Tuesday, September 30, 2008
Michael Carter for Aidsmap (September 30, 2008)
HIV no longer bar to granting of US visa for short visits
Being HIV-positive will no longer be a bar to the granting of a visa to visit the USA, according to new rules issued by the US Department of Homeland Security.
US consular officials will now have the authority to grant visas for short visits to otherwise eligible HIV-positive individuals without having to obtain a special “waiver.” But a visa must be obtained before travel to the US.
The new rule, called the Human Immunodeficiency Virus (HIV) Waiver Final Rule was announced on September 29th . It applies to people with HIV who wish to visit the US for up to 30 days.
But US consular officials will have to be satisfied that HIV-positive visa applicants will not engage in activities in the US that will pose a threat to public health.
Eligible HIV-positive individuals will now be able to obtain a visa to visit the US on the same day as they have an interview with a consular official.
HIV-positive people wishing to enter the US have previously had to apply for a special visa waiver. Should a person be ineligible for entry to the US under the new HIV rules, they will still have the option of applying for such a waiver. Decisions about the issuing of these are made on a case by case by the US Department of Health and Human Services, and the process can be lengthy.
Citizens of the UK and many other countries can make short visits to the US without obtaining a visa in advance from the US consulate. This option will not be available to HIV-positive individuals who, under the new rules must obtain a visa before travelling.
'Sumo virus' warning is issued
A viral skin condition linked to contact sports such as rugby and wrestling has prompted warnings after two deaths in Japan. "Herpes gladiatorum" - dubbed "scrumpox" in the UK - is passed through broken skin.
The Tokyo University researchers, writing in the Journal of General Virology, studied 39 sumo wrestlers diagnosed with herpes between 1989 and 1994. The unusual strain found was easily spread and more severe than other virus types.
The herpes infection is normally associated with the sexually-transmitted form, genital herpes, and cold sores, but in rare cases it can affect other parts of the body.
Herpes gladiatorum is spread through broken skin, and has been often linked before with sports such as wrestling, which involve close body contact.
It is generally diagnosed after the appearance of a rash of blisters, and while it can be treated with antiviral drugs, it can lie dormant in nearby nerve endings, and may re-emerge on a regular basis to cause similar symptoms in patients who contract it.
Sumo wrestlers live and train communally in "stables" called "heyas", providing the perfect environment for the virus to spread.
Two of the infected wrestlers died as a result of the severity of their illness, although it is not clear whether any other aspect of their health may have contributed to this.
While one particular strain, BgOl, is historically associated with herpes gladiatorum, the researchers found another BgKl, was more prevalent in their samples.
Dr Kazuo Yanagi, who led the research, said: "Herpes virus can hide in our nerve cells for long periods of time and symptoms can reappear later.
"Our research showed that the BgKl strain of herpes is reactivated, spreads more efficiently and causes more severe symptoms that BgOl, and other strains.
Analysis of herpes simplex virus type 1 restriction fragment length polymorphism variants associated with herpes gladiatorum and Kaposi's varicelliform eruption in sumo wrestlers
Journal of General Virology 89 (2008), 2410-2415; DOI 10.1099/vir.0.2008/003368-0
Link to Journ Gen Vir abstract
Cluster of multi-drug resistant HIV transmissions in Seattle
Investigators in Seattle have reported a cluster of nine HIV infections involving resistance to multiple drugs from all the three main classes of antiretrovirals. The report is published in the October 1st edition of the Journal of Acquired Immune Deficiency Syndromes.
Seven of the nine men were newly diagnosed with HIV, the other two men had chronic HIV infection and were receiving antiretroviral therapy. One of these cases appears to involve superinfection during antiretroviral therapy that had been suppressing viral load to undetectable levels.
All nine cases involved gay men with high risk sexual activity. None of the men experienced rapid HIV disease progression and one patient initiated a carefully selected antiretroviral regimen that suppressed his viral load to undetectable levels. Nevertheless, the investigators note that the strain of drug-resistant HIV infecting the men was very “fit” and highly transmissible.
About 10% of new HIV infections in the US involve primary drug resistance. This is associated with a poorer outcome, including a faster decline in CD4 cell count. It is recommended that all HIV-positive individuals have a resistance test at the time of their diagnosis and when starting HIV treatment, or when changing therapy because of an increase in viral load.
Drug-resistant HIV is generally less “fit” and less likely to be transmitted than drug-susceptible virus. If, however, drug-resistant virus is transmitted and a cluster of linked infections is identified, it suggests that this stain of the virus has a high level of infectivity.
When a cluster of new HIV infections with drug resistance is spotted it is important to try and identify the transmission chain and to observe the outcome of patients to inform the development of public health measures and treatment strategies.
Since 2003 the US Centers for Disease Control and Prevention and the department of Public Health – Seattle and King County has been performing resistance tests on all treatment-naïve HIV-positive individuals since 2003. Healthcare providers are also encouraged to notify health authorities to report cases of primary multi-drug resistant HIV.
In 2006, health officials in Seattle became aware of two cases of primary multi-drug resistant HIV infection in patients who had never taken antiretroviral therapy. By the end of 2007 a further five cases had been reported in treatment-naïve patients and two cases in patients taking antiretroviral therapy. All the cases had similar resistance profiles, and in eight cases the pattern of resistance was confirmed by genotypic resistance testing.
“We observed a cluster of multi-drug resistant HIV transmitted for more than a 2-year period, but not associated with rapid clinical or laboratory decline”, write the investigators. They add, “methamphetamine and erectile dysfunction drug use among members of this cluster may provide targets for surveillance, intervention activities, and research to assess the impact of use of these agents on the risk of infection with drug-resistant HIV and their relation to clinical outcomes.”
Transmission Cluster of Multiclass Highly Drug-Resistant HIV-1 Among 9 Men Who Have Sex With Men in Seattle/King County, WA, 2005-2007.
Susan E Buskin, PhD, MPH
JAIDS Journal of Acquired Immune Deficiency Syndromes 49(2):205-211, October 2008.
Link to JAIDS abstract
The same edition of the Journal of Acquired Immune Deficiency Syndromes (JAIDS) includes a report of a study
HIV Serosorting in Men Who Have Sex With Men: Is It Safe?
The investigators remind us - Serosorting is the practice of preferentially having sex with partners of concordant HIV status or of selectively using condoms with HIV-discordant partners.
Their study evaluated the epidemiology of serosorting among men who have sex with men (MSM) seen in a sexually transmitted disease clinic, Seattle, WA, 2001-2007, and defined the percentage of visits during which MSM tested HIV positive based on whether they reported nonconcordant unprotected anal intercourse (UAI), UAI only with partners thought to be HIV negative (serosorters), no UAI, or no anal intercourse.
Men reported serosorting during 3295 (26%) of 12,449 visits. From 2001 to 2007, the proportion of visits during which men reported serosorting increased and this change was greater among HIV-infected MSM than among HIV-uninfected MSM. Among men who tested HIV negative in the preceding year, HIV tests were positive in 49 of 1386 who reported nonconcordant UAI, 40 of 1526 serosorters, 28 of 1827 who had only protected anal intercourse, and 0 of 410 who had no anal intercourse, 32% of new HIV infections occurred in serosorters. The prevalence of HIV was higher among serosorters tested during 2004-2007 than among those tested during 2001-2003 .
They conclude: Serosorting offers MSM limited protection from HIV.
HIV Serosorting in Men Who Have Sex With Men: Is It Safe?
Golden, Matthew R MD, MPH , Stekler, Joanne MD, MPH, Hughes, James P PhD , Wood, Robert W MD
JAIDS Journal of Acquired Immune Deficiency Syndromes. 49(2):212-218, October 2008.
Link to JAIDS abstract
And apart from publishing their erudite findings in academic journals Dr. Bob and his prevention players at Seattle Public Health did what?
BBC News on line (September 29, 2008)
Penicillin bug genome unraveled
Dutch researchers have decoded the DNA sequence of the fungus which produces penicillin. It is hoped that uncovering the genome of Penicillium chrysogenum will boost the development of new antibiotics to overcome problems of resistance.
Full details of the 13,500-gene sequence will be published in Nature Biotechnology.
Penicillium chrysogenum is used in the production of antibiotics such as amoxicillin, ampicillin, cephalexin and cefadroxil.
The findings come just in time for the 80th anniversary of the discovery of penicillin by Sir Alexander Fleming. Its use in killing bacteria was discovered in 1928 after mould spores accidentally contaminated a petri dish in a laboratory.
About one billion people are thought to take penicillin every year around the world.
But antibiotic resistance is becoming an increasingly serious problem, as for example has been shown with MRSA. Experts have repeatedly cautioned against overuse of antibiotics and warned there is an urgent need for industry to develop new drugs.
Researchers said in addition to combating resistance, the genome sequence may also help to improve the manufacturing of antibiotics.
Dr Roel Bovenberg, a researcher at DSM Anti-Infectives, the biotechnology company behind the genome sequencing, said the four-year project had thrown up "several surprises" which they were investigating further in collaboration with academics.
"It provides insight into what genes encode for, know-how in terms of manufacturing and new compounds to be identified and tested. “
"There are genes and gene families we did not think would be involved in biosynthesis of penicillins - they weren't on our radar so that is our follow-up work."
Genome sequencing and analysis of the filamentous fungus Penicillium chrysogenum
Marco A van den Berg et al
Nature Biotechnology Published online: 28 September 2008 | doi:10.1038/nbt.1498
Link to Nature Biotech abstract
Monday, September 29, 2008
Risky Behaviors On TV May Be Modeled By Inexperienced Viewers
Content analyses demonstrate that TV programming is highly saturated with sexual content and risky sexual behavior.
A new study in the Journal of Communication shows that people with direct experience with such behavior are not influenced by its portrayal on TV. However, those without direct experience are more likely to participate in the unsafe behavior in the future, regardless of the consequences displayed.
Robin L. Nabi and Shannon Clark of the University of California conducted two studies to assess whether or not televised depictions of risky sexual behaviors alter viewers’ expectations of their own future sexual behaviors, regardless of their consequences.
In the first study, researchers examined the contents of TV programming schemas and found that viewers expect main characters to ultimately survive and thrive despite the adversity they face. In the second study, college women were exposed to various portrayals of promiscuous sexual behavior, such as one night stands, that were edited to display more or less positive or negative outcomes.
In the second study, college women were exposed to various portrayals of promiscuous sexual behavior, such as one night stands, that were edited to display more or less positive or negative outcomes.
Portrayals of the risky behavior were likely to affect only those without direct experience with the target behavior. The portrayal of outcomes—good or bad—did not affect attitudes or intentions regarding that behavior.
Specifically, for those who had not previously had a one night stand, viewing fictional depictions of this behavior significantly increased expectations of the likelihood of having one in the future, regardless of the positive or negative outcomes portrayed.
“Even when behaviors are negatively portrayed, audiences may be motivated to model them anyways,” the authors conclude. “We hope this research stimulates greater care in the application and testing of psychological theories to the study of media content and effects.”
Exploring the Limits of Social Cognitive Theory: Why Negatively Reinforced Behaviors on TV May Be Modeled Anyway
Robin L. Nabi & Shannon Clark
Journal of Communication Volume 58 Issue 3 (p 407-427) (September 2008)
Link to Journal of Communication abstract
Nearly one in three UK HIV patients has considered suicide in the previous week
A UK study of HIV patients at four clinics in London and one in Brighton has found that 31% reported having had suicidal thoughts over the previous week.
The study, published in the journal AIDS , found that heterosexual men, people of black ethnicity and people who had not disclosed their status to anyone were about twice as likely to have suicidal thoughts as other groups.
Other strong predictors of suicidal ideation were being unemployed, being single, and having stopped HIV treatment, though these factors lost significance in multivariate analysis.
Suicidal thoughts were also associated with poor treatment adherence and with having poorer physical and/or mental health, but were not associated with age, being on treatment, time on treatment, type of treatment or viral load.
Since 1990, the authors note, 271 or nearly 2% of the approximately 14,000 HIV positive people who have died in the UK have taken their own lives, and the proportion of deaths due to suicide has increased in the period since effective HIV treatment became available. However, there have not been many studies of suicidality since the advent of combination HIV treatment, and studies have also left it unclear as to whether HIV infection was independently associated with suicidal thoughts or whether they were simply more common in the kinds of people more vulnerable to HIV.
The UK study, led by Professor Lorraine Sherr of Royal Free and University College Medical School, asked all 903 eligible patients attending the five clinics in a three-month period in 2005 and 2006 to fill in a confidential questionnaire asking then whether they had experienced suicidal thoughts over the previous week, and if so how frequently.
Factors not associated with suicide included age, having had unsafe sex, number of sex partners, pessimism about treatment or being infectious, and type of treatment. However suicidality was significantly higher in those who had stopped treatment and there was the same rate of suicidal ideation in those who were poorly adherent.
The study appears to back the idea that HIV infection is an independent psychological stressor in its own right. The authors point out that the 31% rate of suicidal thinking is more than twice as high as that observed in gay men (13%), a group known for high suicide rates. And the fact that 45% of heterosexual men recorded suicidal thinking in the present study, as opposed to 30% of gay men, would point to HIV infection and related factors such as stigma and shame, poor health and health pessimism, and what the authors call “the burden of secrecy and lack of community and social support” as being the most significant influences on suicidal thinking.
Suicidal ideation in UK HIV clinic attenders.
Lorraine Sherr et al
AIDS 22(13):1651-1658. 2008.
Link to AIDS abstract
Natural Viagra? 'Horny Goat Weed' Shows Promise
Move over, Viagra! Researchers in Italy report that an ancient Chinese herbal remedy known as "horny goat weed" shows potential in lab studies as source for new future drugs to treat erectile dysfunction (ED). The study, which provides scientific evidence supporting the herb's well-known use as a natural aphrodisiac.
In the new study, Mario Dell'Agli and colleagues point out that Viagra (sildenafil) and several other prescription drugs are now available for ED, or male impotence. ED affects an estimated 18 million men in the United States alone. Studies show, however, that these drugs may cause side effects such as headache, facial flushing, stomach upset, and visual disturbances.
To find better treatments, the scientists studied herbal extracts reputed to improve sexual performance. Scientists exposed the substances to an enzyme that controls blood flow to the penis and whose inhibition results in an erection.
Of the extracts tested, "horny goat weed" was the most potent inhibitor of the enzyme. By chemical modification of icariin, the active ingredient purified from the extract, the scientists obtained a derivative with activity similar to Viagra and a potential for fewer side effects because it targeted the protein more precisely than sildenafil.
Potent Inhibition of Human Phosphodiesterase-5 by Icariin Derivatives
Mario Dell’Agli et al
Journal of Natural Products, 71 (9), 1513–1517, 2008.DOI: 10.1021/np800049y
Statins 'prevent artery aging'
Drugs given to heart patients to lower cholesterol may have an additional benefit - keeping their blood vessels feeling younger.
Advanced heart disease patients have arteries which have effectively aged faster than the rest of their bodies. University of Cambridge scientists, writing in the journal Circulation Research, say statins may be able to hold back this process. They suggest the same drugs might also prevent damage elsewhere in the body.
While it has been known for some time that they can lower cholesterol levels, this did not fully account for the benefits experienced by some patients, and evidence is growing that they can boost the function of the cells lining the heart arteries. The Cambridge study adds to this evidence, and may shed light on how statins do this.
Cells in the body can only divide a limited number of times, and in patients with heart disease, the rate of division in these arterial cells is greatly accelerated - dividing between seven and 13 times more often than normal. As the cells "run out of " divisions, they can suffer DNA damage, and do not work as well. One of the important roles of these cells is to keep the artery clear of fatty "plaques" which can expand and block them, causing heart attack.
The research found that statins appear to increase levels of a protein called NBS-1, which is involved in the repair of DNA within cells. This means they may be able to hold off the effects of old age in the artery wall for a little longer.
Professor Martin Bennett, who led the research, said: "It's an exciting breakthrough to find that statins not only lower cholesterol but also rev up the cells' own DNA repair kit, slowing the ageing process of the diseased artery.
"If statins can do this to other cells, they may protect normal tissues from DNA damage that occurs as part of chemotherapy and radiotherapy for cancer, potentially reducing the side-effects."
Statins Use a Novel Nijmegen Breakage Syndrome-1–Dependent Pathway to Accelerate DNA Repair in Vascular Smooth Muscle Cells
Melli Mahmoudi et al
Circulation Research. 2008;103:717-725 doi: 10.1161/CIRCRESAHA.108.182899
Link to Circulation Research article
Sunday, September 28, 2008
Lady Constance's Culture Corner
Maybe little Malcolm identified with Russell Harty because they we both 'northern' lads! (5 September 1934 – 8 June 1988) was an English television presenter with a distinctive style (even if some did call it ‘camp’).
Born in Blackburn, Lancashire in 1934, Russell attended Queen Elizabeth's Grammar School and then like other 'scholarship boys' went on to Exeter College, Oxford, for a first-class degree in English Literature. He worked as an English teacher at Giggleswick School!
But it was as a television presenter that he made his marks, keeping his northern tinged distinctive style (even if some did call it ‘camp’) He was a good friend of the playwright Alan Bennett, who has written about him,
He died in London -- an untimely death 20 years ago in 1988 -- from AIDS related Hepatitis B.
Saturday, September 27, 2008
Condition critical: The medical crisis facing America
In February this year, an elderly woman showed up in the emergency room at the University of California, San Francisco, struggling to breathe - not an unusual symptom for a patient with a weak heart. But her underlying condition was not the only problem. She was also being troubled by a cardiac defibrillator and pacemaker, costing tens of thousands of dollars, that had been implanted into her chest at another hospital just days before.
"She was a very frail old lady. It was a bulky device, and it was protruding out of her chest and making her diaphragm jump every time the pacing part went off," recalls Rita Redberg, the UCSF cardiologist to whom the patient was referred. Worse still, it turned out that the woman wanted to die peacefully if her heart gave out. So implanting a defibrillator, which automatically delivers an electric shock to a stalling heart, was completely inappropriate.
"It's a very painful thing to be shocked," Redberg points out. "I said: 'Do you realize that you will not be able to die quietly with this device?' She said: 'No, they didn't tell me that.' We deactivated the device, changed her medicines a bit, and told her to go and enjoy herself."
It is not simply that 75 million Americans have little or no access to medical coverage. Equally damaging in the long term is the fact that through overuse and misapplication the technical advances that are the hallmark of American medicine are killing the system. In some cases, excessive medical care might actually be making people sicker
The US spends twice as much per head on healthcare as many other developed nations, with no clear extra benefit to show for it. The total bill, now over $2 trillion per year, is rising rapidly. At this rate, the Congressional Budget Office (CBO) estimates that the US's health spending will balloon from 16 per cent of GDP in 2007 to 49 per cent in 2082. Meanwhile, ever more of its citizens will be unable to afford medical care.
There also needs to be changes to the way doctors are paid. At present, this usually operates on a "fee-for-service" basis, under which doctors are paid for every procedure they administer, whether or not it is appropriate. The surgeon who implanted the defibrillator deactivated by Redberg's team, for instance, would have been paid a fee of around $1600 by Medicare.,
With such perverse incentives to deliver more care, regardless of its benefits, it is little wonder that costs are spiraling out of control. "There is excessive use of just about everything," says Helen Darling, president of the National Business Group on Health in Washington DC, which represents many of America's leading companies. "It just gets worse and worse."
"It takes me at least 20 minutes to explain why they don't need a test, and how they can actually help prevent a heart attack with lifestyle changes," she says.
Because Redberg is a salaried member of UCSF's faculty, so she can afford to take time to explain why patients don't need a test, and how they can actually help prevent a heart attack with lifestyle changes,. It's a different story for those working on a fee-for-service basis in a cardiology practice that has paid $1 million for a CT machine and could bill patients' insurance plans around $700 per scan: the pressure would be on to use the device as much as possible.
Link to New Scientist article [subscription required]
In 2003, a team led by Elliott Fisher at the Dartmouth Medical School in Hanover, New Hampshire, studied spending by the Medicare program, concentrating on patients with hip fracture, colorectal cancer and heart attacks. If anything, the extra intervention in regions that spent most on treatment seemed to be harmful. For every 10 per cent of additional spending in a region, death rates over five years rose by between 0.3 and 1.2 per cent.
Dartmouth Medical School is the hub of evidence-based medicine in the US. Since 1979, researchers have documented huge variations in the extent and cost of medical care offered in different parts of the country. And as the evidence has stacked up, it has become clear that patients in the highest-spending regions are no healthier.
The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care
Elliot S. Fisher, MD, MPH et al Annals of Internal Medicine, 18 February 2003 | Volume 138 Issue 4 | Pages 288-298
Link to Annals of Internal Medicine abstract
Friday, September 26, 2008
Scientists Unmask Key HIV Protein, Open Door For More Powerful AIDS Drugs
University of Michigan scientists have provided the most detailed picture yet of a key HIV accessory protein that foils the body's normal immune response. Based on the findings, which appear online in the journal PLoS Pathogens, the team is searching for new drugs that may someday allow infected people to be cured and no longer need today's AIDS drugs for a lifetime.
"There's a big hole in current therapies, in that all of them prevent new infection, but none attack the cells that are already infected and hidden from the immune response," says Kathleen L. Collins, M.D., Ph.D., the study's senior author and a U-M associate professor in both internal medicine and microbiology and immunology.
In people infected with HIV (human immunodeficiency virus), there is an unsolved problem with current anti-viral drugs. Though life-saving, they cannot root the virus out of the body. Infected cells are able to live on, undetected by the immune system, and provide the machinery for the virus to reproduce and spread.
"People have to be on the existing drugs, and when they're not, the virus rebounds. If we can develop drugs that seek out and eradicate the remaining factories for the virus, then maybe we could eradicate the disease in that person," Collins says.
The new research details the complex actions of a protein, HIV-1 Nef, that is known to keep immune system cells from doing their normal jobs of detecting and killing infected cells.
Collins and her team show how Nef disables two key immune system players inside an infected cell. These are molecules called major histocompatability complex 1 proteins (MHC-1) that present HIV antigens to the immune system, and CD4, the cell-surface receptor that normally locks onto a virus and allows it to enter the cell.
Collins likens MHC-1 to motion detectors on a house, which send the first signal to a monitoring station if an invader breaks in.
"The immune system, especially the cytotoxic T lymphocytes, are like the monitors who get the signal that there's a foreign invader inside the cell, and send out police cars," she says. "The 'police' are toxic chemicals produced by T lymphocyte cells, which kill the cell that harbors the invader."
By in effect pushing the MHC-I proteins into an infected cell's " " so they fail to alert the T lymphocytes, Nef's actions allow active virus to hide undetected and reproduce. Also, once a cell has been infected, Nef destroys CD4. The result is that this encourages new virus to spread to uninfected cells.
Nef's activities are variable and complex. But the research team's findings suggest that the many pathways involved may end in a final common step. That could make it possible to find a drug that could block several Nef functions.
Collins' lab is now screening drug candidates to find promising Nef inhibitors. Such drugs, which are at least 10 years away from use in people, would supplement, not replace, existing anti-viral drugs given to HIV-infected people. The new drugs would target the reservoirs where the virus hides.
In developing countries, the new drugs could have a huge impact, Collins says. Today, children born with HIV infection start taking the existing anti-HIV drugs at birth. It's very hard to continue costly treatments for a lifetime. But if children could be cured within a few years, global HIV treatment efforts could spread their dollars further and be much more successful, she says.
HIV-1 Nef Targets MHC-I and CD4 for Degradation Via a Final Common β-COP–Dependent Pathway in T Cells.
Malinda R. Schaefer et al
PLoS Pathogens 4(8): e1000131. doi:10.1371/journal.ppat.1000131
Link to PLoS Pathogens abstract
World leaders and philanthropists have pledged nearly $3bn to fight malaria at a summit in New York. The meeting, at the UN, is looking at ways of meeting the Millennium Development Goals - targets on reducing global poverty by the year 2015.
Donors hope the money will be enough to eradicate malaria by that time.
The money includes $1.1bn from the World Bank and $1.6bn from the Global Fund to Fight Aids, Tuberculosis and Malaria.
The British government and private organizations such as the Bill and Melinda Gates Foundation have promised the rest. The Foundation will provide $168.7m to fund a Malaria Vaccine Initiative for research on a new generation of anti-malaria vaccines
The funding, will be used to support rapid implementation of the first ever Global Malaria Action Plan (Gmap).
According to Gmap's projections, more than 4.2 million lives can be saved between 2008 and 2015, if its plan is put into action, and the foundation can be laid for a longer-term effort to eradicate the disease.
Activists and health workers in South Africa celebrated outside the Cape Town parliament building last night after the news that Dr Manto Tshabalala-Msimang has been replaced as South Africa’s Minister of Health by Barbara Hogan, one of the few African National Congress (ANC) Members of Parliament who spoke out openly against AIDS denialism in former president Thabo Mbeki’s government.
Barbara Hogan supported the Treatment Action Campaign’s (TAC) early efforts to get the government to provide antiretroviral therapy (ART) in the public health system.
“We believe that the period of politically supported AIDS denialism has ended with the appointment of the Minister of Health,” a TAC press release declared.
The new President Motlanthe, is a well-respected veteran of the anti-apartheid struggle. Seen as belonging to neither camp within the divided ANC, he was selected as a consensus candidate to lead the country, at least until elections next year, when Zuma is expected to run for President.
Dr Tshabalala-Msimang remins in the governement but has effectively been transitioned out of the Health Department.
During her ttenure as Minister of Health over two million South Africans died of HIV.
Sometimes called Dr Beetroot, for promoting a diet of beets, African potatoes, garlic and lemon as a remedy for people with HIV, she initially resisted the roll-out of treatment to prevent mother-to-child transmission (PMTCT) and of ART in the country. Instead, she supported the right of AIDS denialists to sell high-dose vitamin ‘cures’ without scientific evidence of benefit.
TAC is eager to work with Minister Hogan. In fact, about 50 of the activists serenaded her outside her flat in Cape Town’s City Bowl last night.
According to an report in the Star, she came down to greet the activists. Fatima Hassan of the AIDS Law Project hugged her and announced that it was “the happiest day of her life.” But TAC acknowledges there will be tremendous challenges ahead.
Stigma is contributing to the sexual transmission of hepatitis C virus amongst HIV-positive gay men, a small qualitative study published in the journal Culture, Health and Sexuality suggests. The study revealed that the fear and stigma surrounding hepatitis C means that gay men are engaging in sexual activities with a high risk of hepatitis C transmission and are reluctant to disclose or discuss hepatitis C infection.
The investigator suggests that efforts should be made to counter the stigma that surrounds hepatitis C amongst gay men, and to provide targeted information about the risks of sexual transmission of hepatitis C to gay men with high risk sexual behaviors.
Outbreaks of sexually transmitted hepatitis C have been reported amongst HIV-positive gay men in the UK and across Europe. Sexual behaviors linked with the sexual transmission of hepatitis C in this population are fisting, group sex and unprotected anal sex.
Significant numbers of HIV-positive gay men select sexual partners who are also HIV-positive, a practice called “serosorting.” Although this may avoid the risk of infecting a partner with HIV, it still involves a risk of other sexually transmitted infection, including hepatitis C.
Both HIV and hepatitis C are stigmatized illnesses, arising from the potentially life-threatening nature of the infections and their association with lifestyles that are often perceived as “deviant.”
Earlier research suggests that stigma can affect the willingness of individuals with HIV or hepatitis C to disclose their infection.
Dr Gareth Owen designed a pilot study to determine the emotional experiences of stigma of HIV-positive men who were either coinfected with hepatitis C or had received successful treatment for the infection.
Six in-depth interviews were conducted in London with men aged 32 – 43. All the men had risk factors for the sexual transmission of hepatitis C, including fisting, unprotected anal intercourse and group sex. These activities often occurred within the context of private sex parties where recreational drugs were consumed. Serosorting was reported by all six individuals.
“Feeling” stigmatized because of hepatitis C was common amongst the six men. One individual reported that these feelings were often worse than the physical effects of the infection: “I think how it makes you feel is worse than the actual thing itself…The fear of rejection, the fear of the stigma and all that is actually more toxic than the disease itself.”
“I think that hep C is the big new white elephant in the room”, said one participant, “I think that gay men are afraid of hep C and I think that’s because they don’t seem to know much about it, except maybe it kills you.”
A diagnosis of hepatitis C was perceived as excluding men from the “camaraderie of just being HIV-positive.” This was illustrated by the comments of one of the study’s participants: “Hep C is not yet owned by the gay community like HIV, and if it isn’t owned, then it is outside and more stigmatized…Even within the gay community, and the HIV community too, it has created a ‘them’ and ‘us’ type situation.”
Several of the men indicated that stigma was silencing discussion of hepatitis C amongst HIV-positive men with a high risk of sexual exposure to the virus. “Stigma silences things and that allows more stigma to build in that silence”, said one individual, “but you can understand why people have to remain silent because the stigma is there in the first place.”
Based upon his research Dr. Owen presents a model where the fear of hepatitis C causes hepatitis C to be stigmatized by HIV-positive gay men. This fear leads to sexual rejection should hepatitis C be disclosed, with this sexual rejection leading to shame and more fear, which in turn leads to silence and non-disclosure. “This creates transmission risk in situations where HIV-positive men have serosorted and to engage in unprotected sexual practices.”
An ‘elephant in the room’? Stigma and hepatitis transmission among HIV-positive ‘serosorting’ gay men.
Culture, Health and Sexuality Vol 10 issue 6: 601 – 610, 2008
Hollywood 'paid fortune to smoke'
Tobacco firms paid huge amounts for endorsements from the stars of Hollywood's "Golden Age". Industry documents released following anti-smoking lawsuits reveal the extent of the relationship between tobacco and movie studios.
One firm paid more than $3m in today's money in one year to stars.
Researchers writing in the Tobacco Control journal said "classic" films of the 1930s, 1940s and 1950s still helped promote smoking today. Virtually all of the biggest names of the 1930s, 1940s and 1950s were involved in paid cigarette promotion, according to the University of California at San Francisco researchers.
They obtained endorsement contracts signed at the times to help them calculate just how much money was involved.
According to the research, stars prepared to endorse tobacco included Clark Gable, Cary Grant, Spencer Tracy, Joan Crawford, John Wayne, Bette Davis and Betty Grable.
One of the key documents uncovered by the researchers was a list of payments for a single year in the late 1930s detailing how much stars were paid by American Tobacco, the makers of Lucky Strike.
Leading ladies Carole Lombard, Barbara Stanwyck and Myrna Loy were handed $10,000, equivalent to just under $150,000 in today's money, to endorse the brand, as were Clark Gable, Gary Cooper and Robert Taylor.
Together, the annual price of paying actors was $3.2m in 2008 terms.
The researchers, led by Professor Stanton Glantz, said that the effects of the millions poured into Hollywood by "Big Tobacco" could still be felt today, despite a recent self-imposed ban on promotion within films.
Smoking imagery in films can influence younger people to start smoking.
"As in the 1930s, nothing today prevents the global tobacco industry from influencing the film industry in any number of ways."
"Classic" films with smoking scenes, such as "Casablanca" and "Now, Voyager", and glamorous publicity images helped to "perpetuate public tolerance" of on-screen smoking, they said.
Signed, sealed and delivered: "big tobacco" in Hollywood, 1927–1951
K L Lum
Tobacco Control 2008;17:313-323
Published Online First: 25 September 2008. doi:10.1136/tc.2008.025445
Link to Tobacco Control abstract
Whatever happened to bird flu? The H5N1 virus has been storming across Eurasia and Africa since 2004, destroying birds and killing 245 people, according to official figures. But while it has faded from the headlines, governments and scientists are as concerned as ever about the dangers it poses.
"H5N1 is still out there killing people," says Rob Webster of St Jude Children's Research Hospital in Memphis, Tennessee. "It's doing what we knew it would do - recombining and evolving."
The biggest fear is that H5N1 will evolve to become readily transmissible between people, and we are starting to learn what mutations it needs to do this. Flu spreads among animals if its H protein binds to sugar molecules on cells lining their throats, and so far H5N1 binds better to sugars more common in birds than in mammals. But Wendy Barclay of the University of Reading, UK, reported at a meeting in Oxford, UK, last week, that just two mutations in the H5 protein are enough to make H5N1 bind to mammalian sugar molecules.
H5N1 is not the only threat. "H9 is the real sleeper, the one we have to watch," Webster says. H9 bird flu can cause mild disease in people, but the H9 virus common in poultry across Eurasia now carries several of the same genes which make H5N1 so deadly; a few more mutations and H9 could become a killer too. Many of these poultry have also been vaccinated against H9, which is worrying, because H5N1 probably evolved into a killer in H5-vaccinated poultry, raising fears that the same thing could happen with H9.
H2 also presents a threat. No one born since 1968, when H2 disappeared as a human flu, is immune to this strain. A deadly H2 appeared in pigs in 2006, but was contained.
More bad news. H1N1, has spontaneously developed worrying levels of resistance to the antiviral drug Tamiflu. This calls into question the strategy, which many countries have adopted, of deploying Tamiflu as the first line of defense against a pandemic. It has also mystified virologists, as it shows that drug resistance evolves readily in flu, and does not weaken the virus as some believed it would.
Link to New Scientist article [subscription required]
Thursday, September 25, 2008
Aspirin and Atherosclerosis: Mechanism Uncovered
Aspirin has become one of the most widely used medications in the world, owing to its ability to reduce pain, fevers, inflammation, and blood clotting. In animal studies, aspirin has also been shown to prevent atherosclerosis, though none of its known mechanisms of action would seem to account for this.
In a new study researchers have uncovered the mechanism that may explain aspirin's ability to prevent arterial plaque buildup.
Using cell culture and mouse models, Sampath Parthasarathy and colleagues observed that aspirin –specifically its active byproduct salicylate– can greatly increase the expression of two proteins: paraoxonase 1 (PON1) and apolipoprotein A1 (ApoA1); in the mouse studies, low dose aspirin supplements could increase PON1 and ApoA1 levels by 7- and 12- fold, respectively.
Both of these proteins are beneficial components of the HDL complex, the "good cholesterol" that helps prevent atherosclerosis; ApoA1 removes bad cholesterol from the bloodstream while PON1 is an antioxidant that breaks down toxic lipid peroxides.
The researchers also noted that the heightened expression of PON1 was accompanied by an increase in a receptor called AHR (aryl hydrocarbon receptor); this was intriguing as a chemical known to attach to AHR is resveratrol, the "heart healthy" component of red wine.
Induction of paraoxonase 1 and apolipoprotein A1 gene expression by aspirin.
Priscilla Jaichander et al
Journal of Lipid Research, October, Vol. 49, 2142-2148 October 2008
Link to JLR abstract