Wednesday, October 31, 2007

Rudy's Three Words

Halloween Postscript

Vice President Cheney dressed his dog as Darth Vader. Shouldn't someone explain to him that the nickname for him is not a term of endearment?

universal flu vaccine

New Scientist (Oct 27 - Nov 2, 2007) in

Flu super vaccine

reminds that vaccinating against flu is notoriously difficult. Ordinary flu evolves and needs a new vaccine every year, while a vaccine for a novel pandemic virus will probably come too late for many people. Now Japan's National Institute of Infectious Diseases may have found a way towards the long-sought vaccine against all flu.

Ordinary flu vaccine contains dead influenza A viruses from the H1 and H3 families. When the researchers put this, plus the RNA-like drug Ampligen, into the noses of mice, the mice made antibodies not only to the vaccine viruses but also to H5N1 bird flu - without ever having been exposed to it. Better, when groups of nasally vaccinated mice were exposed to different strains of live H5N1, between half and all of each group survived. Unvaccinated mice, or mice that received vaccine under their skin, died. The team think antibodies in mucus reacting with proteins in the virus could be key.

They say this shows that double-stranded RNA can act as an "adjuvant" to amplify vaccine effects. Most such molecules are toxic, but Ampligen has shown promise in clinical trials.


Cross-Protection against H5N1 Influenza Virus Infection Is Afforded by Intranasal Inoculation with Seasonal Trivalent Inactivated Influenza Vaccine

TakeshiIchinohe et al

The Journal of Infectious Diseases 2007;196:1313-1320

Link to JID abstract

Link to New Scientist article

Vet receiving treatment not likely to comit suicide?

Benedict Carey writing for the New York Times (October 31, 2007) in

Study Tracks Suicide Rate in V.A. Care

announces veterans receiving treatment for depression are no more likely to take their own lives than are civilian patients, a large Department of Veterans Affairs study published yesterday found.

The study, a joint effort with the University of Michigan that included detailed records from more than 800,000 veterans, is the largest and most comprehensive in this group of patients and the first to include troops returning from Iraq and Afghanistan.

It found 1,683 suicides in all, a rate of less than one-quarter of 1 percent — far lower than some past estimates. But experts cautioned against applying the findings too widely, because most former servicemen and women with mental problems do not seek treatment in the Veterans Affairs system.

In contrast to most studies of non-veterans, which have found that the risk of suicide generally goes up with age, the rate was highest among those ages 18 to 44, dropped about 20 percent for those ages 45 to 64 and then rose again after that.

Paradoxically, those who had post-traumatic stress symptoms as well as depression were at significantly lower risk of suicide than those without trauma symptoms, the study found. Veterans being treated for both conditions were 20 percent less likely to commit suicide than those who were treated for depression alone. People suffering from two conditions are usually considered to be at higher risk for harm than those with one.


Suicide Mortality Among Individuals Receiving Treatment for Depression in the Veterans Affairs Health System: Associations with Patient and Treatment Setting Characteristics
Kara Zivin et al

American Journal of Public Health, 10.2105/AJPH.2007.115477

Link to AJPH abstract

Link to NY Times article

UK Welcome?

King Abdullah of Saudi Arabia is on a State Visit to Britain which has attracted criticism, for Saudi Arabia’s human rights record among other things.

The Guardian

The Times

A little Halloween culture

Some call this the greatest finale ever. A little exaggerated perhaps --- unless you are like my young friends who claim that the audience gets ecstatic because the thing is finally over. Oh, by the way, a Welshman playing the Devil --- how haunting is that?

Banned Panasonic ad

Tuesday, October 30, 2007

Dead Ringers Does Top Gear...

Praise abstinence forget abuses Newscenter reports on line (October 30, 2007) im

Bush Praises Ugandan Strongman Blamed For Gay Human Rights Abuses

President Bush met at the White House on Tuesday with Ugandan President Yoweri Museveni for talks that focused on trade, HIV/AIDS but seemingly ignored human rights abuses of gays and lesbians.

The two emerged from the meeting to appear for a camera opportunity with Bush praising Museveni for his push to lower the AIDS rate in the African nation by emphasizing abstinence until marriage.

"Uganda is the epitome of how one can implement a comprehensive ABC strategy to achieve concrete and specific results for the sake of humanity," said Bush.

However, the International Gay and Lesbian Human Rights Commission has uncovered evidence that the Bush administration has funded groups in Uganda that actively promote violence and discrimination against lesbians and gay men. Among those receiving money, according to US government records, is Uganda Muslim Tabliqh, and the Makerere University Community Church, whose leader, Pastor Martin Ssempa, was an organizer of the anti-gay rally in Kampala and the ongoing campaign to threaten the safety of LGBT activists.

Link to (October 21,2007) PEPFAR money being used to ‘promote homophobia’

Link to (October 21, 2007) Righteousness or Thuggery

Link to News report

HIV from Haiti

Neil Bowdler Science reporter for the BBC (October 30, 2007) in

Key HIV strain 'came from Haiti'

reports that the strain of the HIV virus which predominates in the United States and Europe has been traced back to Haiti. It passed from Haiti to the US in about 1969 before spreading further. This is according to a study "The emergence of HIV/AIDS in the Americas and beyond," scheduled for publication in the Early Online edition of the Proceedings of the National Academy of Sciences the week of October 29

"HIV-1 group M subtype B" predominates in the US, Europe, large parts of South America, Australia and Japan. Now the researchers say they know where it came from and they hope knowing this could help find a cure for HIV.

The team examined archived blood samples from five early Aids patients - all of them Haitian immigrants to the United States - and analyzed genetic sequences from another 117 Aids patients from around the world. With this data, they recreated a family tree for the virus, which they believe shows conclusively that the strain came to the US via Haiti - probably via a single person - in around 1969.

Michael Worobey of the University of Arizona in Tucson is one of the study's authors says, "By 1966 the virus first starts spreading in Haiti. A few years later one variant from Haiti gives rise to what would then light the fuse and explode around the world as the Aids pandemic that we first became aware of."

Prof Worobey and his colleagues now want to trace the strain back further. His suspicion is that it probably arrived in Haiti from the Congo via Haitians who were working in Africa during those years.

Link to Proceedings of the National Academy of Sciences

Link to BBC News report

[also contains audio by the Study’s lead author]

See also
our posting (March 02, 2007) Aidsmap coverage of the conference presentation
CROI: Haiti is the source of HIV subtype B
Link to post

HIV early treatment?

Gus Cairns reporting for Aidsmap (October 30, 2007 ) in

EACS: CD4 cells: the lower you start, the lower you finish

A study of UK patients presented at the eleventh European AIDS Conference (EACS) finds that patients starting antiretroviral (ARV) therapy gain roughly equal numbers of CD4 cells regardless of their initial count, except for those starting with extremely low or extremely high counts.

Patients starting treatment at low counts will probably never reach CD4 counts anywhere near normal. This adds to the weight of evidence that starting treatment earlier, before CD4 cell counts fall below 350 cells/mm3 or so, is better than waiting until counts have fallen below 200 cells/mm3 .


Long-term trends in CD4 counts in patients starting HAART: UK-CHIC study
Hughes R et al

Eleventh EACS Conference, Madrid, abstract no. P14.4/04/BPD, 2007.

Link to Aidsmap report

Martin Rowson - The Guardian

Sunday, October 28, 2007

My Chemical Romance - Famous Last Words

(My) Terror trumps everything

Despite winning the Nobel Prize for Literature, Doris Lessing has upset some people. It’s wonderful in these times that at 88 years old she is less afraid than many of us to actually speak her mind. It seems that she told the Spanish Newspaper El Pais that, “September 11 was terrible, but that if one re-examines the history of the IRA what happened in the United States wasn’t so bad”.

Oh how outrageous a British author questioning the sacred --- and we had all begun to believe that 9/11 the Bush administration’s watchword (not to mention Rudy Giuliani’s shibboleth) was sacrosanct. Worse --- a comparison to the mythical (non-terrorist?) IRA that some were so keen to support since the “struggle” was “over there”. Oh dear! It’s almost as catastrophic as the outing of Dubledore.

It did remind me of attitude of my friend the "psychologist" at the time of the release of the movie In the Name of the Father. He took the view, rather smugly I thought, that the story was typically British and that it could never happen over here. The history of the United States and the strength of the checks and balances would prevent the establishment from by passing safeguards --- even in the event of terrorist threats.

But anyway, forget it. That's history --- the 1990s telling a story of the 1970s.

Anyone for water boarding?

Saturday, October 27, 2007

New Rules

Family planning lowers abortion rates

Andy Coghlan writing in the New Scientist magazine (20 – 26, October 2007) in

Pro-choice? Pro-life? No choice

notes that whether you accept the need for abortion or oppose it outright, the most comprehensive survey of global abortion trends since 1995 seems to confirm what many might have suspected - that women will continue to seek out abortions regardless of whether they are legal or not. It also showed the fastest way to reduce the number of abortions is to provide access to reliable contraception.

This is based on a study, published in The Lancet, which shows that the total number of abortions - both legal and illegal - fell worldwide between 1995 and 2003. It compares abortion data from 2003 and 1995 assembled by the World Health Organization and the New York-based Guttmacher Institute, which studies sexual and reproductive health.

It is highly significant that the numbers fell most in rich countries where terminating a pregnancy is legal and safe. On poorer countries where access is restricted or illegal women are prepared to endanger their lives to terminate a pregnancy.

Only three countries in the world ban abortions outright: Chile, El Salvador, and Nicaragua. According to the Center for Reproductive Rights (CRR) in New York, 70 countries representing more than 60 per cent of the world's population permit abortion without restriction. Since 1995 following a Beijing conference calling on government to review their abortion laws, 17 of 196 countries, monitored by CRR, have broadened situations in which abortion is legal.

This is already producing positive consequences according to the WHO. Since South Africa liberalized its abortion laws in 1996 the incidence of post-abprtion infections has fallen by 52 per cent.

In theory, abortion is still fully legal and freely available in the US. But the number of actual provides has declined by 37 per cent between 1982 and 2000. There has been a global impact from the Bush Administration pushing its anti-abortion agenda through its "gag rule" --- the policy of withholding family planning aid from organization that back safe abortion

The Family Planning Association of Kenya (FPAK) lost 58 per cent of its budget because it could not agree to the rule. Joachin Osur, former medical director of FPAK said, " I had to close half of our 16 clinics, serving between 80,000 and 100,000 women annually." Denied adequate contraception and family planning advice, Kenyan women are now having more unsafe abortions.

He says, "One third of Kenya's maternal deaths are due to unsafe abortion."

We might also bear in mind:

Worldwide 48 per cent of all abortions are unsafe and rely on methods such as:

  • drinking terpentine, bleach, or tea mad with manure.
  • inserting herbal preparation into the vagina or cervix.
  • poking sticks, coat hangers, chicken bones or feathers in the uterus.
  • jumping from heights.
  • "Pummelling" -- a massage vigorous enough to shear off the placenta, beak the fetus's neck to cause hemorrhage or rupture the uterus.
  • hot stones on the abdomen to "melt" the fetus.

Induced abortion: estimated rates and trends worldwide
Dr Gilda Sedgh et al
The Lancet 2007; 370:1338-1345

Link to the Lancet abstract

Link to New Scientist article [registration required]

It is an easy thing to triumph in the summer sun
And in the vintage to sing on the wagon loaded with corn
It is an easy thing to talk patience to the afflicted
To speak the laws of prudence to the houseless wanderer

William Blake.

Martin Rowson on the right to protest [from The Guardian]

Friday, October 26, 2007

Catherine Tate

This is for those who asked for more Catherine Tate --- Please note any resemblance to the Senator Larry Craig performance is purely coincidental!

More than $60 billion and no plans to pay

Michael Isikoff and Jamie Reno report for the current Newsweek (Oct 29, 2007 Issue) in

'How Do You Fund a War, But Not the Casualties?’

The secretary of Veterans Affairs presides over the U.S. government's second largest Cabinet department, after Defense. It is a politically sensitive job, especially of late, with new studies showing that the Bush administration has vastly underestimated the cost of providing health care to the more than 750,000 soldiers who have returned home from the wars in Iraq and Afghanistan. But three months ago, former secretary James Nicholson resigned abruptly after a difficult tenure to "get back into the business world"—and tension among vets is rising because the White House still hasn't nominated a replacement.

Some veterans advocates say the VA is in such disarray that the White House has been unable to find a top-notch candidate willing to take the job, much less go through a confirmation hearing.

In response to criticism over the issue, President Bush unveiled new proposals last week to revamp the health-care and disability system for vets, partly by streamlining the bureaucracy. Days later, USA Today reported the results of a new internal VA study showing that the number of Iraq and Afghanistan vets diagnosed with post-traumatic-stress disorder is rising rapidly, from 29,041 a year ago to 48,559 this year. Few of these soldiers are even counted in the Pentagon's official tally of 27,753 wounded in Iraq.

Yet a Pentagon task force recently concluded that the number of mental-health professionals available to vets is "woefully inadequate," and the average wait time for disability claims is six months. Linda Bilmes, a policy analyst at Harvard who will testify before Congress this week, calculates that over the next decade, the disability costs for vets will be at least $60 billion—more than six times the administration's official projections. The numbers coming out of government budget offices, she says, "are significantly underestimating the reality." All this has angered some vets and their families. "I would love to have the president live my life for one week to see how difficult it is," says Annette McLeod, wife of Army specialist Wendell McLeod, who is suffering from PTSD after serving in Iraq. "How do you fund a war but not fund the casualties?"

Link to Newsweek article

Morland - The Times

HIV: New European Guidelines

Gus Cairns, writing for Aidsmap (October 25, 2007) in

Undetectable viral load is goal for all, together with earlier treatment, say new European treatment guidelines

says all HIV-positive people in Europe should be encouraged to start antiretroviral therapy if they have a CD4 cell count below 350, say new European HIV treatment guidelines launched this week at the European AIDS Clinical Society conference in Madrid.

The guidelines also state that the aim of any new therapeutic regimen should be to achieve a viral load below 50 copies/ml for the patient within six months - even for patients with extensive drug experience.

“The minimum goal of what needs to be achievable with salvage therapy is now an undetectable viral load,” said EACS President, Dr José Gatell.

The new European recommendations follow the arrival of two new classes of antiretroviral drugs, CCR5 inhibitors and integrase inhibitors, and evidence from clinical trials that undetectable viral load is now a realistic goal for the majority of highly treatment-experienced who include one of these drug classes in their new treatment regimen.

The revised guidance on when to start treatment follows a host of studies suggesting that earlier HIV treatment may be beneficial. At present guidance in the United Kingdom and some other European countries recommends that treatment should start before the CD4 cell count falls below 200. However a recent UK audit by the British HIV Association showed that 60% of patients had started treatment when their CD4 cell count was below 200, and one-third of these had been in care for more than six months.

The new guidelines are accompanied by two sets of new and equally bold guidelines on the management of metabolic conditions and of hepatitis B and C co-infection.

Acknowledging that the new set of guidelines were “much less conservative and more aggressive than the previous sets” in 2003 and 2005, Gatell said that the arrival of several new drugs, some from completely new classes, “will change substantially some aspects of antiretroviral therapy.”

Cairns reports Gatell was challenged by questioners who remarked that the major crisis facing patients with HIV in Europe was not suboptimal therapy, but getting drugs at all. He commented that doctors were in a limited position to apply political pressure but that “the publication of a set of guidelines that say ´This is the minimum acceptable that you can do is very influential”. ´

The guidelines documents can be downloaded from the EACS

Link to EACS website

The Aidsmap article also contains more details of the Guidelines as well as further links to some of the other studies mentioned

Link to Aidsmap article

Thursday, October 25, 2007

Viral load paradox?

Edwin J. Bernard writing for Aidsmap (October 25, 2007) in

Paradox: people with moderate viral load more likely to pass on HIV

says that HIV may have evolved so that the average viral load set point – around 33,000 copies/ml – seen in most untreated people during chronic infection is finely balanced between being the optimal for HIV transmission and the optimal for host survival according to a study published online this week in the journal, Proceedings of the National Academy of Sciences.

The findings may have important policy implications for ‘imperfect’ HIV prevention technologies, such as vaccines that may reduce an individual's viral load so they can live longer without the need for treatment, but which then increases that individual's transmission potential over a lifetime.

There is currently some disagreement regarding the impact of untreated primary (also called acute) HIV infection versus untreated chronic HIV infection on infectiousness and sexual transmission, and their relative contributions to onward transmission.

Although studies have found that viral load during untreated primary HIV infection is much higher – and therefore individuals are more infectious – than during untreated chronic infection, it is also understood that since untreated primary HIV infection only lasts a matter of weeks or months, the opportunity for transmission is lower compared with untreated chronic HIV infection, which can last for years or even decades.

In fact, a recent US study utilized mathematical modeling to estimate that fewer than 9% of all new sexually transmitted HIV infections originated in people with untreated primary HIV infection, compared with 48% of new infections resulting from sexual contact with people with untreated chronic HIV infection.

However, another recent study from Canada used very different (and arguably more robust) methods – phylogenetic analysis to track the impact of actual primary infections on sexual transmission. Here, almost half of all sexually transmitted HIV infections were found to be due to primary infection.

Adding to the debate is this study by researchers from Imperial College, London, who again utilized mathematical modeling to estimate the impact of untreated HIV infection on transmission.

The main aim of the study was to quantify the relationship between viral load and infectiousness and to estimate its epidemiological impact. The investigators did this by re-examining existing data on viral load during the natural history of HIV infection (from recently-infected gay men in Amsterdam) and data on viral load and transmission (from heterosexual men and women in Zambia).

From their analysis – that medium levels of HIV provide the greatest opportunity for onward transmission – the researchers warn against utilizing “imperfect” prevention technologies – such as vaccines, immunotherapy, or microbicides – which may result in ‘perverse outcomes’. “If the intervention reduces patients’ viral load in such a way as to increase their transmission potential on average,” they write, “then incidence will increase, not decrease. An intervention that reduces viral loads from high to intermediate levels and is therefore beneficial to the individual may nevertheless increase overall incidence and thus cause more overall harm than benefit.”

The investigators also present an hypothesis regarding the evolution of HIV’s virulence. “Seen from the perspective of the virus,” they argue, “a negative correlation between infectiousness and duration of infection could be interpreted as a trade-off between two viral life-history traits, with natural selection leading to an optimal balance in this trade-off."

They wonder if this is “not coincidence but, rather, an outcome of natural selection acting on HIV-1 to maximize opportunities for onwards transmission?”

Lead author Dr Christophe Fraser says that further studies are necessary to prove their hypothesis that it is evolution, and not coincidence, that the average viral load seen in untreated people is finely balanced between optimal HIV transmission and optimal host survival.

“We now want to see whether the virus has adapted in order to allow it to infect the most people, which seems plausible given the results of our study. This would have serious implications for public health policy, because if it is true then some strategies to prevent transmission could end up making the virus more virulent by accident. While it is too early to sound the alarm, more research to prove or disprove this theory is urgently needed. That is what we are focusing on now.”


Variation in HIV-1 set-point viral load: Epidemiological analysis and an evolutionary hypothesis
Christopher Fraser et al

Proc. Natl. Acad. Sci, epub October 22, 2007.
Link to Proc. Natl Acad Sci abstract

Link to Aidsmap article
[also provides Links to other studies referred to in the article]

Pharma payments to med schools

New Scientist magazine, (October 20 – 26. 2007) in

Pharma's Largesse

Stock options, free meals, lecture fees - the pharmaceutical industry showers them all on department heads at some US medical schools.

Drug companies are big investors in medical research and post-qualification training for doctors. Now a survey by Eric Campbell of Massachusetts General Hospital in Boston and his colleagues has put figures on the industry's involvement.

Nearly two-thirds of heads of department from 140 medical school and teaching hospitals said they had some relationship with industry. Over a quarter acted as paid consultants and 1 in 10 sat on a board of directors. Five of the 459 heads reported receiving gifts such as tickets to sporting events in the last year, something industry guidelines generally prohibit

Department heads said they were happy to accept grants of less than $10,000 for educational purposes, but showed concern about larger payments. Financial incentives could make them less vigilant about ensuring that educational materials and research plans are not biased towards specific treatments, Campbell warns.


Institutional Academic–Industry Relationships
Eric G. Campbell, et al


Link to JAMA abstract

Link to New Scientist article

Wednesday, October 24, 2007

Keith Olbermann - Worst Malkin - Fox News Fire Clowns

George Carlin on COUNTDOWN

MRSA links

The New York Times Health blog Well has a posting

Drug-Resistant Staph:
What You Need to Know

It not only answers some basic question but also suggests these interesting links:

One of the most useful Web sites is a MRSA primer from The Centers for Disease Control and Prevention offers a useful Q&A about MRSA in schools. A patient website called MRSA Resources lists a few stories of patients affected by MSRA. Recent Stanford University grad Nick Yee chronicles his struggle with MRSA on his Web site, which includes graphic videos of his wound and treatment. (I couldn’t get through them.) And if you have the stomach for it, a number of people have — inexplicably — posted videos of their MRSA wounds on YouTube.

Link to NY Times blog - Well


Maureen Dowd's Op-Ed Column in today's (October 24, 2007) New York Times is

Madness as Method

Dick Cheney’s craziness used to influence foreign policy.

Now it is foreign policy.

He may have lost his buddy in belligerence, Rummy. He may have tapped out the military in Iraq. He may not be able to persuade Congress so easily anymore — except for Hillary — to issue warlike resolutions. He can’t cow Condi into supporting his bullying as he once did, and Bob Gates is doing his best to instill some common sense.

But the vice president may have hit on a devious tactic used by his old boss Richard Nixon.

President Nixon and Henry Kissinger liked to use madness as a method. In 1969, Nixon told Kissinger to caution the Soviet ambassador that Nixon was “out of control” on Indochina, and could do something drastic.

Cheney seems to enjoy giving the impression that he is loony enough to pull off an attack on Iran before leaving office — even if he has to do it alone, like Slim Pickens riding the bomb down in “Dr. Strangelove” to the sentimental tune of “We’ll Meet Again.” He has even begun referring to his nickname, Darth Vader, noting that it “is one of the nicer things I’ve been called recently.”

The hawks are pounding the drums on Iran as they once did on Iraq, acting as if the hourglass is running out and we have to act immediately or, as the president apocalyptically suggested last week, we could be facing World War III.

Or World War IV, as Norman Podhoretz, a neocon who is a top Giuliani adviser, says. Podhoretz urges bombing Iran “as soon as it is logistically possible” and likened Ahmadinejad to Hitler, as Poppy Bush did with Saddam.

Rudy is using his more martial attitude toward Iran as a weapon against Hillary, painting her as a delicate ditherer on the topic, and Obama is using his more diplomatic attitude toward Iran as a weapon against Hillary, painting her as a triangulator and a two-time administration patsy.

A top Bush 41 national security official told me shortly after Bush 43 got under way that the younger Bush team’s foreign policy was dangerous because it was so “black and white,” so dependent on “bogymen.”

President Bush has settled on his new bogyman, once more ignoring the obvious choice of Osama. Yesterday, he defended his plans to build a missile defense system in Europe by raising the specter of Iran’s nuclear ambitions.

Hit with sticks, the bogyman responded with sticks. He said that Iran will not negotiate with anyone about its right to nuclear technology.

As Pat Buchanan noted on “Hardball,” “Cheney and Bush are laying down markers for themselves which they’re going to have to meet. I don’t see how ... Bush and Cheney can avoid attacking Iran and retaining their credibility going out of office.”

In other words, once our cowboys have talked their crazy talk, they have to walk their crazy walk.

Link to NY Times column

Tuesday, October 23, 2007

Peter Brookes - The Times

A fifth getting tested

Will Dunham reporting for Reuters (October 22, 2007) in

Researchers say HIV testing in U.S. remains low

notes that HIV testing rates have remained low in the United States this decade, with only about one-fifth of people at high risk for infection getting a test in any given year.

This comes from a US study, published in the Archives of Internal Medicine., which also found that many more people at high risk of HIV infection say they plan to get tested than actually do get tested.

Those people who are unaware they are infected may be causing more than half of new U.S. HIV infections, making an expansion of testing a key step toward curbing the spread of the virus that causes AIDS, Brian Pence, an epidemiologist at Duke University in Durham, North Carolina, and one of the researchers.

The study examined responses from about 147,000 people nationwide aged 18 to 64 in U.S. Centers for Disease Control and Prevention health surveys from 2000 through 2005.

They found that 10 percent of all respondents reported they had been tested in the past year, and that a total of 38 percent reported they had ever been tested.

Among people classified as at high risk of infection, 22 percent got tested in the prior year. And only about half of those got the tests on their own initiative. The other half underwent tests as part of medical checkups, health insurance applications, entering the military or some other reason, the researchers said.

Nineteen percent of those classified as at medium risk of infection got tested in any given year.

The researchers looked at the percentage of people in various groups who said they intended to get tested in the coming year and compared that to the percentage who actually got tested in the previous year and found that 27 percent of people at highest risk for infection said they planned to have an HIV test in the coming year but only 11 percent had actually sought out a test in the prior year.

The researchers said that nearly half of HIV tests were given as part of medical checkups or prenatal care, suggesting that policy initiatives to integrate testing into routine medical care have had some success.


Trends in HIV Testing and Differences Between Planned and Actual Testing in the United States, 2000-200
Jan Ostermann et al
Archives of Internal Medicine 2007; 167: 2128-2135.

Link to Archives of Internal Medicine abstract

Link to Reuters report

Aidsmap also cover the study with a more detailed review.

Link to Aidsmap report

Monday, October 22, 2007

The President's Amusement

The AIDS Fight . . .

Daniel Halperin, senior research scientist at the Center for Population and Development Studies at Harvard University's School of Public Health writes an opinion piece in the Washington Post (October 22, 2007) in

AIDS Prevention: What Works?

This is a response to Richard Holbrooke’s ideas [Still Losing the AIDS Fight – October 9, 2007] He commends Holbrooke for focusing on global HIV prevention and even though HIV treatment and care programs must be expanded but he warns that only by preventing new infections can we ultimately hope to turn back this devastating disease.

He warns against notion that testing induces prevention arguing that there is little evidence that knowing one's HIV status fundamentally alters behavior. A few studies have found some modest changes in behavior among those who test positive, but most trials unfortunately show that people who discover that they are not infected with the virus continue acting as they did before being tested -- despite the obvious danger to themselves and to others.

He also reminds us of another neglected aspect of HIV prevention -- one prohibited from funding by the Bush administration's international AIDS program -- which involves expanding family planning services, including for HIV-positive women who do not want to conceive. Reducing unintended pregnancies could greatly decrease the number of infected infants as well as the number of children who eventually become orphans

He concludes:

While approaches such as testing, condom use and abstinence are important, no magic bullet exists for preventing AIDS. The most rigorous evidence suggests that there needs to be a vigorous expansion in Africa of behavior-change programs, for promoting partner reduction in particular, and greatly increased access to safe male circumcision. Of course it would also be useful to expand HIV testing programs, if not primarily for prevention purposes, then at least to help facilitate the care and treatment programs that are also vital to mitigating this pandemic.
Link Halperin’s Washington Post article

FRONTLINE/World | Extraordinary Rendition-Nov 6 | Preview #1

Sunday, October 21, 2007

Ooh, Vicar!

Righteousness or Thuggery?

We know most people say they don't read the Comments -- particularly if it means going back to earlier postings . So you may well have missed the little addition that "James" added to the post of Monday, October 15, 2007

Annihilate in the Name of the Lord

James said...

Uganda has for long suffered from International battering. Homosexuality is a C R I M E in Uganda period. Leave us alone in peace. Look, irrational fear towards straight sex is what gays are suffering from. Homosexuality (Ebisiyaga in our local language)Victims can reform. I have friends who were homosexuals and are together with me now counselling us others who renounced this deadly sexual disorder. Please write to me that I may help you. And please, if you think Dr. Ssempa and Sheikh Bukenya are the only front runners, please forget it. We are here, the Kiboko Squard Against Homosexuality--KISAHO. Thank you.

Well James, did you intend to make youself the poster boy for African internalized homophobia?

I must say that we were not really as aware of your Kiboko Squads as we might have been but thanks to your intervention we did a little research. They are, of course, nothing but the usual band of "political" thugs who replace the political process with intimidation. This is what Radio Katwe says of them

These guys were dressed like civilians but they were all carrying big sticks and they beat up many innocent bystanders. They did not identify themselves and we still do not know the name of their immediate commander.

Those in the know say that these hooligans you saw beating up people on the streets of Kampala are none other than soldiers who have been recruited into the PGB but who are still at the training stage. In fact some people even know them by name. They are PGB trainees.

Well, dear James, we would like to think that this is all a cultural misunderstanding and that we are wrong in interpreting you sentiments but it seems it is the time for polemics. So, if you thought that we would readily reassign
Africa to the heart of darkness and turn a blind eye to your activities ---- think again. We could ask why you don't keep your homophobic Bishops at home --- if you want privacy for your thuggery. We might even ask why you keep taking the money we provide. But we won't. We will remind you that the world is truly becoming a global village and your pseudo science and painful injustices will not pass unnoticed.

AIDS relief money used for WHAT . . . ?

Michael Carter writing for Aidsmap (October 19, 2007)

PEPFAR money being used to 'promote homophobia', charges human rights group

reports money from the Presidential Emergency Plan for AIDS Relief (PEPFAR) is funding organizations in Uganda that actively promote homophobia, a leading human rights charity has warned.

In a letter to the Mark Dybul, US Global AIDS Coordinator, Human Rights Watch, expressed grave concern about “an expanding pattern of attacks in Uganda upon the human rights of lesbian, gay and transgender people”, and highlighted the homophobic activities of Pastor Martin Ssempa, a member of the First Lady of Uganda’s Task Force on AIDS and recipient of PEPFAR HIV prevention money.

Human Rights Watch is calling on the US government to clarify its opposition to attacks on the rights of gay people in Uganda and to articulate that it does not support the use of PEPFAR funds to “promote homophobia.”

Homosexuality is punishable with a maximum life sentence in Uganda and recent months have seen an intensification of attacks on the rights of gay people in the country by government officials and the media.

In August the Ugandan Deputy Attorney General called for the criminal prosecution of lesbians and gays in Uganda, and it has been indicated that the government is “considering changing the laws so that the promotion [of homosexual conduct] itself becomes a crime” and that “catalogues” were being compiled “of people we think are involved in perpetuating the vice of homosexuality.”

It is estimated that Uganda has an adult HIV prevalence of a little under 7% with 940,000 individuals living with the virus. Although PEPFAR guidelines state that men who have sex with men should be a priority for HIV prevention, the Ugandan Information Ministry has protested to UNAIDS about the inclusion of gay people in the planning of HIV prevention initiatives. James Kigozi of the Ugandan AIDS commission has defended the lack of any reference to gay or bisexual men in the country’s HIV strategy saying, “the practice of homosexuality is illegal.”

Organizations that actively promote hatred of gay people and disseminate inaccurate information about the reliability of condoms are barred from receiving PEPFAR funds. But Human Rights Watch highlights the activities of Pastor Martin Ssempa’s Makerere Community Church.

His website has listed Ugandan gay rights activists, posting pictures and contact information and calling them “homosexual promoters.” The pastor testified before a committee of the US Congress in 2005 as a representative of the Ugandan First Lady’s AIDS Task Force. In August he helped organize a rally demanding government action against gay people, calling homosexual conduct “a criminal act against the laws of nature.”

The Makerere Community Church also disseminates information stating that condoms do not protect against HIV and has burnt condoms in public. The organization has received $40,000 in PEPFAR funding to provide an abstinence education program.

“Supporting prejudice with cash is an approach with deadly consequences for all,” said Scott Long of Human Rights Watch. The organization is urging the US government to “condemn the treats against lesbian, gay, bisexual and transgender people in Uganda as both destructive to human rights protections and dangerous to health.”

Link to Human Rights Watch Letter

Link to Aidsmap report

New Rules & some Values

Saturday, October 20, 2007

Force Feeding

Medscape posts one of its Video Editorials by Dr. Matt Wynia, Director of the Institute for Ethics at the American Medical Association which asks

Should Doctors Force-Feed Prisoners?

He points out that according to the US military, about 20 prisoners are now on hunger strike at Guantanamo Bay.[1] Hunger strikes have plagued Guantanamo since it opened.[2]

Each time prisoners refuse food, their doctors face a dilemma.

These can be wrenching cases. Hunger strikers aren't always acting voluntarily. As they pass into unconsciousness, their physicians might wonder whether tube feeding would make them angry, embarrassed, or secretly relieved. And, do they trust prison physicians enough to confide in them?

Amidst this uncertainty, however, 3 things are clear.

First, there is no medical need to force-feed hunger strikers prior to significant weight loss and cognitive decline. Force-feeding an alert and oriented prisoner -- one strong enough to require a restraint chair[3] -- might be a way to assert control over the prison population. It might discourage strikers, or "break" the strike. But it is not medically necessary.

Second, "suicide," as a medical term, has no place in discussing hunger strikes. Hunger strikers aren't generally clinically depressed and would prefer not to die. Major General Jay Hood, the Commander at Guantanamo in 2005, acknowledged the strikers are not suicidal,[4] even if they're willing to die to achieve their political aims. Dr. Hernan Reyes of the International Committee of the Red Cross said that true hunger strikers don't want to die any more than soldiers charging a hill want to die.[5] Risking death is a means to an end.

Third, doctors don't have to face these cases alone. The American Medical Association (AMA) has repeatedly stated opposition to force-feeding competent individuals against their will.[6] The World Medical Association Declaration of Malta concludes that "forced feeding contrary to an informed and voluntary refusal is...never ethically acceptable...[and] feeding accompanied by threats, coercion, force or use of physical restraints is a form of inhuman and degrading treatment.[7]"

Unfortunately, a recent Newsweek article on this issue never mentioned these clear ethical standards.[1] It's up to physicians to support each other to uphold medical ethics. Our military colleagues, many of whom are serving in difficult, sometimes dangerous situations, deserve nothing less.


  1. Thomas E. Should doctors force-feed prisoners? Newsweek. August 20-27, 2007. Available at: Accessed September 27, 2007.
  2. Annas GJ. Hunger strikes at Guantanamo -- medical ethics and human rights in a "legal black hole." N Engl J Med. 2006;355:1377-1382.
  3. Emergency Restraint Chair (ERC Inc). Available at: Accessed September 12, 2007.
  4. Okie S. Glimpses of Guantanamo -- medical ethics and the war on terror. N Engl J Med. 2005;353:2529-2534.
  5. Reyes H. Medical and ethical aspects of hunger strikes in custody and the issue of torture. Available at: Accessed September 12, 2007.
  6. American Medical Association. AMA reiterates opposition to feeding individuals against their will. March 10, 2006. Available at: Accessed September 12, 2007.
  7. World Medical Association Web site. World Medical Association declaration on hunger strikers (Declaration of Malta). October 2006. Available at: Accessed September 12, 2007

Matthew K. Wynia, MD, MPH
Medscape General Medicine. 2007;9(4):5
Posted 10/05/2007

Link to Medscape [registration required]

Link to AMA statement of opposition to force feeding

HIV’s genetic journey

UF researchers track genetic journey of HIV from birth to death

The University of Florida has announced that its scientists have discovered how HIV evolves over the course of a person’s lifetime into a more deadly form that heralds the onset of full-blown AIDS. These findings could pave the way for new therapeutic agents that target the virus earlier in the disease process, before it takes a lethal turn, researchers say.

“We were very interested in understanding how the virus mutates from the beginning of the infection until the end,” said Marco Salemi, an assistant professor of pathology, immunology and laboratory medicine in the University of Florida College of Medicine and lead author on the study. “Previously, the only thing known was that somehow the HIV population mutates. And as soon as that happens, patients start developing AIDS. But no one knew how and where the population evolved over time.”

University of Florida researchers began tracking four children born with HIV, studying blood samples taken at birth, throughout life and just after death, when tissues samples were also taken. Using a high-resolution computational technique, they monitored mutations in a protein that helps HIV attach to human cells and then categorized the virus into two groups, R5 and X4. The R5 population is usually present in high numbers during the early stages of infection. But the X4 population enters the scene later, just before HIV gives way to full-blown AIDS. The researchers tracked the viruses in each patient to find out when and where the telltale X4 population first appeared.

“The general dogma has always been that the X4 viruses are more pathogenic than the R5 viruses. And that really isn’t true. People die from the R5 viruses,” said Maureen Goodenow, senior author of the paper and the Stephany W. Holloway university chair for AIDS research in the UF College of Medicine. “But certainly evolution of these X4 viruses is not a good prognostic indicator. So if we could understand the selective pressures that push viruses to develop like that, and the steps involved in the conversion of viruses, then we might be able to set up new targets for drug development.”

Previous studies have relied on cell culture or animal models to follow the virus’ mutations over time. The University of Florida researchers are among the first groups to study the progression of HIV in human patients.

As the study revealed new information about the evolution of HIV, the scientists learned that most viral changes take place in the thymus, a small organ located behind the breastbone that is responsible for immune cell development.

“We found that the late-stage viruses, the X4 viruses, were localized predominantly in the thymus,” Goodenow said. “It says that the thymus is the place where these viruses develop, or at least where they’re localized and replicate.”

The origin of the X4 viruses has puzzled scientists for years. The research reveals that the X4 viruses are not present in the body all along, as some scientists had speculated, but rather, that they evolve directly from the R5 population just before the onset of AIDS. The researchers also found that HIV followed a similar path in each child, regardless of variations in the patients’ medical histories.

“We’re starting to see what looks like a program of virus development over time. And it doesn’t matter who the person is. And it doesn’t matter what the time scale is,” Goodenow said. “It’s raising the possibility that, in fact, the evolutionary track of the virus is not totally random. There could be a real developmental program that the virus goes through.”

The next step, Goodenow said, will be to track the evolution of HIV in adults before and after treatment. The researchers hope their findings will pave the way for new drugs that interfere with the virus’ ability to evolve in the thymus.


Phylodynamics of HIV-1 in Lymphoid and Non-Lymphoid Tissues Reveals a Central Role for the Thymus in Emergence of CXCR4-Using Quasispecies
Salemi M et al

PLoS ONE 2(9): e950. doi:10.1371/journal.pone.0000950

Link to PLoS ONE article

Link to University of Florida release