Positively Aware Magazine. Current HIV news and updates.

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

Positively Aware Online News Brief. Current HIV News and events

POSITIVELY AWARE 4/02/2012

Number of people on the ADAP waiting list, 3,666

Fate of Affordable Care Act in Supreme Court’s Hands

The Patient Protection & Affordable Care Act (ACA) appeared to be very much at risk after the Supreme Court concluded its three-day review of the legislation on March 28. Oral arguments took place on the individual mandate’s constitutionality, the “severability” of the mandate from the rest of the law, and the affect on the states of the Medicaid expansion planned for 2014.

The first two days of arguments involved the individual mandate, with the plaintiffs claiming it is unconstitutional for Congress to enact a law which forces people to purchase health insurance and Solicitor General Donald Verrilli Jr. defending the government’s position. The mandate was supposedly included to offset the cost of other policies that require insurers to cover sick people, which makes it ironic that Republicans are the ones opposing it. Deputy Solicitor General Edwin Kneedler said the court would have to strike two other provisions along with the mandate: the requirement that insurers cover anyone who applies (including those with “pre-existing conditions”) and the ban on charging higher prices to customers with pre-existing conditions, two provisions that are more popular politically. If the Court rules against the mandate but does not strike down the entire law, it would force Congress to come up with an alternative way to prevent healthcare costs from skyrocketing.

The final session of arguments centered on whether the court will overturn the healthcare law’s Medicaid expansion. The states challenging the law say it’s “coercive” and goes against the fact that Medicaid is a voluntary program operated jointly by states and the federal government. The health law expands Medicaid eligibility to everyone at or below 133% of the federal poverty level ($14,856 for an individual, $30,657 for a family of four). The federal government would initially cover all of the new costs, but states that don’t adopt the new eligibility levels could lose all of their federal Medicaid funding, not just the part associated with the expansion.

The court is expected to rule in June and political pundits are already offering predictions on how the ruling might affect the presidential election and the race for control of the Congress. Neither the White House nor Republicans seem to have a contingency plan for what will happen if the entire law is struck down.

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New Discovery about Marijuana and HIV

Mount Sinai School of Medicine researchers have discovered that marijuana-like chemicals trigger receptors on human immune cells that can directly inhibit a type of HIV found in late-stage AIDS, according to new findings published online in the journal PLoS ONE.

Medical marijuana is prescribed to treat pain, debilitating weight loss, and appetite suppression, side effects that are common in advanced AIDS. This is the first study to reveal how the marijuana receptors found on immune cells—called cannabinoid receptors CB1 and CB2—can influence the spread of the virus. Understanding the effect of these receptors on the virus could help scientists develop new drugs to slow the progression of AIDS.

“We knew that cannabinoid drugs like marijuana can have a therapeutic effect in AIDS patients, but did not understand how they influence the spread of the virus itself,” said study author Cristina Costantino, PhD, Postdoctoral Fellow in the Department of Pharmacology and Systems Therapeutics at Mount Sinai School of Medicine. “We wanted to explore cannabinoid receptors as a target for pharmaceutical interventions that treat the symptoms of late-stage AIDS and prevent further progression of the disease without the undesirable side effects of medical marijuana.”

Because triggering CB1 causes the drug high associated with marijuana, making physicians reluctant to prescribe it, the researchers wanted to explore therapies that would target CB2 only. The Mount Sinai team infected healthy immune cells with HIV, then treated them with a chemical that triggers CB2 called an agonist. They found that the drug reduced the infection of the remaining cells.

“Developing a drug that triggers only CB2 as an adjunctive treatment to standard antiviral medication may help alleviate the symptoms of late-stage AIDS and prevent the virus from spreading,” said Dr. Costantino. CB2 agonists appear to be an effective antiviral drug only in late-stage disease.

As a result of this discovery, the research team led by Benjamin Chen, MD, PhD, Associate Professor of Infectious Diseases, and Lakshmi Devi, PhD, Professor of Pharmacology and Systems Therapeutics at Mount Sinai School of Medicine, plans to develop a mouse model of late-stage AIDS in order to test the efficacy of a drug that triggers CB2 in vivo.

Funding for this study was provided to Drs. Chen and Devi by the National Institutes of Health (NIH). Dr. Costantino is supported by an NIH Clinical and Translational Science Award grant awarded to Mount Sinai School of Medicine.

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D.C. Female Condom Program Highly Effective in Preventing HIV

A new economic analysis conducted by Johns Hopkins Bloomberg School of Public Health and featured in the current issue of AIDS and Behavior, showed that the Washington, D.C. female condom program prevented enough HIV infections in the first year alone to save over $8 million in future medical care costs (over and above the cost of the program). This means that for every dollar spent on the program, there was a cost savings of nearly $20. The program is a public-private partnership to provide and promote FC2 female condoms.

A coalition led by the D.C. Department of Health (DOH) with support from the Washington AIDS Partnership, CVS/Caremark, and the Female Health Company provided educational services and distributed more than 200,000 FC2 female condoms in areas in the District with disproportionately high HIV prevalence rates among women.  The MAC AIDS Fund provided funding support for the project, which subsequently engaged five community-based organizations already working in the field of women’s health and HIV/STD prevention to assist with education and distribution activities.

“These results clearly indicate that delivery of, and education about, female condoms is an effective HIV prevention intervention and an outstanding public health investment,” said Dr. David R. Holtgrave, professor and chair of the Department of Health Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and a national expert in evaluating the efficacy and cost-effectiveness of HIV prevention interventions. Similar community HIV prevention programs involving the female condom should be explored for replication in other high risk areas.”

Black women account for roughly 57% of new HIV infections in all women in the U.S. and 90% of all new HIV infections in the District. The success and affordability of this pilot program suggests that promotion of and education about the female condom can have significant impact in helping prevent infection among women who are at risk of contracting HIV.

“We are extremely excited and encouraged by the success of the DC FC2 Female Condom program,” said Dr. Gregory Pappas, Senior Deputy Director HIV/AIDS STD Administration, D.C. Department of Health. “The District still has a serious HIV epidemic and women are at risk. It is critical that we empower women, especially those at greatest risk, to take control by increasing awareness of the female condom and providing both education and access to this highly effective and affordable option that empowers women to protect themselves.”

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AAHIVM Survey Wants YOU!

The American Academy of HIV Medicine is currently seeking participants in a survey to learn more about attitudes towards HIV care and treatment among both providers and people living with HIV. The study is enrolling about 250 providers and 750 patients. If you are at least 18 years old and currently being treated for HIV, participate in this web-based survey and let them know what you think.

To participate in the survey, click here. It takes approximately 15 minutes to complete the survey.

The survey will ask questions that some people may find uncomfortable to answer, such as your income, education, race, and sexual practices, but you don’t have to answer any questions you don’t want to answer and your responses will be totally confidential. Each respondent will be identified by a unique code. You won’t be identified by name in any database or publications that may result from this study.

Each question is asked to help researchers learn how to improve HIV education for different groups of people. Your participation will be greatly appreciated!

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Updated HHS Antiretroviral Treatment Guidelines Now Available

The HHS Panel on Antiretroviral Guidelines for Adults and Adolescents has released the updated Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Key additions and revisions to the guidelines include:

  • New section on HIV and the older patient
  • New table on cost of antiretroviral drugs
  • Updated recommendations on initiation of antiretroviral therapy (ART) in treatment-naive individuals
  • Expanded discussion of use of hormonal contraceptives in HIV-infected women
  • Preliminary recommendations on co-administration of the newly approved hepatitis C virus drugs Victrelis (boceprevir) and Incivek (telaprevir)
  • Recommendations on "when to start" ART in HIV-infected individuals diagnosed with tuberculosis but not receiving ART
  • Discussion of the role of effective ART in preventing HIV transmission

For a complete preview of key updates to the guidelines, please see What's New in the Guidelines?

To view or download the guidelines, go to the Adult and Adolescent Treatment Guidelines.

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Transgender Activist Alexis Rivera Dies

Photo via YouTube

Highly respected transgender rights activist Alexis Rivera died in San Francisco on March 28 of complications related to HIV. She was 34.

A Los Angeles native, Rivera began her activism as a teenager doing street outreach to LGBT youth in Hollywood and was involved in the transgender community for the past 15 years. She worked as a case manager and, later, the first program director for Children’s Hospital Los Angeles’s iconic Tranny Rockstar program, helping provide vital support services to hundreds of transgender youth in Los Angeles. She participated as a Commissioner for the Los Angeles County Commission on HIV/AIDS; was on the founding board of the Female-to-Male Alliance of Los Angeles; and, for six years chaired the Transgender Service Provider Network. Rivera was a founding member of the League of Trans Unified Sisters (LOTUS), a sisterhood for transgender women. She later worked on a statewide level as Policy Advocate for the Transgender Law Center, playing an instrumental role in advocating for statewide legislative change and training hundreds of transgender community members to speak to elected officials. During this time, Rivera was also a leader of the Transgender Law Center’s Health Care Access Project and helped secure affordable transgender healthcare services in several counties across the state of California.

Due to the many contributions Rivera made over her lifetime, she received several awards including: the Trans-Unity Trailblazer Award; the Latino Caucus on HIV Prevention Leadership Award; the Trans-Unity Spirit Award; and she was named the first winner of the QUEST Advocacy Pagent for transgender woman in 2002.

According to a close friend, “Alexis was an amazing community activist. She was also a mother. She also became a grandmother a month before she died. She was also a sister, a daughter, a granddaughter, and an aunt. She was a mentor to so many, and a friend to many, many more.” In describing her commitment and passion for her community, Rivera is quoted as having stated, “My activism is rooted from love.”

Mason Davis, Executive Director of Transgender Law Center, said in a statement: "She understood that we are stronger together, and she kept organizing until the very end. Alexis' death is a reminder that the fight for equality—and against AIDS—is far from over."

A tribute video can be viewed here.

Memorials for Rivera will be held this weekend in both Los Angeles and San Francisco. For more information, click here.

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Legislation Watch

By Sue Saltmarsh

Let me just get this out of the way. You can read about the proceedings of the Supremes and the ACA above. But the last sentence in that report is “Neither the White House nor Republicans seem to have a contingency plan for what will happen if the entire law is struck down.” Neither does the HIV/AIDS community which has been promoting the ACA as if hired by the White House to do so. We’ve got until June to come up with our Plan B—I hope we waste no more time picking out the few good components of the ACA and buying into the fantasy of the 2014 Medicaid expansion. If indeed the Court throws out the entire law, an unprecedented opportunity will open up for the HIV community to join with all other disease groups to demand single-payer healthcare. DUH.

On March 27, a coalition of 18 Democratic Congresswomen led by Gwen Moore of Wisconsin introduced H.R. 4271, a bill to reauthorize the Violence Against Women Act of 1994. In this, the anti-women House, chances are it will never get out of the Committees on the Judiciary; Energy and Commerce; Education and the Workforce; Financial Services; and Natural Resources. But kudos to the ladies for trying.

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