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POSITIVELY AWARE 12/10/2012

CDPH HIV Surveillance Report Offers Hope for MSM

Bechara Choucair, MD, commissioner of the Chicago Department of Public Health wrote a blog for the Huffington Post on November 30 about the latest findings from the 2012 HIV Behavioral Surveillance Report. The report tracked the HIV situation in Chicago and confirmed some things that are already known—that men who have sex with men (MSM) continue to be the most affected by HIV and that young black men are the only group currently experiencing annual increases in new HIV diagnoses. But it also contained some relatively good news.

Among the notable findings in the report are:

  • Nearly all men who were interviewed (99 percent) reported having had an HIV test in their lifetime. The Centers for Disease Control and Prevention (CDC) recommends annual HIV testing, and over half of Chicago MSM (57 percent) are currently meeting this standard, with the highest rate of routine HIV testing (71 percent) found among young black MSM.
  • More Chicago MSM are aware of their HIV status. In 2008, 50 percent of HIV-positive MSM we interviewed were unaware of their infection at the time of the survey. In this latest report the rate had dropped to 24 percent. This decrease was greatest among black MSM.
  • More HIV-positive MSM, regardless of race, are being linked to care and are on HIV treatment (antiretroviral therapy, or ART). The largest increase was seen in black MSM. In 2008, 44 percent of HIV-positive black MSM surveyed reported taking HIV medications. By 2011 that rate had increased to 84 percent.

According to Choucair’s blog, “Our report soundly demonstrates that since 2008, MSM in Chicago are testing for HIV more frequently, have greater knowledge of their own HIV status and have greater access to HIV antiretroviral therapies. Results are particularly strong and promising for young black MSM. I see these findings as very hopeful signs that increased community mobilization and enhanced efforts in expanding HIV testing and linkage to care are having a positive impact on Chicago's HIV epidemic.”

Download the report here.

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photo: Kim Woodrow, UW
These electrospun fibers can release chemicals or can physically block sperm.

Electrically Spun Fabric Offers Dual Defense against Pregnancy, HIV

A University of Washington team has developed a versatile platform to simultaneously offer contraception and prevent HIV, according to a report on November 30 in ScienceDaily. Electrically spun cloth with nanometer-sized fibers can dissolve to release drugs, providing a platform for cheap, discrete, and reversible protection. The Bill & Melinda Gates Foundation awarded the UW researchers almost $1 million to pursue the technology. The research was published in the Public Library of Science's open-access journal PLoS One.  

“Our dream is to create a product women can use to protect themselves from HIV infection and unintended pregnancy,” said corresponding author Kim Woodrow, a UW assistant professor of bioengineering. “We have the drugs to do that. It's really about delivering them in a way that makes them more potent, and allows a woman to want to use it.”

Electrospinning uses an electric field to catapult a charged fluid jet through air to create very fine, nanometer-scale fibers. The fibers can be manipulated to control the material's solubility, strength, and even geometry. Because of this versatility, fibers may be better at delivering medicine than existing technologies such as gels, tablets, or pills. No high temperatures are involved, so the method is suitable for heat-sensitive molecules. The fabric can also incorporate large molecules, such as proteins and antibodies, that are hard to deliver through other methods.

At a lab meeting last year, Woodrow presented the concept, and co-authors Emily Krogstad and Cameron Ball, both first-year graduate students, pursued the idea. They first dissolved polymers approved by the Food and Drug Administration (FDA) and antiretroviral drugs used to treat HIV to create a gooey solution that passes through a syringe. As the stream encounters the electric field it stretches to create thin fibers measuring 100 to several thousand nanometers that whip through the air and eventually stick to a collecting plate (one nanometer is about one 25-millionth of an inch). The final material is a stretchy fabric that can physically block sperm or release chemical contraceptives and antivirals.

“This method allows controlled release of multiple compounds,” Ball said. “We were able to tune the fibers to have different release properties.” One of the fabrics they made dissolves within minutes, potentially offering users immediate, discrete protection against unwanted pregnancy and sexually transmitted diseases. Another dissolves gradually over a few days, providing an option for sustained delivery, more like the birth-control pill, to provide contraception and guard against HIV.

The fabric could incorporate many fibers to guard against different sexually transmitted infections, or include more than one anti-HIV drug to protect against drug-resistant strains (and discourage drug-resistant strains from emerging). Mixed fibers could be designed to release drugs at different times to increase their potency, like the prime-boost method used in vaccines. The electrospun cloth could be inserted directly in the body or be used as a coating on vaginal rings or other products. This is the first study to use nanofibers for vaginal drug delivery.

While this technology is more discrete than a condom, and potentially more versatile than pills or plastic or rubber devices, researchers say there is no single right answer.

“At the time of sex, are people going to actually use it? That's where having multiple options really comes into play,” Krogstad said. “Depending on cultural background and personal preferences, certain populations may differ in terms of what form of technology makes the most sense for them.”

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Treatment Action Group Welcomes FDA Review of New Tuberculosis Drug

Treatment Action Group (TAG) welcomes the U.S. Food and Drug Administration (FDA) review of bedaquiline, the first new drug from a novel drug class to be reviewed by the FDA for its potential to fight tuberculosis (TB) in nearly 50 years, according to a TAG press release.
  
Bedaquiline (also known as TMC207), is under review for accelerated approval to fight multidrug-resistant tuberculosis (MDR-TB). Currently, only half of MDR-TB patients are cured with existing treatment options, and 15% of people with MDR-TB die while on treatment. Each patient with active MDR-TB is estimated to infect 15 other people with this dangerous and difficult-to-treat form of disease. In the U.S., treating just one case of MDR-TB costs hundreds of thousands of dollars.
 
“We are faced with the threat of being left without effective treatment options for multidrug-resistant TB. Without new drugs to fight TB, we may return to the era before effective treatment options were introduced,” cautioned Dr. Lee Reichman, a leading TB researcher and doctor who testified on behalf of Janssen Infectious Diseases BVBA, the company that developed bedaquiline, to the FDA Center for Drug Evaluation and Research at the Anti-Infective Drugs Advisory Committee Meeting. He noted that current MDR-TB treatment has “devastating side effects that affect both the patients and their desire to take medications.”

“The decision you make today is going to affect millions of people around the world,” TAG executive director Mark Harrington said at the meeting on November 29. “You have a chance to make history today,” he urged. “Be bold. But do it stringently.”
 
In Phase 2 trials, bedaquiline in combination with existing MDR-TB drugs appeared to stop TB germs in more people and do so faster than existing treatment options alone. Bedaquiline also appeared to prevent the development of resistance to companion drugs, and appeared relatively safe, particularly compared to existing MDR-TB drugs.
 
“Bedaquiline is an essential tool to help bring the situation under control,” added Dr. Andreas Diacon, a South African researcher who also spoke for Janssen. “Bedaquiline improves treatment success, protects companion drugs, and will help prevent the spread of drug-resistant TB.”
 
All 18 FDA Advisory Committee members voted that bedaquiline is clearly effective in treating MDR-TB in adults. TAG urges the FDA to consider bedaquiline’s potential to make MDR-TB treatment more effective, shorter, easier, and safer—particularly in the context of the exorbitant cost and inadequacy of existing treatment options. TAG’s hope is that this submission of bedaquiline for MDR-TB will herald a renaissance in TB drug development.
  
TAG encourages pharmaceutical companies and public-sector funders to scale up their investment in research for new tools to fight TB, commending Janssen for its investment in bedaquiline to date. TAG also encourages Janssen to complete Phase 3 confirmatory studies, expedite pediatric studies, explore bedaquiline’s potential to prevent active TB in close contacts of people with MDR-TB, and use computer modeling to ensure the optimal use of bedaquiline in people with HIV on antiretrovirals.

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Australian Olympic Medal Winner Joins T2

Olympic silver medalist Ji Wallace has joined TEAM TO END AIDS (T2), an endurance training program benefiting AIDS Project Los Angeles (APLA), and will run the 2013 Honda L.A. Marathon, APLA announced on December 1

The announcement comes just months after Wallace revealed to the Sydney Star Observer that he is living with HIV. Wallace is the third Olympian to disclose his HIV-positive status, following Magic Johnson and Greg Louganis.

In 2008, Wallace was a cast member with Cirque Du Soleil and suffered a severe fall, causing significant injuries that prevented him from walking. After 21 months of rehabilitation, Wallace was finally able to walk again. Now fully recovered, Wallace says that he is “very excited to be in Los Angeles with T2 for the Honda L.A. Marathon.”

Wallace and his partner Shaun Baldwin participated in Positively Aware’s A Day with HIV and can be seen in the Nov+Dec issue and online in the photo gallery at
www.adaywithhiv.com

TEAM TO END AIDS participants raise awareness and critical funds for the fight against AIDS. Many participants are complete beginners when they sign up, but after completing T2’s endurance training program, T2 athletes are well equipped to cross the finish line. During training season, participants receive consistent support from experienced athletic coaches, knowledgeable fundraising staff, and supportive teammates. More information is available at TEAMTOENDAIDS.com.

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AIDS Foundation of Chicago Partners with Abbott to Launch Need2Know HIV

The AIDS Foundation of Chicago (AFC) marked World AIDS Day by announcing a new campaign called Need2Know HIV, an initiative to educate people about the importance of HIV testing.

In partnership with Abbott Labs, maker of the HIV drugs Norvir and Kaletra, AFC is using social media platforms such as Facebook and Twitter to increase awareness and encourage conversation about testing. The campaign began on World AIDS Day, December 1, and continues through the month.

What sets Need2Know HIV apart from other HIV testing campaigns is that it highlights the importance of diagnosing HIV in its earliest stages, as well as the need for ongoing viral load testing for those living with HIV, according to an AFC press release.

 “It’s simple: we can’t end AIDS without a stronger commitment to HIV testing, and that starts with educating people about the importance of testing to know their status and manage HIV,” said David Ernesto Munar, AFC president/CEO. Munar also noted that people can show their support and educate others by visiting and “liking” the Need2Know HIV campaign on Facebook.

New diagnostic testing can detect both antigens (the actual HIV virus) and antibodies (the body’s response to fight the virus). The combo tests allow people to know their status weeks sooner—within two weeks of exposure—than they potentially could with traditional antibody-only HIV tests.

For those individuals who live with HIV, monitoring the disease plays a key role in their overall treatment. Ongoing viral load tests help patients and their health care providers monitor the response of the virus to antiretroviral drug treatments, helping to guide treatment decisions.

“For nearly 30 years, Abbott has been committed to fighting HIV by developing important tests and therapies for patients,” said Brian Blaser, executive vice president, Diagnostics Products, Abbott. “Our commitment to HIV continues today as we partner together to launch efforts such as Need2Know HIV to help educate people about the critical role testing can play in stemming the tide of this virus.”

People can learn more by visiting the AFC’s website and Facebook page.

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Court Rejects Anti-Gay Groups’ Attempt to Join Lambda Legal Case Seeking Freedom to Marry in Illinois

On November 30, the Circuit Court of Cook County, Chancery Division denied motions to intervene by the Church of Christian Liberty, Grace Gospel Fellowship, and the Illinois Family Institute (IFI) in Darby v. Orr, Lambda Legal's case seeking the freedom to marry for same-sex couples in Illinois.

Lambda Legal and the ACLU of Illinois each filed lawsuits in May 2012 representing a total of 25 same-sex couples from across the state of Illinois seeking the freedom to marry. Two days later, the Illinois Attorney General's office filed papers agreeing that barring same-sex couples from marriage is unconstitutional. The Cook County Clerk and States Attorney also agree that the marriage ban is unconstitutional.

After the Tazewell and Effingham County Clerks moved to intervene, promising a vigorous defense of the marriage ban, the Court entered an unopposed order permitting them to enter the case as defendants. Soon after, the Alliance Defending Freedom, an anti-gay group based in Arizona, filed papers seeking to join the case on behalf of IFI, and Lambda Legal and the ACLU of Illinois opposed IFI's efforts to intervene in the cases. On September 20, the Church of Christian Liberty and Grace Gospel Fellowship filed their own motion to intervene, which Lambda Legal opposed. The ruling on the 30th prohibits that intervention.

“We are now closer to the day these families can tell their stories in court, and explain in their own words why it is so hurtful and wrong to exclude them and their children from ever belonging to married families, without further unnecessary delays,” said Camilla Taylor, Marriage Project Director for Lambda Legal. “The Illinois government should be treating all families fairly. The freedom to marry the one unique and irreplaceable person you love, whether it is someone of the same sex or a different sex, is an essential liberty for all of us. Thousands of couples and their children across the state feel a sense of loss and experience discrimination every day because the state unfairly excludes them from marriage.”


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Mental Health Advocacy Group Releases Report on the Closing of Mental Health Clinics in Chicago

The Mental Health Movement, a coalition led by Southside Together Organizing for Power (STOP) and including AFSCME Council 31, Illinois Nurses Association, Community Mental Board of Chicago and Next Steps, has released a report entitiled “Abandoning the Most Vulnerable: The real consequences of closing City of Chicago mental health clinics.” The report’s analysis of Chicago Department of Public Health (CDPH) transition data and first-hand accounts from clients makes clear that the closure of half of the city’s mental health clinics in April 2012 has been characterized by “poor planning, mismanagement, inaccurate information, and insensitivity to clients.”

Although Mayor Rahm Emanuel and CDPH Commissioner Bechara Choucair claimed cost savings of $2 million (little over 1% of the CDPH annual budget) would be the result of the closures, the data proves otherwise. This claim ignored the budgetary, societal, and human costs of disruptions in care—including increased emergency room visits, hospitalization, police intervention, and incarceration.

The Mental Health Movement is urging CDPH to reopen the six mental health clinics closed in April, adequately staff the remaining six mental health clinics, re-hire African-American and bilingual therapists to ensure more culturally competent care, and implement a meaningful outreach program to let individuals in need of mental health services know about the services available through CDPH.

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Legislation Watch

By Sue Saltmarsh

It remains a mystery why Republicans seem to have no awareness of why they lost on November 6. Not only do they continue to make the same old arguments for no tax increases for the wealthy, more threats to safety net programs, and still seem obsessed with adding abortion language to every bill, but they also managed to defeat a United Nations treaty to ban discrimination against people with disabilities. Really?

The treaty, backed by President Obama and former Senate Majority Leader Bob Dole, a Republican who’s disabled himself, went down to defeat in a 61-38 vote on December 4, falling five votes short of the two-thirds needed for confirmation as “dozens of Senate Republicans objected that it would create new abortion rights [there it is again!] and impede the ability of people to home-school disabled children,” according to a report in The Hill.

Senators. Kelly Ayotte (NH), John Barrasso (WY), Scott Brown (MA), Susan Collins (ME), Dick Lugar (IN), John McCain (AZ) and Lisa Murkowski (AK) are the only Republicans who voted with Democrats in favor of the treaty. There are evidently some “compassionate conservatives” left in Congress.

On November 8, Senator Jeff Merkley, a Democrat from Oregon, was added as a co-sponsor of S. 3573, the LGBT Elder Americans Act of 2012, providing equal treatment of older LGBT individuals.

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