Export More Female Condoms, Not Abstinence Programs, Report Say

By: Penny Starr

Senior Staff Writer, crosswalk.com

(CNSNews.com) - The U.S. government must provide more funding for the worldwide distribution of female condoms while reducing the amount of money it spends on abstinence-until-marriage programs, according to Serra Sippel, executive director of the Center for Health and Gender Equity, or CHANGE.

"The Congressional earmark in PEPFAR (President's Emergency Plan for AIDS Relief) -- which we are in the process of trying to remove the earmark that (gives) money for abstinence and fidelity - what we've found from people we interviewed and from various studies is that the result of that is the stigmatization of condom use," Sippel said Tuesday at a briefing of the Global Health Council in Washington, D.C.

Sippel added that the goal of her advocacy group is to "really push the U.S. government to promote sexual and reproductive condom rights within U.S. foreign policy."

According to the United States Agency for International Development (USAID), the federally funded agency that distributes international aid, $457 million of its budget for FY 2008 is dedicated to family planning programs, including condom distribution.

The CHANGE briefing also marked the release of its "Saving Lives Now: Female Condoms and the Role of U.S. Foreign Aid" report. In it, the center states that the U.S. government supplied nearly 1.9 billion condoms worldwide between 2004 and 2007.

It also reports that the "the United States government plays an important role in shaping global trends in reproductive and sexual health supplies," with America providing 42 percent of "global donor support" for family planning, including the female condom.

But other advocacy groups say that U.S. foreign aid that promotes sexual activity is doing more harm than good around the world.

"Social radicals ... believe they must liberate Third World children from their benighted traditions and religions and to enlighten them in the way of the American teenager," Austin Ruse, president of the Catholic and Family Rights Institute, told Cybercast News Service. "That is, to be sophisticated about sex and riddled with STDs.

"These social radicals believe that young people not only can't, but shouldn't control themselves sexually," Ruse added. "They seek to tear down, rather than build up the human person."

The center's report also detailed strategies used to successfully distribute female condoms, including in Zimbabwe, where it credits Population Services International, another non-profit health advocacy group, for helping with the distribution of female condoms in that AIDS-stricken country.

"Because approximately 97 percent of Zimbabwean women visit a hair salon at least once a month, PSI also promoted female condoms to women in Zimbabwe using hair salons in low-income, urban areas," the report reads.

Wendy Wright, president of Concerned Women for America, cited another report to argue that abstinence programs, not condom distribution, can really help women at high risk for contracting AIDS.

A Feb. 2 article in National Geographic online, said a decline in AIDS rates in Zimbabwe was linked to "behavior changes," as first reported in the journal Science.

"Most important, researchers say, is the substantial decrease in casual sex partners reported by Manicaland residents," the National Geographic online article reported. "This, combined with increased abstinence by teenagers, may be contributing to the HIV decline."

"Our biggest problem is relying on methods that have had terrible failure rates," Wright told Cybercast News Service, "while denying them access to programs that have been proven effective."

Wright said groups with agendas like CHANGE are "trying to wipe out the competition by giving no federal funding for abstinence, even though the evidence shows that abstinence programs are effective in delaying sexual initiative and reducing HIV and AIDS rates."

Canadian Prisons Contributing To Spread of HIV, Researchers Say

About 15% of incarcerated drug users at correctional facilities in the Canadian province of British Columbia reported using injection drugs during their incarceration, causing concern that prisons are contributing to the spread of HIV in Canada, according to one of two recently released studies conducted by researchers from the B.C. Centre for Excellence in HIV/AIDS, the CNS/Vancouver Sun reports.

The first study, published online in Oxford University's Journal of Public Health, followed 1,247 injection drug users for six years. Half of the IDUs were incarcerated at some point during the study. Nearly 15% of those who had been incarcerated reported using injection drugs while in prison, mostly with used needles.

The second study, published in Drug and Alcohol Review, followed 902 IDUs at Insite -- a supervised drug-injection facility in Vancouver, Canada -- over two years. About one-third of the IDUs reported having been incarcerated at each six-month follow-up, 5% of whom reported using injection drugs during their incarcerations.

The studies found that IDUs who have been incarcerated are "more likely to report syringe sharing" and to be living with HIV or hepatitis, the researchers wrote. Evan Wood, a researcher who worked on both studies, said the findings likely underestimate the number of IDUs who reuse needles while incarcerated because many people are unlikely to admit they use injection drugs or reuse needles.

The researchers are calling for needle-exchange programs in prisons to reduce the spread of HIV and hepatitis. Wood said a "coordinated public health response" is needed to address the issue and to protect inmates and their "home communities" from the spread of bloodborne diseases. The researchers added that the findings underline the "urgent need" to expand harm-reduction programs at correctional facilities across Canada.

Officials at Correctional Service of Canada said that "continuing risk behavior by inmates during incarceration presents a public health challenge." Guy Campeau, director of media relations at CSC, said that the department is implementing a "comprehensive" infectious disease program that includes methadone maintenance and the distribution of condoms, dental dams, water-based lubricant and bleach to help reduce the spread of HIV and other diseases. The department has "no plans to implement a needle-exchange program," Campeau said (Munro, CNS/Vancouver Sun, 4/6).

SOURCE: KAISERNETWORK.ORG

Use a Condom - You'll Live Longer

At the 2008 National STD Prevention Conference held in Chicago in early March, Dr. Sara Forhan released an alarming set of data referring to a study of Sexually Transmitted Diseases in female teenagers.

Forhan studied 838 participants in the 2003-2004 National Health and Nutrition Examination survey, all of whom were female teenagers between the ages of 14 and 19. The study showed that approximately one in four teens had one of the four most common STDs found in women-HPV (Human papillomavirus,) Chlamydia, HSV-2 (Herpes simplex virus type 2), or Trichomoniasis.

That is 3.2 million members of America?s female population that have STDs that can cause lifelong damages such as genital cancers, genital herpes, and infertility, among other symptoms. Out of those 3.2 million, 15 percent have more than one of the four major STDs.

While there is no comparable data for male teenagers or young adults between the ages of 20 and 24, it is no secret that STDs in teen and young adults are on the rise. Quite often, it is more difficult to detect STDs that are generally symptom-free, such as HPV and Chlamydia in men, who typically do not undergo regular STD screening tests such as those for women. While the diseases are more prevalent in certain genders and backgrounds, it?s time for every one of us to take to step back to see what we?re up against and how we can fix this ever-growing problem.

Of the four STDs targeted in this study, the most prevalent STD found in teen girls was HPV, which affected 18 percent of the study's participants. According to the Center for Disease Control, over 25 percent of women aged 20 to 24 also have the disease at any given time. The majority of the American population will come in contact with one of the many strains of HPV before their 50th birthday. This is especially unfortunate because there is a strong link between HPV and cervical, penile, and anal cancers, as well as the occasional case of genital warts.

Next comes Chlamydia, a disease with little to no detectable symptoms. The rate of Chlamydia has gone up 36% in men and 16% in women from 2002 to 2006, the CDC says. Still, the disease is more than three times more common in women than men. Unfortunately for these women, Chlamydia is an extremely destructive force if left untreated and can lead to damage of the reproductive organs and infertility.

One out of five adolescents has genital herpes, the catalyst of which is primarily HSV-2, according to the CDC. Apart from genital herpes outbreaks, which do not occur right away and may be mistaken for another condition such as skin irritation in the early stages, there is no way to track HSV-2.

"Genital HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of eight),? the CDC website states. "This may be due to male-to-female transmission being more likely than female-to-male transmission."

Forhan's study also found a disparity in the race of infected teenagers in her study. While 20 percent of non-Hispanic whites and Mexican females were infected with one of the main four STDs, a shocking 48 percent of African-American females were affected.

"Factors contributing to the severe STD impact among African Americans include limited access to quality health care, as well as poverty. Additionally, a higher prevalence of STDs in this population may translate into a greater risk of being exposed. Finally, misperceptions of personal or partner risk may also be factors in increased risk for STDs among African American women," says Nikki Kay of the Center of Disease Control.

However, Dr. John Douglas, Director of the STD Prevention Division at the CDC, assures that the minority trend is not exclusive to African-Americans. ?When compared to whites, the Chlamydia rate among Hispanics is three times higher and the gonorrhea rate is twice as high. Hispanics also have the second highest rate of syphilis in the nation, followed closely by Native American/Alaska Natives, who also have the second highest rate of gonorrhea and Chlamydia in the U.S."

Overall, young females have more STDs than young males. Young African-Americans have more STDs than other races. Now we must consider that statement and ask ourselves why this is happening.

"We are seriously overdue to re-invent 'sex education' - to ensure that adolescents gain understanding about the underlying gender norms that actually shape much of their sexual health and well-being. Specifically, policies and programs need to emphasize young people?s critical thinking skills and their awareness of gender issues," Nicole Haberland and Debbie Rogow say in an editorial reacting to Forhan's study. The two authors wrote the article on behalf of the Population Council, a program which seeks to improve programs and policies for HIV/AIDS; poverty, gender, and youth; and reproductive health.

Haberland and Rogow suggest that the rise in STDs is directly linked to America?s perception of the traditional gender roles men and women play out in a sexual relationship.

"Girls who are submissive to male partners, or who agree that males should 'have more power in the relationship' are less able and less likely to negotiate condom use or to refuse unwanted sex. Boys who are socialized to equate masculinity with physical strength, emotional toughness, and aggressive behavior; with proving their heterosexuality; and with having multiple sexual partners are also at greater risk."

According to the authors, the only way to fix the problem is to develop a stronger focus on gender dynamics among teens. This focus is absent in most sexual education programs, whether they are abstinence or prevention-based.

"Unfortunately, sex educators in the US are busy battling right wing opposition and have had little time or space to heed this call,? Haberland and Rogow explain. "Indeed, most sex education programs ignore gender issues, or touch on them at best superficially."

The call for education on gender relations and stereotypes also offer a solution to the controversial call for "sex education" to be taught at a younger age since many students drop out of school before high school, when sexual education is usually taught. The authors discuss this in a November 2005 article entitled Sexuality and Relationships Education: toward a Social Studies Approach:

"Unfortunately, in some cases, implementing this shift boils focusing only on negative aspects of sexuality (protection against abuse) or on lessons about intercourse and contraception for children who are not prepared for such information. In contrast, a culturally appropriate focus on social norms related to gender might also be considerably more appropriate for under-12 children than focusing predominantly on sexuality per se."

Even when taught to teens, Haberland and Rogow have found that the few gender-based sexual education programs that exist have had their success. In Latin America, the Project H program for young males targets gender awareness issues. An evaluation of the program showed more condom use and less STD symptoms among its participants.

In the US, where there is also a great concern about the growing levels of STDs in youth, the authors have also found a program that?s got the attention of teens. "Another example, closer to home, is the Brooklyn-based nonprofit Scenarios USA. Scenarios sponsors a critical thinking and creative writing program through public school districts in New York City, Cleveland, South Texas, and Miami, as well as through Planned Parenthood and through Black Entertainment Television."

Scenarios USA presents a new theme based around issues of love, sex, and gender every year. This year?s theme is "What?s the real deal about masculinity?" The theme was discussed through a story, play, and scriptwriting contest, which will be translated into publications, performances, and films that will be displayed throughout high schools and via television.

The data released by Dr. Sara Forhan at the National STD Prevention Conference only supports a pattern that America has been trying to deter for years though health and education programs. STDs have a significant prevalence in teens between age 14 and 19, as well as young adults between age 20 and 24. This is especially true for women and minorities, who are as much affected by society?s social constructs as they are sexually transmitted diseases.

It is only through gaining a greater understanding of our own strengths and, perhaps more importantly, vulnerabilities that teens can conquer the norms of sex as we know it. We need to recognize the faults of traditional gender roles and utilize that knowledge to protect ourselves from undesirable sexual situations and consequences.

Those who see themselves as being in a favorable sexual situation must still be aware of both contraceptive and STD screening services available to them, both of which are crucial to STD prevention and treatment. According to a study by Sherry Farr and her colleagues at the CDC, it shows that only 39% of women are actually taking advantage of both services, thus putting themselves at unnecessary risk.

The old cliché "knowledge is power" has never been more relevant than in a case such as the struggles of teens and young adults against sexually transmitted diseases, so get educated and get involved!

SOURCE: Kait Silva, acedmagazine.com

Vaccine Failure Is Setback in AIDS Fight - Test Subjects May Have Been Put at Extra Risk Of Contracting HIV

By David Brown
Washington Post Staff Writer
Friday, March 21, 2008; A01

The two-decade search for an AIDS vaccine is in crisis after two field tests of the most promising contender not only did not protect people from the virus but may actually have put them at increased risk of becoming infected.

The results of the trials, which enrolled volunteers on four continents, have spurred intense scientific inquiry and unprecedented soul-searching as researchers try to make sense of what happened and assess whether they should have seen it coming.

Both field tests were halted last September, and seven other trials of similarly designed AIDS vaccines have either been stopped or put off indefinitely. Some may be modified and others canceled outright.

Numerous experts are questioning both the scientific premises and the overall strategy of the nearly $500 million in AIDS vaccine research funded annually by the U.S. government.

"This is on the same level of catastrophe as the Challenger disaster" that destroyed a NASA space shuttle, said Robert Gallo, co-discoverer of the human immunodeficiency virus (HIV), which causes AIDS, and head of the Institute for Human Virology in Baltimore.

The recently closed studies, STEP and Phambili, used the same vaccine -- made from a common respiratory virus called adenovirus type 5 that had been crippled and then loaded with fragments of HIV. Both studies were halted when it became clear the STEP study was futile and possibly harmful.

The results of the Phambili vaccine trial, which was conducted in South Africa, were revealed last month and only worsened the gloom. Although the number of new HIV infections in that study was far smaller than in STEP -- and too few to draw firm conclusions from -- those results, too, hinted at a trend toward harm among vaccine recipients.

Many researchers are questioning the scientific premises on which all those studies were based and are wondering, along with AIDS activists, what effect this near-worst-case scenario might have on tests of future vaccines.

The working hypothesis for what went wrong is that the vaccine somehow primed the immune system to be more susceptible to HIV infection -- a scenario neither foreseen nor suggested by previous studies.

The National Institute of Health, which funded the STEP and Phambili trials, is convening a meeting next week to reassess its AIDS vaccine program. But some respected scientists have already reached a verdict.

"None of the products currently in the pipeline has any reasonable chance of being effective in field trials," Ronald C. Desrosiers, a molecular geneticist at Harvard University, declared last month at an AIDS conference in Boston. "We simply do not know at the present time how to design a vaccine that will be effective against HIV."

He told a rapt audience that he has reluctantly concluded that the NIH has "lost its way in the vaccine arena" and that he thinks it should redirect its AIDS vaccine funds to basic research and away from human trials.

In this fiscal year, the NIH's budget for AIDS vaccine research is $497 million. The STEP and Phambili trials were each expected to cost about $32 million. Pharmaceutical giant Merck & Co. has spent an undisclosed amount developing the vaccine and helping to manage the studies.

"We can't afford to have any more trials like this," said Mark Harrington, head of the activist Treatment Action Group and a longtime observer of AIDS research. "We have to stop and reassess and recommit to basic science, or people will begin to lose faith."

At the moment, only two things are certain.

The first is that the vaccine, developed by Merck, could not have caused HIV infection because it contains only three proteins from HIV, not the entire virus. The second is that there are no obvious villains.

"I do not think that what happened in this trial is an example of scientists blindly rushing into dangerous things," said John P. Moore, an AIDS virologist at Weill Cornell Medical College, who has criticized vaccine trials he considered futile. "In the general HIV-research community, I didn't know anyone who said this was going to happen."

Both trials recruited people who were at high risk of HIV infection through sexual activity. The STEP subjects included many male homosexuals; the Phambili volunteers were male and female heterosexuals. Half the people in each trial were randomly assigned to get three shots of vaccine, and half to get three shots of a harmless liquid containing no adenovirus or HIV proteins.

Each trial was to have 3,000 participants. STEP had finished enrolling subjects in North and South America, the Caribbean and Australia. Phambili (which means "moving forward" in the Xhosa language of South Africa) had signed up 801 by the time it was shut down.

While scientists hoped the Merck vaccine might prevent some infections, its chief purpose was to stimulate "cell-mediated" immunity to produce a less severe illness. Specifically, the vaccine was expected to lower the "viral load" of HIV in the bloodstream, which in turn would both prolong survival and lessen the chance the person would infect others.

Many experts are questioning the wisdom of that strategy, even if it had worked perfectly. Urging millions of people to take an AIDS vaccine that probably would not protect them from the virus, they say, would be a hard and confusing task, even in places where the epidemic still rages.

For the moment, that is an academic question. The vaccine failed to achieve any of its goals.

In both studies, people who got vaccine were more likely -- not less -- to become infected, with trends suggesting roughly a twofold risk. In the STEP study, which has many more cases to evaluate, nearly all that added risk was in people who had high levels of antibodies to adenovirus type 5 before they got their first shot -- evidence they had been previously infected with that strain. Uncircumcised men in that group had the highest risk.

So how could this have happened?

The leading theory is that activation of the immune system, a cascade of events that occurs naturally when a person is infected with a virus or bacterium or gets a vaccine against one of them, in some way increased the risk of HIV infection.

Activation causes cells called CD4 T-lymphocytes (among many other things) to proliferate. CD4 cells are the targets of choice for HIV. In their activated state, they are coated with molecules called CCR5 co-receptors, which HIV needs to attach itself to a cell.

The hypothesis is that people who received the vaccine had greater-than-normal activation and consequently produced more and fatter cellular targets for HIV. That then increased their chances of becoming infected should they encounter the virus in unprotected intercourse.

Two things undercut this idea.

People have been suffering immune-activating infections and getting vaccines for years, and there has never been evidence that those events increased a person's risk of acquiring HIV. These vaccine trials would be odd places to first notice such a thing. Furthermore, people in the STEP study who got the vaccine did not have more activated CD4 cells than people who got placebo -- something that Merck vaccine executive Mark B. Feinberg called "kind of an interesting and unexplained observation."

"There is something very, very peculiar" going on in the vaccine trials, said Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases, which sponsored them.

The multiple surprises have reminded researchers how much they still do not know about HIV's biology. It has also focused attention on questions they never asked.

For example, none of the monkey experiments with the Merck vaccine subjected animals to the kind of sexual exposure that people in the trial had -- namely, repeated encounters with low doses of HIV, with no single exposure being especially high-risk.

Why not?

The researchers did not have any reason to believe the vaccine might be harmful (although they acknowledged it might not be effective), and in any case such a study would have required quite a large number of monkeys, which are expensive to acquire and maintain for research.

Instead, researchers vaccinated a relatively small number of monkeys with the Merck vaccine and then injected them with the monkey equivalent of HIV in a manner that guaranteed they would become infected. Those animals did much better over the long run than infected but unvaccinated ones.

That was once enough to move a vaccine into human trials. But it probably never will be again.

1 in 4 teenage girls found to have sex-related disease

More than one in four teenage girls is infected with common sexually transmitted diseases, federal researchers reported Tuesday in a new study that for the first time quantifies a persistent problem.

Young women and girls ages 14 to 19 in "alarming" numbers are contracting human papilloma virus, chlamydia, genital herpes and trichomoniasis, said Dr. Sara Forhan, a researcher at the U.S. Centers for Disease Control and Prevention who led the study team. Almost half of black teens were infected.

An estimated 3.2 million have one or more of those four sexually transmitted diseases, or STDs, all of which can cause permanent damage. Cancer-causing HPV was the most common STD by far, followed by chlamydia.

Teen girls get such diseases when they don't protect themselves by avoiding sex, using contraception and remaining monogamous. The problem of disease transmission is compounded because many do not get tested or treated, CDC officials said.

"They don't really think they can catch it. They just don't believe they would be the ones to get it," said Lourdes Salgado, 17, a Plantation High School senior who gives talks to students about how to avoid STDs.

STD rates were higher among black female teens, with 48 percent infected compared with 20 percent of white and Mexican teens, the study showed. CDC officials blamed the disparity partially on a lack of access to health care and education, but said the main reason is that STDs are more prevalent in the black community, making each sexual encounter more risky.

"This does not mean African-Americans are taking higher individual risks than other groups. In fact, research suggests the opposite," said Dr. John M. Douglas Jr., director of sexually transmitted disease prevention at the CDC. Still, he said, the nation must face "this extraordinary racial disparity."

The high infection rates were not a surprise, said health officials in South Florida and elsewhere, but the study puts harder numbers to the problem. Researchers based the new estimate on a 2004 nationwide health assessment program that examined, among others, 838 teen girls in what was called a representative sample of the U.S. population.

No state breakdowns were done, but Florida has reported rising numbers of teen girls with STDs. Almost 14,000 girls ages 10 to 19 contracted chlamydia in 2005, including 1,100 in Broward and 615 in Palm Beach County. Overall, chlamydia cases rose 75 percent in the prior decade.

The four STDs are not considered as serious as HIV/AIDS, gonorrhea and syphilis, which were not tracked in the study. But all can damage the body if left untreated. HPV can cause cervical cancer, the bacterial infection chlamydia can lead to abnormal pregnancies, and genital herpes viruses and the parasite trichomoniasis can make it easier to catch HIV/AIDS.

The study showed that about half of teens reported being sexually active, and about 40 percent of those were infected.

A second CDC study showed that the nation's health care system misses many opportunities to test teen girls when they come into clinics for contraception, Douglas said. Only 38 percent who came in after unprotected sex were tested, counseled or treated.

"We need to do a better job on lots of different fronts," Douglas said.

An HPV vaccine for girls and women ages 11 to 26 has been available since 2006 but is controversial. Critics have argued that giving it to young girls may encourage promiscuity and expose them to side effects. But many advocates say it's a strategy for preventing an infection that kills 3,700 women annually.

A few states made the vaccine mandatory for school admission, while Florida and others have not.

Plantation High School's Salgado said South Florida teens often ignore advice to get tested because it's not easy to find or reach a testing site.

"It's far away and some can't get there," she said. "Some don't know about it. Some are scared to go because of their parents."

Salgado is leading a group organizing an HIV/AIDS testing day March 25 across from her school. A small-scale attempt at another school last month brought 46 teens to a mobile testing van, said Norman Powell, president and CEO of Comserv Inc., a community group.

SOURCE: Bob LaMendola, www.sun-sentinel.com

Group gets to test new Merck AIDS drug in gel

WASHINGTON, March 11 (Reuters) - A group working to develop a gel or cream women could use to protect themselves against the AIDS virus said on Tuesday they have permission to use an experimental new drug from Merck and Co.

It is the sixth HIV drug to be tested by the International Partnership for Microbicides, said the group's chief executive officer, Dr. Zeda Rosenberg.

The drug is known only by its experimental name L'644. It is a member of a class of drugs known as gp41 fusion inhibitors. They stop the AIDS virus from attaching to the immune system cells it targets.

"It's a completely different mechanism of action to what we have currently under development and what the field has under development," Rosenberg told Reuters in a telephone interview.

"It's pretty early in the life cycle for HIV. Most of us feel that, for a microbicide to be really effective, it has to get at the infection in its earliest timepoints."

Microbicides are products, such as gels or creams, that could be applied vaginally or anally to prevent transmission of the human immunodeficiency virus that causes AIDS.

So far, attempts to create a microbicide have failed.

The AIDS virus has infected 33 million people globally, according to the World Health Organization. It has killed 25 million, and there is no vaccine to prevent the fatal and incurable virus.

Condoms can protect men and women, but health experts note that many men refuse to use them. In many countries, a women who demands that her husband or partner use a condom can face refusal or even a beating.

According to the United Nations, in sub-Saharan Africa almost 61 percent of adults infected with HIV are women. Most cases of HIV are transmitted sexually.

The nonprofit IPM has another agreement with Merck for a royalty-free license to develop another compound, L'167/CMPD167, which belongs to the class of molecules known as CCR5 blockers.

"Merck is pleased to contribute the results of our research and development to this worldwide effort to protect women from HIV infection," said Dr. Daria Hazuda, vice president of scientific affairs for infectious disease and HIV at Merck Research Laboratories.

The microbicides group also has agreements with Pfizer to develop its CCR5 blocker maraviroc; with Gilead Sciences to develop tenofovir, a licensed HIV drug; with Bristol-Myers Squibb; and with Johnson & Johnson subsidiary Tibotec Pharmaceuticals to try to make a microbicide out of its HIV drug dapivirine.

The field could use some successes.

Last month a study showed one microbicide candidate, called Carraguard, did not protect women from infection.

Two other potential microbicides have made women more likely to become infected -- a spermicide called nonoxynol-9 and a product called Ushercell, made by Toronto-based Polydex Pharmaceuticals. (Editing by Mohammad Zargham)

SOURCE: By Maggie Fox, Health and Science Editor, guardian.co.uk

FDA Warning - Internet Sales of Bogus STD Preventatives

The FDA issued an emergency alert today warning consumers of drugs being sold on the Internet falsely claiming that they can prevent or treat sexually transmitted diseases. The products are sold under the names of Tetrasil, Genisil, Aviralex, OXi-MED, Imulux, Beta-mannan, Micronutrient, Qina, and SlicPlus and make claims such as:

"Treatment Kills all Herpes Viruses WITHOUT having to use conventional drugs or medications," "Greatest STD Protection Without Condoms," (SlicPlus) and "The active ingredient in our product is FDA certified to destroy 99.9992 percent of all pathogenic organisms [ie] Chlamydia" (OXi-MED).

Since these drugs have not been submitted to the FDA, they are in violation of FDA rules and should not be taken as they have not been tested for the safety or effectiveness and may pose a health threat to consumers. The FDA regards these drugs as "mislabeled" and/or "misleading" and states they do not include sufficient instructions for consumers.

Consumers should stop taking these drugs immediately and should report any adverse effects to the FDA's MedWatch group at 800-FDA-1088.

SOURCE: Edmund A. Normand, Editor orlandoinjuryboard.com

Contraceptives: What about your health?

Your method of birth control can actually do more than just protect against pregnancy. It may also affect things such as your appearance and your risk of certain kinds of cancer.

Health benefits
Some methods of birth control have benefits for your health.

Clearer skin: Studies have shown a connection between the use of the birth control pill and decreased amounts of acne. This is because the pill can moderate levels of hormones called androgens, regulating the production of oil in the skin.

Protection from certain diseases: The birth control pill is associated with protection from some diseases affecting women. These include benign ovarian cysts, endometrial (uterine) cancer, ovarian cancer, iron deficiency (anemia), and pelvic inflammatory disease.

Reduced pain and menstrual flow: Birth control methods that contain hormones are linked to a reduction in the volume of menstrual flow and the painful cramps that often accompany your period.

Protection against STIs: Condoms provide protection against sexually transmitted infections (STIs). Depending on the nature of your sexual relationship, this protection can be vital, even if you use another form of birth control, because the other forms of birth control do not provide protection from diseases such as AIDS/HIV, chlamydia, gonorrhea, genital herpes, human papillomavirus (associated with genital warts and cancer of the cervix), and syphilis.

Things to watch out for
Your state of health is an important consideration when deciding on or during the use of any birth control method. Certain birth control methods may affect some medical conditions, and medication for some conditions may change the effectiveness of some birth control methods.

Antibiotics: The antibiotic rifampin reduces the effectiveness of birth control pills. As for other antibiotics, there is less conclusive evidence that they decrease the effect of oral contraceptives. This effect may only occur in a small number of women. But it's best to err on the side of caution, as more research is needed to determine the effect of antibiotics on the modern low-dose birth control pills used today. Adding a barrier method (e.g., male or female condom) is a good idea if you're taking antibiotics.

Medical conditions: Women with epilepsy need to determine the proper form of birth control with their doctor and neurologist. Many anti-seizure medications may reduce the effectiveness of hormone-based birth control methods by speeding up the breakdown of these hormones in the liver. Including a barrier method will reduce the chance of pregnancy.

Women who have any of the following conditions should talk to their doctor before deciding on a birth control method:

• high blood pressure
• liver disease
• history of blood clots in a vein (deep vein thrombosis) or lung (pulmonary embolism)
• migraine headaches
• family history of stroke

Latex allergy: Most male condoms are made of latex. People who are allergic to latex can consider such options as condoms made from polyurethane and female condoms. Lambskin condoms are also available, but they offer less protection against STIs. If protection from STIs is not an important issue, there are many options, ranging from sponges to IUDs to pills.

SOURCE: MediResource, canada.com

Activists Call for More Family Planning In Fight Against HIV/AIDS

The United Nations estimates that 2.5 million children are infected with HIV / AIDS, with nearly 90 percent of them in sub-Saharan Africa. Activists in the fight against the disease say one of the best ways to prevent mother-to-child transmission of the HIV virus is to prevent unintended births. From Washington, reporter William Eagle has the story.

In recent years, anti-retroviral AIDS drugs have been in the forefront of the fight to prevent the spread of the disease from a mother to her baby.

The most influential program in fighting HIV/AIDS in Africa is the President's Emergency Plan for AIDS Relief, or PEPFAR. Among other things, PEPFAR funds treatment and prevention efforts.

Principal deputy AIDS coordinator and chief medical officer for PEPFAR Dr. Thomas Kenyon notes that the United States has been a global leader in preventing mother-to-child transmission, called PMTCT.

"To date," he says, "we have supported PMTCT services for women in more than 10 million pregnancies, of whom 800,000 were found to be HIV positive."

He says PEPFAR's support for anti-retrovirals has helped avert 150,000 infant infections.

But some health activists note that despite much progress, only one in 10 HIV-positive women in Africa has access to the medications. They say a more effective way to stop infections is preventing unintended pregnancies among HIV-positive women.

According to recent newspaper reports, researchers with the U.S.-based group Family Health International say contraception is more reliable and less expensive than AIDS drugs.

Policy analyst Katie Porter, of Population Action International in Washington, says PEPFAR could be far more effective by strengthening its prevention programs - including mother-to-infant prevention - by making contraceptives available to those who want them.

"The immediate concern," says Porter," is that PEPFAR is not supporting access to [a wide variety of] contraceptives. While they support condom use, which is important, they are not providing other contraceptive commodities to women in what would be a very appropriate setting. If you can intervene when women come in for these services and offer them contraceptives, you help to reduce unintended pregnancies among HIV-positive women, and that would further enhance these programs."

PEPFAR supporters say its job is preventing the transmission of HIV/AIDS, and the only contraceptive that does so is the condom. But they note that USAID sponsors family planning programs that include a wide variety of contraceptives, including IUDs, oral tablets and injected medications such as NORPLANT.

When President Bush introduced PEPFAR five years ago, he proposed a budget of $15 billion for its first five years, the majority of which would benefit 15 focus countries - 12 of them in Africa. [They include: Botswana, Ivory Coast, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia. The others are Guyana, Haiti and Vietnam].

Recently, it was announced that that goal would be surpassed - for a total of nearly $19 billion.

But Porter says only a very small portion of that money is earmarked for family planning and reproductive health, despite the critical role it plays in helping prevent HIV infection. As an example, she addressed President Bush's 2008 budget.

She says,"If you look at PEPFAR's 15 focus countries, where efforts to address the needs of women and girls and to address HIV prevention is paramount, we are seeing a decrease, or flat-lining, of funding for international family planning [in 10 of the countries]."

Population Action International says four of the 15 focus countries receive no family planning assistance, while only one - Rwanda - is marked to receive a small increase. The group says all 11 countries have high fertility rates and an unmet need for contraception.

PEPFAR supporters say that it is the US Congress that authorizes and appropriates funding, with the president's approval. That includes deciding on the amount of money allocated to the agency in charge of the bulk of family planning services, USAID. They note that PEPFAR's goal is preventing the transmission of HIV/AIDS. Therefore, PEPFAR's only involvement in family planning is in recommending methods that prevent the spread of the disease - using condoms or practicing abstinence.

Porter says advocates and providers are also concerned about some of the rules that are attached to PEPFAR's funding. For example, one says that at least one-third of all the prevention funds must go to programs that only teach abstinence. Some researchers complain that there is no scientific evidence that teaching restraint alone is effective.

Porter says organizations that receive PEPFAR funding must also sign a pledge opposing prostitution. But prostitutes are at high risk of HIV and unintended pregnancies.

She says, "There is concern in the field that having such a statement would alienate the very people they are aiming to provide services to."

PEPFAR officials disagree. They say their programs target everyone, including high-risk groups like those who practice prostitution.

They say PEPFAR is supporting the most diverse prevention strategy of any donor, which addresses prevention of mother-to-child transmission, as well as preventing sexual transmission by delaying sexual activity, being faithful, and using condoms.

Kenyon says from 2004 to 2007, the United States provided 1.8 billion condoms worldwide - more than all other donors combined.

At the same time, the U.S Government has a voluntary family planning and reproductive health program, through USAID's Office of Population and Reproductive Health.

USAID has provided an average of $440 million in family planning in the past five years, more than the average $427 million provided during the Clinton administration.

Kenyon says this program is coordinated with PEPFAR to ensure appropriate linkages between these two distinct programs.

"We have a number of countries where we are adding counseling and testing to family planning centers," he says. "[We are also] adding services for prevention of mother-to-child transmission as is done through the Africa Medical Research Education Foundation in Kenya. [It] has introduced PMTCT services in more than 30 family planning centers and reached more than 20-thousand women. We [are also improving] linkages between HIV programs and family planning programs. [We are also] linking family planning programs with HIV care, and to the prevention of mother-to-child transmission."

PEPFAR officials say that a comprehensive strategy is necessary - which combines the expertise of PEPFAR in fighting HIV with the family planning programs of USAID.

SOURCE: William Eagle, voanews.com

EXPOSURE FEARED: 40,000 LV clinic patients urged to be tested for viruses

Syringe reuse at Endoscopy Center of Southern Nevada 'common practice'

Forty thousand Nevadans soon will receive word that they might have been exposed to HIV and hepatitis strains B and C in what a federal health official called the largest notification of its kind in U.S. history.

Patients who visited the Endoscopy Center of Southern Nevada at 700 Shadow Lane between March 2004 and Jan. 11 are being urged to get tested for the diseases as soon as possible.

Health officials cautioned them to practice safe sex and use condoms.

At a Wednesday afternoon news conference attended by health officials and doctors from the facility, officials said six people diagnosed with acute hepatitis C in recent months received treatment at the center near Valley Hospital Medical Center. They are believed to have been exposed to the disease when anesthesiologists reused syringes to administer medications.

The Endoscopy Center of Southern Nevada is a high-volume gastrointestinal practice where colonoscopies are frequently performed. Reuse of syringes and vials at the facility was a "common practice" undertaken by everyone from doctors to technicians, health officials said.

The business was investigated for other unsafe practices such as not properly cleaning endoscopic equipment used in colonoscopies and upper gastrointestinal procedures.

The medical facility was open for business Wednesday. It could be subject to sanctions or lose its Medicare contract at a later date, state health officials said.

Dr. Eladio Carrera, a gastroenterologist and internal medicine physician at the center, attended the news conference, but he did not address why he and other staffers did not follow correct medical procedures. In a statement, he expressed concern for patients, then refused to take questions.

Dr. Dipak Desai, the center's administrator, was not at the news event and could not be reached later at the office for comment.

LARGEST SUCH NOTIFICATION

"Las Vegas has the dubious distinction of having the largest patient notification of its kind," one involving the reuse of syringes and consequent spread of disease, said Joseph Perz, an epidemiologist with the federal Centers of Disease Control and Prevention in Atlanta.

Like some Nevada physicians, Perz said, he was stunned by the magnitude of what happened in Las Vegas.

"It certainly is unsettling to think of the scope of this,'' he said. "Let's not forget the impact on people when they receive the notification letter. A lot of people are going to lose sleep.''

Health officials began investigating the endoscopy center in early January after learning of three people who had been diagnosed with hepatitis C, a chronic, potentially lethal blood-borne virus that can cause liver cancer and liver failure.

The three other cases were identified later.

Each of the individuals underwent procedures requiring injected anesthesia at the medical center between June and September 2007. Five underwent the procedures on the same day at the facility, said Brian Labus, the health district's senior epidemiologist.

The health district subsequently notified the Nevada State Board of Licensure and Certification about the hepatitis C cases and the possibility that exposure occurred at the same medical facility.

The board inspects facilities before they accept patients to determine whether they meet construction requirements and health care regulations. The board also evaluates medical facilities to ensure they comply with the law and provide quality patient care.

After a joint investigation by the board and the health district, it was determined that syringes -- not needles -- and the use of vials of anesthesia medication on multiple patients were potential sources of infection.

A syringe would become contaminated by the backflow of blood when patients with a blood-borne disease were injected with medication, health officials said. That syringe, in turn, would be reused to withdraw medication from a different vial. That vial could become contaminated and result in infection.

During the investigation Labus said doctors, nurses and other medical personnel at the facility were asked whether it was the norm to reuse syringes and vials.

"They admitted, 'This is what we were told to do,' " Labus said.

So far there have been no cases of hepatitis B or HIV linked to the endoscopy center that have been reported to the health district.

INCUBANCY MIGHT BE KEY

Dr. Lawrence Sands, director of the health district, said at the news conference that it could be too early in the investigation for reports about HIV to surface, considering the incubation period for symptoms. Depending on an individual's health, symptoms of HIV might not appear for several years.

The incubation period for hepatitis C is six to eight weeks, and only 20 percent to 30 percent of people exposed actually have symptoms, Labus said.

"Hepatitis C is a serious medical condition,'' Sands said.

"As a precaution and in order to take appropriate steps to protect their health, it is important for these people to get tested and for anyone with the illness to seek medical attention.''

Health officials said Wednesday evening they don't believe the hepatitis C cases are the result of colonoscopies or gastroenterology procedures performed at the center, though the state licensing board referenced in its report problems arising from these procedures that could spread infection.

Lisa Jones, chief of the licensure and certification board, said the reuse of syringes and vials of medication were considered more of a public health risk than the fact that endoscopic equipment was not cleaned properly by clinic personnel.

Instead of cleaning one endoscope and then using fresh solution to clean another one, the same dirty solution would be used, the report states. Jones said one batch of cleaning solution should be used for a single endoscope or set of instruments.

But that issue was not raised at the news conference.

"I didn't want to go into too much detail (about the endoscopic equipment) because of time," Jones said in a telephone interview Wednesday evening. "We felt it was significant enough to cite (in the report) as a deficiency."

District Attorney David Roger said his office "will look at all the facts and circumstances of the Health District investigation" before deciding whether criminal charges are warranted.

When asked who would pay the costs of patients getting tested and treated for diseases spawned because of diagnostic procedures, health officials didn't have any immediate answers.

"That hasn't been worked out yet,'' Sands said. "We hope to get that worked out over the weeks that come.''

Dr. Cheryl Hug-English, associate dean of admissions and student affairs for the University of Nevada School of Medicine, said students are taught from their first year of medical school that what transpired at the Endoscopy Center of Southern Nevada "is not an acceptable practice."

"Certainly the standard of care for many years is not to reuse syringes," Hug-English said. "The proper practice is repeated and ingrained that syringes cannot be reused. ... We take this very seriously.''

In residencies, medical students are monitored by program directors on proper practice, she said.

Carrera, accompanied by Drs. Sanjay Nayyar and Clifford Carrol, said in the statement that the center wants "to express our deep concern about this incident to the many patients who have put their trust in us over the years.''

"As always, our patients remain our primary responsibility and we have already corrected the situation.''

Carrera went on to say that the investigation marked the first time "anything like this" has happened at the facility.

He said the center was "officially notified" of the hepatitis C outbreaks Feb. 6 and submitted a detailed plan of correction to the licensing board on Feb. 15.

Jones said the agency conducted an investigation at the facility from Jan. 9 to Jan. 17.

"This is beyond unfortunate,'' Larry Matheis, executive director of the Nevada State Medical Association, said after learning of the possible exposures. "Even in the early days of the HIV epidemic when I was the administrator of the Nevada State Health Division, I don't think we ever had a situation like this. ... I'm sure that's why the red flags went out. It's unusual to have an outbreak of hepatitis C.''

FOLLOW-UP WILL BE NEEDED

Matheis and other Nevada health officials said they couldn't recall such an event involving so many people occurring in the state.

Dr. Don Havins, chief executive officer and special counsel for the Clark County Medical Society, said he was alerted by the health district of the hepatitis C cases but wasn't made aware that five of the six people probably were exposed at the same facility on the same day.

He said that is a major concern because others treated that particular day will need to get tested.

"That's the most important thing right now, getting to those people,'' he said.

Matheis said the issue definitely requires follow up and intensive review.

He said the medical association will send information to all Nevada physicians to alert them about such mistakes. He said there might be a need to review Nevada laws to ensure that measures are in place to prevent future similar incidents.

"The Board of Medical Examiners also should be looking at this as well,'' Matheis said. "This is why we have systems in place, to make sure that patient safety is built-in and redundant practices don't occur.''

Evelyn McKnight, co-founder of Hepatitis Outbreak National Organization for Reform, a national advocacy group, said in an e-mail Wednesday that her heart dropped when she heard that 40,000 Nevadans were being notified they might be exposed to hepatitis C and B and HIV.

McKnight was one of 99 cancer patients infected with hepatitis C while undergoing cancer treatment at a Nebraska oncology center.

"Once again, we have an outbreak that involves two common elements -- an outpatient clinic and the reuse of medical equipment that is intended to be used only once,'' she said. "When we hold our restaurants to higher standards than our doctors' offices, that's a tragedy."

On Wednesday, Angelo Dominic, 76, sat in the medical building that houses the Endoscopy Center of Southern Nevada and shook his head in disbelief. Dominic, now being treated for prostate and heart problems, said he had a colonoscopy at the facility within the last year.

He couldn't believe medical personnel would have reused syringes.

"I was a medic in Korea, and I knew you could never do that," he said.

"I've had to deal with prostate cancer and now I have to worry about hepatitis and HIV. Why can't these people care about other people? Where do they come from?"

SOURCE: ANNETTE WELLS and PAUL HARASIM, Las Vegas Review Journal

HIV Stigmatization Still Widespread

Stereotypes and misinformation about HIV that are commonplace among the general public are also evident in a surprising number of clinical staff, a study from the University at Buffalo has found. Published in the journal AIDS Patient Care and STDs, Lance S. Rintamaki's study shows that more than 25 years after its discovery, HIV still has the power to generate a broad array of stigmatizing behavior. People infected with HIV have previously labeled dealing with stigma as the most significant social and psychological challenge of the HIV experience and Rintamaki's study shows little has changed.

Sufferers' experiences were categorized by the type of stigmatizing behavior that they experienced most often in the presence of health-care personnel. These categories were: lack of eye contact; assuming physical distance; using disdainful voice tone or inflection; asking confrontational questions; showing irritation, anger, nervousness, fear or panic; taking excessive precautions; scaring, mocking, blaming or ignoring patients; providing substandard care or denying care, and being generally abusive.

Stigmatizing experiences included judgmental behavior and panic on the part of providers when informed of a patient's HIV status, doctors "hermetically sealing" themselves before approaching the patient and patients being told they were going to die. Participants described being blamed openly by health-care providers for their condition. One patient told of being scolded by a phlebotomist; "If you hadn't done this to yourself, we wouldn't have to be going through this!" when he objected to being "poked" painfully several times as she searched for a viable vein to draw blood.

Other reports included the hospital worker who refused to mop the floor in an HIV patient's hospital room, the dentist who turned away a patient because of his HIV status and rough-handling by paramedics. One participant said he had so little eye contact with his neurologist that he couldn't describe the doctor's face. Another participant recounted a nurse's disdain when she delivered his AIDS diagnosis: "It was just so callous and cold the way she said it; 'You have AIDS.' There was no feeling. It's almost like a stone-faced warden or something. No concern."

"Given patients' sensitivity to any indication of bias or discrimination, it's likely that even well-intentioned health-care personnel sometimes engage in behaviors that are interpreted negatively by their patients," said Rintamaki. "The findings from this study give health-care personnel additional insights on what to avoid, or if certain protocols are standard procedure, what to explain further. These approaches might help to prevent misunderstandings."

SOURCE: Kate Melville, scienceagogo.com

Anti-HIV Gel Proven Safe, Tolerable For Women

Newswise ? An experimental anti-HIV gel is safe for women to use on a daily basis, according to researchers at the University of Alabama at Birmingham (UAB) and the University of Pittsburgh School of Medicine.

In testing, the gel, called tenofovir, was favorably self-applied and tolerable to non-HIV-infected women, a significant boost to HIV and AIDS prevention efforts focused on next-generation microbicides to reduce infection rates, the researchers said.

The women study participants said if tenofovir gel is approved for the prevention of HIV infection, they would be willing to apply the gel to themselves daily or before sex, whichever is determined the best use.

?The gel is safe to use, and well tolerated by HIV-negative women. That?s a key message in our findings,? said Craig Hoesley, M.D., associate professor in the UAB Division of Infectious Diseases and author on the initial Phase II results. ?This sets the stage for larger studies to see if tenofovir can prevent HIV infection.?

The tenofovir Phase II trial results were presented Monday, Feb. 25 at an international microbicides meeting in New Delhi, India. The researchers are part of the U.S. National Institutes of Health-funded Microbicide Trials Network, an international team of researchers devoted to exploring and evaluating anti-HIV microbicides.

?Based on what we have learned we can proceed with greater confidence on a path that will answer whether tenofovir gel and other gels with HIV-specific compounds will be able to prevent sexual transmission of HIV in women when other approaches have failed to do so,? said Sharon L. Hillier, Ph.D., director of reproductive infectious disease research at the University of Pittsburgh School of Medicine and principal investigator on the Phase II study.

Researchers evaluated if tenofovir was safe to use every day for six months, or safe to use prior to each act of intercourse. They found both approaches equally safe. Women in the study were asked to use condoms in addition to the gel.

Researchers found no disruption of liver, blood or kidney function in each group of women using a different gel regimen, including those given a placebo gel that looked and felt identical to the tenofovir gel.

The study included 200 sexually active HIV-negative women enrolled at UAB, Bronx-Lebanon Hospital Center in New York and the National AIDS Research Institute in Pune, India. Participants were age 19 to 50, and 64 percent were married.

In addition to the safety findings, researchers found women in the study significantly willing to follow the gel-apply guidelines. Eighty percent of the women instructed to use the gel within two hours of having sex said they followed instructions, and 83 percent instructed to use the gel daily said they had done so in the week prior.

Hoesley said if the gel were approved to help prevent HIV infection, more than 90 percent of the study volunteers said they would seriously consider using it, regardless of the regimen, to protect their sexual health.

?We asked women ?How acceptable is this as a prevention option, is it too messy, is it a nuisance, and will you use it?? Our study showed they will use it and they?re not bothered by the gel,? Hoesley said.

The active ingredient in tenofovir gel is a class of anti-retroviral drugs called nucleotide reverse transcriptase inhibitors, which act against HIV by blocking the virus? ability to replicate and grow inside the body.

Tenofovir was developed by Gilead Sciences, Inc., of Foster City, Calif.

The Microbicide Trials Network was established in 2006 by the National Institute of Allergy and Infectious Diseases with co-funding from the National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the National Institutes of Health.

SOURCE: University of Alabama at Birmingham, NEWSWISE.COM

Stimulating Thymus Reactivates T-Cell Production

FRIDAY, Feb. 22 (HealthDay News) -- It's possible to stimulate the thymus gland to produce new immune system T-cells in adults infected with HIV, U.S. researchers say.

HIV infection destroys T-cells, which leads to the collapse of the immune system and severe infection. The thymus gland produces T-cells early in life but gradually loses function and becomes mostly inactive in adulthood. That means it's difficult for HIV-infected adults to produce new T-cells to rebuild their depleted immune systems.

It has long been believed that it wasn't possible to reactivate T-cell production in the thymus. The new study, by researchers at the Gladstone Institute of Virology and Immunology and the University of California, San Francisco (UCSF), is the first to show that therapy can help boost thymus function in adults.

The two-year study of 22 HIV-infected adults found that treatment with growth hormone (GH) increased thymus mass and more than doubled the number of newly made T-cells. The results are published in the March issue of the Journal of Clinical Investigation.

"These results represent new proof-of-principle findings that thymic involution can be reversed in humans," study author Dr. Laura Napolitano, an assistant investigator at Gladstone and an assistant professor of medicine at UCSF, said in a prepared statement.

"Improved T-cell production may be helpful for some medical conditions such as HIV disease or bone marrow transplantation. These findings contribute new information to our understanding of T-cell production and are also an important step to determine whether immune therapies might someday benefit patients who need more T-cells," Napolitano said.

However, much more research is needed to determine whether stimulating production of new T-cells actually provides a health benefit for HIV patients or anyone else, the researchers said.

SOURCE: Forbes.com

One in five HIV patients in New York say they never use condoms

Approximately one-fifth of HIV-positive patients report never using condoms with regular or casual partners in a study conducted in New York and published in the February edition of AIDS Patient Care and STDs. Inconsistent use of condoms was associated with the presence of symptoms of depression, and most of the patients reporting unprotected sex had a detectable viral load.

Although the investigators found no link between use of antiretroviral treatment and inconsistent or non-existent condom use in their multivariate analysis, they did find that patients who reported poor adherence to antiretroviral therapy were more likely to never or inconsistently use condoms.

Patients in the study were asked about their sexual behaviour and adherence using an audio computer-assisted self-interview and the results of this interview were made available to their doctors. The investigators suggest that these interviews could be used to identify ?a core group of nonadherent patients who do not consistently use condoms, and then deliver targeted intensive psychosocial services and prevention interventions to them.?

Thanks to the success of antiretroviral therapy people with HIV can live, longer, healthier lives. This good health means that individuals with HIV are likely to remain sexually active. Therefore HIV prevention efforts are being focused on people with diagnosed HIV infection and in 2003 the US Centers for Disease Control and Prevention announced an initiative to screen for sexual risk behaviour during HIV clinic appointments.

Investigators wanted to see if audio computer assisted interviews were a successful means of obtaining information about issues including sexual risk behaviour, adherence to antiretroviral therapy, and the presence of depressive symptoms.

A total of 198 patients at two HIV clinics with a predominately Latino population were recruited to the study in 2004. The patients were told that their answers during the computer-assisted interview would be provided to their HIV doctor.

Three quarters of the patients were Latino, 36% were gay/men who have sex with men, and 25% were women.

In the four weeks before the study, 65% reported being sexually active, with 24% reporting a regular partner only, 5% a casual partner only and 35% both a regular and a casual partner.

Of the patients who reported sex with a regular partner, 34% said they didn?t always use condoms and 18% said they never used condoms. Of the patients who said they had had sex with a casual partner, 26% reported not using condoms every time and 15% said they never used condoms. Overall 35% of sexually active individuals reported inconsistent condom use and 19% reported never using condoms.

Women were more likely than men to report never using condoms (32% vs, 15%, p = 0.047), and heterosexuals were more likely than gay men to report not using a condom every time with a regular partner (p = 0.04).

Taking antiretroviral therapy was associated with inconsistent condom use with regular partners in univariate analysis (p= 0.05). But this association disappeared in multivariate analysis that adjusted for age, race, gender and HIV transmission category. In multivariate analysis, the only factors significantly associated with not using condoms were self-reported depression (p = 0.03) and self-reported poor adherence to antiretroviral therapy (p = 0.02).

Of the patients who reported never using condoms with regular partners, 76% had a viral load above 400 copies/ml. All the patients who reported never using condoms with casual partners had a viral load above 400 copies/ml.

?We found that almost one fifth of those who had been sexually active in the past four weeks reported never using condoms with their regular or casual sex partners. Over one third of these patients reported not using condoms every time?, comment the investigators.

?Most patients with recent HIV RNA results who reported unprotected sex?had detectable HIV RNA?, the researchers observe, adding, ?the fact that a substantial number of patients with detectable HIV RNA are practicing unprotected sex is a serious concern.?

The investigators acknowledge that their study had some limitations, including the lack of diversity in the population. Nor were the investigators able to say if patients were having unprotected sex with partners of the same HIV status, or if men were adopting ?strategic positioning? (assuming the receptive role with men who were HIV-negative or of unknown HIV infection status).

SOURCE: Michael Carter, aidsmap.com

Web site allows anonymous warning of STD infections

NEW YORK (Reuters Life!) - A Web site that enables people with sexually transmitted diseases (STDs) to send anonymous email warnings to their partners could help slow a rise in new infections, a New York health official said.

InSpot.org uses the E-Card model to send messages like "I'm So Sorry" to notify people that they may have been exposed to a disease. It also offers information about getting tested and treatment.

"Making use of some of the emerging technologies makes sense," said Sue Blank, of New York's Department of Health and Mental Hygiene.

"We're getting the word out to the community."

Blank hopes the site will help to reduce new syphilis infections in New York which rose by 56 percent during the first half of the current fiscal year.

Users of the site, which went online in San Francisco in 2004, can choose from a selection of messages.

"It provides an easy, convenient, anonymous way for people to be responsible about notifying their partners about a possible exposure to an STD," said Deb Levine, of the San Francisco Internet Sexuality Information Services, which created InSpot with the city's Department of Public Health.

There are 15 million new cases of STDs in the United States each year, according to the Web site. The rise in syphilis in New York mirrors a national trend that shows syphilis has risen sharply among gay and bisexual men in the United States this decade.

Levine said that in San Francisco, syphilis rates have fallen since the site was introduced.

In addition to New York and San Francisco, the Web site is now active in six other U.S. cities. It has also been launched in eight U.S. states, as well as two Canadian cities and Romania.

SOURCE: Edith Honan, Reuters.com

USC students' demand for condom dispensers denied

Since administrators decided against installing condom machines in University of South Carolina residence halls, students will have to go a little further for safety when they want to go all the way.

The Residence Hall Association, representing student residents, took an opinion poll that found most USC students wanted condom machines installed in dorms. Student residents and the RHA alike said the administration's decision was a disappointment.

The school is reluctant to install these machines because the administration fears it will hurt its public image, said Assistant Director of Student Learning Sean McGreevey.

"The university's number one concern is recruitment and retention," he said. "There is a proportion of people out there who will view these machines negatively and the administration has to take that into account."

SOURCE: Kimberly Wexler, www.dailyfreepress.com

Though the school decided against installing in-dorm condom machines this year, the RHA and the administration will continue discussing the possibility of installing them in the future, said RHA President Amanda Pippin.

"I think if these condom machines prevent even one couple from engaging in unsafe sex, then the project of installing them would be worthwhile," she said.

Pippin said the RHA plans to tackle the image issue by installing the machines in areas accessible only to dorm residents, avoiding public bathrooms or dorm lobbies.

"They will only be available and noticeable to the residents of that particular dorm," she said.

USC freshman Ben Orpizcolon said the public's perception of in-dorm condom machines will vary, but the machines will ultimately benefit students. Though residence advisors make condoms available, he said, many people are embarrassed about something so personal.

"It would benefit students and encourage safe sex to have them available in the dorms," he said.

While Northeastern University has condom machines in some residence halls, Northeastern student health representatives would only confirm the school has them and declined further comment.

Boston University Student Health Services offers free condoms in its office waiting area and allows students to purchase up to 20 condoms for $5.

BU spokesman Colin Riley said regardless of image, BU does not need condom machines in dorms because there is no shortage of places that sell condoms on or near campus.

"We believe that our students are mature and able to make these decisions responsibly," he said. "Practicing unsafe sex is a sign of immature and uninformed decision making, especially because condoms are available all over the city."

SOURCE: Kimberly Wexler, dailyfreepress.com

Contraception: It's better to be doubly safe than sorry

A new study indicates that the safe sex message is getting through to Australian women, with nearly 70 per cent of those surveyed currently using contraception and 15 per cent using not one but two contraceptive methods to prevent pregnancy and protect themselves from sexually transmitted diseases.

The study, by Dr Nick Parr and Dr Stefania Siedlecky from Macquarie University's Demographic Research Group, was published recently in the Australian and New Zealand Journal of Public Health.

It uses survey data from more than 3000 women aged between 18 and 44 about their contraceptive use. The variation in the seven most prevalent contraceptive practices between different age groups, marital status, parity, education level, place of residence, birthplace, and Aboriginal or Torres Strait Islander descent was examined.

Results showed that education, cultural factors arising from ethnic background and the nature of sexual and family relationships were all important factors in determining contraceptive choices.

Two-thirds of respondents were using contraception, including more than 15 per cent who used more than one method. The contraceptive pill was the most widely used method (39 per cent), followed by the condom (28 per cent). Interestingly, more than one-quarter of pill users (28 per cent) were using condoms as well.

"Following its introduction in 1961, the oral contraceptive pill was rapidly adopted by Australian women, while the use of other methods, including condoms, declined," explain Parr and Siedlecky. "However, the arrival of HIV/AIDS in Australia in 1982 focused attention on the public health implications of contraceptive use, particularly the importance of condom use. Consequently condom use increased.

"Condoms are the only contraceptive that protect against sexually transmitted infections and HIV/AIDS for both men and women. However, since the condom alone is less effective as a contraceptive than hormonal methods and intra uterine devices (IUDs), the twin goals of preventing the spread of STIs and preventing unwanted pregnancy through the simultaneous use of both the pill and the condom - so-called dual protection - has been advocated."

While the study indicates that the use of the Pill and the increasing use of dual protection methods have been adopted by most subgroups, it appears a more widespread use of condoms is required among particular groups.

"Women under 25 and students were found significantly more likely to use the combination of pill and condom," say Parr and Siedlecky. "This could reflect a greater number of sexual partners in this demographic and the associated greater need for protection against both STIs and unwanted pregnancy.

"However, rising rates of chlamydia and gonorrhea indicate there is still a need for more widespread use of condoms, either as a single method or combined with other methods. High rates of STIs and lower levels of condom use, either alone or in combination, may also be an indication of a greater need for education and access among people living in remote Australia or for those of Aboriginal or Torres Strait Islander descent."

SOURCE: Macquarie University, PHYSORG.COM

Condom distribution may stir local controversies

Awareness group to visit several colleges

While they know it may stir up some controversy, representatives from AIDS awareness group Bethany Place plans to pass out more than 6,000 condoms at metro-east colleges next week but not at Southwestern Illinois College.

The giveaway is part of the observance of National Condom Week, according to Katie Barnhart, the Bethany Place community prevention and education coordinator. She said the message is too important not to get out.

"The idea is to get awareness up so people know how to protect themselves," Barnhart said. "The idea was to do five colleges in the five week days because a college campus is a great place to find young single people who are most likely to be sexually active and in need of hearing our message."

McKendree University, Southern Illinois University Edwardsville, Lewis and Clark College and Kaskaskia College agreed to host an safe sex awareness program and the condom giveaway. Southwestern Illinois College approved the group's request to have a table with information about safe sex. But school leaders shot down the request to pass out condoms.

"While Southwestern Illinois College was happy to approve a recent Bethany Place request for that group to set up an information table promoting safe sex on Valentine's Day, which is also National Condom Awareness Day," said SWIC spokesman Mike Fleming. "The college respectfully chose not to allow simultaneous distribution of free condoms. On this occasion and historically if and when we've been asked, we have always declined because we do not see it as a community college charge."

Fleming said "There are likely more appropriate distribution alternatives" than passing out condoms at the college.

"We do not think it is in the best interest of our diverse-taxpayer community to potentially offend any individuals or groups who might question such participation," Fleming said.

McKendree organizer Tami Eggleston, an associate professor of psychology at the school, said she is trying to keep things tasteful and informative at the same time.

"We'll have experts in to talk to people and we'll also have some students making presentations and talk about staying safe." Eggleston said. "Next week is also sexual responsibility week, so this is not all just about