antiretrovirals

Covering AIDS in America: a NY Times analysis

gaywrites:

Where are we in the struggle to end AIDS? How far have we come?

A piece in the New York Times today explores these questions and more, exemplifying the huge amount of work that must go into accurately covering a topic as significant as the AIDS crisis. 

It turns out we’ve come a long way in the AIDS epidemic, and much of our generation has no idea how different things were 30-odd years ago. The writer of this article, linked above, also wrote the first New York Times piece about AIDS, when it was thought to be strongly tied to homosexual men. 

This piece speaks volumes to journalists’ role in uncovering AIDS. My favorite section:

The epidemic has brought a new focus on the power of epidemiology to identify a disease’s transmission patterns long before discovery of its cause. In the early days, epidemiologists provided the evidence to show that AIDS could be transmitted through contaminated blood transfusions, a fact many blood bank officials initially refused to accept. Later, lessons learned from AIDS were instrumental in helping control tuberculosis and curbing the spread of SARS.

Yet AIDS still presents extraordinary challenges — not least to journalists trying to chronicle the epidemic’s unfolding story, to remind a new generation of the importance of safe sex, and to follow the sometimes halting effort to make effective drugs available to all who need them.

Read the article above to brush up on the history of AIDS and get a feel for what we’re hoping to accomplish soon. This is extremely important work and we need to recognize it. 

To think, they called it GRID (gay-related immune deficiency) is appalling.  I remember, as kid, that it was also referred to as the Gay Cancer.

Israeli Study May Point to the Future of the HIV Epidemic in Men Who Have Sex With Men - The Body

Over the past decade across high-income countries such as Canada and Australia and regions such as Western Europe an unexpected and disturbing trend has emerged – an increase in syphilis and HIV infections among men who have sex with men (MSM). Now researchers in Israel have found similar trends in HIV in that country. Furthermore, researchers there have found another troubling trend: A significant proportion (about 30%) of MSM newly infected with HIV have strains of this virus that are resistant to some anti-HIV therapies.

The Israeli report, published in the June 1, 2011 issue of the journal Clinical Infectious Diseases has incited an editorial to accompany it that calls out for concerted action to help communities of MSM become more resilient so that they can re-embrace safer-sex behaviours and help reduce the spread of HIV. The editorial cautions against the incorrect assumption made by some MSM that use of potent anti-HIV therapy, commonly called HAART or ART, will render them or their partners sexually non-infectious.

READ MORE

The ADAP Watch - The Body

ADAPs With Waiting Lists (8,100 Individuals in 13 States*, as of May 12, 2011)


Alabama: 12 individuals
Arkansas: 58 individuals
Florida: 3,825 individuals
Georgia: 1,515 individuals
Idaho: 14 individuals
Louisiana: 682 individuals**
Montana: 26 individuals
North Carolina: 235 individuals
Ohio: 397 individuals
South Carolina: 664 individuals
Utah: 0 individuals***
Virginia: 668 individuals
Wyoming: 4 individuals

ADAPs With Other Cost-Containment Strategies (Instituted Since April 1, 2009, as of April 13, 2011)

Arizona: reduced formulary
Arkansas: reduced formulary, lowered financial eligibility to 200% FPL (disenrolled 99 clients in September 2009)
Colorado: reduced formulary
Florida: reduced formulary, transitioned 5,403 clients to Welvista from 2/15-3/31/11
Georgia: reduced formulary, implemented medical criteria, participating in the Alternative Method Demonstration Project (AMDP)
Idaho: capped enrollment
Illinois: reduced formulary, instituted monthly expenditure cap ($2,000 per client per month)
Kentucky: reduced formulary
Louisiana: discontinued reimbursement of laboratory assays
North Carolina: reduced formulary
North Dakota: capped enrollment, instituted annual expenditure cap, lowered financial eligibility to 300% FPL (grandfathered in current clients above 300% FPL)
Ohio: reduced formulary, lowered financial eligibility to 300% FPL (disenrolled 257 clients in July 2010)
Puerto Rico: reduced formulary
South Carolina: lowered financial eligibility to 300% FPL (grandfathered in current clients above 300% FPL)
Utah: reduced formulary, lowered financial eligibility to 250% FPL (disenrolled 89 clients in FY2010)
Virginia: reduced formulary, transitioned 207 clients onto waiting list and PAPs, only distribute 30-day prescription refills
Washington: instituted client cost sharing, reduced formulary (for uninsured clients only), only paying insurance premium for clients currently on antiretrovirals
Wyoming: reduced formulary, instituted client cost sharing

ADAPs Considering New/Additional Cost-Containment Measures (Before March 31, 2012****)

Alabama: reduce formulary
Colorado: institute client cost sharing, establish waiting list
Florida: lower financial eligibility
Hawaii: establish waiting list
Illinois: lower financial eligibility to 300% FPL (grandfather in current enrollees from 301 – 500% FPL), disenroll clients not accessing ADAP for 90 days
Kentucky: reduce formulary
Montana: reduce formulary
Oregon: reduce formulary
Puerto Rico: reduce formulary
South Carolina: disenroll 200 clients based on financial eligibility
Tennessee: establish waiting list (as of July 1, 2011)
Washington: cap enrollment, establish waiting list, reduce formulary
Wyoming: reduce formulary

ADAPs With Current or Anticipated Cost-Containment Measures, Including Waiting Lists, May 2011

* As a result of ADAP emergency funding, Hawaii, Idaho, Iowa, Kentucky, South Dakota and Utah eliminated their waiting lists; Idaho reinstituted a waiting list in February 2011.
** Louisiana has a capped enrollment on their program. This number represents their current unmet need.
*** Utah instituted a waiting list in May 2011. To date, no individuals have been added.
**** March 31, 2012 is the end of ADAP FY2011. ADAP fiscal years begin April 1 and end March 31.

New hope against HIV/AIDS

A silver bullet to defeat HIV/AIDS still doesn’t exist, but the world is getting closer.

An international study released this week found that transmission of the virus can be nearly eliminated if patients are simply given drug therapy as early as possible.

The trial was among 1,763 couples where one partner was infected. The couples were split into two groups - in one group the infected partners had received anti-retroviral drugs immediately upon diagnosis, in the other, the infected partners had begun therapy later.

Over the course of six years, researchers found that those who had started treatment early were 96 percent less likely to transmit the virus to their partners than those who had begun treatment later. The data was so overwhelming that the study was terminated years ahead of schedule.

The results are the first to prove what HIV/AIDS experts already suspected - that immediate treatment offers major health benefits. They also back San Francisco public health officials’ much-debated recommendation from last year that people should be treated as soon as possible after their diagnosis.

“The pendulum has really swung towards early treatment,” said Dr. Grant Colfax, director of HIV prevention for San Francisco’s Public Health Department.

It’s poignant that the study’s release is happening just weeks before the 30th anniversary of the first reports of HIV in the United States.

“This year there have been a lot of positive signs in terms of turning the epidemic around,” Colfax said. “Maybe in another 30 years, (HIV) won’t be around.”

In the meantime, this study poses a new challenge to public health officials. The evidence is clearly starting to show that it’s much better to treat patients earlier, but from where will the money come?

Anti-retroviral medications have made huge strides in the past five years. The side effects are less debilitating and the drugs are more widely available in poor countries that have been racked by the epidemic.

Unfortunately, they’re still very expensive. Many poor countries, already struggling to deliver therapy to those with full-blown AIDS, will probably conclude that they can’t afford to launch early treatment programs for people who aren’t already sick.

That would be a mistake. Yes, anti-retroviral medications are pricey - but what are really expensive are new HIV infections. Early treatment offers enormous returns for patients’ health and productivity, and now, it appears, that benefit extends to their partners as well. It doesn’t come cheaper than that.

This article appeared on page A - 9 of the San Francisco Chronicle