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Use of HIV Prevention Drug Grows, but Lags Among Minorities


The pill, known as PrEP, can reduce the risk of contracting the virus that causes AIDS by 90 percent. Its use has expanded sharply, but more among whites than minority groups.


Eric Russell, 24, recently joined a health support group for young Latino and black gay men, where he learned about the HIV-prevention pill known as PrEP. He resisted the medication at first, convinced he didn’t need it and fearful that taking it would stigmatize him.

But after Russell learned more about PrEP, short for pre-exposure prophylaxis, he decided it would be a good investment in his health. The Los Angeles man started taking the drug this year and now encourages other young minority men to do the same.

“A lot of people won’t necessarily tell you their [HIV] status,” said Russell, who is on Medicaid, the public health insurance program for low-income people. “You have to look out for yourself.”

Medicaid beneficiaries in California are taking the HIV-prevention pill in greater numbers than ever before. Across the United States, PrEP use is also rising significantly, according to data released this week.

In California’s Medicaid program, known as Medi-Cal, the number of PrEP users rose from 79 in the first half of 2012—the year the drug was first approved for preventive purposes—to 3,295 by the end of 2016, according to a report released last month by the California HIV/AIDS Policy Research Centers.

Nationally, the total number of PrEP users rose from 8,768 in 2012 to 77,120 in 2016—an average annual increase of 73 percent in each of those four years, according to new data released by, an HIV website run jointly by Emory University’s Rollins School of Public Health and Gilead Sciences Inc., which manufactures the pill. Gilead told financial analysts in July 2017 that 136,000 people in the U.S. were taking PrEP, also known by its brand name, Truvada.

Truvada was first approved by the Food and Drug Administration in 2004 to treat HIV, then eight years later to help prevent it. It can reduce the risk of contracting HIV by more than 90 percent, according to the federal Centers for Disease Control and Prevention. If taken daily, the medicine’s presence in the bloodstream can prevent the HIV virus from taking hold and spreading in the body. It costs about $1,500 a month but is covered by Medicaid and many private insurers.

Wide ethnic and racial disparities persist in its use, however, with far less uptake among non-white Medicaid enrollees than among their white counterparts.

The authors of the California study found the rate of PrEP use among black Medi-Cal enrollees in 2016 was 37 percent lower than the white rate, even though new diagnoses among blacks are four times that of whites. Latinos had the lowest rate of PrEP usage among Medi-Cal recipients—about one-quarter that of whites—while their rate of new infection was 1.5 times higher.

That disparity exists nationwide as well, with disproportionately low use of the HIV-prevention pill among blacks and Latinos.

About 44 percent of people who could potentially have benefited from PrEP in 2015 were African-Americans, but only 1.4 percent of those—7,000 out of about half a million—had prescriptions for PrEP, according to a new studyreleased Tuesday by the CDC. And in a similar time period, a quarter of people who could have benefited from PrEP—nearly 300,000—were Latino, but only about 3 percent of them had PrEP prescriptions, according to the study. Among whites who were candidates for the drug, 14 percent had prescriptions.

Disparities in use of the HIV-prevention pill are also geographic. Nearly half of all PrEP users reside in five states that account for 37 percent of the U.S. population—California, Florida, New York, Illinois and Texas—according to AIDSVu. The majority of new HIV diagnoses—52 percent—are in the South.

The California researchers cited several possible reasons for the racial and ethnic disparities, including a lack of knowledge about PrEP, the perceived stigma of taking it, mistrust of doctors and an inadequate understanding—or denial—of the HIV risk. They also found disparities by age, with greater use among people 25 and older.

The report was based on 2012-16 data from the California Department of Health Care Services, which runs Medi-Cal. The report’s authors said studying PrEP use among Medicaid patients is important because they are particularly vulnerable to HIV infection and “might most benefit from public health policy interventions to support uptake” of the prevention drug.

The ethnic and racial disparities shown in the data are an important finding because of the role the pill can play in helping reduce new infections, said Nina Harawa, an associate professor at the David Geffen School of Medicine at UCLA, and the lead author of the California study.

“We are at this point where it’s really possible to turn the tide on new infections,” Harawa said. “PrEP is a huge part of the strategy to eventually get to zero cases of new HIV. We need to make sure resources around PrEP are being used wisely and getting to the right people.”

Hoping to encourage wider use of the drug, California eliminated a rule in 2014 that had required doctors to seek pre-authorization to prescribe it. State health officials say they believe that decision helped increase the number of prescriptions. Two years later, another law required that information about the HIV-prevention pill be provided to people who test negative for HIV.

Tony Cava, spokesman for the Department of Health Care Services, said the rise in PrEP prescriptions can also be attributed to outreach by advocacy groups and dissemination of educational materials in areas with residents at high risk of HIV.

More resources are needed to “redouble efforts to reach the communities that are impacted,” said Craig Pulsipher, another author of the study and a state affairs specialist at AIDS Project Los Angeles, which sponsored the group that Eric Russell attended.

Such efforts paid dividends in New York, where the number of Medicaid enrollees using the HIV-prevention drug rose more than 300 percent in the two years from July 2013 to June 2015, following a statewide initiative to educate doctors and patients about it, according to a study published by the CDC in 2015.

Doctors play an important role in the uptake of PrEP, Pulsipher said.

“We hear very frequently about providers who are still unfamiliar with PrEP or unwilling to prescribe it,” he said. “If you live in West Hollywood, you can just walk down the street” to find a doctor willing to prescribe Truvada. “If you live in South L.A., access looks very different.”

Last year, the Los Angeles LGBT Center launched a campaign to educate black and Latino gay and bisexual men, as well as transgender women, about the HIV-prevention medication. The campaign began with volunteers distributing information about PrEP in West Hollywood bars, and has continued with art installations and conversations with people at gay pride and other events, said Paul Chavez, the campaign’s manager.

“What we found in our outreach was that a lot of people are not aware that Truvada actually exists,” Chavez said.

He said outreach workers must gain the trust of people who haven’t always felt comfortable seeking medical care, much less cared to prevent HIV. “Accessing health care can be overwhelming, period,” Chavez said. “You add these layers on top of this, and the barriers start piling up.”

Author: Anna Gorman


Alzheimer’s disease will become manageable like HIV, say award-winning scientists 

People will be able to take drugs to prevent Alzhiemer's, scientists believe 
People will be able to take drugs to prevent Alzhiemer’s, scientists believe 

Alzheimer’s sufferers may be able to live with the disease without the devastating symptoms within the next few decades, scientists said as they were awarded the Brain Prize for their work fighting the illness.

Professor Michel Goedert, of Cambridge University, who discovered the importance of tau protein in Alzheimer’s said he could see a time when dementia became a chronic illness like HIV.

Prof Goedert who shares the one million euro Brain Prize with four colleagues, said: “Alzheimer’s will become something like HIV. It’s still there but it has been contained, or whittled down by drug treatments.

“It will disappear as a major problem from society.”

Prof Goedert was awarded the prize alongside Professors John Hardy and Bart De Strooper of University College London who developed the hypothesis that Alzheimer’s is caused by a build-up of amyloid protein in the brain, and Professor Christian Haass of Ludwig-Maximilians-University of Munich.

Prof Hardy said in the future, treatments for Alzheimer’s would be taken before the disease developed to prevent symptoms rather than trying to reverse them. He said may drug trials had failed because they had started when the disease was too well established.

Prof John Hardy celebrating with colleagues in London
Prof John Hardy celebrating with colleagues in London

“The mistakes we have made is the trials is that treatment has been given too late,” he said.

“It’s like popping a statin to stop a heart attack.

“But when we first started we knew almost nothing about Alzhiemer’s and now we understand a huge amount.”

Prof De Strooper added: “In 10 years we will have a completely different picture.”

The Brain Prize organisers said the winners had made essential contributions to the genetic and molecular knowledge of Alzheimer’s disease ‘which are the foundations for finding new ways to diagnose, treat and possibly even prevent it and other devastating diseases of the ageing brain’

Professor Anders Bjorklund, chairman of the Lundbeck Foundation Brain Prize selection committee, said: “Alzheimer´s disease is one of the most devastating diseases of our time and the remarkable progress that has been made during the last decades.

“These four outstanding European scientists have been rewarded for their fundamental discoveries unravelling molecular and genetic causes of the disease that have provided a basis for the current attempts to diagnose, treat and possibly even prevent neurodegenerative brain diseases.

“The award recognises that there is more to Alzheimer´s disease than amyloid, and that the field of dementia research is more than Alzheimer´s disease alone.”


High uptake and use of vaginal ring for HIV prevention observed in open-label study

Nearly 90 percent of participants in an open-label study of a vaginal ring infused with a drug to prevent HIV are using the monthly ring at least some of the time, according to an interim analysis of study data. In addition, the rate of HIV infection among participants in the open-label study, which has no placebo arm for comparison, is half of what might be expected in the absence of the ring, according to mathematical modeling that has significant limitations.

These preliminary findings from the HIV Open Label Extension (HOPE) study were presented today during a press conference at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston and will be reported tomorrow in an oral presentation at the meeting.

“It would be ideal for women to have discreet HIV prevention tools that they want to use and can control by themselves,” said Carl W. Dieffenbach, Ph.D., director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH and the primary funder of the study. “Interim data from the HOPE open-label extension study appear to be sending a positive signal about the desirability of the anti-HIV vaginal ring in a setting more like the real world than previous trials. We look forward to the final results from this study, which should provide more definitive information.”

The HOPE study launched in 2016 as a follow-on to the NIH-funded ASPIRE clinical trial. ASPIRE demonstrated that a silicone ring that continuously releases the anti-HIV drug dapivirine in the vagina safely reduced the risk of HIV infection by 27 percent. An exploratory analysis of the Phase 3 ASPIRE study data subsequently found that the monthly ring reduced the risk of HIV infection by at least 56 percent in women who used it most or all of the time. The goals of the current HOPE study are to gather data on whether and how women use the dapivirine ring knowing it is safe and moderately effective, and to further examine the relationship between adherence to the ring and protection from HIV infection. Final results are expected in 2019.

Since all HOPE study participants previously completed the ASPIRE trial without becoming HIV-infected, an aspect of their behavior other than the use of the vaginal ring may be contributing to protection from the virus, according to the study investigators. HOPE study participants received HIV prevention counseling and services during their participation in ASPIRE, which lasted for a median of one year and seven months. The women continue receiving HIV prevention counseling and services in the current study.

The Phase 3b HOPE study, also known as MTN-025, is being implemented by the NIH-funded Microbicide Trials Network (MTN) at 14 former ASPIRE study sites in Malawi, South Africa, Uganda and Zimbabwe. Because women accounted for 58 percent of new HIV infections among adults in southern and eastern Africa in 2016, protecting them from acquiring the virus is essential to controlling the HIV epidemic.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, both part of NIH, co-fund the MTN with NIAID.

While ASPIRE study participants did not know until the end of the trial whether they had received the dapivirine ring or a placebo ring, the HOPE study team is offering the dapivirine ring to all who enroll. HOPE study participants are sexually active, HIV-negative women ages 20 to 49 years who participated in ASPIRE and are not pregnant. More than 1,400 women had enrolled in the HOPE study as of October 2017, the data cutoff for the interim analysis.

The HOPE study is being led by Jared Baeten, M.D., Ph.D., a professor of global health, medicine and epidemiology at the University of Washington in Seattle; Thesla Palanee-Phillips, Ph.D., M.Sc., director of network trials and research center programs at the Wits Reproductive Health and HIV Institute in Johannesburg, South Africa; and Nyaradzo M. Mgodi, M.B.Ch.B., M.Med., a clinical pathologist and clinical research site leader at the University of Zimbabwe-University of California San Francisco Collaborative Research Program in Harare, Zimbabwe.

“Our interim analysis suggests that women in the HOPE study are choosing to use the dapivirine ring at least some of the time now that they know it can safely reduce their risk of HIV infection, and this is helping them achieve a level of protection,” said Dr. Baeten.

Participants in the HOPE study are being offered the dapivirine ring to insert into their vagina for a month at a time for up to 12 consecutive months. During the first three months, the women attend monthly study visits where they may obtain a new ring. Thereafter, they attend quarterly visits where they may obtain three rings at a time, a schedule that more closely resembles how the ring might be distributed in a real-world setting.

Participants may remain in the HOPE study regardless of whether they accept or use new rings. By allowing women to opt out of ring use but remain in the study, researchers are gaining insight into whether participants like using the ring and why, as well as what factors influence use and non-use. More than 90 percent of participants accepted the ring when they entered the study.

Adherence to the ring is being assessed by measuring residual levels of dapivirine in returned rings and blood levels of dapivirine. Some 89 percent of the rings returned as of October 2017 have residual dapivirine levels consistent with some use during the prior month. In contrast, 77 percent of returned rings in the ASPIRE study had residual dapivirine levels consistent with some use during the prior month, suggesting that adherence in the HOPE study is roughly 16 percent higher than it was in ASPIRE. Investigators lacked data to precisely quantify the duration of ring use in either study. The ring is designed to be worn continuously throughout the month to provide effective protection. Measurements of blood levels of dapivirine were not included in the interim analysis.

As of October 2017, HOPE study participants have become infected with HIV at a rate of 1.9 new infections per 100 person-years of follow-up. Person-years are the sum of the number of years that each participant has been in the study.

Other forms of HIV prevention have proven to provide high levels of protection from the virus. For instance, oral tablets of the medication Truvada for HIV pre-exposure prophylaxis (PrEP) reduce the risk of HIV infection by up to 92 percent in people at high risk when taken daily as prescribed, although taking a daily pill can be challenging for some people.

Because the HOPE study lacks a concurrent control group receiving a placebo ring, investigators used a mathematical approach to estimate what the HIV incidence would be if the women in the study had lacked access to the dapivirine ring.

First, the researchers determined the characteristics of the HOPE study population based on age, location and presence of a curable sexually transmitted infection when joining the study. Next, they identified an equal number of women from the placebo group in the ASPIRE trial who had similar characteristics and calculated the HIV incidence in that set. Then the investigators repeated this mathematical sampling of the ASPIRE placebo group 10,000 times. In this modeling exercise, the average HIV incidence was 4.1 new infections per 100 person-years for the ASPIRE participants receiving the placebo–twice the rate found in the new interim analysis of the HOPE study population. The investigators never calculated an HIV incidence as low as 1.9 per 100 person-years in their mathematical sampling of the ASPIRE placebo group. Comparing the HOPE study population to the ASPIRE placebo group is significantly limited by the differences between the two groups, however. In addition, the HOPE study is not powered to determine the effectiveness of the ring.


AIDS Saskatoon closing La Ronge support operation

Changes to federal funding are going to take a toll on the fight against HIV in northern Saskatchewan. These changes are forcing Jason Mercredi to make a difficult decision, cutting AIDS Saskatoon‘s only support worker in the La Ronge region.

“This is a major setback, especially for northern Saskatchewan,” Jason Mercredi, executive director of AIDS Saskatoon, said.


AIDS Saskatoon’s last funding agreement with the federal government was for $293,532 per year over a three-year period. But following a request to renew funding for operations through 2020, they were turned down.

The organization is one of 40 HIV-AIDS service organizations across the country being denied funding as the Public Health Agency of Canada (PHAC) shifts its focus to prevention from care and peer support.

“Peer support has been consistently identified as best practice for getting the hardest to engage people engaged in services,” Mercredi said. “And when we engage people in services, we save lives.”

After initial confusion, PHAC provided AIDS Saskatoon transitional funding until March 31.

“Transitional funding was provided to help organizations establish new partnerships, seek other sources of funding, transfer their services to other local providers, or close out their currently funded projects,” PHAC said in a press release.

The current support worker being lost in La Ronge is an Indigenous woman living with HIV, an invaluable support for the region. It’s a position she’s held for five years and her employment will come to an end on March 31.

“She’s devastated,” Mercredi said. “She’s a solid employee, she’s on our management team; we’re one of the few AIDS service organizations across Canada that actually have HIV-positive Indigenous women on the management team.”


Adele Cook works out of the Scattered Sites Outreach Building in La Ronge, educating the public on the virus, operating the needle exchange and serving as an outreach person for HIV-positive people in the area.

According to Mercredi, having that support worker on the ground in La Ronge has helped significantly with resource development. This fiscal year, they’ve been able to visit 19 northern communities; they also held a body mapping art retreat to support HIV-positive women in the north. In 2017, over 100,000 condoms were sent to northern Saskatchewan to help with prevention.

“We want local people on the ground,” Mercredi said. “Northern Saskatchewan is one of the hardest hit areas for new infections for HIV rates and so it’s going to be tough.”

HIV rates are on the rise across Saskatchewan, with 170 new cases in 2016 – 10 of those in the La Ronge region.

But the PHAC said the changes to the funding requirements doesn’t mean cuts to funding.

“Four previously funded organizations in Saskatchewan will receive the same or more funding from PHAC, and three new organizations, not previously funded, are now being funded to implement activities to address HIV and other sexually transmitted infections in Saskatchewan through the Community Action Fund,” PHAC said in a statement.

Battlefords Family Health Centre and All Nations Hope Inc. were also denied funding.

The good news is, talks to get AIDS Saskatoon’s funding reinstated are ongoing after the Canadian AIDS Society called for an external investigation into the funding decisions by PHAC.

“The answers being given for refusal of their projects were not in line with the project requests, so that was a big indicator at the time,” Gary Lacasse, executive director of the Canadian AIDS Society, said.

“There is some openness from the Public Health Agency and the Minister’s office to address these gaps.”

Despite that, the goal remains the same for Mercredi.

“We just want to keep maintaining and supporting those communities as best we can,” he said.


Lessons Learned from the Early Days of HIV/AIDS

Harold W. Jaffe, MD

By looking back on the early days of the HIV/AIDS epidemic, the medical community can learn many lessons, including the value of multidisciplinary teams, the vital role of acute care clinicians, the insight that can be gained from simple studies, how to properly engage infected communities, and how to address the fears of the public.

“Given that emerging infections continue to surprise, are we now more prepared than we were in the early days of AIDS?” Harold W. Jaffe, MD, said in a presentation at the 25th Conference on Retroviruses and Opportunistic Infections (CROI), in Boston, Massachusetts. “In some ways, I think the answer is yes.”

When the Centers for Disease Control and Prevention (CDC) published its weekly morbidity and mortality report on June 5, 1981, Jaffe said, “Neither I nor my CDC colleagues were prepared for what crashed down on our heads.”

That year, Jaffe, an infectious disease specialist with the CDC, was working with colleagues on suppressing a reemergence of syphilis in the United States. At the time, physicians in the US believed the end of infectious disease was in sight. Just 3 years prior, Robert G. Petersdorf, MD, had written that “even with my great personal loyalties to infectious disease,” he could not fathom the need for more of these specialists.

Yet, as Jaffe would point out, they were faced with a new pestilence, one they could not have prepared for: human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS).

Originally believed to be complex cases of Pneumocystis pneumonia (PCP) and Kaposi sarcoma (KS), within a month, more reports of patients with the condition were coming from Los Angeles, New York City, and San Francisco. Some of these patients were dying, most were of the men who have sex with men (MSM) population, and all were found to be immunodeficient, which confused physicians at the time, Jaffe said.

In order to determine what was occurring, the CDC began collecting systematic reports, developing a case definition of KS/OI (Kaposi sarcoma/opportunistic infections). “Soon we began receiving reports of KS/OI in gay men from additional American cities,” Jaffe said. “We also noticed that a small number of cases had been diagnosed in 1979 and 1980 but had not been reported.”

Born forth of this puzzling and alarming scenario were 3 major theories, Jaffe said. They were the sexually transmitted infections (STI) theory, the environmental theory, and the immune overload theory.

“Given the high rates of sexually transmitted infections seen in MSM at the time, a [sexually transmitted disease] was a prime suspect,” Jaffe said. “The environmental theory postulated that an immunosuppressive drug or chemical was the cause, and here, the leading suspects were nitrite inhalants, known as ‘poppers,’ used to enhance sex with men. Finally, there was the immune overload theory, that suggested there was no single ideology—rather, immunodeficiency resulted from the cumulative effects of multiple infectious agents, environmental toxins, and perhaps other factors, such as exposure to semen.”

After a CDC-run trial revealed that this patient population was more likely to have more sexual partners and that ‘poppers’ were not immunotoxins, as believed, the STI theory gained traction, and the condition became known as AIDS.

The public reception of the condition that seemingly only impacted MSM was mostly flippant, Jaffe said, until January 1983, when the CDC revealed a wider population of at-risk patients, which included those who were transfusion recipients, patients with hemophilia, injection drug users, female sex partners of men with AIDS, and those born to mothers with AIDS.

Then, on March 4, 1983, the CDC published its first guidelines for prevention of AIDS, which recommended that sexual content avoided with those with AIDS, that high-risk group members should be aware that increased sexual partners raised their risk, and that those at-risk should refrain from blood and plasma donations.

“In retrospect, these key recommendations related to sexual activity and blood donation were essentially correct, and were based entirely on epidemiologic studies,” Jaffe said.

Just 2 months later, François Barré-Sinoussi, Luke Montagnier, and colleagues in Paris, reported isolating a novel retrovirus that they called LAV (lymphadenopathy-associated virus), from the lymph node of a homosexual man, Jaffe said. A year after that, Robert C. Gallo and colleagues demonstrated the virus that they called HTLV-III (human t-lymphotropic retrovirus type III), which they claimed was the cause, and subsequently helped to develop the first diagnostic test to screen antibodies of the virus in the blood.

Meanwhile, Jaffe noted, African patients with AIDS began to appear in European clinics, bringing the infectious disease community’s attention to central Africa, where yet another epidemic was underway. These patients were remarkably heterogeneous compared to previously noted populations—the male to female ratio was approximately 1 to 1. Additionally, homosexuality, intravenous drug use, and blood transfusions were not found to be risk factors among this population.

By 1985, the concern about the virus in the United States quickly became fear. People began to believe casual contact could transmit the disease.

“This fear resulted in unwarranted discrimination against infected persons,” Jaffe said. “A leading symbol of this discrimination was Ryan White, an HIV-infected teenager with hemophilia who was not allowed to attend school for fear of contagion. As his school attendance was being debated, someone fired a bullet through the window of his home.”

Fortunately, a Montefiore Medical Center and CDC study soon brought forth the guidelines for the education and foster care of HIV-infected children. Coupled with studies dispelling the believed occupational risks of acquiring HIV, they soon became the basis for public health education to destigmatize the disease.

As time passed, more federal programs and funding would lead to antiretroviral therapies and advancements in the treatment of the condition. As important, however, are the lessons to learn from the early days, which “have been and will be tested by new health threats,” Jaffe said.

While it tested the medical community, the epidemic taught lessons to physicians that have advanced the way infectious disease is approached. Jaffe noted that there are now international health regulations which aide in countries’ abilities to respond to and assess health threats.

With the absence of a vaccine or curative therapy, Jaffe said, conventional wisdom says that it is too hard to end the epidemic as a public health threat.

“But looking back on the early days of AIDS, we see the conventional wisdom may be wrong,” Jaffe said. “In speaking about the goals of the US Space program more than 50 years ago, President John F. Kennedy said, ‘We choose to go to the moon not because it is easy, but because it is hard.’ I’d like to think that if he were speaking about AIDS, President Kennedy would say we choose to end the epidemic not only because it is hard, but also because it is right.”

Author: Matt Hoffman

LGBT Resource Center will offer free HIV testing for students, faculty 

LGBT Resource Center
(Photo by David A. Barnes)

On Thursday, March 8 between 12-5 p.m., the University of Georgia LGBT Resource Center will be hosting quick and free HIV testing.

This event will be open to all UGA students and faculty on a first come, first serve basis and will occur in room 221 of Memorial Hall.

The resource center is promoting National Women and Girls HIV/AIDS Awareness Day, coming up on March 10, but all genders and gender identities are welcome to get tested.

According to senior coordinator Rashad Small, the center has been providing free HIV tests for about two years.

This event is made possible with help from the Specialty Care Clinic of the Northeast Health District of Georgia, who will be providing licensed professionals to give the HIV tests. The clinic, located in the Clarke County Health Department, typically offers free HIV testing on weekdays.

Live Forward, previously known as AIDS Athens, is another organization that will be providing volunteers. The goal of their organization is to provide stable housing to individuals living with or affected by HIV/AIDS and they also provide free HIV testing with quick results.

To participate in the event, there is no need to sign up — testing will be done on a first come, first serve basis.

Author: Sofi Gratas


Vancouver Native Health says funding change will likely mean agency loses longtime HIV program

A Downtown Eastside clinic designed for Indigenous people living with HIV/AIDS is in danger of losing funding to another nonprofitnull

For almost 20 years, Indigenous people living with HIV/AIDS have visited 441 East Hastings Street for medical care, social services, and often just a warm meal.

It’s a program called Positive Outlook, and it has operated there under the Vancouver Native Health Society (VNHS) since almost as long as executive director Lou Demeraiscan remember. But it looks like that’s about to end, Demerais told the Straight.

“It appears that Vancouver Coastal Health Authority [VCH] has decided to take away funding that we’ve been getting for our drop-in centre for people who are HIV-positive,” he said in a telephone interview. “They’re going to do an RFP [request for proposals]. Presumably, they’ve found interest from other agencies who might be able to provide these services better than us.”

VCH confirmed the news but declined to grant an interview.

VNHS has received $1.1 million from VCH each year for its Positive Outlook program. According to the nonprofit’s charity filings, losing that money will amount to a 16-percent reduction in total annual revenue.

VNHS’s contract for the Positive Outlook program expires on March 31. Demerais said that is normal; Positive Outlook has always run on annual contracts, but every year the contract has been renewed without issue. Now, after March 31, Demerais said that it’s all but certain the program will move to another service provider.

“What we don’t understand is why they [VCH] are doing it,” he said. “They’ve never given us an explanation as to why it’s necessary at this point. So we think there is some other motivation behind it.”

Demerais recalled the program’s origins. “It was back in the ‘90s,” he began.

Those years, deaths attributed to HIV/AIDS in Vancouver rose from 86 in 1989 to a peak of 203 in 1994, according to the B.C. Vital Statistics Agency. Overdose deaths soared during the same period, prompting the regional health authority to declare a public-health emergency.

“So we started Positive Outlook in response to the pandemic that was sweeping through the neighbourhood in the 1990s,” Demerais continued. “Overall, it helped prolong people’s lives, got them to live longer. We’ve had people now who have been with us since the ‘90s who are still clients of the program.”


Demerais said that at this point, VNHS doesn’t know if it will file a response to VCH’s request for proposals. He said it has yet to be issued, and their contract is up in a month, leaving little time to organize a submission.

“We think they’re waiting until the last minute to weaken our chances of being able to re-apply,” he said. “We’re not exactly sure what they will require that might be new.”

Demerais argued VNHA’s Positive Outlook program is unique in the ways it’s tailored to the Downtown Eastside’s large Indigenous population.

“What we’ve been trying to do lately is meet some of the needs of people who had experienced the residential-school program,” he noted. “We’ve tried to bring some elders into the mix so that they would have someone to talk to about some of their deeply seated psychological difficulties, in a kind of traditional way. We’ve been working on that and we’re at a point now where we wanted to implement more of the traditional elder services. Whether or not we’re going to be able to do that, we’re beginning to doubt.”

by Travis Lupick


Beauty Bar: MAC Cosmetics Viva Glam Sia

We tried it, so you can know before you go buy it.

MAC Cosmetics Viva Glam Sia.
MAC Cosmetics Viva Glam Sia. MAC COSMETICS

What it is: MAC Cosmetics teams up with another music superstar for its Viva Glam initiative. And, this time, the celebrity face is Chandelier singer, Sia.

The Australian singer-songwriter follows in the footsteps of Miley Cyrus, Nicki Minaj and more to help create a Lipstick shade that will help to benefit men, women and children living with and affected by HIV and AIDS.

The limited-edition release is a matte red lipstick that boasts a warm, vivid hue that’s “as loud as you dare to be,” according to the company’s website.

The MAC Viva Glam initiative dates to 1994, and every scent from the Viva Glam products go to benefit the cause.

What we say: While you may, or may not, need another red lipstick in your makeup drawer, it’s hard to skip a release like this one.

Not only does this lipstick go toward a very important cause, it also happens to have the perfect shade of red that’s sure to work with most (if not all!) skin tones.

The formula is pigmented and ultra-matte. While it takes a tad to dry, our tester found it was perfect when paired with a lightweight balm to ward off some of the creasing.

If you’re a fan of philanthropy — and a bold red lip, don’t skip this Sia-MAC release.

Where to get; Hudson’s Bay

What it will cost you: $22


Source: Beauty Bar: MAC Cosmetics Viva Glam Sia

Safe injection sites’ role in the opioid epidemic

Needle exchange

Massachusetts Gov. Charlie Baker and Boston Mayor Marty Walsh have expressed skepticism over supervised injection sites as an effort to address the state’s ongoing opioid epidemic. Baker suggested that the research on safe injection sites as a “path to treatment” was inconclusive.

Safe injection sites provide a space for people to use drugs intravenously with sterilized equipment and supervision to mitigate the dangers of overdose. Some also offer counseling, medical resources and referrals to treatment. While they are illegal in the U.S., a number of sites exist elsewhere, such as in Vancouver and Sydney.

Have these sites increased drug use or thwarted people who use drugs from seeking treatment? Or do they encourage users to enter treatment? Two reviews, one published in Drug and Alcohol Dependence in 2014, and one published in 2017 in Current HIV/AIDS Reports, indicate that supervised consumption facilities promote uptake of treatment. The more recent review looked at 47 studies published between 2003 and 2017 on supervised drug consumption facilities. The authors found a handful of studies that demonstrated a positive link between safe injection site use and entry into treatment.

One of these studies compared detoxification enrollment among those who used Vancouver’s supervised injection facility in the year before and after it opened. They found the facility’s opening was linked to a 30 percent increase in detox use, which in turn was linked to pursuing long-term treatment and injecting at the facility less. A later study of the site focused on use of detox services located at the facility, and found that 11.2 percent (147 people) used these services at least once over the two years studied. The authors conclude that these findings indicate supervised injection facilities might serve as a “point of access to detoxification services.”

Another study of Vancouver’s facility, published in the New England Journal of Medicine in 2006, found “an average of at least weekly use of the supervised injecting facility and any contact with the facility’s addictions counselor were both independently associated with more rapid entry into a detoxification program.” A 2011 study of the Vancouver facility published in Drug and Alcohol Dependence offered similar conclusions, and a qualitative account of injection drug users’ experiences at the facility adds narrative backing to quantitatively documented benefits.

At a supervised injection site in Sydney, a year-and-a-half long study allowed researchers to determine that 16 percent of clients at the site referred to treatment went on to receive it, leading the authors to conclude that the center “engaged injecting drug users successfully in drug treatment referral and this was associated with presentation for drug treatment assessment and other health and psychosocial services.” Reports from this site indicate that facility clients were more likely to start treatment than non-clients (38 percent vs. 21 percent).

Though supervised injection sites are illegal in the United States, one opened underground in 2014. The findings from the first two years of the site’s operation were published in 2017 in the American Journal of Preventive Medicine. Each participant was asked the same set of questions about their use patterns every time they injected drugs at the site. From this data, the authors conclude that the site established a number of benefits, including safe disposal of equipment, unrushed injections and immediate response to overdoses. The authors add that if the site were sanctioned, it might be able to offer additional benefits, including healthcare and other services.

A concern around safe injection sites is that they increase drug use. But a study of 871 people who inject drugs found no substantial increase in rates of relapse into injected drug use among former users before and after the Vancouver site opened. However, the researchers also found no substantial decrease in the rate of stopping drug use among current users before and after the site opened. Another study of 1,065 people at this facility found that only one individual performed their first injection at the site, which counters fears that such facilities promulgate injection drug use.

Research indicates that many who use supervised injection facilities have the desire to access treatment. A study published in 2010 in the Journal of Public Health queried 889 people who were randomly selected at a supervised injection facility. “At each interview, ∼20 percent of respondents reported trying but being unable to access any type of drug or alcohol treatment in the previous 6 months,” the authors write. The main barrier to access, respondents said, was waiting lists for treatment.



Canada and Sweden most LGBT-friendly travel destinations

The recent introduction of marriage equality has improved Germany’s position in the SPARTACUS Gay Travel Index, ranking the most LGBT-friendly destination countries. Germany now shares third place with eleven other countries. Canada and Sweden find themselves at the top of the list. The SPARTACUS Gay Travel Index is updated annually and informs travelers on the situation of lesbians, gays, bisexuals and transgenders (LGBT) in 197 Countries and Territories.

For the first time this year, the SPARTACUS Gay Travel Index also takes into account the legal situation of transgender individuals. Canada gets full marks in this criterion and thus manages to secure joint top spot in the Index for the first time, along with Sweden. The top ten LGBT-friendly countries further consist of mostly European Union countries that have already introduced marriage equality legislation, such as The Netherlands, France, Spain and Belgium. The SPARTACUS Gay Travel Index also sees improvements in Israel, Colombia, Cuba and Botswana. On the other hand, due to numerous killings of gays, lesbians and transsexuals in 2017, Brazil has been rated down markedly compared to previous years. The USA are also on the losing side, now being ranked on 39th rather than their previous 34th place. This is mostly due to attempts by the Trump administration to curtail transgender rights in the military as well as repealing anti-discrimination legislation that had been introduced under the previous government.

Overall, Somalia, Saudi Arabia, Iran, Yemen, the United Arab Emirates, Qatar and Malawi garnered particularly negative scores, with Russian Federal Republic Chechnya coming dead last in the index, due to the the state-organised persecution and killings of homosexuals in 2017 taking place there.

The SPARTACUS Gay Travel Index is assembled using 14 criteria in three categories. The first category is civil rights. Among other things it assesses whether gays and lesbians are allowed to marry, whether there are antidiscrimination laws in place, or whether the same age of consent applies to both heterosexual and homosexual couples. Any discrimination is recorded in the second category. This includes, for example, travel restrictions for HIV positive people and the ban on pride parades or other demonstrations. In the third category, threats to individuals by persecution, prison sentences or capital punishment are assessed. Evaluated sources include the human rights organization “Human Rights Watch”, the UN “Free & Equal” campaign, and year-round information on human rights violations against members of the LGBT community.