Tuesday, January 31, 2017

How the GOP’s Medicaid Reform Could Limit Access to Newer, Pricier Drugs

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“When you’re under per-capita caps, you’re not able to be innovative.”

January 31, 2017


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As Republicans hash out a plan to overhaul Medicaid, patient advocates are concerned that the changes will result in less access to the newest, and often most expensive, medical treatments.

Medicaid is the state and federal health insurance for low-income people. The latest version of the GOP’s plan to revise it institutes a per-capita spending cap, reports STAT. This would mean that states would receive a set dollar amount for each person eligible for the program and would have more control over who is eligible and what is covered. But it also means states would be on their own once they reached their federal spending cap and might not be able to adjust to pay for new treatments.

Medicaid programs are already trying to restrict access to expensive treatments, such as the drugs to cure hepatitis C. This practice, experts warn, could become more common in the future.

STAT reports that Medicaid has a history of covering new treatments and responding to emergency health threats, for example by providing HIV meds that helped stem the epidemic.

“It’s a huge concern,” Barbara Otto, CEO of Health and Disability Advocates, told STAT. “When you’re under per-capita caps, you’re not able to be innovative.”

In addition to patient advocates, lobbyists for pharmaceutical companies are concerned about the GOP’s plans because it could mean fewer people could have access to the treatments. (Currently, Medicaid gets a federally mandated discount on meds.)

Republicans are working on the overhaul now, with hopes to move forward along with their plan to repeal and replace the Affordable Care Act.


  
Read more articles from POZ, here

HIV Drug Resistance: I am a Warrior


January 31 2017
 
 
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I was born and raised in Poughkeepsie, New York, and I’m 56 years old. I tested positive in 1990, while living in Albany, and was diagnosed with AIDS one year later. My AIDS diagnosis came after I got esophageal thrush, which is basically a severe, systemic yeast infection that can spread throughout the entire body. It took over two years of heavy-duty antifungals and a complete dietary makeover to finally rid myself of it, without any re-occurrences. 

Living With AIDS My T cell count at the time of my HIV diagnosis was about 220 to 250, where it remains 26 years later. I am a long-term survivor of AIDS — I have been living with it for 25 years — and HIV. Based upon guidelines from the Centers for Disease Control and Prevention, I probably became HIV-positive 10 to 12 years before my first positive test, which would mean I’ve really been living with HIV for 38 years. 


My CD4 to CD8 ratio, which is considered a more accurate barometer of how well the immune system is functioning, has held steady at between 10 to 14 percent. My T4 cell count has dipped below 100 numerous times throughout the years. 

Building Resistance I only did AZT for a short period, because I realized — after extensive research — that they were dosing it too high, and subsequently killing people. 

I began single-drug therapy — one of the early protease inhibitors — the first year it became available. I had access to it from participation in a clinical trial, one of many I have fought hard to get into over the years. 

But as a result of previous drug therapy, and drug cross-resistance, my resistance profile is extensive. I am now fully or partially resistant to at least 90 percent of all antiretroviral medications currently available. 

In the mid-1990s, I came down with a severe case of hepatitis A, for which I was hospitalized [for] over two weeks. During that period, I was informed by my HIV doctor that if my liver enzymes did not come down, I would die, thanks to my weakened immune system. I didn’t. Then around 2008 or 2009, I was diagnosed with hepatitis C. At that time, doctors assumed that giving hep C treatment to people who were HIV-positive, with 200 or fewer T4 cells would fail. My T4 cells hovered around 200 at the time, so my gastrointestinal doctors could not decide if, or when, therapy should be started.
 
 
Steve Baratta
 
When I moved into the beginning stages of liver failure, my HIV doctor hospitalized me. Her nothing-less-than-heroic measures saved my life. She stopped all the HIV meds and — because my GI doctors kept waffling — we decided that I would be my HIV doctor’s first hep C patient. Once again, she saved my life. 

I responded to the hep C treatment within the first month and achieved full remission within six months. After a grueling, horrible year of interferon shots and ribivarin, I am now cured of hep C. 
After I finished that treatment, I was able to go on a four-drug HIV regimen. I am what they call a person who responds virologically, but has no response immunologically, which means I now have an undetectable viral load, but my immune system has never recovered. My T4 cells have never been higher than 250. 

My Fight Back Even with this treatment resistance, the need to constantly switch medications, and the battle to keep my immune system healthy, I’ve always stayed busy. I joined the protest group, ACT UP, in the mid-1990s, and participated in many direct action demonstrations locally and nationally. I was a co-founder of one of the first organizations outside of New York City for people living with AIDS, in Albany. I served for many years as a member of the community constituency group overseeing all HIV and AIDS research for the federal government. My last year as part of the group, I was elected to serve on the executive committee, the only non-medical person [to do so]. This committee had final say on which HIV and AIDS trials would start anew or continue. Those two years were invaluable in terms of my educating myself about this disease. 

I served for years as a member of the HIV and AIDS advisory board for Albany Medical Center, where I was eventually appointed to the hospital’s own advisory board. I was one of the first members of the New York State HIV Prevention Planning Group, setting up all of the local Ryan White HIV/AIDS Program networks throughout the state. I have served in many different roles as an HIV housing advocate nationwide.

I Couldn’t Be Prouder One of the things of which I am proudest is helping the associate dean of Albany Medical College start their own HIV/AIDS regional education program in schools. I continued to participate as an educator and speaker for at least 10 years. 

*As told to Savas Abadsidis

Read more articles from PLUS, here.
 

New Medical Guide Brings LGBT Care Into Practice

 
"Almost everyone could use help on this topic.” 
 
A new textbook is providing medical professionals with the tools needed to address specific health needs in the LGBT community. 

Lesbian, Gay, Bisexual, and Transgender Healthcare: A Clinical Guide to Preventive, Primary, and Specialist Care was born out of frustration, says Dr. Jesse Ehrenfeld of the Vanderbilt University School of Medicine, who authored the book with Dr. Kristen Eckstrand. 


Dr. Jesse Ehrenfeld of the Vanderbilt University School of Medicine

“Our students came to us and said, ‘We’re not getting the training we need,’” Ehrenfeld told AMA Wire

In addition to sections on sexually transmitted infections, adolescence, and mental health issues, the text also delves into internalized homophobia, political inequality and immigrant health. 

“LGBT health is a relatively new field,” says Ehrenfeld, “and there is a growing recognition of the gap between the unique needs of LGBT patients and what most clinicians understand. Almost everyone could use help on this topic.”


Getty Images


These gaps not only make it more difficult for physicians to treat LGBT patients, but make patients hesitant to seek out medical services—especially if they identify as transgender or gender-nonconforming. 

A survey conducted by the National Center for Transgender Equality found that nearly 30 % of trans people postpone seeing a doctor due to concerns about discrimination. 

Just last week, a federal judge ruled it was legal for doctors and hospitals to refuse service to trans people if it was based on religious beliefs. 

More broadly, one in five LGBT adults routinely withhold information about their sexual practices from physicians for fear of judgment.







Ehrenfeld, the first openly gay member of the AMA board of trustees, hopes the guide will expand empathy and understanding in the medical community. 

“It’s not just a book for internists. It’s not just a book for surgeons,” he said. “It’s designed to be a book that any practicing clinician would find valuable, whether they’re looking for care recommendations or just trying to understand how they can make their practice more affirming, welcoming and accepting of LGBT patients.”

Read more articles from NewNowNext, here.

As the Threat of Emerging Drug-Resistant Gonorrhea Rises, What’s Next?


Noting past mistakes in testing protocol, researchers hope for new antibiotics and genetic screening that can guide treatment.
January 30, 2017



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The public health community is increasingly concerned that strains of gonorrhea that evade the last standing treatment for the sexually transmitted infection (STI) will eventually begin to circulate.

MedPage Today reports on researchers’ reflections on past mistakes in testing protocol that led to this point as well as their hopes for staying one step ahead of the ever-evolving bacterial infection with the development of new antibiotics and the use of genetic screening to guide treatment.

In September 2016, the Centers for Disease Control and Prevention (CDC) sounded an alarm about a cluster of gonorrhea infections identified in Hawaii that showed decreased susceptibility to ceftriaxone and a very high level of resistance to azithromycin. (All individuals in the cluster were ultimately treated successfully, however.) This announcement was considerably more urgent than one the CDC had made only two months before when it warned of signs of emerging drug resistance in gonorrhea in the United States.

The combination of ceftriaxone and azithromycin is now the only recommended treatment for gonorrhea. After penicillin was first used to treat the STI during the 1940s, gonorrhea eventually developed resistance to that and subsequent antibiotics.

The CDC stops recommending an antibiotic when 5 percent of cases are no longer responsive to it.

Alan Katz, MD, MPH, the head of a research team at the Hawaii State Department of Health’s Diamond Head STD Clinic, told MedPage Today that gonorrhea would likely cross that 5 percent resistance threshold “in years, but not a lot of years.”

William M. Shafer, PhD, a microbiologist and immunologist at Emory University, told MedPage Today that the CDC made a critical mistake in the 1990s when it abandoned a form of testing for gonorrhea called minimum inhibitor concentration. MIC testing, as it is known, indicates whether bacteria is developing antibiotic resistance. Instead, the CDC favored a simpler, faster test that could identify gonorrhea but provide no information about emerging drug resistance.

According to Katz, just 5 percent of gonorrhea cases in the United States receive MIC testing. In Hawaii, this figure is 25 percent because public health officials want to detect drug-resisting bacterial infections as they migrate eastward from Asia, touching down in that state first. All seven of the cases in the new Hawaii cluster were identified with this technique.

Budget cuts to public health clinics across the country are also to blame for emerging drug resistance in gonorrhea, Jeffrey Klaussner, MD, MPH, an epidemiologist at the University of California, Los Angeles, told MedPage Today. This hobbled, for example, the ability of public health workers to monitor patients with gonorrhea to ensure that they finished their antibiotics and were fully cured.

The economics of the pharmaceutical industry, in which companies tend to seek big profits by developing treatments taken over long periods, have stymied the development of antibiotics taken only for a very short time. Consequently, future research will likely have to be driven by governmental investment. Should politicians sour on spending money on diseases associated with stigmatized behaviors, such funding could take a hit.

The antibiotic ETX0914, which has completed Phase II trials (a Phase III trial result is required for approval), has thus far proved effective against gonorrhea, even against strains showing resistance to the current recommended antibiotic regimen.

Researchers are also hoping that in the future, tests of gonorrhea could identify the antibiotics that are likely to be effective against that particular strain. In some cases, this could allow for the use of older antibiotics that are no longer recommended to treat the STI.

To read the MedPage Today article, click here.
  
Read more articles from POZ, here

Monday, January 30, 2017

Trump's Block Grants Would Destroy Medicaid, Bedrock of HIV Care


January 29, 2017


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Michael Kink, executive director of the Strong
 Economy for All Coalition (Credit: Erik McGregor)
The federal-state Medicaid program has been the bedrock of HIV/AIDS treatment and care since the beginning of the epidemic -- and like so many other effective, successful and humane government initiatives, President Trump and the GOP-controlled Congress want to destroy it.
The mechanism of destruction is "Medicaid block grants," which presidential adviser Kellyanne Conway said this week would be a key component of Trump's plan to replace the Affordable Care Act (ACA).

The rhetoric surrounding block grants sounds eminently reasonable. "[T]hose who are closest to the people in need are really administering it," Conway told NBC Sunday Today. "You really cut out the fraud, waste and abuse, and you get help directly to them."

What Conway didn't say is that block grants would eliminate the legal entitlement to medically necessary benefits and services that is the heart of Medicaid -- and of HIV/AIDS and disability care in America.

"Entitlement" is another word that's developed disturbing connotations for the public due to targeted, repeated attacks by conservative politicians and talking heads.

They suggest it's an unearned benefit enjoyed by undeserving people -- but the fact is that an entitlement is a legal right.

If you need a medication, treatment or service under Medicaid, you've got a legal right to get it. And, under the current program, the federal government pays at least 50% and up to 90% of the cost of needed care.

Of course, people living with HIV/AIDS had to fight to make this legal right a reality -- and it hasn't been easy.

But the demonstrations, lawsuits, lobbying campaigns and community mobilization that are the hallmark of the movement successfully fought state by state across the country to ensure that millions of Americans living with HIV/AIDS got essential care, lifesaving treatments when they became available, and the housing and supportive services necessary to live and thrive.

The legal right to care under Medicaid has often been the foundation of this fight for survival.
For homeless and low-income people living with HIV, for all people disabled by AIDS-related illnesses and comorbid conditions and particularly for people of color, the Medicaid entitlement has been the difference between life and death.

The expansion of Medicaid under the ACA was hampered by a deadly Supreme Court ruling that has allowed cruel governors and state legislatures to inflict suffering and death on low-income people living with HIV by refusing to increase access to care in some states. Nonetheless, the ACA has extended access to lifesaving HIV care in 32 states and the District of Columbia.

All of this goes away under block grants. The federal legal right to care disappears.

Without a legal right to care, state or local-level Medicaid administrators can ration services, impose new cutoffs on eligibility and create new hurdles or roadblocks to services.

And, without a continuing cost-sharing component, states won't be able to afford increasing expenses due to new medications, rapidly aging populations, new epidemics or other challenges. Moreover, many GOP block grant proposals actually cut Medicaid funding.

If Medicaid is cut and block-granted and the ACA is repealed, state budgets will explode with billion-dollar shortfalls.

At the same time, federal funding for public schools, housing and environmental programs will be slashed, opening new billion-dollar gaps.

State funding for AIDS care will compete with nursing homes for seniors, home care and independent living services for people with disabilities, and public school and university funding in an atmosphere one state capital lobbyist recently compared to that in Lord of the Flies.

In this atmosphere, many cynical and ruthless politicians will seek to divide and conquer, creating categories of "deserving" and "undeserving" people that will further demonize and marginalize people of color, trans people, drug users and LGBTQ folks -- as they've always done.

And, they'll be free to rob chunks of federal funding to replace existing state health care spending, then swap out that money for corporate subsidies and sports stadiums, just like they did in 1997 after Bill Clinton and the GOP Congress block-granted the federal welfare program for impoverished families with children.

It's a nightmare scenario -- but it's real.

It will only take 51 votes in the U.S. Senate to block grant Medicaid and move Americans living with HIV/AIDS into Lord of the Flies territory.

We've got to fight back in Congress -- and we've got to get ready to fight state by state if we lose.
Perhaps the only good news is that we're not alone: Millions of Americans from all backgrounds need lifesaving care funded by Medicaid.

Seniors in Nevada and Arizona, drug users in Indiana and coal miners in West Virginia all depend on a solid and well-funded Medicaid program for survival.

In the coming Medicaid Hunger Games, they should be our allies, not our opponents.

AIDS activists and advocates can and will build powerful cross-constituency alliances to build power quickly -- and there's not a moment to lose. Moreover, we will teach the direct action skills that built our movement and saved millions to a new set of health care warriors who will fight in Washington and in state capitals around the country for our lives and our democracy.

Michael Kink is executive director of the Strong Economy for All Coalition and served as senior staff attorney and legislative counsel for Housing Works from 1994 to 2008.

Read more articles from theBODY, here.

 

White House Staying Mum on Rumors of Anti-LGBT Exec Order


January 30 2017 
 
 
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Rumors are floating that President Trump will rescind President Obama’s executive order banning anti-LGBT discrimination by companies that hold contracts with the federal government and perhaps put a “religious freedom” order in place.

At today’s press briefing, White House press secretary Sean Spicer refused to discuss the matter when Washington Blade reporter Chris Johnson brought it up. “I’m not getting ahead of the executive orders that we may or may not issue,” Spicer said. “There’s a lot of executive orders, a lot of things the president has talked about and will continue to fulfill, but we have nothing on that front now.” 

A week ago, when asked if Obama’s order would stand, Spicer replied, “I just don’t know the answer.”

Bloomberg Government first reported on the rumors Friday, in a story that is available to clients only. The story noted that “a range of options are under consideration for an executive order that could target LGBTQ people with discrimination, including allowing contractors to discriminate in hiring, allowing taxpayer-funded workers to refuse to serve LGBTQ people or allowing Indiana-style discrimination where contractors could refuse service to LGBTQ people,” according to a Human Rights Campaign press release.

“Indiana-style discrimination” refers to the “religious freedom” law signed by Mike Pence, now vice president, in 2015 when he was governor of Indiana. The law would have given legal cover to businesses that turned away LGBT people or others who offended the business owner’s religious sensibilities. Amid public outcry and boycotts, it was amended so as not to allow such discrimination.

“The rumors of an anti-LGBTQ executive action by President Trump are deeply troubling,” said JoDee Winterhof, HRC senior vice president for policy and political affairs, in the press release. “We already know that he is willing to target and marginalize at-risk communities for his perceived political gain. As the president and his team plan their next steps, we want to make one thing clear: we won’t give one inch when it comes to defending equality, whether it is a full-on frontal assault or an attack under the guise of religion. Mike Pence should know that better than anyone given his track record in Indiana. The Human Rights Campaign will stand with those who have already been targeted by this administration and are prepared to fight tooth and nail against every effort to discriminate.”

Trump has said he would sign anti-LGBT laws such as the proposed First Amendment Defense Act, a national version of state-level “license to discriminate” laws, which would apply to government workers as well as private businesses and nonprofits, protecting them from penalties if they cite religious objections in refusing service to LGBT people or others.

In what was seen by many as a cynical move, Trump cited antigay discrimination in his executive order blocking entry to the U.S. by people from seven majority-Muslim countries. “The United States should not admit those who engage in acts of bigotry or hatred, (including ‘honor’ killings, other forms of violence against women, or the persecution of those who practice religions different from their own), or those who would oppress Americans of any race, gender or sexual orientation,” his declaration stated.

That caught the attention of Lambda Legal CEO Rachel B. Tiven, who issued this statement: “LGBT people refuse to be pawns in Mr. Trump's dangerous and inhumane game. We utterly reject his discrimination against Muslims in the guise of concern trolling for LGBT rights. If he really wants to help LGBT people, he can pledge to retain the Executive Orders that help protect us and to nominate a Supreme Court justice who supports equal treatment of all regardless of their sexual orientation or gender identity.”

Read more articles from the Advocate, here.  

Suicidal Behavior is Higher in People Seeking HIV Tests


January 30 2017
 
 
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Social isolation is all too common for people who receive a new HIV diagnosis. As Plus previously reported, nearly one-third of older adults living outside nursing homes or hospitals live alone, and those living with HIV are at higher risk for suicide. 

In fact, the risk of someone killing themselves because of their diagnosis and a lack of support is so high that it’s time healthcare professionals begin to implement suicide prevention in tandem with HIV testing and care. 

One cross-sectional study by the department of psychology at Stellenbosch University in Matieland, South Africa, discovered that suicide rates three times higher among people living with HIV than in the general population. 

According to the study, out of 500 people seeking HIV testing, one in five reported suicidal ideation in the previous week, and 24 percent within the previous two weeks. 18.05 percent reported suicidal thoughts, 2.07 percent reported a desire to kill themselves, and 4.15 percent said they’d commit suicide if they had an opportunity. 

Dr. Jason Banties, lead researcher of the study, said, “Our findings may be in part a result of the relative homogeneity of our sample in terms of socioeconomic status. Future studies [that] draw from a broader cross-section of individuals may help to identify the socioeconomic and contextual factors that contribute to suicide ideation behavior in this population.”

While the study found no association between suicidal ideation and age, gender, unemployment, family income or food insecurity, it did find strong associations with depressive disorders, anxiety, trauma and stress-related disorder. 

Researchers suggest that because these numbers are so prevelent, it's time we start implementing stronger support for those living with HIV who also have mental disorders.

HIV testing doesn’t only need to be administered in clinics. If suicide ideation behavior continues to grow among those living with HIV, it will qualify as a public health problem. It’s time we integrate mental health services inside HIV care systems. 

And it starts by simply talking about it. 

Read more articles from PLUS, here.
 

All Evidence Points to Trump Having Zero Plans to Battle HIV


January 30 2017
 
 
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Donald Trump’s first week as president has been the nightmare we've mostly been expecting, and LGBT people weren't left behind in his path of destruction.

Following the inauguration, all references to LGBT people disappeared from the White House website, including an apology from Secretary of State John Kerry about the government’s history of purging LGBT workers from federal jobs in the 1950s and '60s. Most troublingly, the webpage for the Office of National AIDS Policy has been removed, triggering reports that the program had been eliminated.
 
Jeffrey Crowley, the former director of ONAP under President Barack Obama, told The Advocate that there’s no indication the office has been shuttered as of yet.

Crowley, who served in the office from 2009 to 2011, said that he didn’t start until a month after Obama’s inauguration, as most White House staff are political appointees and change between presidents. The previous ONAP staff ended their service on January 4, which means it could be weeks before the LGBT community learns about the department’s future in Trump’s White House.

“This administration is widely recognized to be behind in the transition,” he explained. “If it took me a month to get in, I presume it will take longer than that for them to even make a decision about whether they’ll have an ONAP.”

The truth is that Trump, who said almost nothing regarding HIV/AIDS prior to his election, likely doesn’t have a strategy in place for tackling the ongoing epidemic — or even maintaining the programs already in place. The 45th president mentioned HIV just once on the campaign trail; that was in regards to the U.S. President’s Emergency Plan for AIDS Relief, a program set up by President George W. Bush to tackle the spread of the disease in Africa. Trump's comments left much to be desired.

During an appearance at the No Labels Conference in October 2015, an audience member asked if Trump would “commit to doubling the number of people on treatment to 30 million people by 2020” through the program.  

“Those are good things — Alzheimer’s, AIDS,” the candidate said at the annual summit, which is intended to promote bipartisan cooperation on critical issues. “We are close on some of them. On some of them, honestly, with all of the work done, which has not been enough, we’re not very close. The answer is yes. I believe strongly in that, and we are going to lead the way.”

But as Ed Yong first pointed out in The Atlantic, there’s a problem with Trump’s response: “It’s unclear if Trump actually understood the question, given that PEPFAR doesn’t cover Alzheimer’s.” His transition team would later question the need for foreign aid to curb HIV/AIDS, referring to it as a “massive, international entitlement program.” As of the time of writing, the White House’s PERFAR web page remains active.

Jason Cianciotto, the vice president of policy, advocacy, and communications for Harlem United, told The Advocate that since October 2015, Trump has “not said anything about HIV/AIDS, domestic or international.”

“Our analysis of President Trump’s record on HIV/AIDS in the U.S. found that he doesn’t have one,” he said.

Harlem United, an advocacy organization focusing on HIV/AIDS, co-authored a report with the Boston-based care center Fenway Health on where the major party candidates stood on the need to end the ongoing HIV crisis globally. The two groups examined the nominees’ campaign statements and public platforms, as well as interviews and news articles written about them. Trump was the only candidate to remain virtually silent on the virus, with his campaign website totally ignoring the issue.

If HIV/AIDS isn’t on Trump’s radar at all, that could be a major problem under the new administration. Last Monday, the president signed an executive order instituting a hiring freeze on all federal government jobs. The move was intended to reduce the “dramatic expansion of the federal workforce in recent years,” press secretary Sean Spicer said.

The failure to restaff ONAP could jeopardize the office’s future under future administrations,  Crowley said, which would have a devastating effect on the progress we’ve made in tackling the spread of HIV in the U.S. In 2010, Obama unveiled the National HIV/AIDS Strategy, an ambitious plan that designed to “reduce the number of new diagnoses by at least 25 percent,” among other things.

That strategy has fallen short of its high goals, but under Obama, the rate of HIV infections has flatlined at around 40,000 new cases each year, according to David Ernesto Munar, the CEO of Chicago’s Howard Brown Health Center.

Without a policy to match the previous administration’s, it’s highly likely that those numbers would increase, especially given his vice president’s previous failures on HIV.

As the governor of Indiana, Mike Pence dramatically reduced state spending on public health, leading to the closure of the sole Planned Parenthood in Scott County, a rural district located in the southeast corner of the state. It was just one of five that operated in Indiana prior to the cuts. That center provided crucial HIV testing and preventative care to the county’s 28,000 residents. 
Without those resources, there was a major outbreak of the virus, leading to 190 new cases of HIV in 2015.

In addition, Pence advocated the diverting of federal funding for the Ryan White Care Act, a program that provides life-saving resources for low-income people living with HIV, to conversion therapy on his website during his 2000 campaign for Congress. The Republican has yet to respond to criticism of his record on HIV/AIDS.

Following the election, critics were asked to give Trump a chance — or wait and see what becomes of his policies. HIV-positive individuals don’t have that option.
 
Read more articles from PLUS, here.

Successful HCV Treatment Reverses Some Cognitive Decline in Small Study

Istock

The ongoing study includes those with and without HIV, which is associated with declining cognitive function.

January 30, 2017


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Curing hepatitis C virus (HCV) may dial back some forms of cognitive decline in those with and without HIV.

Publishing the findings of their ongoing study in a letter in the journal Neurology, German researchers designed an open observational trial of individuals with HCV who did and did not have HIV. They also assessed a group of controls (individuals who did not have either virus) to serve as a comparison to the others before they started hep C treatment.

None of the participants who had HCV had cirrhosis of the liver, a history of substance dependence or cerebral diseases. All those with HIV had an undetectable viral load for at least six months.

The participants received a battery of tests of cognitive function, some of which were based on self-reporting. These tests were taken upon entry into the study and a second time at least 12 weeks after completing treatment for HCV.

In 2015 and 2016, the researchers assessed 25 HCV-positive individuals, 15 of whom had HIV. All but one individual was male.

At the study’s outset, those with hep C had significantly poorer performance with regard to visual and working memory, processing speed, attention and executive function (which includes a series of cognitive processes integral for cognitive control over behavior) compared with the control group. The researchers did not see a difference in cognitive function based on HIV status.

So far, 12 of the participants have completed HCV treatment: two with Technivie (ombitasvir/paritaprevir/ritonavir) plus ribavirin, nine with Harvoni (ledipasvir/sofosbuvir) and one with Sovaldi (sofosbuvir) plus ribavirin. All of them achieved a sustained virologic response 12 weeks after completing therapy (SVR12, considered a cure).

Tests indicated that between the study’s outset and the follow-up assessment, those who were cured of hep C experienced improvements in visual memory, processing speed, attention and executive functioning. The severity of fatigue also declined while self-reported quality of life improved.

The study is limited by its small sample size.

To read the Neurology letter, click here.

Read more articles from POZ, here.
  

This Governor Plans to Slash $4.8M From State HIV/AIDS Investments


The cuts could derail the “ambitious but achievable goal” of eliminating HIV transmission 
by 2020.
January 30, 2017


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Massachusetts Gov. Charlie Baker has proposed cutting $4.8 million from the state’s HIV/AIDS investments in prevention, education and outreach as part of the budget for fiscal year 2018, reports Mass Live.

In total, the governor’s proposal is for a $40.5 billion budget, an increase of $1.6 billion from the current fiscal year. Despite the $4.8 million cut, the state will still invest $28.3 million in its HIV/AIDS efforts.

“This recommendation, which follows a $900,000 [midyear] cut to the current fiscal year’s budget, signals a dangerous retreat by the state on efforts to fully eradicate HIV transmission in Massachusetts,” said Carl Sciortino, executive director of AIDS Action Committee, a statewide provider of HIV/AIDS services, in a statement.

Sciortino points out that thanks to past investments in HIV treatment education and outreach, the state is nearing its goal of eliminating HIV transmissions by 2020 by ensuring that 90 percent of people living with HIV are aware of their status, that 90 percent of those diagnosed with the virus are receiving treatment and that 90 percent of those on treatment are virally suppressed.

“That ambitious—but achievable—goal will not be met without investment, support and partnership from the state, which is not in evidence with this budget recommendation,” said Sciortino. “In Massachusetts, those who are living with HIV and those who are most vulnerable to infection―Black and Latino men and women; gay and bisexual men; transgender men and women; people who are homeless, particularly young people; and those who are incarcerated―are some of our most vulnerable residents. Unnecessarily prolonging their vulnerability to HIV is cruel, and asking them to bear the burden of budget reductions is unfair, immoral and unjust.”

Baker’s proposed budget is just a starting point. Committees from the House and Senate will negotiate on the final budget, which must be signed by the governor before the start of the 2018 fiscal year, which is July 1, 2017.

Read more articles from POZ, here.
  

Human antibody trial adds new hope for HIV vaccine

Credit - BSIP/UIG Via Getty Image
Antibody 10-1074 could be key to creating a vaccine in the future






A human trial has shown tentative but significant progress towards a vaccine for HIV.

An HIV cure has eluded the scientific community for decades. Typically, when a virus strikes, the body recognises the foreign entity and sends in the troops to destroy it. The HIV virus gets around this by infecting the immune system’s first port of call - the T-cells. In the process, they are destroyed or hijacked to help create new HIV viruses.

Now, a study in Nature Medicine has shown that the antibody 10-1074 can effectively neutralise the virus by targeting a structure on the HIV envelope protein known as V3 loop. During trials, volunteers – 19 of which have the virus, 14 of which don't – were given differing doses of the antibody. It was shown to be safe, and induce high antiviral activity in all participants. In particular, among the 13 volunteers with the highest levels of HIV (most were taking antiretroviral medication to subdue it), 11 exhibited a fast drop in levels.

"These antibodies are highly potent and are able to effectively neutralise a large number of different HIV strains,” co-author on the paper, Florian Klein of the University of Cologne, said. “Therefore, they play an important role in the quest for and development of an HIV vaccine."

As the trials continued, the HIV virus was seen to mutate to defend against the introduction of 10-1074 meaning a variety of antibodies appears to be needed to truly eradicate the virus in a treatment or vaccine form. Further research into the specific antibody is slated for the next few months.

This study also adds to a body of work from other researchers across the globe similarly hunting for a vaccine. Last year, great strides were made in a UK trial that combines antiretroviral drugs with a drug that reactivates dormant HIV, and a vaccine that stimulates the immune system. It was reported that the blood of a 44-year-old male social care worker from London, the first of 50 people involved in the study, showed no detectable signs of HIV after the treatment took place.

"This is one of the first serious attempts at a full cure for HIV," Mark Samuels, the managing director of the National Institute for Health Research Office for Clinical Research Infrastructure, said at the time. "We are exploring the real possibility of curing HIV. This is a huge challenge and it’s still early days but the progress has been remarkable."

The treatment developed by the UK scientists lures the virus from its dormant state, then triggers a response from the body's immune system, which then attacks it. The method, dubbed "kick and kill" (or "shock and kill"), has been successful in lab tests. In 2014, the journal Cell published research that researchers had "flushed" out the virus in mice. "This is the first time the shock-and-kill approach designed to flush out latent viruses has seen tangible success in an animal model," scientists said at the time.

The treatment developed by the UK scientists lures the virus from its dormant state, then triggers a response from the body's immune system, which then attacks it. The method, dubbed "kick and kill" (or "shock and kill"), has been successful in lab tests. In 2014, the journal Cell published research that researchers had "flushed" out the virus in mice. "This is the first time the shock-and-kill approach designed to flush out latent viruses has seen tangible success in an animal model," scientists said at the time.













Why Red State Queers Are the New Frontier


January 30 2017 
 
 
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Ever since I was little, I have been a blue-ribbon homosexual in a bright red state. As soon as I could stand, I wanted to dance. As soon as I could walk, I wanted to strut. And as soon as I saw Patrick Swayze in Dirty Dancing, I knew that someday I wanted to kiss a boy on the mouth. But it wasn’t until the reality of being in Texas came into focus that I realized that my swishy, sparkly tendencies were going to be a problem.

That’s the thing about being born gay; you can’t exactly choose where you get to grow up. I was lucky enough to be born in America, but that is where my luck stopped. My family was from the sticks of east Texas, where there were more churches than libraries and Friday night football was a spiritual experience. But just like my sexuality, I wouldn’t change my Texas roots if I could. They're just as much of a part of me as anything else, and to deny them is to reject all of the things that I love about my childhood, my family, and my culture. But in our current political atmosphere, many LGBT Americans view Texas and any other red state as places that are devoid of any redeeming qualities, too far gone to be worth the trouble. To these LGBT folks who reside in blue utopias, I say shame on you for becoming complacent just because your neighborhood is safe.
 
The characteristics of any culture are not a zero-sum game. Instead, they are as richly layered as the people who are a part of it. I was born a Texan gay man, and many of the qualities and characteristics of my home state are as much a part of me as any conservative cowboy on the farm. After moving around the globe, I came to the realization that I do not have to abandon my roots just because a small part of what it means to be a Texan can be coupled with anti-LGBT leanings. I am a Texan and I am LGBT, so my living and breathing is proof that this isn’t always the norm, and there are many others just like me who deserve to call their state home.

I also have the means and ability to move if I wanted to. It’s a part of my privilege, which is also a part of the problem in our country. Those with privilege don’t have to concern themselves with the problems of those that don’t. This is exactly why everyone who has the privilege of moving away from their red hometowns should be encouraged to stay and make a difference, both for themselves and for the LGBT Americans who don’t have the privilege of fleeing to a blue paradise.

To suggest that LGBT Americans in red states should escape homophobia and transphobia by moving to blue states is to deny the immense progress we have made in LGBT rights. People’s minds can be changed and victories can be won in each state government, no matter how difficult it may seem. Twenty years ago, the state and federal rights that we now have were merely pipe dreams, but our community refused to let hate beat out hope. Today, we still need to be steadfast in our commitment to LGBT rights across the country, and that means staying put in our red states and demanding respect.

With the most anti-LGBT Cabinet ever forming, it is no time to become complacent in our journey to equality. Anyone who loves the big skies of Texas, the red mountains of Arizona, or the blue beaches of Florida should have every right to feel safe and included in their hometown culture.
So, you blue state babies, quit complaining about how you want to secede from the red states and throw your full support behind your LGBT brothers and sisters who are still trying to make a difference. Yee-haw.

TYLER CURRY lives in Austin and is the editor at large for Plus magazine. Follow him on Twitter @IAmTylerCurry.

Read more articles from the Advocate, here.