Good News for ADAP

As a result of emergency ADAP funding announced by the Department of Health & Human services on July 19, Idaho, Montana, and Nebraska were able to eliminate their waiting lists. Alabama, Georgia, North Carolina, and Virginia were able to reduce the overall number of individuals on their waiting lists.

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CDC Updates Gonorrhea Treatment Guidelines Due to Antibiotic Resistance

The Centers for Disease Control and Prevention (CDC) released updated guidelines for the treatment of gonorrhea, which is a major cause of pelvic inflammatory disease, ectopic pregnancy, and infertility and can facilitate HIV transmission. The updated guidelines were published in the CDC’s Morbidity and Mortality Weekly Report on August 9.

The CDC recommended only oral antibiotic treatment as the first line of defense for gonorrhea until this update, but now instead recommends that infections be treated with the injectable antibiotic ceftriaxone in combination with one of two other oral antibiotics, either doxycycline or azithromycin. This change in treatment has significant implications for medical providers and patients alike, as it involves not just the simple act of taking pills but also an injection administered by a certified health professional.

“We applaud the CDC’s preemptive strike of changing recommended treatment and with the intention of extending the life of the last effective drug,” said William Smith, Executive Director of the National Coalition of STD Directors (NCSD). “However, the rising resistance of gonorrhea to our last line of defense against it must be a clarion call to policymakers and private industry alike to invest in the research and development pipeline for new antibiotics and more sophisticated diagnostics…and quickly. We desperately need additional options to meet the challenges of this infection,” continued Smith.

Last summer, the CDC issued a report that outlined the U.S. being on the verge of a highly untreatable gonorrhea epidemic as gonorrhea has developed resistance to every class of antibiotics used against it and there is no new drug in the pipeline. Documented increases in resistance throughout the country are what have prompted the CDC to make the current recommended treatment change.

The CDC has also released a Cephalosporin-Resistant Gonorrhea Response Plan that makes a number of important recommendations to clinical providers and state and local health departments to help deal with the rise of antibiotic-resistant gonorrhea.

“The response plan includes a number of recommendations that are imperative to protect the public’s health, but NCSD’s member health departments throughout the country have seen drastic budget cuts, furloughs and layoff of staff, and constricted program activities over the past several years to the point where most are as bare bones as one can imagine,” Smith remarked. “In the face of this real and emerging threat, federal, state, and local governments must reinvest in health department STD programs without delay,” Smith urged.

Last year, federal government support to national STD prevention and control efforts at CDC totaled just under $155 million. State and local government contributions vary widely, but the vast majority of health department STD programs have seen significant budget reductions in recent years, some to the point where state and local contributions are zero.

“Finally, we know that resistance to treatment is already highest among gay men and other men who have sex with men (MSM)—the same population where concern rightly looms over increasing rates of HIV infection, especially among young MSM of color,” said Dr. Peter Leone, Chair of NCSD’s Board of Directors. “Treatment-resistant gonorrhea is a major health issue for all Americans, but it is likely to hit this population first and it is likely to have worrisome repercussions for increased HIV infections,” Dr. Leone concluded.

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BLT Mice Help Investigate HIV Migration via T-Cells

Not only does HIV infect and destroy CD4+- helper T-cells, the virus also appears to use those cells to travel through the body and infect other CD4+ T-cells. A new study from investigators at Massachusetts General Hospital (MGH) is the first to visualize the behavior of HIV-infected human T-cells within a lymph node of a live animal, using a recently developed "humanized" mouse model of HIV infection. The study will appear in the journal Nature and had been released in advance online.

“We have found that HIV disseminates in the body of an infected individual by 'hitching a ride' on the
T-cells it infects,” says Thorsten Mempel, MD, PhD, of the MGH Center for Immunology and Inflammatory Diseases, who led the study. “Infected T-cells continue doing what they usually do, migrating within and between tissues such as lymph nodes, and in doing so they carry HIV to remote locations that free virus could not reach as easily. There are drugs that can manipulate the migration of T-cells that potentially could be used to help control the spread of virus within a patient.”

It has long been assumed that free virus travels by diffusion through tissue fluids to encounter new cells that can be infected. But recent studies have suggested that HIV can also pass directly from cell to cell when structures called virological synapses form during long-lasting interactions between T-cells. Since CD4+ T-cells usually migrate quickly and form only transient contacts with other cells, the current study was designed to examine whether HIV alters the migration of infected T-cells, allowing the kind of persistent contact that enable virological synapses to form, thus facilitating the spread of infection.

The team's experiments used “humanized” mice, which have been transplanted with human blood cells, liver, and thymus tissue (called BLT mice), human cells necessary for HIV infection. BLT mice are the only non-primates that can be infected with HIV. After first confirming that human T-cells enter and normally migrate within the animals' lymph nodes, the researchers injected the animals with HIV engineered to express green fluorescent protein (GFP), allowing them to track the movement of infected cells within living animals using a method called intravital microscopy. They observed that within two days, infected T-cells continued to migrate and were uniformly distributed within lymph nodes but remained in nodes closest to the site of injection.

To test the role of T-cell migration in HIV infection, the researchers injected another group of BLT mice with HIV and at the same time treated them with an agent that prevents T-cells from leaving lymph nodes. Two months later, levels of HIV in the bloodstream and in lymph nodes distant from the site of injection were much lower than in untreated HIV-infected animals, lending credence to the theory of T-cell migration carrying virus throughout the body. Treatment with the migration-suppressing agent, however, did not reduce viral levels in animals with already established HIV infection.

According to Mempel, the availability of the BLT mouse was instrumental in their ability to carry out this study. “This approach provides a new vantage point to investigate previously unexplored aspects of HIV pathogenesis,” he said.

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Cicero, Illinois Settles Transgender Lawsuit

The city of Cicero, Illinois has settled a civil rights lawsuit brought by a transgender Latino woman who had been illegally searched and harassed by the city's police officers, according to a report in ChicagoPride. Bianca Feliciano alleged in her suit that Cicero police officers verbally abused, harassed, and taunted her on the basis of her gender-identity on February 6, 2011.

As she and another trans woman were walking down a street in Cicero, she says officers wrongfully accused them of engaging in sex work and after seeing her identification with her female gender and name, the officers “claimed that if Feliciano was properly disciplined and punished she would not be the way she is right now. The officers also insulted her by denying her gender-identity, stating 'You are not female, you have a dick between your legs,' and threatened her with jail, claiming she was committing an act of fraud because her ID said she was female.”

She further alleged that the police officers who arrested her (charges were later dropped) repeatedly called her a man, referred to her with male pronouns, and “made crude, offensive remarks about her 'titties' and genitalia. When completing her arrest reports, the officers used the former male name given to her at birth, and they refused to return her State Identification card, even after they were shown the legal documentation demonstrating she had legally changed her name.”

The city of Cicero agreed to pay Feliciano a $10,000 settlement and also to enact a new policy about how police officers in the city must treat transgender people.

“We are pleased that the Town of Cicero is taking a step forward by creating this policy,” said Joey Mogul, one of Feliciano's attorneys, a partner at the People's Law Office, and director of the Civil Rights Clinic at DePaul University College of Law. “We are hopeful that this ends the unjust and abusive treatment of transgender people by Cicero police officers and we hope that other police departments follow suit.”

Feliciano is also satisfied with the settlement, saying in a statement, “I'm glad to settle this case and I hope this policy will mean that what happened to me doesn't have to happen to anyone again. LGBTQ youth and others should never have to go through the abuse I suffered from the Cicero Police Department.”

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Milton Hershey School Reverses Position

A Pennsylvania school for lower income and socially disadvantaged students said on August 6 that it “will now treat HIV-positive applicants the same as all others and has offered admission to a previously rejected Philadelphia-area teenager,” according to a story at abcnews.com.

School president Anthony Colistra issued a statement, saying, “Although we believed that our decisions regarding Abraham Smith's [a pseudonym] application were appropriate, we acknowledge that the application of federal law to our unique residential setting was a novel and difficult issue. The U.S. Department of Justice recently advised us that it disagrees with how we evaluated the risks and applied the law. We have decided to accept this guidance."

Colistra said the private boarding school also is developing training on HIV-related issues for its employees and students.

The boy's lawyer, Ronda Goldfein, said the school's actions did not end the lawsuit, and that the offer of admission for the coming year was being assessed by the ninth-grader.

"We couldn't be happier that they're doing the right thing, but if you turn a blind eye to a law, you're responsible for the harm caused while you were turning that blind eye," Goldfein said.

In Washington, Justice Department spokeswoman Nanda Chitre welcomed the school's decision and noted that federal law protects people with HIV from discrimination.

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Australian Olympic Medalist Comes Out as HIV-Positive

Ji Wallace, an Australian Olympic trampolinist who won a silver medal at the Sydney 2000 Olympic Games, though he didn't compete in London, has been inspired to come out as HIV-positive after watching a recent Piers Morgan interview with diver Greg Louganis.

In a letter to the Sydney Star Observer, Wallace said, “I felt inspired to write. I too am an Olympic medal winner living with HIV. I have never publicly disclosed this before but felt inspired by [the] interview… and by Anderson Cooper’s ‘coming out’ letter last month describing ‘value in being seen and heard’ in the face of disturbing violence, bullying, persecution, and condemnation by peers, colleagues, government officials, and worst of all, family and friends. I too have been the victim of these atrocious behaviours. Luckily I managed to come through.”

He added, “Being seen does have value. A voice does have value. I have the support of my boyfriend, my great friends and my loving parents. Many do not and this is, in part, for them.”

Read more here.

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Illinois Red Ribbon Lottery Launched Again

Starting this week, $3 can win you $40,000 while you support the effort to end HIV/AIDS in Illinois. The Illinois Lottery on August 7th re-launched the popular Red Ribbon Cash game, a $3 instant scratch-off lottery ticket. One hundred percent of the proceeds from this lottery game will go toward HIV prevention and care. Tickets are currently available at all participating retailers.

The Red Ribbon lottery was first enacted in 2007 and had been set to sunset this December. Through the hard work of community advocates including West Side HIV/AIDS providers, AIDS Foundation of Chicago, and the bill’s sponsors State Senator Jacqueline Collins (D-Chicago) and State Representative Karen Yarbrough (D-Maywood), this program has been extended until 2017.

The General Assembly just passed a devastating state budget that slashes funding for community-based HIV prevention, care, and housing programs by 42%. This game provides an independent funding stream generated by the community for HIV/AIDS prevention and care in areas hardest hit by this epidemic. Last year alone, the Red Ribbon lottery generated $1.4 million for HIV/AIDS treatment, prevention, and care.

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Warren Winkelstein Jr. Dies at 90

PHOTO: PEG SKORPINSKI VIA UC-BERKELEY

Dr. Warren Winkelstein Jr., an epidemiologist and researcher who headed a groundbreaking study that connected unprotected sex between men to HIV/AIDS, died July 22 at his home in Point Richmond, California, of complications from an infection reports The New York Times. He was 90 years old.

Winkelstein was an emeritus professor of epidemiology and a former dean of the University of California Berkeley's School of Public Health. Dr. Winkelstein was considered an innovative master at designing studies that would answer tough questions about the causes, risk factors, and transmission of disease.

He was best known for the San Francisco Men’s Health Study, which began in 1984 and tracked 1,034 single men, both straight and gay, from areas of the city with the highest rates of AIDS. At that time, HIV had been identified, but scientists did not know what behavior, sexual or otherwise, might increase the risk of infection.

What set Dr. Winkelstein’s study apart from other studies being done at the time was his insistence on using probability sampling to find participants. This methodology involved selecting blocks from the census and actually going to the homes to ask men to participate, rather than putting advertisements in newspapers and waiting for responses. The goal was to make sure that the study participants were as representative a sample of men as possible. It was the only study at the time that used a representative group of men living in San Francisco, often called the epicenter of the U.S. epidemic.

Dr. Winkelstein kept teaching after he retired in 1991 and also wrote biographical sketches of leading figures in the history of epidemiology. He always taught his students to work with other scientific researchers. In a 2004 interview in the journal Epidemiology, he said, “You can make a lot of mistakes individually, but by collaboration, you eliminate a lot of dumb errors.”

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Legislation Watch

Sorry for the tardiness on this, but on July 25, Democratic Representatives James Himes of Connecticut and Barbara Lee of California introduced HR 6187, the Cure for AIDS Act to establish a research program under the Congressionally Directed Medical Research Program of the Department of Defense to discover a cure for HIV/AIDS. On August 2, it picked up two more co-sponsors, both Democrats from Florida—Kathy Castor and Frederica Wilson. Wouldn’t that be something? The Defense Department coming up with a cure!

HR 3053, the REPEAL Act gained Democrat Paul Tonko of New York as its 36th co-sponsor.

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