Since last World AIDS Day

Created on 29 November 2012 Written by Jeannie Wraight Category: World AIDS Day 2012

It’s been an interesting year in the HIV world. Much has happened since last World AIDS Day. Listed below, we highlight the top 6 biggest HIV stories of the year. While much, much more has gone on since last World AIDS Day, our top 6 issues have changed and shaped the field of HIV the most.

In addition to the key occurrences below, 2012 closes out the first year of HIV Haven. We’d like to thank all of our readers for making this is such an amazing year and we hope you continue to visit us throughout the coming years.

1. The Milton Hershey School Scandal  Let’s start from World AIDS Day 2011. On this day the Pennsylvania AIDS Law Project announced a (lawsuit) against The Milton Hershey School in the name of 13 year old ‘ Abraham Smith ‘ (an alias used to protect the child’s identity and privacy) and his mother.

Abraham Smith was denied access to The Milton Hershey School located in Hershey Pennsylvania, solely on the grounds that he is HIV positive. The free, live-in school provides a free education, housing and health care to under privileged children. MHS maintained that they were not subject to obeying the Americans with Disability Act (ADA) (which states no person will be denied access to a public venue based on a physical disability) because their ‘unique environment’ which consisted of homes of small groups of children living together, exempted them from the ADA. They stated that the boy posed a clear and imminent danger to the students of MHS.

Immediately following the Pennsylvania Law Projects announcement, a series of demonstrations, petitions and a boycott on Hershey Co. products commenced. On the AIDS Healthcare Foundation  (who contributed to the child’s legal fees) website and Facebook page, the MHS Facebook page, the Facebook pages of many HIV organizations, including HIV Haven, and in articles about this issue, those both for and against, strongly vocalized their opinions on this case as well as on people with HIV in general.

Although the comments were about 50/50, the Abraham Smith/MHS legal action showed that although many people in the U.S. are educated about HIV and the risks a person with HIV poses to others, it also became very apparent that HIV stigma is alive and well in the U.S. at a rate many of us found alarming. In August, MHS reversed their decision and policy to not allow HIV positive student’s attendance to the school and instituted HIV education trainings after the U.S. Department of Justice told MHS that they indeed had violated the Americans with Disabilities Act. In September the case was settled for $700,000. The boy was offered admittance to the school which he declined.

2.  FDA approval of PREP (Pre-exposure prophylaxis) In July of this year (just prior to the International AIDS Conference in Washington DC), the Food and Drug Administration (FDA) approved the use of Truvada as PrEP for individuals at high risk of HIV infection and who may engage in sexual activity with HIV-positive partners.

The FDA instituted a strong box warning that all HIV negative people taking Truvada as PrEP must first be confirmed HIV negative and must take an HIV test at least once every three months.

Most HIV advocates view PrEP as ‘another tool in the prevention toolbox’. Here at HIV Haven we feel that PrEP in general may be appropriate for certain individuals including the negative partner in a serodiscordant relationship and men who have sex with men who are at high risk due to multiple partners and not using adequate protection.

As for using Truvada for PrEP, we feel this is not the best option. High rates of kidney damage have been seen in HIV positive individuals taking Truvada. This risk is barely justifiable for a person on HAART unless they have no better treatment options. It certainly is not justifiable for an HIV negative person.

3.  HIV home testing In August the FDA approved the use of the OraSure HIV rapid home test to be sold over the counter at pharmacies. The justification for this act was to allow for a larger number of people to be tested for HIV. Statistics show that 20% of the 1.2 million people with HIV in the U.S. are unaware of their HIV status. This not only puts these individuals for risk of illness due to a lack of treatment but also places others at risk who do not use protection during sexual intercourse. The ability to purchase an HIV test and administer the test in the privacy of one’s home will undoubtedly lead to more people being tested for HIV. That’s the good news.

The bad news is that the test has a lower level of accuracy than a test administered in a doctor’s office/ HIV testing site or the Home Access HIV test approved in 1996 which requires an individual to send a blood sample to a laboratory. The Home Access test maintains a 98.98% accuracy rate compared to 86.64% to 92.98% accuracy for the OraSure home based test. This equates to approximately one false negative test for every thirteen positive test results and one false positive result for every 462 negative result.

Another issue with the home test is the lack of support provided the test taker. In a clinical setting, every person taking the test must receive pre and post test counseling. If a positive result occurs they are counseled and linked to treatment, care and other resources. Of course the quality of the pre and post test counseling varies from councilor to councilor but some live assistance is better than no assistance. The home test does provide a toll free number to call for assistance but chances are a significant portion of those who test positive will not use utilize this assistance and may avoid taking the first step of getting care until they are sick. With the lack of HIV education and stigma which still exists in the U.S. it is not unimaginable that carrying the weight of a positive diagnosis on one’s own may lead to suicide, depression, isolation or self abusive behavior.

4.  AIDS 2012 and Obama no show In July of this year the International AIDS Conference took place on American soil for the first time in over 20 years due to the recently lifted travel ban disallowing HIV positive citizens from foreign countries to enter the U.S.

The International AIDS Conference is a biennial conference organized by the International AIDS Society. This year’s conference was the 19th IAC. It is customary for the leader of the hosting country to appear and speak at the conference. Barrack Obama declined to attend the 19th IAC opting to send a video in his absence. This was viewed by many in the HIV community as a snub particularly as the White House was only minutes away from the convention Center.

5.  Two more people may be cured of HIV? During a session at AIDS2012 it was announced that there are two more individuals that may have been cured of HIV. Both gentlemen were given stem cell transplants to treat their leukemia. Unlike Timothy Ray Brown, the first person cured of HIV using cells that did not have the CCR5 co-receptor, the cells used in these two cases did have CCR5. Individuals with the CCR5 deletion are immune to HIV. Another difference from Timothy’s case was that these two men remained on ARV’s.

It has now been 1,300 days since the procedure and neither man has detachable HIV in their blood. In these two cases, only a significant period time off of ARV’s will determine whether they have actually been cured.

Stem cell transplants are very toxic, dangerous and costly procedures. Only those with Leukemia and HIV will be able to utilize this option if it turns out to be a cure strategy.

6.  The Arrival of the Quad In August of this year, Stribild, formally known as Gilead’s Quad drug, was approved by the FDA as an HIV therapy. The drug is the first once a day ARV that contains four drugs in one pill (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate).  Two of the drugs, emtricitabine and tenofovir disoproxil fumarate were already in use for the HIV population. Elvitegravir is newly approved only as part of this four drug pill and is an HIV integrase strand transfer inhibitor, as is cobicistat which is a pharmacokinetic enhancer.

The FDA has issued a box warning that Stribild can cause a buildup of lactic acid in the blood and severe liver problems, both of which can be fatal. Stribild is not approved for people with chronic hepatitis B virus infection. Other serious side effects include new or worsening kidney problems, decreased bone mineral density, fat redistribution and changes in the immune system (immune reconstitution syndrome). Common side effects observed in clinical trials include nausea and diarrhea.

AIDS activists, patients and professionals were outraged with Gilead’s initial wholesale pricing of $28,500 per patient, per year for the stand alone treatment in the U.S. Stribild was just approved in Canada with a considerably lower price tag of $16,600 wholesale.

It is extremely questionable why Gilead agreed to provide Stribild to Canadian residents at such a dramatically lower price but is unwilling to lower the price in the United States although some states such as Louisiana were able to secure a much cheaper price for ADAP.

Let’s hope that this World AIDS Day begins a year of good health, good research and brings us closer and closer to a time when World AIDS Day will exist solely to remember a time before we found the cure.

Written by Jeannie Wraight

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2 Comments

  1. Let see how 2013 effects us and the world.

  2. Please come and enjoy the event,
    Free testing , Free Food, Free Give Away.


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