HIV infection and food insecurity have created a vicious cycle in sub-Saharan Africa. Those who go hungry tend to engage in more risky sexual behaviors, and those infected with HIV/AIDS are more likely to go hungry because their illness prevents them from finding work. A team of researchers at UCSF and Massachusetts General Hospital conducted a study on the relationship between these two problems in Uganda and found antiretroviral drugs could help but are not the complete answer to the problem. Read more here.
Understanding HIV latency and how to stop it is the key to finding a cure. People infected with HIV must follow a strict regimen of drug treatment to prevent the disease from progressing into AIDS. Treatment, however, does not cure HIV; it merely subdues the virus. If the patient stops treatment, the virus “wakes up” within just a few weeks and starts attacking the body’s immune system. Now scientists have developed a technique for tracking HIV lying dormant inside individual cells, potentially making the virus easier to target. Read more here.
Could we see the end of HIV/AIDS epidemic in our lifetime? Researchers are getting closer to a possible cure. Truvada, a drug that has long been used as treatment for HIV-positive patients, is also the first and only FDA-approved medication to prevent HIV. Researcher Robert Grant of the UCSF-affiliated Gladstone Institutes conducted a study that expanded previous findings that the drug can also be used as a prevention method. Read the full article here.
Activism has long been a factor in advancing treatment and finding a cure for AIDS. Organizations like ACT UP (AIDS Coalition To Unleash Power) and TAG (Treatment Action Group) advocated for those infected from the beginning of the epidemic. Because of these groups, patients have benefited from research funding that has led to cutting-edge treatments and transformed HIV and AIDS from a death sentence to a manageable condition.
Producer David France has made a documentary “How To Survive a Plague,” which chronicles the history of ACT UP and TAG using archival footage to tell the story of these activists and their struggle to be heard. The film is set to open in New York, Los Angeles and San Francisco on Friday, Sept. 21, with a national release to follow.
Diane Havlir, MD, and Chris Beyrer, MD, MPH, co-authored a perspective that appears in today’s New England Journal of Medicine.
Havlir is a professor of medicine at the University of California, San Francisco (UCSF) and the chief of the UCSF Division of HIV/AIDS and Positive Health Program at San Francisco General Hospital and Trauma Center. She served as co-chair of AIDS 2012, the XIX international AIDS Conference.
Here is an excerpt from the NEJM perspective:
We are at a moment of extraordinary optimism in the response to the human immunodeficiency virus (HIV). A series of scientific breakthroughs, including several trials showing the partial efficacy of oral and topical chemoprophylaxis1,2 and the first evidence of efficacy for an HIV vaccine candidate,3 have the potential to markedly expand the available preventive tools. There is evidence of the first cure of an HIV-infected person. And most important, the finding that early initiation of antiretroviral therapy can both improve individual patient outcomes and reduce the risk of HIV transmission to sexual partners by 96%4 has led many to assert what had so long seemed impossible: that control of the HIV pandemic may be achievable.
Read the full perspective in the New England Journal of Medicine.
The scourges of immune-compromised HIV patients have always included opportunistic, chronic infection with other viruses — among them the herpes viruses that cause Kaposi’s sarcoma and chronic cytomegalovirus (CMV) infection.
Before antiretroviral therapy became effective and widely available in the United States, Kaposi’s sarcoma — a form of cancer — was common and sometimes a cause of death among HIV patients. CMV is well known as a cause of pneumonia and diseases of the retina, gastrointestinal tract and neurological system in infants, transplant recipients and in others whose immune systems are weakened.
For HIV patients the threat is greatly reduced when anti-retroviral therapy preserves or restores immune function, but it is not necessarily eliminated.
There’s now hope that clinically useful drugs might emerge from the work of Charles Craik, PhD, a UCSF School of Pharmacy chemist who appears to have found a way to specifically target Achilles’ heels in these herpes viruses.
The importance of CMV infection in particular is being revisited in HIV patients, as CMV now is believed by a growing number of scientists to play a role in the increased susceptibility and earlier onset of diseases associated with aging, even among those in whom the HIV virus is well-controlled. An estimated 95 percent of patients infected with HIV also harbor CMV, as does a large fraction of the broader population. The suspected link between CMV and diseases of aging is thought to be the perpetuation of low-level chronic inflammation by the virus.
It’s still early days for this idea. “It’s controversial whether chronic inflammation – which exists in these patients – is a true independent driver of this process,” meaning accelerated aging, according to UCSF’s Steven Deeks, MD, who studies aging in HIV patients. Deeks is a believer.
Craik has just received a new injection of research funding to pursue his drug strategy. The funds come via a unique competition sponsored by the UCSF Clinical and Translational Science Institute. Finalists for the T1 Translational Catalyst Award, including Craik, received consultation from business leaders with experience evaluating and guiding pharmaceutical ideas toward clinical development.
Down to the lowliest disease-causing virus, every living thing appears to use proteins that chop up other proteins to get anywhere in life. Craik is an internationally recognized expert on these proteins, called proteases. He uses his knowledge of protein structure and molecular interactions to target specific proteases needed by disease pathogens in ways that won’t harm human proteins.
Craik already has decades of experience in identifying protein targets on disease pathogens, including early career work on HIV protease inhibitors. With the new award he plans to further test molecules that might serve as new drugs.
UNICEF Goodwill Ambassador Whoopi Goldberg, second from left, poses with UCSF’s Diane Havlir, second from right, U.S. co-chair of the XIX International AIDS Conference, before speaking Friday at the symposia session, “Looking to the Future in HIV and TB.” © IAS/Ryan Rayburn – Commercialimage.net
A report by Louise Chu, assistant content manager for University Relations at UCSF:
Actress and comedian Whoopi Goldberg was a featured speaker during the Friday symposia session “Looking to the Future in HIV and TB,” urging better TB prevention for children.
Goldberg, a UNICEF International Goodwill Ambassador, is a longtime advocate of people living with HIV. Friday’s address focused on HIV’s effect on children, who become especially vulnerable to contracting severe, often fatal, forms of TB.
Goldberg emphasized the need to do testing for both HIV and TB in countries most affected by the diseases, and offer access to testing and treatment at the same clinics where women are getting family planning services and prenatal care.
Read her AIDS 2012 blog post here.
Other celebrities who have spoken at the conference include Sir Elton John, Debra Messing and Danny Glover.
AnthonyHarries of the International Union against Tuberculosis and Lung Disease, United Kingdom, talks with Judith Currier of UCLA at the XIX International AIDS Conference (AIDS 2012) in Washington, D.C. © IAS/Ryan Rayburn – Commercialimage.net
A report from Gabriel Chamie, MD, MPH, UCSF assistant professor of medicine, Division of HIV/AIDS, San Francisco General Hospital and Trauma Center:
At Friday morning’s plenary session, Dr. Anthony Harries delivered an outstanding overview of tuberculosis (TB)/HIV co-infection, summarizing recent updates and unresolved issues in TB prevention, diagnosis and treatment.
TB is the leading cause of death in HIV-infected persons worldwide, and the incidence of TB remains unacceptably high in settings with generalized HIV epidemics.
Fortunately, as Dr. Harries summarized succinctly, we now have the tools, based on good evidence, to tackle HIV-associated TB, including the “3 Is”, isoniazid preventive therapy (IPT), intensified TB case-finding (ICF), infection control, and antiretroviral therapy. Antiretroviral therapy (ART) clearly prevents active TB disease and the importance of starting ART early during TB treatment is now well established. IPT for prevention of active TB disease is effective, synergistic with ART in its protective effects, and a part of WHO international guidelines.
Unfortunately, IPT scale-up has been extremely slow and a lack of integrated HIV/TB service delivery results in too few HIV-associated TB cases receiving timely ART. Implementation research to address these gaps is needed.
Finding, diagnosing and treating TB (intensified case finding) is critical for reducing TB associated mortality and TB transmission.
[World Health Organization] guidelines for simple symptom screening for TB in HIV-infected persons provide guidance to “rule-out” TB, but numerous challenges remain. The symptom screen has a high negative predictive value, but the symptoms are non-specific and common, and TB diagnosis remains a major obstacle. Dr. Harries emphasized that the usual ways of diagnosing TB (sputum smear and chest x-ray) in much of the world are time consuming, costly and insensitive.
Recent TB diagnostics, including the Xpert MTB/RIF assay and a point-of-care urine LAM assay, are major breakthroughs. However questions remain: how far can we decentralize these diagnostics? How far can we reduce the costs through broader implementation?
Dr. Harries closed with a call to action, saying, “We must implement what we know works,” and we must “use the full weight of our collective conscience to tackle the poverty that is at the root of this HIV/TB epidemic.”
A detailed review of the issues he covered in this plenary will be published in the Journal of the International AIDS Society.
This is a snippet from an interview with Steve Morin in which he discusses what is behind the bipartisan support of PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief.
“PEPFAR enjoys strong bipartisan support for a number of reasons,” Morin said. “It responds to a humanitarian need, it is vital to some of our bilateral agreements with countries that have high burdens of disease, and it allows the United States to have a leadership role.”
Steve Morin, PhD, is a Professor of Medicine, and Chief of the Division of Prevention Science in the Department of Medicine at the University of California, San Francisco (UCSF). He is Director of the Center for AIDS Prevention Studies (CAPS) and the AIDS Policy Research Center (APRC). He is also Associate Director of the UCSF/Gladstone Institute of Virology & Immunology Center for AIDS Research (CFAR). He also holds the Walter Gray Endowed Chair in HIV/AIDS Science at UCSF’s AIDS Research Institute.
A report by Katerina Christopoulos, MPH, assistant professor of medicine, UCSF HIV/AIDS Division at San Francisco General Hospital and Trauma Center:
Ever felt like you were wasting time at the Department of Motor Vehicles? Now you can accomplish key health screening by getting a rapid HIV test while you wait.
In an innovative partnership between community-based organization Family and Medical Counseling Service and the Penn Branch DMV in in southeast Washington, D.C., individuals can get tested for HIV without losing their place in line – and get $7 off their DMV service. Counselors emphasize the importance of getting an HIV test before offering the test and clients are taken into a private room for an oral swab that gives results in 20 minutes.
A compelling presentation in session at the International AIDS Conference by Angela Wood, the social worker who leads the program, demonstrated the power of partnering with local political leaders in establishing HIV testing in non-traditional settings. Wood described getting buy-in first from the city council, who then supported her meeting with the head of the DMV.
Since October 2010, the program has tested nearly 9,000 clients with a test positivity rate of 0.5%, diagnosing 49 individuals with HIV. The majority of these HIV diagnoses represent new infections, though some are individuals who want to re-engage with care.
All individuals who test HIV positive receive immediate, discreet linkage to care services with escort to a community site where they can undergo confirmatory testing, access social work services, and receive an appointment with a medical provider within two weeks.
Though the acceptance rate of testing is around 15 percent, 40 to 50 people test per day, which almost exceeds the capacity of the two counselors who conduct testing. Use of an electronic medical record on-site to record test results allows the program to track testing numbers and review prior test results.
In a city where HIV rates in certain neighborhoods are comparable to parts of Africa, this program represents a truly creative effort to expand and normalize HIV testing and a remarkable collaboration between government and public health.
XIX International AIDS Conference (AIDS 2012) Washington D.C. Thursday Plenary Paul Semugoma Global Forum for MSM and HIVUgandaAfrica © IAS/Steve Shapiro – Commercialimage.net
A report by Brad Hare, MD, associate professor of medicine, UCSF medical director, HIV/AIDS Division, San Francisco General Hospital and Trauma Center:
Gay, bisexual and other men who have sex with men (MSM) remain the population most heavily affected by HIV in the United States.
[The Centers for Disease Control and Prevention (CDC)] estimates that MSM represent approximately 2% of the US population but accounted for 61% of all new HIV infections in 2009.
Even though the overall number of new HIV infections was stable from 2006-2009, there was an estimated 34% increase among young MSM and 48% increase among black MSM over that time.
Paul Semugoma, a gay Tanzanian physician and activist working in Uganda with a special interest in LGBTI populations and health disparities, passionately addressed the [International AIDS Conference (IAC)] at a plenary session on Thursday. He highlighted issues for MSM across the globe, emphasizing that not all countries collect data on HIV infections in MSM populations specifically.
In every region where these statistics are collected, MSM have a higher prevalence than the general population, including in Sub-Saharan Africa, Asia, Latin America, the Caribbean, Oceana, Europe and North America. In North America and Europe, dramatic racial differences within MSM populations exist, with black MSM being 72-111 times more likely to be HIV infected than white MSM.
Barriers to reaching MSM for HIV prevention education and research, testing and delivery of health care include criminalization of same-sex practices, stigma, and lack of cultural competency among health care providers. Dr. Semugoma provided examples of how anti-gay laws and policies in Senegal and Uganda have prevented reaching this high-risk population.
Dr. Semugoma closed his remarks by providing an impassioned call to action to address MSM in the global approach to HIV, reminding us that we cannot achieve an AIDS-free generation without including MSM.
Nearly 4,000 people around the world have shown their support for ending the global AIDS epidemic by signing an online declaration during the XIX International AIDS Conference.
The “Washington, D.C. Declaration” outlines a nine-point action plan that includes focusing on HIV prevention, ending discrimination against HIV patients, boosting research investment and making treatment available to all those who need it.
Sign the D.C. Declaration
The document is the official declaration of AIDS 2012, which has brought together thousands of medical experts, health care professionals, activists and people living with HIV under this year’s theme “Turning the Tide Together.” The biennial meeting hosted by the International AIDS Society began July 22 and runs through July 27. Read the full story on UCSF’s website.
A report from Elise Rile, a UCSF associate professor of medicine in UCSF HIV/AIDS Division at San Francisco General Hospital and Trauma Center:
Debbie McMillan went to the street at age 14, began sex work soon thereafter and ultimately used drugs to avoid the reality of what it took to survive on the street.
She was incarcerated for soliciting as a sex worker and, as a transgender woman housed in a men’s prison, this is where she became HIV-infected.
Debbie represents people at the heart of the AIDS epidemic, many of whom are left out of the conversations that guide HIV programs and policies. For example, drug users and sex workers are currently barred from entering the United States, which means that research, care and policy conversations taking place during the International AIDS Conference will happen without the voice of many people who are impacted the most.
Debbie also pointed out the continued U.S. federal ban on needle exchange programs despite consistent scientific evidence showing their effectiveness to prevent HIV, a decision she sees as a failure to acknowledge science.
Drug users and sex workers want to be part of the conversations that address HIV. Specifically, they want to use scientific evidence and their experiences to be part of an informed solution.
Criminalizing behaviors that put people at risk for HIV and excluding the voices of those living with, at risk for, caring for and studying HIV do not prevent HIV, rather these decisions jeopardize public health and continue to fuel the epidemic.
A report from Sheri Weiser, MD, MPH, MA, assistant professor of medicine in the Division of HIV/AIDS and the Center for AIDS Prevention Studies (CAPS) and Burke scholar in Global Health Sciences at UCSF:
Following the Wednesday morning plenary session where there was a strong call to increase HIV research and funding for women, this session highlighted the strong role of gender inequality and gender based violence in fueling the HIV epidemic and worsening the health of affected women.
Dr. W. Tun reported on a population based study in 8 districts across 4 provinces in Zambia, and found that 1/3 of both women and men endorsed gender inequitable attitudes, 1/3 of both genders agreed that wife beating was justified in certain circumstances, and 40% of both genders agreed that rape is justified in certain circumstances.
This work highlighted the critical importance of targeting gender norms in both men and women in order to combat gender-based violence.
Dr. Kathleen Weber reported alarming statistics from a national study among HIV-infected and HIV-negative but at-risk women in the United States. She found that among over 2000 women followed for up to 10 years, 72% had reported a history of sexual or physical abuse at study entry.
Importantly, among HIV-infected women, women who had experienced any gender-based violence over the previous 12 months had 40% higher odds of mortality. Even more surprising was that HIV-negative women who had experienced recent violence had over 4 times the odds of death. She concluded that identification of and referral for recent abuse may improve survival among both HIV-infected and at risk women.
This session ended with a reminder that sexual and physical violence is not limited to women.
Dr. Christine Dunkle presented some sobering data from the Men’s Health Use and Violence Study in South Africa from a population-based study among [more than] 1700 households in South Africa. She found that 1 in 10 men in the study had experienced male on male violence. Both victims of violence and perpetrators were more likely to report risky sexual practices and symptoms of sexually transmitted diseases.
Importantly, both victims and perpetrators of male on male violence had much higher odds of reporting that they had perpetrated violence against their female partners. In addition, both perpetrators and victims of violence had much higher odds of testing HIV-positive.
This work highlights the importance of targeting male on male violence in sexual violence and HIV programs not only to reduce HIV transmission, but also to improve the physical and mental health and well being of both men and women.
Sheri Weiser photo by Jason Bardi
Brad Hare, MD, associate professor of clinical medicine at UCSF and medical director of the Positive Health Program at San Francisco General Hospital and Trauma Center, reports here on a panel at the XIX International AIDS Conference that included UCSF’s Annie Luetkemeyer about a new era in hepatitis C treatment, which is an increasing cause for concern. See related videos here on the importance of diagnosing hepatitis C early in the course of infection and here and here on new hepatitis C therapies. Also see Hare’s earlier report on some of the latest hepatitis C research at the conference. Here is Hare’s latest report:
Over the last few years, cases of acute hepatitis C virus (HCV) infection, often acquired through sexual transmission among men who have sex with men (MSM), have been increasingly recognized.
Dr. Daniel Fierer reviewed data suggesting more rapid progression of liver fibrosis/scarring after acute HCV infection in HIV-infected individuals, including four cases of rapid progression to liver decompensation within 2-7 years after new HCV infection. He suggested that acquiring HCV on top of pre-existing HIV, particularly at lower CD4 counts, may be partially responsible for this rapid progression.
Dr. Lo Re reported increased rates of liver decompensation (6.3% vs. 5.0%) among HIV/HCV co-infected patients who were on antiretroviral therapy compared to HCV mono-infected patients in the Veterans Aging Cohort.
Treatment for HCV infection is currently undergoing dramatic changes – becoming more effective with shorter treatment duration and including the possibility of all-oral regimens in the near future.
Translating strategies using new drugs and novel treatments to HIV co-infected patients, who have lower treatment responses to standard interferon-ribavirin treatment regimens, is urgently needed.
Dr. Annie Luetkemeyer from the UCSF HIV/AIDS Division presented findings from ACTG 5269 in which nitazoxanide (NTZ) was added to standard HCV treatment with pegylated interferon and ribavirin. While NTZ did not significantly improve HCV virologic cure rates overall, there was a signal for improved responses with the addition of NTZ among patients who had IL28B T/T genotype, which is typically associated with poorer responses to interferon-based therapy.
These observations taken together should remind patients and clinicians to be aware of the possibility of acute HCV infection in HIV-infected patients, particularly MSM, and to screen, diagnose and treat patients with the best regimens possible to cure HCV and prevent liver fibrosis.
Brad Hare Photo by Susan Merrell/UCSF
A report from Jacqueline Tulsky, MD, a professor of clinical medicine, UCSF Department of Medicine based at San Francisco General Hospital and Trauma Center:
Would your dentist be willing to offer you an HIV test? Though not in sync with the title of the [AIDS 2012] session, this intriguing question was explored by Lisa Metsch and colleagues in a mailed survey of 2,567 members randomly selected to be a representative sample of members of the National Dental Association.
In exploring expanded venues for fulfilling the [Centers for Disease Control and Prevention] 2006 guidelines to screen all adults age 18 to 65 at least once in their lifetime, dental offices are potential high-yield sites. An estimated 3.6 million Americans report that they are at significant HIV risk, yet have never been HIV tested. Three quarters of these people have seen a dentist within the past 2 years. Dental care offers opportunities to serve at-risk individuals who are otherwise unlikely to be tested or to receive preventive care services.
The response rate on the survey was a robust 70% with 1,802 surveys returned. Preliminary data analysis revealed that while 41% of dentists would be willing to offer rapid HIV testing using fingerstick blood, the number rose to 63% when the question asked about performing rapid oral HIV tests in the office. Nearly 50% thought that HIV testing was part of a list of health care services that they should make available to patients.
The Perception of Others
In multivariate analysis, dentists were more willing to offer testing if they perceived their patients (adjusted odds ratio (AOR) = 3.5; CI: 2.7, 4.3) and their colleagues (AOR= 2.7; CI: 2.2 3.2), as having a positive attitude toward HIV testing by dentists.
The audience for the session was clearly intrigued by the possibility of testing inside a dental setting, but asked about the challenge of appropriate counseling and linkage to care. In discussions afterwards, the UCSF National Clinician’s Consultation Center, a free phone education and support program for medical professionals, was identified as a source of information about HIV testing and linkage to care throughout the U.S.
Although John Greenspan, BDS, PhD, is an oral pathologist and the associate dean for Global Health with the UCSF School of Dentistry, he was instrumental during the early 1980s in identifying oral lesions associated with HIV infection. That led to breakthrough research in treatment for people living with HIV/AIDS.
The American Dental Association honoring an AIDS pathologist may not be typical, but neither is Dr. Greenspan’s career. To learn more about his body of work and the award he received from the ADA, go to my story, which can be found here.
Linda Scruggs, an HIV-positive woman, right, talks at a morning press conference with Chewe Luo and Diane Havlir. Photo by Jason Bardi/UCSF
A report by Monica Gandhi, MD, MPH, associate professor of clinical medicine, UCSF Division of HIV/AIDS, at San Francisco General Hospital and Medical Center:
The waves of optimism which have swept through this conference were, for the first time in many years, stirring the field of women and children in the Wednesday morning plenaries.
Following a riveting and comprehensive discussion by Dr. Chewe Luo from Zambia on the current state of maternal-to-child-transmission and treatment of children worldwide, Linda Scruggs, an HIV-positive woman working in the field for [more than] 20 years, mounted the platform to spontaneous applause.
Mrs. Scruggs was diagnosed with HIV in 1990 and is now a wife, mother and a minister whose life was “blessed and transformed by HIV.”
She started her presentation by giving honor to a number of people, including her son (now 21) with whom she was pregnant when she was offered the choice of abortion on a “cold November day in Baltimore, Maryland” after a new HIV diagnosis.
She spoke not from her expertise as a capacity builder, but from her position as a woman living with HIV and delivered a series of mandates to the audience and policymakers, including to:
- enroll women at rates “more than 10 percent” in treatment-related research,
- pay more than lip service to women in Obama’s national HIV/AIDS strategy,
- combat gender-based violence,
- refund PEPFAR, the Global Fund and Ryan White programs, and
- to not just tack on women’s programs as an afterthought to male-dominated programs.
She then gave a series of candid, goose bump-raising glimpses into her own life that has led to the “falling away of her shackles” and her position of strength today. Her presentation was moving, interrupted frequently by applause, and was an intensely personal glimpse into the life of a woman living with HIV amidst the facts and figures of other talks at this conference.
Given that 50 percent of HIV infections worldwide are in women and girls, this mid-week plenary was important, moving, powerful and necessary.
A report by Vivek Jain, MD, assistant adjunct professor, UCSF HIV/AIDS Division at San Francisco General Hospital and Trauma Center:
Session Report- Hillary Clinton Morning Plenary 7/23
U.S. Secretary of State Hillary Rodham Clinton gave a rousing speech to the conference on July 23. She began by reflecting on the last US-based [International AIDS Society] conference in 1990 and proudly welcomed the delegates back to the United States.
She reviewed the tremendous progress in the HIV/AIDS epidemic and highlighted the U.S.’s role in this work, culminating in [President’s Emergency Plan for AIDS Relief (PEPFAR)] and now a move from an emergency response to a more sustained response. She then reiterated her call for an AIDS-free generation, which has become one of the rallying cries of the conference and a strong organizing theme.
Reaffirming the U.S. government’s commitment to end AIDS, she said to the doubters: “I know I’m preaching to the choir, but we need the congregation to keep singing and lift up their voice to everyone who’s outside.”
[Clinton] then moved through her vision of the tools that will be needed to achieve an AIDS-free generation: more patients accessing HIV therapy, combination prevention efforts including circumcision, and stronger activities to prevent mother-to-child transmission.
Towards these ends, she then announced four specific new funding programs:
- First was an $80 million investment to investigate and support innovative approaches to ensuring women who are diagnosed with HIV get access to treatment programs and ART.
- Second was a $15 million program in implementation research to identify specific interventions for higher risk groups.
- Third was a $20 million challenge fund to support country-led plans to expand services.
- Fourth was a $2 million fund to promote and strengthen civil society institutions.
She also announced new U.S. Government partnerships with Walgreens (to promote adherence) and Medscape (to promote education). Lastly, Clinton announced that Dr. Eric Goosby will be releasing a blueprint by World AIDS Day in December 2012 outlining the future directions for PEPFAR and the U.S. national response.
Overall, the speech was well received, and represented a good mix of reflection, call to action, and specific new U.S. government commitments and plans to achieve our stated goal of promoting an AIDS-free generation.
Session Report – Sheila Tlou Morning Plenary 7/23
Sheila Tlou of Botswana delivered a morning plenary address on July 23 called “Turning the Tide in Affected Countries: Leadership, Accountability and Targets.”
She is the UNAIDS Director of the Regional Support Team for Eastern/Southern Africa. Tlou framed her call for more leadership first by reviewing some historical examples of stepping forward: the Botswanan leaders who supported PMTCT after ACTG 076 showed ART could prevent vertical transmission.
She also highlighted leaders’ efforts to promote the “B+” therapy option for pregnant women to avoid vertical transmission and to preserve their health, saying: “option B+ is the way to go, and no woman should settle for less.”
Tlou chided global decision makers for havingdiscussion about the cost implications of option B+, saying “if men were the ones getting pregnant, would we be wondering about the costs? I don’t think so. Women have the right to be alive, and to stay alive.”
This clarion call was followed by another call for serious expansion of sexual education, both to promote safe sex practices, to destigmatize sex, and to promote a healthy vision for sexual activity.
Tlou then discussed PREP and stated quite correctly that since Truvada “was tested in populations in our region, therefore populations in our regions should receive support to implement it.” Otherwise, we will be at risk for having perpetrated guinea pig science.
Lastly, Tlou spoke in general terms about the need for good in-country governance, elimination of corruption, accountability and transparency and emphasized how important these will continue to be in the fight against AIDS.
Photo of Plenary Session with Secretary of State Hillary Rodham Clinton © IAS/Ryan Rayburn – Commercialimage.net
Chief Tayak and the Piscataway Nation of American Indians, who have lived in the Maryland-D.C.-Virginia area for 12,000 years, gives a blessing at the opening session of AIDS 2012, XIX International AIDS Conference in Washington, D.C.
Bill and Hillary Clinton, Sharon Stone, Kathleen Sebelius, Bill Gates and Elton John are a few of the headliners to speak this week at AIDS 2012, the XIX International AIDS Conference, which runs through July 27 in Washington, D.C.
A report by Jeff Sheehy, director for communications at the AIDS Research Institute at UCSF, a longtime HIV/AIDS and LGBT human rights activist and a person living with HIV:
“What we learn in time of pestilence: that there are more things to admire in men than to despise.”
-Albert Camus, The Plague
Hillary Clinton was electrifying this morning at the opening plenary committing the U.S. to an “AIDS free generation,” but I found myself wishing George W. Bush were here too.
The first AIDS Conference I attended was in Durban in 2000 (though I was one of many San Franciscans in the streets at the last one held in the U.S. in 1990). I came out of that conference with a stark awareness that something terrible was happening throughout Sub-Saharan Africa and with fear that the world would either temporize or dribble out just enough resources to salve our wealthy country consciences.
I could not have imagined that 12 years later, 8 million people from low- and middle-income countries would be on life-saving medications and the global leader in that effort would have been George W. Bush.
Bush has not been popular among many in liberal San Francisco, for a lot of obvious reasons, but half of those 8 million people are directly treated through his signature initiative, the President’s Emergency Plan for AIDS Relief. Through 2010, $46 billion has been committed, an effort that seems almost imaginable in this time of austerity.
I’d like to see Mr. Bush because he deserves a victory lap and, as a person living with HIV, I owe him a standing ovation. But I’d also like to see him here because it would remind all of us, including myself, that this horrible disease that has cost the world so much, sometimes brings us all together in a common effort. We forget for a moment our differences and remember that we are all human and we have a moral responsibility to each other.
To quote Camus again, “What’s true of all the evils in the world is true of the plague as well. It helps men to rise above themselves. All the same, when you see the misery it brings, you’d need to be a madman, or a coward, or stone blind, to give in tamely to the plague.”
If we are to find the resources we need to deploy if we are to have an “AIDS free generation,” we need to rise above ourselves and we need a dose of Bush’s stubborn determination to not give in tamely.
And I ask the question everyone is asking, “Where is Barack?” Will he come to this conference?
A report from Jacqueline Tulsky, MD, a professor of clinical medicine, UCSF Department of Medicine based at San Francisco General Hospital and Trauma Center:
Twenty-two years ago, the last time the International AIDS Conference (IAC) opening session occurred in the United States, the landscape for HIV prevention and treatment was barren. At the 2012 conference Opening Session, a new era was welcomed in, where it is possible to “Turn the Tide” of the epidemic using a combination of interventions that we currently have in hand.
With the lifting of the ban against travel into the U.S. by persons living with HIV/AIDS, the International AIDS Society (IAS) has brought the International AIDS Conference back to Washington, D.C. The program had representatives of all the key components needed to address the HIV/AIDS epidemic in the U.S. and globally – persons living with HIV, scientists, politicians, health advocates and finance specialists. From the opening remarks by the conference Co-Chairs, Elly Katabira of Uganda and Diane Havlir of the U.S., to the sincere but challenging thanks of an HIV-infected mother and her HIV uninfected daughter from Nigeria, the world was put on notice that the HIV/AIDS epidemic can be controlled.
One of the most powerful moments was the opening presentation of inaugural AMFAR/IAS Elizabeth Taylor Award by Sharon Stone to the first award to two Iraqi physicians who were imprisoned for providing care to HIV-positive persons. Two years ago, their plight was the focus of a campaign by attendees at the Mexico IAS conference. “Treating AIDS is not a crime,” declared the Allayi brothers.
The first president of the World Bank ever to address the IAC, Jim Young Kim pledged to use the power of the World Bank to address the inexorable link between poverty and HIV infection.
The Opening Session closed with announcements by Kathleen Sebelius, the Secretary of Health and Human Services, about new initiatives in public-private partnerships to address HIV/AIDS in the United States, including programs with retail pharmacies to support adherence to treatment and additional access to HIV clinical education. She also characterized the Affordable Care Act as a cornerstone piece in the overall US AIDS Strategy and reiterated the recent news that new funding will end the ADAP (the program that pays for HIV related drugs) waiting lists that exist in 9 states in the U.S.
When the AIDS epidemic first swept through San Francisco in the early 1980s, UCSF doctors quickly realized two key points. First, the primary patient population getting the disease – gay men – was already the target of significant discrimination, including in the health field. So those patients needed doctors who weren’t just willing to treat them, but were passionate about it. Second, many of the patients were struggling with serious socio-economic issues in addition to their HIV. Read more.
This is a snippet from an interview with Paul Volberding in which he discusses the future of the AIDS epidemic and the possibility of ending it outright: how we can do it, who will pay for it, and more.
In this video, Diane Havlir, MD, the chief of the UCSF Division of AIDS at San Francisco General Hospital and Trauma Center (SFGH) discusses the Washington D.C. Declaration, which is the official declaration of the XIX International AIDS Conference.
The Declaration was announced earlier this week by the IAS. In anticipation of that, I shot this video last week, asking Dr. Havlir to explain what it is and why it is being advanced now, on the eve of AIDS 2012.
Here she talks about the “why” of the declaration. This was an opportunity to do tremendous good, she said. The second video can be viewed here
A number of advances in HIV prevention and treatment and a promising advance in the quest for the cure have matured to the point that we now have the possibility to usher in an AIDS-free generation.
On the eve of AIDS 2012, the XIX International AIDS Conference in Washington, DC, UCSF is launching its first-ever blog, UCSF AIDS 2012, to cover the news as it unfolds and to offer daily expert analysis and insight along the way.
In addition to several professional staff writers, the blog will feature more than two dozen full-time faculty from UCSF and San Francisco General Hospital and Trauma Center (SFGH) who will be listening to and analyzing the latest research in their own fields of expertise.
UCSF’s group of contributors includes many who are the top experts in their fields — and several who have been on the frontlines of the epidemic since its beginning more than 30 years ago . They are among the hundreds of clinicians and researchers who have helped make UCSF a global leader in AIDS research and have enabled SFGH and the City of San Francisco to continue setting the standard of care for people with HIV worldwide.
This blog will explore the latest developments in clinical care and research, the history as well as the future of the epidemic, offer perspective on the local and global problems associated with HIV, explore the role of activism in AIDS and examine the quest for a cure. The blog will also report what it will take to end the epidemic.
AIDS 2012 comes at a unique time in the history of the disease. Humanity is at a crossroad — a turning point where we can now ponder the beginning to the end of the global scourge of HIV, which has claimed the lives of tens of millions of people worldwide. It will not be easy, but together humanity can turn the tide on the epidemic — a hope reflected in the theme of the AIDS 2012 conference, which is co-chaired by UCSF Professor Diane Havlir. It is also a theme explored in the official declaration of AIDS 2012 .
In 1983, UCSF’s Jay Levy, MD, co-discovered HIV. Today, 29 years later, on the eve of the XIX International AIDS Conference in Washington, D.C., he reflects on the state of the research field. The physician-scientist, who’s now exploring stem cell approaches to fighting the disease, said,
“When they asked me 20 years ago where are we in our knowledge of the immune system, I said: ‘2nd grade. Perhaps now we’re in 5th grade — we’ve got a lot to do.”
A declaration calling for global support to end the AIDS epidemic was announced yesterday by the International AIDS Society, with support from the University of California, San Francisco (UCSF). The goal? For scientists, politicians, celebrities and all other concerned citizens of the world to sign on to the document to express their support – they are looking for signatures in English, Spanish, French, Portuguese, German, Russian, Chinese, Arabic, Swahili , Japanese, Hindi and Thai.
“We can save millions of lives with the knowledge we have today if we fully implement the proven strategies we now have to treat those living with HIV and prevent new infections,” said Diane Havlir, MD, chief of the UCSF Division of HIV/AIDS at San Francisco General Hospital and Trauma Center and U.S. co-chair of AIDS 2012.
UCSF’s AIDS 2012 blog has been a great success, featuring in-depth coverage of the International AIDS Conference in Washington, D.C., highlighting studies from HIV/AIDS research community, and drawing thousands of visitors from a total of 111 countries. Thanks for your interest in this important topic, and thanks to our contributors and experts who provided the content. This blog will no longer be updated, but visit www.ucsf.edu for the latest in health and research news.
Going hungry can make you miserable, and a new study shows that it can make you sick too.
A recent study by UCSF researchers followed low-income HIV patients in San Francisco over two years and tracked their visits to emergency rooms during that time. Of the 347 participants, all of whom lived in substandard housing, 56 percent of them were classified as “food insecure,” which means they regularly worried about getting access to enough food.
Those who were food insecure ended up at the ER or being hospitalized twice as often as those who had regular access to nutritious meals, according to the study’s primary investigator, Sheri Weiser, MD, an assistant professor of medicine at the UCSF HIV/AIDS Division.
“For a long time we have known that adequate nutrition is crucial for HIV-positive patients to live long healthy lives. Our findings that food insecure individuals are also more likely to use costly services from hospitals and emergency rooms build on our previous work showing that food insecure individuals experience poorer HIV treatment outcomes,” Weiser said.
Food insecurity is a much bigger issue in San Francisco than elsewhere in the country because of the high cost of living in the city. By the time a person pays rent for a single-room occupancy (SRO) unit, many of which don’t include kitchen facilities, there’s little money left to buy food – much less a well-balanced meal.
Nationwide, one in seven Americans is considered food insecure. That figure jumps to one in five in San Francisco, according to the San Francisco Food Bank.
The study suggests that paying for a basic need like food for these individuals could save thousands or millions in health care costs down the line.