PHILADELPHIA (AP) — Mayor Michael Nutter signed legislation Thursday to afford equal rights to lesbian, gay, bisexual and transgender people, saying he hoped Philadelphia would become “the most LGBT-friendly” city in the world.

Nutter, city and state lawmakers and gay rights advocates said the legislation makes Philadelphia the first city in the U.S. to offer tax credits to companies that extend the same health care coverage to LGBT employees’ domestic partners and their children as they provide to heterosexual spouses and their children.

Photo: Matt Rourke

They said the legislation also makes Philadelphia the first city to offer businesses tax credits as a way to encourage providing transgender-specific health benefits.

“My goal is for Philadelphia to be one of, if not the most, LGBT-friendly cities in the world and a leader on equality issues,” said Nutter, adding that the signing struck a personal note because his friend, the late City Councilman John Anderson, was a gay man and a mentor who inspired him 30 years ago to pursue a life of public service.

In addition to the business tax incentives, which were backed by the Greater Philadelphia Chamber of Commerce as well as LGBT advocacy groups, the legislation requires gender-neutral bathrooms in newly constructed city-owned buildings, revises Philadelphia’s anti-discrimination law to include transgender people, extends decision-making rights to life partners on medical and other issues, and changes city forms and websites to offer options for same-sex couples and transgender people.

“Equal protection under the law means equal protection under the law,” said Councilman James Kenney, sponsor of the legislation. “It doesn’t mean sanctioned by religion or custom or anything else.”

Kenney called the bill, which the City Council passed easily last month, “the next iteration of civil rights and freedom in the United States.”

“This is a city that is truly respecting all its citizens,” said state Rep. Brian Sims, a Philadelphia Democrat and the first openly gay candidate to be elected to the Legislature. “It is because of that respect that we are indeed a first-class city and we will continue to shine.”

Neither gay marriage nor civil unions are legal in Pennsylvania, and the state has a law that defines marriage as between a man and a woman.

Read the original article here.

Stepping out of the high-tech medical lab on wheels and into a sunny afternoon in the projects, McHale Colman, 28, doesn’t seem to notice that he has experienced something revolutionary.

“Anytime I see these buses, I try to come get tested and get it out of the way,” he says with a shrug. “I jump on it: It’s private, I don’t got to go nowhere, I’m in the ’hood.”

After all, free mobile screening programs have become common sights in neighborhoods like this one — Bartram’s Village in Southwest Philly — as public-health organizations try to capture poor residents who tend not to access regular primary care.

But the lab that Colman visited is unique: It’s the first in Philadelphia — and possibly the first in the nation — to pair rapid HIV testing with rapid hepatitis C testing, follow-up confirmatory testing and immediate connections to care. The program, called Do One Thing, is spearheaded by Amy Nunn, a medical researcher at Brown University. It rolled out with HIV tests last summer and added hepatitis C in December, targeting hot spots in Southwest Philly zip codes where the rates of HIV infection are among the highest in Philly — in fact, higher than in some countries in Africa. (Risk is increased due to factors like intravenous drug use or unregulated tattooing, such as in prison or at “tattoo parties.”) The van is out three days a week, sending outreach workers knocking on doors, handing out flyers and explaining those alarming statistics, working toward a goal of testing 12,000 area residents.

Photo by Neal Santos

It’s an aggressive approach to a disease that Philly Health Commissioner Donald Schwarz recently called a “time bomb” — particularly if Gov. Tom Corbett doesn’t agree to Medicaid expansion in Pennsylvania. “There will be a very large number of people in Philadelphia who will require diagnosis and treatment for hepatitis C. We have been trying to do something about this epidemic that is invisible for the moment,” Schwarz told City Council recently. Hepatitis C is about five times more prevalent than HIV nationwide, but infected people can remain asymptomatic for years, often to be diagnosed only after severe liver damage, including cancer or cirrhosis, has occurred.

Now, with an aging baby boomer population expected to manifest hepatitis C in record numbers over the coming decade, public-health officials are worried. “This could be really costly to the health-care system, in terms of liver transplants, or you’ll have a lot of people potentially dying,” says Philly viral hepatitis prevention coordinator Alex Shirreffs. “There’s definitely a concern that if we don’t start paying attention to hepatitis C, we’re going to be catching people too late.”

But experts are also hopeful. The past few years have been a time of extraordinary progress in the diagnosis and treatment of hepatitis C, bringing the creation of a rapid test, new Centers for Disease Control (CDC) screening guidelines and radically improved treatment regimens that have doubled cure rates among the hardest-to-treat patients. Here in Philly, Do One Thing is just one of several public-health innovations around hepatitis C, including an unprecedented viral-surveillance initiative, a planned public-awareness campaign and a behind-the-scenes effort to educate doctors about new standards of care.

As of now, though, there’s still very little money to go around — not for treatment and not even for screenings. So, for example, while the rapid test was hailed as a major advancement when it was released in 2011, “unfortunately, because the [federal] government didn’t provide a lot of funding for governments to deliver rapid tests, it didn’t … get many done,” says Shirreffs.

In Philly, at least, all that could change, says Drexel professor Dr. Stacey Trooskin, who leads the hepatitis-C component of Do One Thing and, with Shirreffs, co-chairs the year-old, so-far-unfunded coalition Hepatitis C Allies of Philadelphia (HEP CAP). “We’re really focused on trying to put Philadelphia on the map as a city that is facing hepatitis C head on, and trying to address it as the public-health issue that it is.”

To that end, Do One Thing isn’t the only program pushing hep-C screenings: Philadelphia Health Management Corp., for one, is running a pilot effort funded by the CDC. But there’s hope that Do One Thing’s model — which brings testing to the most affected neighborhoods — just might launch a national movement.

Still, to get a program like this up and running means facing numerous regulatory and technical hurdles. In Nunn’s case, those included identifying a lab that could process confirmatory blood tests — a challenge because blood has to be analyzed within six hours of being drawn, and the van keeps late-night and Saturday hours. But the tests are necessary because one in five people who initially test positive do not have chronic infections.

Then there was the problem of connecting those who test positive to care — which can be hard when phone numbers are disconnected or housing is unstable. That’s why the same-day tests results are so important, Nunn says: Otherwise, “You lose a lot of patients to follow-up.” And, finally, there’s what Nunn calls “the real bugaboo”: paying for treatment. Hepatitis C is increasingly curable, but a 12-week course of Incivek, one of the newer drugs, is priced at a jaw-dropping $49,200.

So far, most of the people who’ve been diagnosed on the Do One Thing van have either had insurance or been Medicaid eligible — linkage-to-care coordinators can help them apply — and they’ve all been connected to care. Some people who know they’re positive come in for testing anyway, Nunn says, and get linked to care again. Up to now, Do One Thing has administered 3,000 HIV tests (about 1.3 percent positive) and 550 hepatitis C tests (5.5 percent positive).

The CDC has shown interest in the Do One Thing approach, Nunn says. The federal public-health agency is now two years into its own hepatitis C action plan, which among other things designated age-based screening guidelines. The CDC suggests people aged 47 to 67 get tested; previously, tests were based on risk factors alone.

Epidemiologists considered that change a victory — but in some cases an empty one. Today, Trooskin says, “Primary-care providers are just not testing.” Even the city’s own health centers, which offer risk-based screening, don’t routinely follow the CDC guidelines.

“There’s a lot of misconceptions among primary-care providers about what treatment is available and who’s eligible for it. A lot of primary-care providers aren’t aware that hepatitis C is curable, and they certainly aren’t aware of the rapidly evolving treatment paradigm,” Trooskin says, noting that several experimental treatments offer hope for a 90 percent cure rate. “To get that message out to primary-care providers is really important. Even if [patients are] not treatment candidates today, they may be in a year or two.”

HEP CAP has been getting experts to visit primary-care practices beginning this month and provide education on the guidelines, treatment and referral options.

But more targeted efforts remain elusive, since, as Trooskin puts it, “What we know about the epidemiology of hepatitis C is really the tip of the iceberg.” That could soon change, since Philly was one of seven cities nationwide to receive a federal viral-hepatitis-surveillance grant to study the city’s epidemic. “This idea of a neighborhood-based approach, going out into the community and linking individuals to care, is really going to be the next frontier when it comes to finding individuals that are [hepatitis C] positive but are not currently in care or are unaware of their infection,” Trooskin says. “I don’t think we can just wait for folks to come into the doctor’s office. We need to be out in the community.”

Read the original article here.

For the first time, a federally convened panel of experts is recommending HIV testing for all adults based on evidence that early detection of the virus could lead to more effective treatment of infection.

Nearly 1.2 million Americans are living with HIV and about 5o,000 become newly infected with the virus every year, according to the latest statistics from the Centers for Disease Control and Prevention (CDC). And an estimated 20% to 25% of HIV-positive individuals are not aware they are infected.

That could change if HIV testing became more routine, which is the intent of the latest recommendation from the U.S. Preventive Services Task Force (USPSTF), which calls for HIV testing of everyone aged 15 to 65, including pregnant women, during regular checkups. The CDC already calls for testing of all adults, regardless of their risk status.

In 2005, the panel reviewed the latest studies at the time and advised that only those at highest risk of being exposed to HIV– including people who received blood transfusions before banks began screening for the virus, people who used intravenous drugs and those who had unprotected sex with multiple partners — be screened.

But in the intervening years, new studies on anti-HIV drugs showed that the medications could keep the virus at bay and possibly even prevent infections from progressing. The drugs were most effective, however, if patients took them soon after becoming exposed, so regular HIV screening could help more people to become aware of their status and take advantage of the therapies. The task force is recommending that those younger than 15 or older than 65 be screened only if they are at increased risk getting infected. All pregnant women should be screened, including women in labor who are unaware of their HIV status, since administering anti-HIV medications can significantly lower the risk of transmitting the virus from mother to child. Researchers even reported success in functionally curing a newborn of HIV infection after the infant, which contracted HIV from the mother, was given a combination of drugs within hours of birth.

In coming to its conclusion, which were published in the Annals of Internal Medicine, the USPSTF considered both the benefits and harms of screening and determined that widespread testing would identify the disease in more people and at its earliest stages, so patients can start therapy and improve their chances of keeping their HIV levels low and not passing the virus on to others. Those benefits, the panel concluded, outweighed the potential harms from screening, such as false-positive results or the side effects associated with the anti-HIV therapies, including heart problems and lipid abnormalities.

The task force members hope that universal screening will make more individuals aware of their HIV status, and place much-needed emphasis on preventing infections in the first place. Previous prevention campaigns that focused on safe sex, condom use and abstinence have only been marginally effective in reducing new infection rates. “The fact is that the best way to deal with HIV is don’t get it in the first place,” Dr. Virginia Moyer, the chair of the task force and professor of pediatrics at Baylor College of Medicine told TIME in November, when a draft of the current recommendations was released for public comment. “Yes, we can screen and treat, and it makes a difference, but it still involves treatment that if you could avoid it, you wouldn’t want to have. If we can really focus on prevention, that would be great.”

The USPSTF’s guidelines are not binding, but the group’s advice is often followed by doctors and adopted by professional medical groups. The task force says screening should be voluntary and only done with a patient’s consent. “That was always the intent of the guidelines, but people had questions about it so we put that in explicitly to make sure it was clear. In other words, people should not be screened without their knowledge,” says task force member Dr. Douglas K Owens, a professor of medicine at Stanford University who is also with the VA Palo Alto Health Care System.

“HIV is a very critical public health problem and we need a better way to prevent infections and treat people who have HIV. Of course the best way to reduce HIV disease and deaths is to not become infected and our hope is that message will get out and people will take steps to reduce their risk,” says Owens. “We hope this will provide more impetus for people to provide screening and that more people will learn about their status and that’s important because treatment for HIV is very good and treatment early in disease is important. Often people are asymptotic and they wouldn’t know they have HIV or that they are candidates for treatment. That’s why screening is important.”

Read the full recommendation statement here.

Read the original article here.

The study, called the “HVTN 505 clinical trial,” kicked off in 2009 and had enrolled about 2,500 people in 19 cities. Participants were all men who have sex with men and transgender people who have sex with men. Half received an experimental vaccine developed by the National Institutes of Health, and half received dummy, or placebo, shots.

A scheduled safety review on April 22 found that slightly more volunteers who had received the vaccine later became infected with HIV. Overall, 41 cases of HIV infection occurred in the volunteers who received the experimental vaccine and 30 cases of HIV infection occurred among the recipients who received the dummy injection.

It’s not clear why, but the National Institute of Allergy and Infectious Diseases – a branch of the NIH — noted the increased risk of HIV among vaccine group was not statistically significant when compared to the placebo group, meaning the findings may be due to chance.

The safety review also showed the vaccine failed to reduce the amount of HIV virus in the blood, called the “viral load,” in people who had been diagnosed with HIV and were tracked for 20 weeks of follow-up.

The NIH said in a statement Thursday that it is stopping vaccinations, but will continue to study the volunteers’ health.

Multiple attempts at creating an AIDS vaccine have failed over the years. But researchers continue to try, pointing to modest success in a 2009 study in Thailand. (At left is a 2009 CBS Evening News report on that study)

“NIAID remains committed to the pursuit of a highly effective, preventive HIV vaccine as part of a multifaceted HIV prevention research program,” the agency said in a statement.

The NIAID has more information on the failed vaccine trial in a “questions and answers” website.

Read the original article here.

Across Philadelphia, people often don’t find out they have HIV until the infection has already progressed to AIDS.

About 15 out of every 100,000 people in the Philadelphia metropolitan area received an initial diagnosis of AIDS, also known as Stage 3 HIV. That rate of late-stage diagnoses is about 50 percent higher than the national average, according to data from the U.S. Centers for Disease Control and Prevention’s 2011 HIV surveillance report.

Those with AIDS have likely been living with the virus for many years. HIV prevention activist Luke Messac said years without treatment increase the chances someone will experience immune-system damage or spread the virus to others.

“One thing you have to consider is: How do most people come to realize they have HIV? It’s through their physician,” said Messac, a third-year medical student at the University of Pennsylvania.

Covering more people with health insurance could boost HIV testing and the chances for early detection and treatment, Messac said. A member of Act Up Philadelphia, Messac wants Gov. Tom Corbett to expand Pennsylvania’s Medicaid program through the federal health law.

Messac says smart government policies can reduce the number of people without health insurance coverage and improve health-care choices in low-income communities.

“These things all prevent people from getting to the doctor when they need to,” Messac said.

Health advocates are pushing for more routine HIV testing for lots of reasons — including a hope to detect and treat infection before it progresses to AIDS.

Door-to-door testing effort

Researcher Amy Nunn, an assistant professor of medicine at Brown University, is leading a door-to-door HIV testing campaign in Philadelphia’s 19143 ZIP code. That neighborhood in Southwest Philadelphia has the city’s highest rate of HIV infection.

Her efforts have also helped expand testing access at a nearby health center, the Health Annex.

Every patient who walks through the clinic door now qualifies for an HIV test, and the electronic-records system now has pop-up notices that remind medical personnel to suggest screening to everyone.

“Before only people that were perceived to be at high-risk were offered HIV testing in general,” Nunn said. “Now we are trying to move away from that and towards offering everyone a test.”

Nunn said increasing access to testing is just one part of her effort. Her group asked Philadelphia clergy to support HIV testing and then launched a social marketing campaign featuring pastors and other religious leaders.

“You can’t just offer testing and expect, overnight, that thousands of people will step up and say yes,” Nunn said. “We’re trying to stimulate demand and normalize testing and treatment.”

Nunn said treatment is an important prevention strategy.

“If we treat people, the chances that they transmit the virus to others are reduced by about 96 percent,” she said.

To find events in your area, visit the NWGHAAD website: http://www.womenshealth.gov/nwghaad/events

There have been campaigns involving condoms, abstinence and even the circumcision of all men younger than 46. But one relatively new strategy, called treatment as prevention, is causing quite a buzz.

The idea is to give all HIV-positive people antiretroviral drugs to drive down the levels of virus in their systems so they no longer pose a threat of transmitting the disease.

Sounds good in theory, but how well does it play out in the slums of Nairobi or the townships of Johannesburg?

Two studies published in the journal Science find that, in places where HIV drugs are widely available, the risk for new HIV infections drops dramatically and overall life expectancy increases by more than a decade.

In other words, treatment as prevention isn’t just a buzz word floating around health conferences but a promising strategy for stopping HIV — even in a part of the world with one of the most severe AIDS epidemics.

Epidemiologists from Harvard University followed 17,000 HIV-negative South Africans for seven years in the province of KwaZulu-Natal. They found that, when more than 30 percent of HIV-positive people are on powerful anti-HIV drugs, it cuts the risk of contracting the virus by about 38 percent, compared to when less than 10 percent of those infected have treatment.

“The intention of this program [the South African government's antiretroviral drug program] is not treatment as prevention,” Till Barnighausen, a health economist who contributed to the study, tells Shots. “The intention of this program is treatment for treatment, to save lives.”

A true treatment-as-prevention model, Barnighausen says, would offer antiretroviral therapy to everyone who is HIV positive. But the South African government is providing medications only to the sickest of the sick.

Nevertheless, Barnighausen and his colleagues saw a sharp reduction in new HIV infections when drugs were widely available to the community.

“It is a program with all the failures and challenges of a real-life, public-sector, nurse-led program in southern Africa,” Barnighausen says. “And despite these challenges, we see a strong effect of HIV treatment on HIV incidence. And that’s extremely encouraging.”

Infectious disease specialist Dr. Myron Cohen at the University of North Carolina, who wasn’t involved in this study, calls the findings “a home run.”

Cohen published a landmark report in 2011 showing that HIV treatment nearly eliminates the chance that an infected person will transmit the virus to a partner.

The current study, Cohen says, demonstrates that treatment as prevention doesn’t just work at the individual level but also at the community level. And thus, the findings are hugely important for public health.

“It’s teaching us something,” he says. “You don’t have to treat everybody to see a community benefit.”

In a companion article, Barnighausen and his team found that overall life expectancy in KwaZulu-Natal rose more than 11 years since the province scaled up HIV treatment in 2004.

But even when studies like these show the broad benefits of anti-HIV medications, major challenges remain in getting drugs to the millions of Africans who need them, including the issue of who pays for these costly drugs.

Questions also remain about how sustainable these programs will be, especially given that HIV-positive patients are going to need to be on those drugs for the rest of their lives.

Read the original article here.