Health
AIDS 2012: Fenton stresses an end to HIV/AIDS is “within our grasp”
Head of CDC’s HIV/AIDS response stressed more needs to be done to fight epidemic
Dr. Kevin Fenton of the Centers for Disease Control and Prevention. (Photo courtesy of CDC)
The head of the Centers for Disease Control and Prevention’s response to HIV/AIDS stressed on Wednesday that he is confident that an end to the epidemic is near.
“Ending the epidemic really means really reducing the numbers of new infections which are occurring as well as protecting the lives of those who are infected,” Dr. Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, told the Blade during the International AIDS Conference at the Walter E. Washington Convention Center. “The cure discussion is very exciting. I think we’re moving along and understanding what the elements of a cure are likely to be, but it will take some time to reach there. Ending the epidemic I think is within our grasp, and we must continue to push for a cure as well.”
Fenton spoke to the Blade a few hours before he took part in a panel that discussed older adults with the virus. The CDC estimates that nearly 11 percent of the roughly 50,000 new HIV infections that occur each year in the United States are among those older than 50. Statistics further indicate that 16.7 percent of new diagnoses in 2009 were among this demographic, with half of them also having AIDS.
The CDC further predicts that half of people with HIV in the country by 2015 will be 50 or older.
“We’re all getting older,” said Fenton. “The baby boomers are now coming out of the workforce, many of whom are HIV infected and are going to be living their lives.”
Stigma, a lack of health care, financial insecurity and a lack of information about the virus are among the challenges that public health officials and HIV/AIDS service providers continue to confront in their efforts to curb new infection rates among older people. In spite of these hurdles, increased access to anti-retroviral drugs and other medications have allowed people with HIV to live longer lives.
“That’s a huge difference to where we were 30 years ago,” noted Fenton. “We now need to prepare for the other health conditions that come with aging: high blood pressure, strokes, diabetes, etc., as people age. This is an appropriate time for us to be reflecting on that.”
Fenton stressed that both the health care reform law that President Obama signed in 2010 and the White House’s National HIV/AIDS Strategy provide what he described as a “framework” to effectively address older adults and other at-risk populations.
“We need to be honest that most infections are occurring among young people in the United States — those under 40 years, so we need to ensure that our resources are being used to address the epidemic in those who are at greatest risk,” he added. “Nevertheless, we still see a substantial proportion of new infections occurring in older adults and I think the conversations that we need to have collectively is how do we ensure that there are proportionate investments to meet the needs of older adults in the U.S. and that we’re mindful of their needs and actively planning for their needs as well.”
Fenton: Conference highlights American leadership on fight against HIV/AIDS
AIDS 2012 is the first time that the United States has hosted the International AIDS Conference since 1990.
“It’s wonderful that we’re able to bring the international community back to the United States to both celebrate the progress we’ve made in the global response against HIV and to reflect on certainly U.S. leadership in the fight against AIDS at home as well as abroad,” said Fenton. “It’s also been fantastic that new concepts and calls for a greater sense of urgency in moving towards an AIDS-free generation, the beginning of the end of AIDS — fantastic themes for everyone across the U.S. as well as around the world for everyone to begin to reflect on.”
More than 30,000 delegates, journalists and HIV/AIDS activists have traveled to D.C. for the five-day gathering that will end on Friday. Some, such as the AIDS Healthcare Foundation, have used the conference as an opportunity to criticize the Obama administration’s response to the epidemic.
“You have to think about where we’ve come from, especially in the last few years,” said Fenton who once again referred to the health care reform bill and the National HIV/AIDS Strategy. He also pointed to safer-sex campaigns that specifically target black men who have sex with men and further engagement with communities impacted by the epidemic. “There’s a lot that we have done over the last few years. We always can do more and we need to do more faster.”
One specific challenge to which Fenton pointed is the underlying socio-economic issues that prevent people with HIV from accessing treatment once they learn their status. He noted that only 28 percent of Americans with the virus are “maximally benefitting from treatment.”
“People may not want to go to an HIV clinic because they’re too embarrassed, they’re afraid of seeing their friends or colleagues or they may not be able to simply afford just to be there because a day in the clinic means a day not working and when you have a family to feed or rent to pay, sometimes you make decisions which are not necessarily to the benefit of your health,” he said. “So there are many issues and what we’re hearing at this conference is we need to be honest about that cascade and we need to think about improving on every aspect of the cascade to have an overall benefit.”
Researchers from the National Institutes of Health and the HIV Prevention Trials Network earlier this week released a study that found high rates of HIV, unemployment and incarceration among black gay men in six cities. The report notes that even though black gay men more likely to practice safer-sex than other groups, they remain at higher risk for the virus.
“It’s not just about individual risk behaviors; but poverty, homelessness, having a sexually transmitted infection, who you’re having sex with really matters, and the kind of sex you’re having really matters,” said Fenton in response to the study. “We now need to be thinking about ways of supporting black gay men — in fact all gay men in this country — to make the right choices for their individual health, but how do we create those social and structural support environments so that they can make the right choices for optimal health. And that’s really important moving forward.”
“We often think of it as being a very rare disease, but what we do know is that it isn’t really. Most people with HIV live in cities with more than 500,000 inhabitants and that four states in the United States account for more than 50 percent of the epidemic and the top 10 states account for about 73 percent of the epidemic,” he said. “The epidemic isn’t randomly distributed and you have these geographic pockets which are hard hit. The fact that we’re in D.C. allows us to both celebrate some of the successes we’re now having in D.C. with HIV response, but it challenges us again to do more.”
Monkeypox
US contributes more than $90 million to fight mpox outbreak in Africa
WHO and Africa CDC has declared a public health emergency
The U.S. has contributed more than $90 million to the fight against the mpox outbreak in Africa.
The U.S. Agency for International Development on Tuesday in a press release announced “up to an additional” $35 million “in emergency health assistance to bolster response efforts for the clade I mpox outbreak in Central and Eastern Africa, pending congressional notification.” The press release notes the Biden-Harris administration previously pledged more than $55 million to fight the outbreak in Congo and other African countries.
“The additional assistance announced today will enable USAID to continue working closely with affected countries, as well as regional and global health partners, to expand support and reduce the impact of this outbreak as it continues to evolve,” it reads. “USAID support includes assistance with surveillance, diagnostics, risk communication and community engagement, infection prevention and control, case management, and vaccination planning and coordination.”
The World Health Organization and the Africa Centers for Disease Control and Prevention last week declared the outbreak a public health emergency.
The Washington Blade last week reported there are more than 17,000 suspected mpox cases across in Congo, Uganda, Kenya, Rwanda, and other African countries. The outbreak has claimed more than 500 lives, mostly in Congo.
Health
Mpox outbreak in Africa declared global health emergency
ONE: 10 million vaccine doses needed on the continent
Medical facilities that provide treatment to gay and bisexual men in some East African countries are already collaborating with them to prevent the spread of a new wave of mpox cases after the World Health Organization on Wednesday declared a global health emergency.
The collaboration, both in Uganda and Kenya, comes amid WHO’s latest report released on Aug. 12, which reveals that nine out of every 10 reported mpox cases are men with sex as the most common cause of infection.
The global mpox outbreak report — based on data that national authorities collected between January 2022 and June of this year — notes 87,189 of the 90,410 reported cases were men. Ninety-six percent of whom were infected through sex.
Sexual contact as the leading mode of transmission accounted for 19,102 of 22,802 cases, followed by non-sexual person-to-person contact. Genital rash was the most common symptom, followed by fever and systemic rash.
The WHO report states the pattern of mpox virus transmission has persisted over the last six months, with 97 percent of new cases reporting sexual contact through oral, vaginal, or anal sex with infected people.
“Sexual transmission has been recorded in the Democratic Republic of Congo among sex workers and men who have sex with men,” the report reads. “Among cases exposed through sexual contact in the Democratic Republic of the Congo, some individuals present only with genital lesions, rather than the more typical extensive rash associated with the virus.”
The growing mpox cases, which are now more than 2,800 reported cases in at least 13 African countries that include Kenya, Uganda, Rwanda, and prompted the Africa Centers for Disease Control and Prevention this week to declare the disease a public health emergency for resource mobilization on the continent to tackle it.
“Africa has long been on the frontlines in the fight against infectious diseases, often with limited resources,” said Africa CDC Director General Jean Kaseya. “The battle against Mpox demands a global response. We need your support, expertise, and solidarity. The world cannot afford to turn a blind eye to this crisis.”
The disease has so far claimed more than 500 lives, mostly in Congo, even as the Africa CDC notes suspected mpox cases across the continent have surged past 17,000, compared to 7,146 cases in 2022 and 14,957 cases last year.
“This is just the tip of the iceberg when we consider the many weaknesses in surveillance, laboratory testing, and contact tracing,” Kaseya said.
WHO, led by Director General Tedros Adhanom Ghebreyesus, also followed the Africa CDC’s move by declaring the mpox outbreak a public health emergency of international concern.
The latest WHO report reveals that men, including those who identify as gay and bisexual, constitute most mpox cases in Kenya and Uganda. The two countries have recorded their first cases, and has put queer rights organizations and health care centers that treat the LGBTQ community on high alert.
The Uganda Minority Shelters Consortium, for example, confirmed to the Washington Blade that the collaboration with health service providers to prevent the spread of mpox among gay and bisexual men is “nascent and uneven.”
“While some community-led health service providers such as Ark Wellness Clinic, Children of the Sun Clinic, Ice Breakers Uganda Clinic, and Happy Family Youth Clinic, have demonstrated commendable efforts, widespread collaboration on mpox prevention remains a significant gap,” UMSC Coordinator John Grace stated. “This is particularly evident when compared to the response to the previous Red Eyes outbreak within the LGBT community.”
Grace noted that as of Wednesday, there were no known queer-friendly health service providers to offer mpox vaccinations to men who have sex with men. He called for health care centers to provide inclusive services and a more coordinated approach.
Although Grace pointed out the fear of discrimination — and particularly Uganda’s Anti-Homosexuality Act — remains a big barrier to mpox prevention through testing, vaccination, and treatment among queer people, he confirmed no mpox cases have been reported among the LGBTQ community.
Uganda so far has reported two mpox cases — refugees who had travelled from Congo.
“We are for the most part encouraging safer sex practices even after potential future vaccinations are conducted as it can also be spread through bodily fluids like saliva and sweat,” Grace said.
Grace also noted that raising awareness about mpox among the queer community and seeking treatment when infected remains a challenge due to the historical and ongoing homophobic stigma and that more comprehensive and reliable advocacy is needed. He said Grindr and other digital platforms have been crucial in raising awareness.
The declarations of mpox as a global health emergency have already attracted demand for global leaders to support African countries to swiftly obtain the necessary vaccines and diagnostics.
“History shows we must act quickly and decisively when a public health emergency strikes. The current Mpox outbreak in Africa is one such emergency,” said ONE Global Health Senior Policy Director Jenny Ottenhoff.
ONE is a global, nonpartisan organization that advocates for the investments needed to create economic opportunities and healthier lives in Africa.
Ottenhoff warned failure to support the African countries with medical supplies needed to tackle mpox would leave the continent defenseless against the virus.
To ensure that African countries are adequately supported, ONE wants governments and pharmaceutical companies to urgently increase the provision of mpox vaccines so that the most affected African countries have affordable access to them. It also notes 10 million vaccine doses are currently needed to control the mpox outbreak in Africa, yet the continent has only 200,000 doses.
The Blade has reached out to Ishtar MSM, a community-based healthcare center in Nairobi, Kenya, that offers to service to gay and bisexual men, about their response to the mpox outbreak.
Health
White House urged to expand PrEP coverage for injectable form
HIV/AIDS service organizations made call on Wednesday
A coalition of 63 organizations dedicated to ending HIV called on the Biden-Harris administration on Wednesday to require insurers to cover long-acting pre-exposure prophylaxis (PrEP) without cost-sharing.
In a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, the groups emphasized the need for broad and equitable access to PrEP free of insurance barriers.
Long-acting PrEP is an injectable form of PrEP that’s effective over a long period of time. The FDA approved Apretude (cabotegravir extended-release injectable suspension) as the first and only long-acting injectable PrEP in late 2021. It’s intended for adults and adolescents weighing at least 77 lbs. who are at risk for HIV through sex.
The U.S. Preventive Services Task Force updated its recommendation for PrEP on Aug. 22, 2023, to include new medications such as the first long-acting PrEP drug. The coalition wants CMS to issue guidance requiring insurers to cover all forms of PrEP, including current and future FDA-approved drugs.
“Long-acting PrEP can be the answer to low PrEP uptake, particularly in communities not using PrEP today,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “The Biden administration has an opportunity to ensure that people with private insurance can access PrEP now and into the future, free of any cost-sharing, with properly worded guidance to insurers.”
Currently, only 36 percent of those who could benefit from PrEP are using it. Significant disparities exist among racial and ethnic groups. Black people constitute 39 percent of new HIV diagnoses but only 14 percent of PrEP users, while Latinos represent 31 percent of new diagnoses but only 18 percent of PrEP users. In contrast, white people represent 24 percent of HIV diagnoses but 64 percent of PrEP users.
The groups also want CMS to prohibit insurers from employing prior authorization for PrEP, citing it as a significant barrier to access. Several states, including New York and California, already prohibit prior authorization for PrEP.
Modeling conducted for HIV+Hep, based on clinical trials of a once every 2-month injection, suggests that 87 percent more HIV cases would be averted compared to daily oral PrEP, with $4.25 billion in averted healthcare costs over 10 years.
Despite guidance issued to insurers in July 2021, PrEP users continue to report being charged cost-sharing for both the drug and ancillary services. A recent review of claims data found that 36 percent of PrEP users were charged for their drugs, and even 31 percent of those using generic PrEP faced cost-sharing.
The coalition’s letter follows a more detailed communication sent by HIV+Hepatitis Policy Institute to the Biden administration on July 2.
Signatories to the community letter include Advocates for Youth, AIDS United, Equality California, Fenway Health, Human Rights Campaign, and the National Coalition of STD Directors, among others.
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