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Positively Aware, The HIV News Journal published by the Test Positive Aware Network

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POSITIVELY AWARE October 3rd 2011

Number of people on the ADAP waiting list, 9,066

Crest for National Gay Men's HIV/AIDS Awareness Day Sept 27thHHS Releases $1.84 Billion in Grants for HIV/AIDS Care and Medications

The U.S. Department of Health and Human Services (HHS) announced on September 26 that it has released more than $1.84 billion to ensure that people living with HIV/AIDS continue to have access to life-saving health care and medications. The grants are funded through the $2 billion appropriated to the Ryan White HIV/AIDS Program for the current fiscal year.

"These grants will help make a real difference in the lives of Americans living with HIV/AIDS, especially those in underserved rural and urban communities, ensuring they get access to quality health care and support systems," HHS Secretary Kathleen Sebelius said. "The care and services these grants support will help Americans living with HIV/AIDS to live longer, healthier lives."

Approximately $1.21 billion will be sent to states and territories under Part B of the Ryan White Program, with $813 million of that total designated for the AIDS Drug Assistance Program (ADAP). Sixteen states will also receive Emerging Community grants based on the number of AIDS cases over the most recent five-year period. Moreover, a total of $8,386,340 in Part B Supplemental grants was awarded to 36 states and territories that demonstrated need based on the severity of the HIV/AIDS epidemic in the state/territory. These grants provide supplemental funding to address specific needs, including projected ADAP shortfalls and additional core medical services. For a list of Part B Supplemental awards, visit: www.hrsa.gov/about/news/2011tables/110926hivaids.html#finalpartb .

In addition, 30 Part B States and Territories will receive $40 million in ADAP Emergency Relief Funding (ERF) for the purpose of eliminating or reducing ADAP waiting lists and/or supporting cost containment strategies to prevent implementation of a waiting list. For a list of ADAP ERF awards, visit: www.hrsa.gov/about/news/2011tables/110926hivaids.html#partbadap .

A total of $645 million was awarded to 52 cities to provide core medical and support services for individuals living with HIV/AIDS under Part A of the Ryan White Program. These awards go to eligible metropolitan areas with the highest number of people living with HIV/AIDS and to transitional grant areas experiencing increases in HIV/AIDS cases and emerging care needs. The Part A awards include $49.6 million for the Minority AIDS Initiative to improve access to care in disproportionately impacted communities. For a list of Part A awards, visit: www.hrsa.gov/about/news/2011tables/110926hivaids.html#finalparta .

Seventy-five percent of Part A and B funds must be spent on "core medical services." The remaining 25% pays for support services that help people living with HIV/AIDS achieve desired medical outcomes.

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ADAP Advocacy Association Sends Appeal to House Members to Join HIV/AIDS Caucus

The ADAP Advocacy Association (aaa+) announced on September 28 that it has sent an appeal to the entire House of Representatives asking them to join the new HIV/AIDS Caucus. The letter was sent using MyGov365, a nonpartisan civic engagement platform, and it stressed the need for bipartisanship to successfully combat HIV/AIDS in general, and the crisis facing the AIDS Drug Assistance Programs (ADAPs) in the United States, specifically.

"We commend Representatives Barbara Lee, Jim McDermott, and Gary Franks for their leadership on forming the HIV/AIDS Caucus, as well as the 60 Members of Congress who have already joined it," said Brandon M. Macsata, CEO of the ADAP Advocacy Association. "But considering the importance of this issue—including a record number of people living with HIV/AIDS on ADAP being denied access to life-saving medications—we must ensure that as many Members of Congress join the Caucus as possible."

The letter reads, in part: "The ADAP Advocacy Association is asking EVERY House Member to join this very important Caucus. HIV/AIDS is NOT a partisan issue. Since the Human Immunodeficiency Virus (HIV) doesn't ask people it is about to infect about their political party affiliation, it is incumbent upon our elected officials to combat HIV using the very same standard. Partisanship needs to be left out of the equation altogether."

The letter also stressed the need for the HIV/AIDS Caucus to take up the ongoing ADAP crisis as its very first priority. The letter can be read online at http://www.adapadvocacyassociation.org/pressroom.html.

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ViiV Healthcare Reaffirms Commitment to U.S. Regions Hardest Hit by HIV/AIDS

ViiV Healthcare announced on September 26 the 2011 grant awardees of the Positive Action Southern Initiative expansion, focused on supporting African-American and Latino populations in Florida, North Carolina, South Carolina and Tennessee. Established in 2010 and initially piloted in Alabama, Georgia, Louisiana, and Mississippi, the initiative focuses on linking people living with HIV into care and/or enhancing their treatment adherence and delaying disease progression.

“Access to adequate resources and support for effective interventions and quality services to fight HIV continues to be a challenge in the southern United States,” said Patrick Packer, Executive Director of the Southern AIDS Coalition. “With these grants, the Positive Action Southern Initiative helps to provide life-saving resources to those who need them most.”

“ViiV Healthcare is committed to supporting communities most affected by HIV. The local community solutions and programs proposed by our awardees represent realistic goals that will help to lessen the impact of HIV in disproportioned communities,” said Bill Collier, Head of North America, ViiV Healthcare. “The HIV community plays a pivotal role in positively impacting areas in critical need of HIV/AIDS resources, and we are proud to assist these grassroots organizations and programs to further support the care of people living with HIV.”

To read more about the awards, including details about the awardees, go to http://www.viivhealthcare.com/media-room/press-releases/2011-09-26.aspx

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HUD Awards $8.8 MILLION to Improve Housing and Services for HIV-positive People

The U.S. Department of Housing and Urban Development awarded nearly $9 million on September 22 to seven states that will offer permanent and transitional housing and support services to more than 200 families and individuals living with HIV/AIDS. Provided through HUD’s Housing Opportunities for Persons with AIDS (HOPWA) Program, these projects will also develop new cross program approaches in HIV care by creating an Integrated HIV/AIDS Housing Plan in their communities. 

“These resources will allow public agencies, nonprofits, and housing authorities to forge new partnerships so that together, we can deliver comprehensive housing solutions and services for low-income families dealing with HIV,” HUD Secretary Shaun Donovan said. “These communities will be innovating to more effectively and efficiently assist vulnerable households with HIV and serve as models for others to improve health outcomes and reduce risks of homelessness.”

HUD’s grant funding will support the following cities and organizations:

LOCATION                                          AGENCY
Los Angeles:                         Los Angeles County Commission on HIV
Jacksonville, FL:                   River Region Human Services, Inc.
Boston:                                  Justice Resource Institute, Inc.
State of Maine:                      Frannie Peabody Center
Albany and Rochester, NY    Corporation for AIDS Research Education & Services Inc.
Portland, OR:                        City of Portland
Dallas:                                   City of Dallas

In collaboration with other parties, these groups will offer supportive housing over the next three years to 208 households. Grants funded under this initiative advance HUD’s implementation of the National HIV/AIDS Strategy (NHAS will also help achieve the Obama Administration’s Opening Doors Strategy to prevent and end homelessness.

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Prevention Advocates' Open Letter Urges Rejection of PrEP Misinformation

Close to 100 openly HIV-positive gay and bisexual men from across the United States and around the world have signed a letter calling for an open discussion of the challenges and opportunities presented by pre-exposure prophylaxis (PrEP) for HIV prevention in gay and bisexual men and transgender women. The open letter is designed in part to urge FDA review of PrEP and to clarify facts about important PrEP research that advocates say have been misrepresented in a paid ad campaign sponsored by the AIDS Healthcare Foundation (AHF).

Results from the international iPrEx study showed that a once-daily dose of the HIV medication Truvada can prevent HIV infection by 42 to 93%. This was confirmed by results of the TDF2 study which showed a 63% reduction of risk of infection.

Most of the HIV prevention community welcomed the news of a new tool that could significantly reduce infections in the populations at highest risk for HIV in many parts of the world. One HIV treatment provider, however, the AIDS Healthcare Foundation, has taken out an extensive series of full-page advertisements in gay papers around the country claiming that gay and bisexual men will act recklessly and will spread HIV if they are allowed to use PrEP. The AHF ad campaign claims that it is supporting gay and bisexual health by urging the FDA to ignore the PrEP study.

But many gay men didn’t see it that way (see “I Haven’t Given Up, I’ve Taken Charge” by Nick Literski, who’s taking PrEP, in the July/August issue of Positively Aware). The open letter challenges both the tone and content of the AHF communications and encourages "a full and factual discussion of the pros and cons of PrEP ... based on facts, not misinformation." Reminding the world that "gay and bisexual men invented safer sex … and have worked tirelessly to prevent new HIV infections," the letter also points out that gay and bisexual men account for more than half of new HIV infections in the United States and are in particular need of new HIV prevention approaches.

The letter acknowledges that PrEP, "is no magic solution to the HIV crisis," and that research, "raises important questions … includ[ing] how to best support regular PrEP use; how to ensure the continued use of condoms and other precautions for those who decide to take PrEP; how to target PrEP to those who will benefit most; and how to pay for this new HIV prevention tool." Its signers express their commitment "to promoting safer sex and the open exchange of accurate information on HIV prevention," and to "clarify the facts about PrEP, open up community discussion and make clear our belief that we are entitled to respect, accurate information, and new HIV prevention tools." The letter concludes by calling on all interested parties to "get the facts about PrEP, seek information, and express opinions … but to do so based on real information, not fear of the scientific process or prejudice against gay/bi men."

The letter was coordinated by a group of U.S.-based AIDS advocacy organizations, including the AIDS Foundation of Chicago, the AIDS Vaccine Advocacy Coalition (AVAC), the International Rectal Microbicide Advocates (IRMA), and Project Inform.

Openly HIV-positive gay and bisexual men who wish to add their name to the letter can do so at: http://tinyurl.com/pozPrEPletter.

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New Study Addresses “When to Start?” Question

Some recent studies have found that starting highly active antiretroviral therapy earlier is better. Now a new study led by researchers at the University of North Carolina at Chapel Hill finds that there may be a limit to how early the therapy, known as HAART, should start, according to a report in ScienceDaily on a study which is published in the September 26 issue of the journal Archives of Internal Medicine.

The new results could help determine where the starting line for antiretroviral therapy should be drawn, said Michele Jonsson Funk, PhD, research assistant professor in the UNC Gillings School of Global Public Health and lead author of the study. "The drugs used to treat HIV are expensive, treatment is life-long, and the side effects can be serious," Jonsson Funk said. "So we really need to know if the patient's investment will pay off, how large the benefit is likely to be, and how long it will take to realize it.

"The bottom line from these findings, taken together with other studies published over the last few years, is that initiating therapy when the patient's CD4 count is between 350 and 500 appears to be beneficial over the long term. But for patients with a CD4 count above 500, the jury is still out."

There is wide agreement among researchers and health-care providers that HIV patients with CD4 counts below 350 should be on antiretroviral therapy. However, there is still uncertainty regarding starting treatment at higher CD4 counts. This study was aimed at answering that question.

The researchers found slower progression of HIV among patients whose CD4 counts were between 350 and 499 when they began treatment. The findings also showed a 41% reduction in the relative risk of AIDS or death for patients who started receiving HAART with CD4 counts of 200 to 349; and reductions in the risk of death of 29% and 49% associated with HAART initiation at CD4 counts of 200-349 and 350-499, respectively. However, there appeared to be no benefit to initiating treatment at CD4 counts between 500 and 800.

The results are based on statistical analyses that Jonsson Funk and study co-authors performed on data collected from 9,455 HIV patients in Europe, Australia, and Canada between 1996 and 2009. The patients were enrolled in the CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe) Collaboration.

Dr. Joseph Eron, co-author of the study, a professor in the UNC School of Medicine and a member of the UNC Center for AIDS Research, was also a co-author of a landmark HIV prevention study called HPTN 052, which found that early treatment (CD4 count of 350-550) with combination antiretroviral therapy led to a 96% reduction in transmission of the virus to the uninfected partners of HIV-positive participants and a 40% reduction in their own risk of developing a serious illness. Those results are consistent with the results reported by Jonsson Funk.

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Novel Computational Analysis Predicts New Targets for the Control of HIV

A new computational approach has predicted numerous human proteins that HIV requires to replicate. These discoveries "constitute a powerful resource for experimentalists who desire to discover new targets for human proteins that can control the spread of HIV," according to the study that appears in the September 22 issue of PLoS Computational Biology, a journal published by the Public Library of Science.

The recent research is examining whether human proteins can be targeted to cure HIV. “Since viruses such as HIV have very small genomes, they must exploit the cellular machinery of the host to spread. Therefore, disrupting the activity of selected host proteins may impede viruses. Moreover, since human proteins evolve at a much slower rate than HIV proteins, human proteins that are targeted by drugs are very unlikely to develop mutations that render the drugs ineffective,” according to a report of the study in ScienceDaily.

In fact, three studies published in 2008 systematically silenced virtually every human gene in order to discover HIV Dependency Factors (HDFs), i.e., those genes that are necessary for HIV to survive and replicate. Each of these three studies discovered hundreds of HDFs. However, only a handful of HDFs were common to two or more experiments.

"We set out to untangle this mystery," said T. M. Murali, a computer scientist at Virginia Tech and co-author of the study. "We hypothesized that many HDFs have not yet been discovered. Other papers had suggested that HDFs may themselves interact with each other. Inspired by these observations, we hypothesized that we could predict new HDFs by exploiting the proximity between HDFs within networks of interactions between human proteins."

To this end, they used an algorithm called SinkSource developed by Murali and co-author Brett Tyler of the Virginia Bioinformatics Institute, also at Virginia Tech. Tyler explained, "We treated the human protein network as if it were a system of tanks connected by pipes carrying water. This arrangement allowed us to study the flow of predictive information (water) from proteins we are certain about (full tanks) to those we are uncertain about (empty tanks). The further you get from the full tanks, the weaker the trickle, and the less water accumulates in the bottom of the tank. Mathematically, you can show that, over time, every empty tank accumulates some stable level of water. At the end of the analysis, tanks accumulating lots of water were judged to be good predictions."

"We found that SinkSource and one of its variants made predictions of very high quality," Murali added. "We evaluated predicted HDFS using a number of additional datasets that we did not use during the prediction step."

Their most exciting results used an analysis of HDF activities in African green monkeys and pig-tailed macaques, both of which respond differently to Simian Immunodeficiency Virus (SIV). The African green monkey does not develop disease when infected by SIV, while pig-tailed macaques do. The authors showed that predicted HDFs had very different patterns of expression in the two species, especially in lymph nodes and within 10 days after infection with the virus. They also showed that predicted HDFs participated in human cellular processes that are known to be subverted by the virus, including gene transcription and translation, energy production, protein degradation, and transport across the nuclear membrane. Moreover, many predicted HDFs themselves directly interacted with proteins in HIV.

From these results, the researchers concluded, “Our results suggest that many HDFs are yet to be discovered and that they have potential value as prognostic markers to determine pathological outcome and the likelihood of Acquired Immune Deficiency Syndrome (AIDS) development."

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Legislation Watch

By Sue Saltmarsh

Besides the numbers released from HHS for the funding of HIV/AIDS programs, there was other HIV legislative news.

H.R. 3053, “a bill to eliminate discrimination in the law for those who have tested positive for HIV” was introduced by the irrepressible Barbara Lee of California with the support of 12 other Democrats, including Illinois’ Jesse Jackson, Jr. and Mike Quigley. The Repeal Existing Policies that Encourage and Allow Legal (REPEAL) HIV Discrimination Act (HR 3053) would require the U.S. Attorney General and the Secretary of Health and Human Services to update guidelines and assist states in changing discriminatory criminalization policies against people living with HIV/AIDS. Within the text of the legislation, are the following facts:

  • The Ryan White Comprehensive AIDS Emergency Act of 1990 (CARE Act) mandated that States prove the adequacy of their laws for criminal prosecution of “intentional transmission” of HIV before they could receive Federal funding for HIV/AIDS prevention.
  • By 1993, approximately half the States had HIV-specific criminal legislation. Most of these felony laws do not require that HIV transmission actually occur for a person to be charged and convicted. Being unaware of one's HIV status is the primary defense to prosecution under State criminal laws, because almost all statutes that criminalize exposure to HIV do so only if the accused individual, prior to the time of exposure, has been tested and informed that he or she is infected with HIV.
You can read the entire bill here. This is one we should all get our Representatives to support!

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