of Zambia National Co-ordinator Rosemary Sishimba has said seven per cent of the older people in Sub-Saharan African countries are living with HIV/AIDS pandemic.
Officiating at media breakfast organised by Helpage International on Wednesday, Sishimba said it was sad that the media had not prioritised coverage of the elderly in society.
“Little is known about the vital role of older persons in social development, in the context of the HIVand AIDS pandemic a disease that has ravaged African countries socially and economically,” Sishimba said.
She said the evidence suggests that the older persons had taken the burdensome role of caring for the children as a result of HIV and AIDS in sustaining families,usually with scanty resources.
“We carried out regional consultative meetings on HIVand AIDS for the older people in eight African countries and we found out that in Kenya 72,550 older people were living with the pandemic,” she said. “As at now we have not yet established the per centage rate for Zambia as we are still carrying out the survey,” Sishimba said.
She said it was important for the government and cooperating partners to ensure that the older people in society were sensitised on the social norms of condom use.
“The problem that the older people are facing right now is that they think HIV and AIDS is a disease that can only be contracted by the young in society,” she said. “The existing preventive education message targets younger people, leaving out or programme that would be relevant to older people,”
Sishimba said the media should play an active role in reporting and sensitizing the aged in society about the pandemic.
“The Non-Governmental Organizations (NGO) need to collaborate with media to sensitize the public and government about the need and circumstances of older people in general and older care givers. It is however very unfortunate that the media houses hardly have interest in reporting on issues concerning the older people in society,” Sishimba said.
She said if the Sub-Saharan countries were to win the fight against HIV and AIDS more concerted efforts was an important aspect.
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“As HIV-infected individuals live longer with potent antiretroviral therapy (ART), metabolic complications such as low bone density and osteoporosis are increasingly recognized,” said Michael Yin, MD of Columbia University Medical Center in New York and lead author of the study. “Although numbers of HIV-infected postmenopausal women are increasing and postmenopausal women are at highest risk for osteoporotic fractures, few studies have evaluated skeletal status in this group. We hypothesized that postmenopausal women might be particularly vulnerable to the adverse effects of HIV infection or ART on the skeleton and our results indicate that this may indeed be the case.”
To test their hypothesis, Yin and his colleagues initiated a longitudinal study to assess bone health in 92 HIV-positive and 95 HIV-negative postmenopausal women. Bone mineral density of the lumbar spine, femoral neck and hip as well as body composition were measured by dual x-ray absorptiometry (DXA). Researchers found that HIV-positive postmenopausal women had lower bone mineral density at both the spine and hip than HIV-negative postmenopausal women.
“HIV infection was independently associated with lower bone mineral density after adjusting for body mass index (BMI) and traditional osteoporosis risk factors,” said Yin. “While the reason for HIV-associated bone loss remains unclear, it may be related to increased levels of cytokines (proteins produced by cells that aid communication between cells), direct effects of antiretrovirals on bone cells or hormonal/nutritional deficiencies that are common in HIV.”
“Estrogen protects against the effect of cytokines on bone resorption,” said Yin. “Therefore, as HIV-positive women become estrogen deficient during menopause, they may be at higher risk for accelerated bone loss and fracture.”
Other researchers working on the study include Don McMahon, Chiyuan Zhang, Aimee Shu, Ronald Staron, Ivelisse Colon, Jay Dobkin, Scott Hammer and Elizabeth Shane of Columbia University Medical Center in New York, N.Y.; David Ferris of Bronx-Lebanon Hospital Center in N.Y.; and Jeffrey Laurence of Weill Cornell Medical College in New York, N.Y.
The article, “Low bone mass and high bone turnover in postmenopausal HIV-infected women,” will appear in the February 2010 issue of JCEM.
(CNN) — Advocates for sex workers in South Africa have warned that this summer’s World Cup could be a public health disaster.
With up to half a million football fans expected to visit South Africa for the World Cup, and up to half of South Africa’s prostitutes carrying the HIV virus, there have been calls for the country to decriminalize prostitution to help tackle the spread of HIV.
Eric Harper, director of the Cape Town-based Sex Worker Education and Advocacy Taskforce (SWEAT), told CNN that the World Cup would inevitably lead to a demand for sex workers.
“And where there’s demand there will be a supply,” Harper told CNN. “It could be a potential recipe for disaster both for the clients and the sex workers,” he added.
Harper told CNN that while there are no accurate figures for the number of sex workers in South Africa, his organization believes there are 3,000 in Cape Town alone.
The UN estimates that in South Africa 5.7 million people are HIV positive, more than in any other country. A 2005 University of Michigan study found that 46 percent of female sex workers in Johannesburg had HIV.
Those figures, coupled with the expected influx of visitors for the World Cup, are causing concern for some South Africans.
Harper said HIV is just one of the dangers faced by South Africa’s sex workers. As well as the risk of contracting other STIs, there is the chance of unwanted pregnancies and the ever-present threat of violence and rape.
Prostitution is illegal in South Africa, but the law is currently being reviewed as part of a larger assessment of all sexual offenses. Harper believes decriminalizing prostitution can help control the spread of HIV.
“Throughout the world people have acknowledged that if you want to reduce HIV you need to be able to engage the population and address human rights concerns,” he told CNN.
“One of the key messages is that decriminalization is a way of accessing sex workers.”
Harper argued that criminalization drives prostitution underground. He said that removing the threat of prosecution would make it easier to provide sex workers with condoms and make it easier for sex workers to turn down clients who refuse to use condoms.
Any possible change to the legal status of prostitution remains some way off, with South Africa’s Law Reform Commission expected to make its recommendations to the Minister of Justice in 2011. Meanwhile, Harper would like to see prostitution decriminalized at least for the duration of the World Cup.
It’s an idea that was also put forward in 2007 by police commissioner Jackie Selebi, now suspended on corruption charges. But Dellene Clark, of the Law Reform Commission, told CNN that the government was not considering a temporary amnesty and that it would be “nigh on impossible” to rush the legislation through parliament in time for the tournament.
Julian Seedat of the South African National AIDS Council, which advises the government on HIV and AIDS, is also expecting an increase in prostitution during the World Cup, but he is more optimistic about the health implications.
“I don’t think the World Cup will necessarily bring an increased risk of the spread of HIV,” he told CNN.
“Over the years there has been an incredible amount of education and awareness work done among sex workers. Years ago the high-risk groups were thought to be homosexuals and sex workers, but there has been such a focus on education for these groups that their behavior has really changed. It’s quite the norm for a commercial sex worker to have a bag full of condoms.”
Seedat said all public health centers in South Africa offer free voluntary counseling and HIV testing, and that organizations like SWEAT had helped educate sex workers about the importance of using condoms and being tested if they have practiced unsafe sex.
“People in the sex work sector make sure that they’re protected, that they’re tested and that they know their [HIV] status,” he said.
Harper said most sex workers do practice safe sex, but many clients don’t want to use a condom. He added that as long as prostitution remains illegal, protecting sex workers and their clients during the World Cup would be problematic.
He told CNN, “We have to make condoms freely available and we have to make it possible for sex workers to report human rights violations like child prostitution and people trafficking.”
AIDS activist Deloris Dockery is having some success lobbying religious leaders in Newark, New Jersey, to discuss HIV prevention with their congregations, NJ.com reports.
According to the article, Dockery was diagnosed with HIV in 1994. She has since earned a master’s degree in public health and now heads the One Conversation program at the New Jersey–based Hyacinth AIDS Foundation.
As part of her outreach work, Dockery travels to churches throughout the Newark area giving presentations and organizing testing centers. She urges religious leaders to talk about safer sex, needle exchange programs and early detection.
One in 47 people in Newark is living with HIV/AIDS. And one in 62 African Americans in New Jersey is living with HIV/AIDS compared with one in 705 whites, according to the city’s Department of Health and Senior Services.
The California-based AIDS Healthcare Foundation (AHF) has filed a petition to amend state regulations to explicitly require condom use in the Los Angeles adult film industry, which has an ongoing sexually transmitted infection (STI) epidemic.
AHF’s petition calls on the California Occupational Safety and Health Standards Board (Cal/OSHA) to clarify protection for adult film industry workers and to include a condom requirement to the “bloodborne pathogens” regulations.
“We are taking this action on behalf of the thousands of workers who are needlessly exposed to [STIs] during the production of adult films in California. We look forward to Cal/OSHA’s swift action on this issue,” said Michael Weinstein, AHF’s president.
According to the Los Angeles County Department of Public Health (LADPH), transmission of STIs is 10 times more likely to occur among adult film workers than the general population.
Between 2003 and 2007, LADPH documented 2,013 chlamydia cases and 965 gonorrhea cases among adult film workers. There have been at least 25 industry-related HIV cases since 2004.
