Friday, November 21, 2008

• CDC's HIV Testing Recommendations Not Being Followed, Studies Show

CDC's HIV Testing Recommendations Not Being Followed, Studies Show
[Nov 21, 2008]

      Two years after CDC recommended routine HIV testing for people ages 13 to 64, several studies presented at a recent conference indicate that the recommendations generally are not being followed, the Washington Post reports (Brown, Washington Post, 11/21). According to the Baltimore Sun, researchers at the Forum for Collaborative HIV Research -- based at the George Washington University School of Public Health -- said on Thursday during the conference that HIV testing is a significant step to ending the epidemic in the U.S. About 1.1 million people are living with HIV in the U.S. and one in five is unaware of his or her status. The researchers also said that people who are unaware that they are HIV-positive are responsible for transmitting 50% to 70% of new sexually transmitted infection cases. John Bartlett, chief of infectious diseases at Johns Hopkins University School of Medicine and a co-chair of the meeting, said the high number of people unaware of their HIV status should be a "call to action that the test will be offered on a more regular basis" (Brewington, Baltimore Sun, 11/21).

According to the Post, the studies show that the most common reasons for not following CDC's recommendations are misconceptions by clinicians that the tests take too much time, as well as an unwillingness by health insurers to pay for the tests. Kevin Fenton -- director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention -- said, "Reimbursement is a major barrier to routine testing." The Post reports that testing a patient who receives an initial saliva test, followed by a blood test for confirmation if possible, costs about $80 to $120 if the patient is charged (Washington Post, 11/21).

The Sun also reports that a continuing stigma associated with HIV/AIDS is contributing to a lack of widespread testing. Richard Rothman, associate professor in Johns Hopkins University's Department of Emergency Medicine, said 2006 data show that emergency departments tested patients at a rate of 3.2 tests per 1,000 visits. "There are many missed opportunities in recognizing patients earlier in the course of their illness," he said (Baltimore Sun, 11/21). Veronica Miller, executive director of the forum, said that HIV/AIDS is a "life-threatening disease that is so grossly underdiagnosed and undertreated in this country." She said that about 5% of patients presenting with serious illness are routinely tested for HIV in hospital EDs. For example, at John H. Stroger Jr. Hospital of Cook County in Chicago, about 2,000 people who went to the ED and were ill enough to be admitted were offered HIV tests. Slightly less than 1% tested HIV-positive, and more than 90% had CD4+ T cell counts less than 200, one of the factors that leads to an AIDS diagnosis (Washington Post, 11/21).

According to the AP/Indianapolis Star, 11 states have changed their laws to no longer require special consent for HIV testing, which is a "key step to making an HIV test part of the standard battery that patients expect." People living with HIV are "mostly likely" to be found in EDs because many are uninsured and have low incomes, the AP/Star reports. Bartlett said that routine HIV testing in patients who are not critically ill is given in no more than 100 of the U.S.'s 5,000 EDs, adding that about 40% of pregnant women and their infants who should be tested for HIV are not. "Those are what we call missed opportunities," he said (Neergaard, AP/Indianapolis Star, 11/20).

The studies also show that if routine HIV testing were implemented in the U.S., HIV detection could occur at earlier stages in many people (Washington Post, 11/21). Miller said that it is "crucial to understand how important routine HIV testing is at every level of American society so everyone knows their status; it's the first step in controlling the HIV epidemic" (Tasker, Miami Herald, 11/20). Bartlett said HIV testing today is "much better, it's much easier, it's much cheaper. The treatment is really great now." CDC's Bernard Branson said the agency "find[s] people are very receptive to being tested, and there was concern about that before." He added that "people are taking the recommendations to heart and implementing them as much as was feasible for them." According to the AP/Star, data from the studies presented on Thursday indicate that more than 80% of ED patients were "amenable" to HIV tests and that most ED staff were opposed to administering the tests. This is "[p]resumably because [EDs] are so busy, and there is confusion on how much HIV counseling is needed," the AP/Star reports. There are no nationwide data on the impact of the new guidelines, according to Branson (AP/Indianapolis Star, 11/20).

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Advocates Rally at White House, Urge Obama To Prioritize HIV/AIDS
[Nov 21, 2008]

      More than 1,000 HIV-positive people and HIV/AIDS advocates gathered near the White House on Thursday to urge President-elect Barack Obama to improve both domestic and global HIV/AIDS initiatives, VOA News reports (Lesser VOA News, 11/20). The groups that organized the rally are asking Obama to take action on a national AIDS strategy in the U.S., as well as build upon current efforts abroad through the President's Emergency Plan for AIDS Relief during his first 100 days in office (100 Days To Fight AIDS release, 11/20).

Michael Swigert, associate director of Africa Action, said that Obama's first 100 days in office will be "a critical period" for setting HIV/AIDS priorities, including appointing the next U.S. global AIDS coordinator and other global health positions. Swigert said that it is "important that Obama fill those positions with qualified individuals who support comprehensive prevention programs." According to Swigert, President Bush's HIV/AIDS work is "probably his most popular foreign policy" and has generated "good will for us abroad." Under the next administration, the U.S. should "continue to be a leader" in these efforts, he said.

According to Swigert, HIV/AIDS funding should be a priority for the next president as well as the next Congress. He acknowledged that current economic conditions will pose challenges for the next administration to fund expanded HIV/AIDS initiatives but said that the U.S. "need[s] to provide $59 billion over five years" through PEPFAR "to fight not just HIV but also malaria and tuberculosis." Swigert added that the U.S. will need to set "hard treatment targets" and increase the availability of generic drugs to meet the goal of achieving universal treatment access by 2010. Although PEPFAR has done "an increasingly better job" of not relying on brand-name medications, the program "still could do better in stretching taxpayer dollars further to save lives in Africa," Swigert said. According to Swigert, there is a "big push" in the U.S. development community to "consolidate development assistance" and "harmonize" the funding of development programs in Africa. Therefore, it is "really important" for Obama to build on his "incredible popularity" by enlisting U.S. allies in Europe to address issues like HIV/AIDS "that really affect Europeans, Americans as much as Africans," Swigert said.

According to VOA News, Obama during the U.S. presidential campaign committed to guarantee treatment and care for HIV-positive people in the U.S., provide housing for people living with HIV, end the federal ban on needle-exchange programs and redirect abstinence-only education into broader HIV prevention programs. In addition, Vice President-elect Joe Biden in July helped pass a bill to reauthorize PEPFAR in Congress, VOA News reports (Lesser, VOA News, 11/20).

An audio discussion with Swigert is available online.

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About Half of Nurses in U.K. Have Experienced Needle Stick Injuries, Many Are Concerned About HIV Risk, Study Says
[Nov 21, 2008]

      A recent report by the United Kingdom's Royal College of Nursing found that 48% of the 5,000 nurses polled had been injured by a needle previously used on a patient during their careers, with about one-third fearing risk of exposure to bloodborne diseases such as HIV and hepatitis, BBC News reports (BBC News, 11/19). According to the PA/Google.com, the survey also found that although most nurses who had experienced a needle injury were provided with information about risks from their employer, 28% were not. In addition, about one-third of nurses within the National Health Service who had experienced an injury regarded the support they received from their employer as adequate (PA/Google.com, 11/19). According to BBC News, one-quarter of nurses who said they experienced needle sticks reported that their employer did not provide them with post-exposure prophylaxis. In addition, a poll of nurses in the report revealed that nearly half of the nurses do not have access to safety devices, such as shielded needles, that could protect nurses from infections like HIV and hepatitis, RCN said.

RCN General Secretary Peter Carter said, "It is clear that needle injuries are an everyday threat for nurses" (BBC News, 11/19). Currently, 94% of employers have a policy that covers prevention and reporting of needle stick injuries, but only 55% of the nurses surveyed had received training from their employer on safe needle use. Ninety-six percent of nurses said they use needles as part of their jobs, according to the PA/Google.com. Carter said, "Government and employers in the NHS need to start taking this issue seriously by introducing needle policies and investing in safer alternatives to traditional needles so that these accidents don't happen in the first place" (PA/Google.com, 11/19). An NHS Employers spokesperson said the agency acknowledges the RCN report and takes the "issue of needle stick injuries very seriously" (BBC News, 11/19).

The report is available online.

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Rise in New HIV Cases in Philippines Stirs Debate on Reproductive Health Bill
[Nov 21, 2008]

      In the face of increasing HIV cases in the Philippines, lawmakers are debating a reproductive health bill that could have a significant impact on reversing the upward trend in new cases through HIV prevention, care and support services, IRIN/PlusNews reports (IRIN/PlusNews, 11/19). The bill would increase HIV services in the country, as well as require government hospitals to include contraceptives in the supplies they purchase and make reproductive health education mandatory in schools (Kaiser Daily HIV/AIDS Report, 11/14).

According to a recent report from the Department of Health's National Epidemiology Center, 57 new HIV cases were recorded in September -- a 128% increase in the number of reported cases compared with the same period last year. Gerard Belimac, program manager of the National AIDS and STI Prevention and Control Program, said, "While the Philippines is still considered a low-incidence country, the epidemic level could come in three years," adding, "More and more people are resorting to risky behavior." Belimac said that although HIV has not reached epidemic levels in the country, UNAIDS has estimated that about 8,300 people are HIV-positive. He added that new HIV cases are primarily found in high-risk groups such as commercial sex workers and men who have sex with men. Ferchito Avelino, national coordinator of the Philippine National AIDS Council, said that although Filipinos may be aware of the risk of HIV/AIDS, such knowledge is not translating into behavior change. In addition, he said that misconceptions about the virus have created a false sense of security, adding that although the country has a relatively low number of HIV cases compared with other nations, "there is no room for complacency." Avelino also called for an aggressive HIV prevention campaign, noting that the median age bracket in which Filipinos first engage in sexual activity is becoming younger.

According to Belimac, it is crucial that the government approves the bill because HIV programs are achieving 30% coverage overall and only sex workers are fully covered by the programs. Belimac said, "In order to reverse the trend, we must have 80% coverage," adding that a "lack of political will" is the main obstacle to preventing HIV transmission. For example, he said most local governments do not have budgets for HIV intervention programs, which indicates lack of commitment. "HIV prevention takes a back seat and, with their limited funds for health services, the local government units are not entirely to blame; HIV prevention competes with other health services," Belimac said (IRIN/PlusNews, 11/19).

Catholic Bishops Introduce Version of Bill
In related news, Catholic bishops in the country are drafting their own version of the reproductive health bill because of the fact that it promotes the use of contraceptives and condoms, Reuters reports. The Rev. Melvin Castro of the Episcopal Commission on Family and Life said that the bishops have been working with lawmakers to draft an alternative to the measure, given that they consider it unconstitutional and an infringement on the religious beliefs of Filipinos. About 85% of the nearly 90 million people in the Philippines are Catholic. Castro said, "We would not allow a legislation that would allocate money from a majority of the taxpayers who are Catholics to be allocated to a program which is against their beliefs." According to Reuters, some bishops have threatened to refuse Holy Communion and other sacraments to politicians who support the bill (Reuters, 11/20).

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Uganda Begins Drafting National Circumcision Policy, Health Official Says
[Nov 21, 2008]

      Uganda's Ministry of Health has started to draft a medical male circumcision policy for HIV prevention, the New Vision/AllAfrica.com reports. "Assessment of the capacity of health units to implement the policy has been conducted," Sam Zaramba, general director of health services, said. He also said that the policy "will not be a stand alone strategy" but part of the country's HIV prevention strategy that emphasizes abstinence, condom use and fidelity (Bugembe, New Vision/AllAfrica.com, 11/20).

HIV/AIDS Biggest Challenge to Ugandan Army, President Says
In related news, Uganda's President Yoweri Museveni on Tuesday said that HIV/AIDS is the most significant challenge faced by the country's army, New Vision/All Africa.com reports. Museveni urged soldiers at Kaweweta military training school in Nakaseke to live responsibly in terms of HIV/AIDS prevention and care. "If you die or get sick from AIDS, you let us down," he said, adding that more soldiers have died from AIDS-related causes than in combat (Kiwanuka, New Vision/AllAfrica.com, 11/20).

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Many Women in India's Karnataka State Unaware Condoms Can Prevent HIV; Expanded Access to Condoms, Prevention Efforts Needed
[Nov 21, 2008]

      About 35% of women in India's Karnataka state know that condoms can prevent HIV transmission, according to India's National Family Health Survey, the Times of India reports. The survey indicated a need for increased access to HIV prevention and education and expanded access to female condoms, according to the Times. The NFHS survey also found that 12.3% of women and 32.6% of men in the state have comprehensive knowledge about HIV.

According to the Times, Karnataka has not been included in a National AIDS Control Organization condom distribution program despite the state's high HIV prevalence, which is twice as high as the national HIV prevalence. Other states with a high HIV prevalence, such as Manipur, also are not included in the NACO program, the Times reports. State HIV/AIDS control organizations last year supplied Karnataka with about 250 million male condoms, and a portion of NACO's annual budget has been allocated to distribute condoms in areas that have an increased risk of HIV, according to the Times.

NACO is scaling up efforts to introduce female condoms across the country. About 1.5 million female condoms were distributed in four states -- Andhra Pradesh, Maharashtra, Tamil Nadu and West Bengel -- and placed in government medical stores, Pritpal Marjara, team leader for technical support of NACO, said. Marjara added that the agency plans to obtain an additional 1.5 million female condoms for the program, which is expected to cost four million Indian rupees, or about $700,000. The condoms will be sold through nongovernmental organizations at a "highly subsidized rate" of 3.5 Indian rupees, or about 69 cents, Marjara said. NACO aims to reach 200,000 commercial sex workers through the program, Marjara said. NACO also is increasing the number of condom vending machines in train stations and public restrooms as part of the program, Mayank Agarwal, a joint director at NACO, said (Nagaraj, Times of India, 11/19).

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Reports Examine U.S., European HIV/AIDS Funding
[Nov 21, 2008]

      The groups Funders Concerned About AIDS and the European HIV/AIDS Funders Group recently released reports detailing HIV/AIDS funding that found total HIV/AIDS-related philanthropy increased to $555 million among U.S.-based funders and $168 million among European-based funders. Summaries of the reports appear below.

• "U.S. Philanthropic Support To Address HIV/AIDS in 2007," FCAA: According to the report, disbursements from U.S. philanthropies in 2007 increased by 10% compared with 2006. Eighty percent, or $446 million, of the funding in 2007 was allocated to international HIV/AIDS efforts. More U.S. funders -- 45% in 2007 compared with 35% in 2006 -- provided support to address exclusively the domestic epidemic, according to the report.
  
  
• "European Philanthropic Support To Address HIV/AIDS in 2007" (.pdf), EFG: The report found that 94% of European funders allocated all or some of their resources to HIV/AIDS outside of European Union countries. In addition, 6% of European funders in 2007 focused only on HIV/AIDS within E.U. countries, and 19% of all European funding was devoted to addressing the disease in Western and Central Europe (FCAA release, 11/20).

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