World AIDS Day

Testing, Testing.

Guest Post By Kevin Fenton, M.D., Ph.D., FFPH, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC). 

Every year on December 1, we commemorate World AIDS Day to bring attention to the tremendous impact of the HIV epidemic in the United States and around the world. In observance of World AIDS Day, today CDC launched a special report, CDC Vital Signs on HIV Testing in the United States, in recognition of the pivotal role that HIV testing plays in our national HIV prevention strategy.

Some highlights of the CDC Vital Signs report on HIV testing include:

    •    In 2009, an estimated 82.9 million Americans ages 18-64—45% of this age group—reported they had been tested for HIV.

    •    At least 1 in 3 Americans who test positive for HIV is tested too late in his or her infection to get the full advantage of life-saving treatment.

    •    Gay, bisexual, or other men who have sex with men have the highest rates of HIV, but a 2008 study conducted in 21 major US cities, found that about 40% had not been tested in the past year.

    •   African Americans made up more than half of HIV diagnoses in 2008, but 2 in 5 African Americans have never been tested.

CDC recommended in 2006 that HIV testing become a routine part of medical care, including testing of all adolescents and adults at least once, testing at least annually for persons at increased risk, and testing of women during each pregnancy. Since that time, HIV testing has increased, and more people are being tested for HIV than ever before. However, many challenges remain: 55% of Americans ages 18 to 64 still have never been tested, according to CDC Vital Signs. And of the estimated 1.1 million people living with HIV in the United States, 1 in 5 do not know they are infected.

More needs to be done. HIV testing is vitally important because it can save lives. For anyone who is infected, it is important to know his or her HIV status in order to access effective life-extending treatment, avoid HIV transmission to partners, and have a better quality of life.

Treatment for HIV is most effective before symptoms develop. It can do much to slow the infection that leads to AIDS and death. Without treatment a person infected with HIV will develop AIDS in about 10 years. With early treatment a 25-year-old adult can survive on average 39 more years.

According to the Vital Signs report, nearly one-third (32%) of the people found with HIV in 2007 were diagnosed late. This means that they likely had HIV for a long time without knowing it because they developed AIDS soon (less than one year) after their HIV test.

Health care providers play a critical role in stopping the spread of HIV as most HIV testing is conducted in health care settings. It is important that patients listen to their doctors and it is important that doctors and other health care providers speak openly and honestly with patients about HIV, and offer routine testing per CDC recommendations.

CDC also plays a critical role. We are committed to strengthening our efforts against the epidemic and working with partners to increase HIV testing. CDC continues to expand its efforts in areas where the burden of disease is greatest. We recently announced an expansion of a successful HIV testing initiative to reach more hard-hit populations, including African Americans, Latinos, men who have sex with men and injection drug users. In 2010, CDC provided more than $60 million to support HIV testing efforts in 30 of the hardest hit jurisdictions in the United States.

In addition, CDC provides funds to all health departments and more than 130 community-based organizations to implement HIV prevention programs, including HIV testing. We are also working to get messages out about testing through the Act Against AIDS  campaign. Of critical importance, the National HIV/AIDS Strategy, recently released by the White House, provides a new opportunity to refocus and intensify federal, state, and local HIV testing efforts.

Now more than ever, effective HIV prevention is a critical public health priority for the U.S. and the world, and HIV testing to identify those infected is a vital component of that effort. Working together, we can increase HIV testing. Everyone needs to know how important HIV testing is – it is a simple measure that can literally save the health and lives of hundreds of thousands of Americans and help to bring an end to this tragic epidemic.

UN Conference on AIDS Stresses Drug Treatment

Drug punishment doesn’t help in the AIDS fight.

Press Release from the United Nations Information Service:

VIENNA, 21 July (UN Information Service) - Drug dependence is a health disorder, and drug users need humane and effective treatment - not punishment. This was the key message of a UNODC discussion paper launched at the XVIII International AIDS Conference in Vienna today. "Let us stop stigmatizing the users. Give them high-quality medical treatment, counselling and follow-up, not detention," said Gilberto Gerra, Chief of the Drug Prevention and Health Branch at the United Nations Office on Drugs and Crime (UNODC).

Entitled "From coercion to cohesion: Treating drug dependence through health care, not punishment",  the paper was released in conjunction with the re-launch of the Open Society Institute's (OSI) 2010 report, "Detention as Treatment: Detention of methamphetamine users in Cambodia, Laos and Thailand".

The UNODC report highlights that the practice of putting drug users in compulsory detention centres and in prisons is on the increase and notes that such settings can often breed human rights violations, including forced labour and violence, in contravention of internationally recommended approaches.

HIV prevalence among detained persons is often higher than in the general population due to factors including the use of non-sterile drug equipment by injecting users. In addition, there is often an absence of HIV prevention programmes, limited heath services and lack of access to antiretroviral treatment.

The launch session of the paper "From coercion to cohesion" was moderated by Christian Kroll, Global Coordinator for HIV and AIDS at UNODC. Speakers included, Gilberto Gerra; Anand Grover, UN Special Rapporteur on the Right to Health; Rebecca Schleiffer, Advocacy Director, Health and Human Rights Division at Human Rights Watch; and Daniel Wolfe, Director of International Harm Reduction Development at OSI.

The panellists explored the role of public security and public health systems in implementing drug dependence treatment, which, according to UNODC, should be evidence-based and managed by public health professionals. Treatment should promote prevention of HIV and respect the human rights of people who use drugs. Voluntary, community-based drug dependence treatment services are more likely to attract those drug users who need treatment, and would save money, states the paper.

UNODC is the lead agency for HIV prevention, treatment, care and support for injecting drug users and in prison settings.

Graphics Credit: http://www.pinknews.co.uk

White House Pushes Cautiously Forward on Needle Exchange

Clean syringes become part of federal AIDS strategy.

As most people know, addicts who inject drugs have played a major role in the HIV epidemic. In the U.S. alone, there are an estimated one million “injection drug users,” as the government calls them. They are linked to almost 20% of new HIV infections each year. (Roughly 56,000 new HIV infections occur in the United States annually, according to CDC estimates.)

And in black and white, on page 16 of the July 2010 position paper titled “National HIV/AIDS Strategy for the United States”, the White House made it official. In a list of “proven biomedical and behavioral approaches that reduce the probability of HIV transmission,” the report has this to say:

 “Among injection drug users, sharing needles and other drug paraphernalia increases the risk of HIV infection. Several studies have found that providing sterilized equipment to injection drug users substantially reduces risk of HIV infection, increases the probability that they will initiate drug treatment, and does not increase drug use.”

That relatively mild statement represents a bold departure from the AIDS/HIV policies of previous administrations--when such policies existed at all. The White House has bolstered its contention with citations:

Latkin, C, Davey, M, and Hua, W. Needle Exchange Program Utilization and Entry into Drug User Treatment: Is There a Long- Term Connection in Baltimore, Maryland? Subst Use Misuse, 41(14):1991-2001.

Vlahov D, Junge B. The role of needle exchange programs in HIV prevention. Public Health Rep. 1998;113 (Suppl 1):75-80.

Put simply, clean needles save lives. Needle exchange programs put more addicts in contact with social services, thereby easing their entry into drug treatment programs.

“Comprehensive, evidence-based drug prevention and treatment strategies have contributed to reducing HIV infections,” the report states. “In 1993, injection drug users comprised 31 percent of AIDS cases nationally compared to 17 percent by 2007. Studies show that comprehensive prevention and drug treatment programs, including needle exchange, have dramatically cut the number of new HIV infections among people who inject drugs by 80 percent since the mid-1990s.”

By the end of this year, the report pledges, “Centers for Disease Control and Prevention (CDC)  and the  Substance Abuse and Mental Health Services Administration (SAMHSA) will complete guidance for evidence-based comprehensive prevention, including syringe exchange and drug treatment programs, for injection drug users.”

One question not answered in the White House document—how to pay for new treatment initiatives of this kind.

Graphics Credit: https://www.accesscontinuingeducation.com