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The Rhode Island House Committee on Health, Education and Welfare last week held a hearing on a proposed amendment to a state requirement that physicians obtain written consent before administering an HIV test, the Providence Journal reports.
Under current state law, the written consent requirement does not apply to pregnant women, who are tested for HIV unless they sign a form to opt out of the test. The amendment, which is co-sponsored by Reps. Joseph McNamara (D) and Donna Walsh (D), would extend HIV testing to everyone except those who sign a form to opt out of the testing.
According to the Journal, the Rhode Island medical community widely supports the proposed amendment, while the American Civil Liberties Union Rhode Island opposes it. Nicole Alexander, a pediatric medicine fellow at Brown University, at the hearing noted that physicians still would be required to discuss HIV testing with patients before administering a test under the amendment. Brian Alverson, a pediatrician at Hasbro Children's Hospital, said HIV testing among pregnant women increased from 52% to 92% when the written consent requirement was waived. Alverson added that the increased testing allowed HIV-positive women to receive treatment earlier and reduced the number of mother-to-child HIV transmissions. The Rhode Island ACLU affiliate said the amendment would make it easier for physicians to administer HIV tests without informing patients.
According to the Journal, about 150 people are diagnosed with HIV/AIDS annually in the state.
(Dujardin, Providence Journal, 3/28).
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Pope Benedict XVI "set off a firestorm of protest" earlier this month when he commented that condom distribution "isn't helping, and may be worsening" the spread of HIV/AIDS in Africa, but "in truth, current empirical evidence supports him," Edward Green, a senior research scientist at the Harvard School of Public Health, writes in a Washington Post opinion piece. The condom has become a "symbol of freedom and -- along with contraception -- female emancipation," Green writes, adding that those who "question condom orthodoxy are accused of being against these causes."
Members of the HIV/AIDS and family planning communities "take terrible professional risks if we side with the pope on a divisive topic such as this," Green writes, noting that his comments "are only about the questions of condoms working to stem the spread of AIDS in Africa's generalized epidemics -- nowhere else."
According to Green, several research articles published in peer-reviewed journals such as the Lancet, Science and BMJ "have confirmed that condoms have not worked as a primary intervention in the population-wide epidemics of Africa." He adds that condom promotion "has worked" in countries such as Cambodia and Thailand, where HIV is transmitted primarily through commercial sex. "In theory, condom promotions ought to work everywhere," Green writes, adding that this is "not what the research in Africa shows."
Green writes that "people think they're made safe by using condoms at least some of the time" and they "actually engage in riskier sex." In addition, many people in Africa rarely use condoms in stable relationships "because doing so would imply a lack of trust," Green continues, adding that it is "those ongoing relationships that drive Africa's worst epidemics" where most HIV cases occur in general populations rather than high-risk groups like commercial sex workers, men who have sex with men or injection drug users. "And in significant proportions of African populations, people have two or more regular sex partners who overlap in time," creating an "invisible web of relationships through which HIV/AIDS spreads," Green writes. What has proven effective in Africa are "[s]trategies that break up these multiple and concurrent sexual networks -- or, in plain language, faithful mutual monogamy or at least reduction in numbers of partners, especially concurrent ones," Green writes, adding, "'Closed' or faithful polygamy can work as well."
Green says that he is "not anti-condom," adding, "All people should have full access to condoms, and condoms should always be a backup strategy for those who will not or cannot remain in a mutually faithful relationship." In addition, "liberals and conservatives agree that condoms cannot address challenges that remain critical in Africa such as cross-generational sex, gender inequality, and an end to domestic violence, rape and sexual coercion," Green continues, concluding, "Surely it's time to start providing more evidence-based AIDS prevention in Africa"
(Green, Washington Post, 3/29).
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One of the first attempts to use gene therapy to treat HIV has produced promising results in clinical trials.
When the therapy was tested on 74 patients, it was shown to be safe and appeared to reduce the effect of the virus on the immune system.
In theory, one treatment should be enough to replace the need for a lifetime of antiretroviral therapy.
The study, by the University of California, Los Angeles, appears in the journal Nature Medicine.
Highly active antiretroviral therapy (HAART) has greatly improved the prognosis for people infected with HIV.
However, it must be taken on a daily basis, there is a risk of adverse reactions and the virus - which has an astonishing capacity to evolve rapidly - is starting to develop resistance to the drugs.
Therefore, new ways to combat the virus are badly needed.
Stem cells
The latest therapy involves giving patients blood stem cells modified to carry a molecule called OZ1, which is designed to stop HIV reproducing itself by targeting two key proteins.
The patients in the trial either received the therapy, or a dummy treatment.
After 48 weeks the researchers found there was no statistically significant difference in the amount of HIV circulating in the blood of the two groups of patients.
However, after 100 weeks the patients who received the gene therapy had higher levels of CD4+ cells - the key cells of the immune system which are specifically destroyed by HIV.
Lead researcher, Professor Ronald Mitsuyasu, said the research was the first to come through tightly controlled trials in which patients did not know whether they were getting the therapy or the placebo.
He said: "Gene therapy has the potential of needing only a one-time or infrequent administration of product and would allow the patients to control their own HIV internally without the need for continuous drug therapy.
"While this treatment is far from being perfected, it is not yet as effective or as complete as current antiretroviral therapy in controlling HIV, the study did show proof of concept that inserting and administering a single anti-HIV gene in the patients' own blood stem cells and giving it back to them could reduce viral replication to some degree when anti-HIV medications are stopped."
However, Professor Mitsuyasu said long-term follow up was needed to ensure the therapy was safe.
'Exciting' area
Jo Robinson, of the HIV charity Terrence Higgins Trust, said: "Gene therapy is an exciting area which aims to create a one off treatment for HIV, avoiding the need for people to take daily medication.
"However, it's a very complex area and early days in research terms so we're a long way from something like this being on the market.
"This particular trial proved safe and has shown some promising results which definitely warrant further investigation.
"Some people find their HIV becomes resistant to current treatments over time so it's essential that we invest in researching potential new approaches like this."
Keith Alcorn, of the HIV information service NAM, said: "The viral load responses in this study were very modest, and for any other sort of product would not justify going forward.
"However, the researchers have shown enough of an effect for us to be hopeful that a gene therapy approach to HIV treatment might eventually deliver effective treatments for the disease."
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American teenagers who take virginity pledges promising they will not have sex before marriage are just as likely to be sexually active as non-pledgers and moreover are less likely to protect themselves against pregnancy and sexually transmitted diseases said a scientist who recommended that all teenagers, especially pledgers, should receive birth control advice.
The new study was the work of Janet Elise Rosenbaum from the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland and is published in the 1 January 2009 issue of Pediatrics.
In her background information Rosenbaum explained that the US government spends more than 200 million dollars a year promoting abstinence, including virginity pledges, and this study uses more robust methods than previous studies have in comparing the sexual activity of teenagers who take pledges and those who do not.
Rosenbaum analyzed data from a nationally representative set of respondents taking part in the National Longitudinal Study of Adolescent Health which included middle and high school students who reported never having had sex or having taken a virginity pledge at the start of the study. The start of the study was 1995 and all 3,440 surveyed teenagers were over 15 at the time.
289 youngsters who reported taking a virginity pledge in the survey one year later, in 1996, were then matched with 645 non-pledgers on over 100 different factors including religious belief and attitude toward sex and birth control. Rosenbaum then compared the results taken five years later, which included what the two groups reported about their sexual behaviour, age at first sex, and their partners, plus the results of medical exams for sexually transmitted diseases.
The results showed that:
Five years after the pledge, 82 per cent of the pledgers denied ever having made a pledge.
There was no difference in self-reported premarital sex, anal and oral sex, and incidence of sexually transmitted diseases between pledgers and non-pledgers.
Pledgers had 0.1 fewer past-year partners but did not differ in age at first sex and lifetime sexual partners.
Compared to matched non-pledgers, fewer pledgers reported using birth control and condoms, both in the past year and the last time they had sex.
Rosenbaum concluded that there was no difference in sexual behaviour among virginity pledgers and non-pledgers, and pledgers were less likely to protect themselves from pregnancy and sexually transmitted diseases before marriage.
"Virginity pledges may not affect sexual behavior but may decrease the likelihood of taking precautions during sex," she wrote, and recommended that healthcare professionals should offer birth control information to all teenagers, and to virginity pledgers in particular.
Rosenbaum told the press that:
"Taking a pledge doesn't seem to make any difference at all in any sexual behavior."
"But it does seem to make a difference in condom use and other forms of birth control that is quite striking," she said, according to a report in the Washington Post.
She said that her research was more robust than previous studies because they were comparing " a mixture of apples and oranges", whereas in this study she "tried to pull out the apples and compare only the apples to other apples".
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One of the reasons why Coca-cola is not an effective spermicide is because sperm are faster and may reach an egg in time to fertilise it, says an expert in the Christmas issue published on bmj.com today.
The author, Deborah Anderson, a professor in obstetrics and gynaecology at Boston University and Harvard Medical School, writes that Coca-cola douches were allegedly used during the 1950s and 60s as a contraceptive when other methods were not easily available. The acidity alledgedly worked as spermicide to kill sperm and the classic coke bottle shape lent itself to a "shake and shoot" applicator!
In this analysis, Professor Anderson provides eight reasons why you're better off not reaching for a Coca-cola after sex, unless you want to drink it:
-- Coca-cola is not very effective in killing sperm.
-- Sperm are faster than Coca-cola and could escape douching and reach the cervical canal.
-- Coca-cola may be good for tenderising steaks and removing corrosion from car bumpers but is not good news for vaginal tissue. Coca-cola damages the top layers of cells and could make a woman more prone to sexually transmitted infections.
-- The good bacteria that keep vaginas healthy could be adversely affected by coke and this could result in fungal and bacterial infections.
-- Douching could lead to pelvic inflammatory disease and ectopic pregnancy.
-- The Coca-cola formula is a secret so this means no research has been done on whether it would cause birth defects.
-- You need skill to douche effectively with Coca-cola - not practical, especially in the dark when bottle caps can go dangerously astray.
-- There are much more effective and easy to use methods of contraception around.
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Adolescent health risk behaviors often occur together, suggesting that youth involvement with one risk behavior may inform understanding of other risk behaviors, but in a study to examine the association between involvement in non-sexual risk behaviors and trends among sexual behaviors, Mailman School of Public Health researchers found that sexual behaviors vary considerably between those youth engaged in no risk health behaviors and those engaged in multiple health risk behaviors. Despite these differences, trends in sexual risk behaviors among youth engaged in multiple nonsexual risk behaviors -- such as smoking and driving while drinking -- and those engaged in few or no risk sexual behaviors are remarkably similar. Study findings from the Journal of Adolescent Health are published online.
"These analyses suggest caution about assuming that one can readily improve sexual risk behaviors by targeting other teen risk behaviors," says John Santelli, MD, MPH, professor and chair of the Heilbrunn Department of Population and Family Health at the Mailman School of Public Health, and lead author. "Trends in nonsexual health risk behaviors are quite different from patterns of change in sexual behavior and thus are unlikely to be driving trends in sexual behaviors, despite the strong associations between non sexual and sexual risk behaviors."
Dr. Santelli and his team analyzed data from the Youth Risk Behavior Survey, a nationally representative survey of U.S. high school students, collected from 1991 to 2007. Students were categorized into groups according to risky behaviors - such as smoking or alcohol use - and each group was examined for trends in four sexual behaviors: ever having sexual intercourse, having four or more lifetime partners, current sexual activity, and the use of contraception during the last sexual experience.
The findings indicate that students who engaged in nonsexual high risk behaviors were three times more likely than lower risk students to say they had had four or more lifetime sexual partners. About 87 percent of students engaging in the highest risk behaviors ever had sex, compared with only 13 percent of those engaging in low or no risk nonsexual behaviors.
However, the data confirm no matter where they fell on the risk spectrum, teens seemed positively influenced by social forces and intervention messages in the 1990s and early 2000s, when there was a decline in sexual experience and number of sexual partners across the board.
"The three biggest changes in adolescent behaviors in the last 16 years have been delaying sex, increasing the use of condoms, and reducing the number of partners," notes Dr. Santelli. "All three are areas that HIV education has clearly identified as goals."
However, while interventions aimed at reducing risky sexual behaviors in adolescents seemed successful for a while, the new data also show that this trend might be reversing, Dr. Santelli said. He also suggests that recent increases in sexual risk behaviors may have ominous implications for prevention of unplanned pregnancy and STIs among youth.
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Human Immunodeficiency Virus (HIV) is a virus. You may hear that someone is "HIV infected", "has HIV infection", or "has HIV disease." These are all terms that mean the person has HIV in his or her body and can pass the virus to other people.
HIV attacks the body's immune system. The immune system protects the body from infections and disease, but has no clear way to protect it from HIV. Over time, most people infected with HIV become less able to fight off the germs that we are all exposed to every day. Many of these germs do not usually make a healthy person sick, but they can cause life-threatening infections and cancers in a person whose immune system has been weakened by HIV.
People infected with HIV may have no symptoms for 10 or more years. They may not know they are infected. An HIV test is the only way to find out if you have HIV. See HIV Counseling and Testing for information and resources on HIV testing in New York State.
HIV spreads when infected blood, semen, vaginal fluids, or breast milk gets into the bloodstream of another person through:
direct entry into a blood vessel;
mucous linings, such as the vagina, rectum, penis, mouth, eyes, or nose, or
a break in the skin.
HIV is not spread through saliva (spit).
HIV is spread through:
Vaginal, anal, or oral sex without using a condom.
Sharing needles, syringes, or works to inject drugs, vitamins, hormones, steroids, or medicines.
Women with HIV infection can pass HIV to their babies during pregnancy, delivery, and breastfeeding.
People who are exposed to blood and/or body fluids at work, like health care workers, may be exposed to HIV through needle-sticks or other on-the-job exposures.
It may also be possible to pass HIV through sharing needles for piercing or tattooing.
A person infected with HIV can pass the virus to others during these activities. This is true even if the person:
has no symptoms of HIV
has not been diagnosed with AIDS
is taking HIV medications
has an "undetectable" viral load
HIV is not spread by casual contact like sneezing, coughing, eating or drinking from common utensils, shaking hands, hugging, or use of restrooms and drinking fountains.
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Acquired Immune Deficiency Syndrome (AIDS) is a late stage of HIV disease. There are medications that have helped people living with HIV or AIDS live longer, healthier lives. Some people have lived for more than 20 years and have taken medicines for more than 10 years. But, there is no cure.
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