Showing posts with label HIV. Show all posts
Showing posts with label HIV. Show all posts

February 19, 2020

13 Million Russians Have Watched A Ground Breaking Film on Russia's HIV ~Too Little Too Late

Image result for russia and hiv
 Too little too late...A hundred people per day,” reads this screenshot from vlogger Yury Dud's YouTube documentary about Russia's HIV epidemic. This was the average number of victims on a daily basis in 2018.


One of Russia's most popular vloggers or video bloggers, Yury Dud, has released a documentary movie describing the HIV/AIDS situation in Russia. Since its launch on February 11, Dud's movie has received nearly 13 million views.
That makes Dud's documentary one of the most viewed YouTube videos in Russia today. And it couldn't have come at a more urgent time.
Russia faces an HIV epidemic. By the end of 2019, Russia's Ministry of Healthcare estimated the number of HIV positive Russian citizens at one million, meaning that the syndrome affects around one percent of Russia’s adult population. Meanwhile, the Russian government remains silent. As sociologist Iskander Yasaveyev wrote last November for the independent newspaper Novaya Gazeta: 
Of the 1,400,000 cases of HIV infection registered in our country since 1987, more than half —around 750 thousand — were recorded after 2012, the starting year of Putin's third presidential mandate. 
Luckily, Russia's booming vlogosphere is there to say what goes unsaid elsewhere. Vloggers such as Dud have a significant following as they offer a rare alternative in a country whose media is heavily censored and controlled by the government. Television is the predominant source of information in Russia, meaning that most alternative media, with the exception of online television station Dozhd(Дождь), are newspapers and radio stations. This means that vloggers’ popular YouTube channels are the only real independent competition for state-owned television channels. 
Dud, a former sports journalist, is one of Russia's leading vloggers, with over six million followers on his YouTube channel. He often interviews Russian-speaking celebrities but has also produced several professional documentaries on controversial issues in Russian society.

He's a considerate and thoughtful approach to some truly tricky topics has made Dud nothing less than a superstar on the RuNet. Global Voices asked Zhenya Snezhkina, a Prague-based Russian journalist and expert on Russian vloggers, to explain the popularity of video bloggers in Russia today and Dud’s success in particular: 
Quick feedback that gives content creators the ability to better assess their audiences’ needs and expectations. As censorship has intensified in Russia, more and more people have tried to find ways to avoid it, transferring to platforms whose structure doesn't allow the Russian authorities to censor them so easily. So today, several tens of millions of users now prefer uncensored media.
From the very beginning of his YouTube career, Dud spoke about himself as a person who asks inconvenient questions and digs up the reality of various situations. Without judgement, but with understanding. He's basically reinvented the format of the interview, moving beyond the need for “well-behaved” interviewees. As his channel developed, its scope expanded to including topics that are risky to discuss. In 2019, his record breakers were his films about Kolyma [part of the Russian Gulag] and Beslan [a terrorist attack on a school in the Russian Caucasus]. Both movies have over 19 million views each. Both incensed the pro-Kremlin propagandists. It was logical that the HIV situation in Russia should become one of his next topics, because it is a tragic situation.
The title of Dud's latest documentary translates as “HIV in Russia  the epidemic that no one talks about” («ВИЧ в России — эпидемия, про которую не говорят») and runs for nearly two hours. It starts by citing key statistics, including the fact that on average, in 2018, 100 people died of the virus every day. The film includes several testimonies by HIV positive people and their partners, touching upon diverse topics: couples in which one partner is HIV-positive and the other isn't, HIV-positive children, HIV and drug consumption, myths about HIV transmission, HIV activism, the need for sexual education in schools, and the authorities’ silence. The movie revolves around real-life stories and is conducted, as are Dud's other videos, in a colloquial style that differs significantly from the tenor of official media in Russia.  
 I work in a clinic and my first patient today was a young man who came for an HIV test, and he said he did so because he saw this video. It's amazing.
— Anastasiya Botushan, YouTube, February 13, 2020
Following the release of Dud's documentary, there has been an explosion in HIV testing — a fact which reflects the lack of effective governmental campaigns to prevent the epidemic. One article suggests that the demand for HIV testing in Russia has increased by 5,500 percent since February 11.
Apparently, the success of the movie has also made the authorities sit up and take notice. The Duma, Russia's parliament, organized a screening of the movie on February 14:

А у нас в Госдуме такой вот немного неожиданный выбор для Дня Святого Валентина. Показывают Юрия Дудя.

View image on Twitter

And for Valentine's Day, we made an unusual choice at the State Duma. We are being shown Yury Dud's film.
On February 16, the Accounts Chamber of Russia, which oversees financial control of the state budget, announced that would review the effectiveness of measures aimed at supporting HIV-positive Russians. Its head Alexey Kudrin praised Dud's movie on Twitter:

Юрий Дудь снял нужный фильм об эпидемии ВИЧ в России. Уже инфицировано более 1 млн. В 2018 году от СПИДа умерло 37 тыс человек. В среднем по 100 человек в день. Сравните с коронавирусом. пока в нашей стране - гораздо более реальная угроза  @yurydud

Yury Dud has made a much needed movie about HIV in Russia. More than one million people are infected. In 2018, 37,000 died of AIDS — that's on average 100 persons a day. Compare that with the coronavirus. #HIV in our country remains a much more real threat.
Snezhkina, the Prague-based journalist, does not believe that the authorities’ approach will change overnight. Nevertheless, she is optimistic about the prospects of wider social awareness about HIV in Russia:
Basically the “authorities” have heard the words of Dud and his heroes  the movie was shown in the State Duma and at the Ministry of Health. I don't think the movie will bring any radical changes. But the fact that so many people have found out about HIV-testing and the existence of drugs [for the condition], will have much more significant consequences.
One of the most poignant moments in Dud's film is his interview with Katya, a former drug user who died while the film was shot. Throughout their conversation, Katya insists several times that:
We are not lepers. I hope there'll be a free flow of information [about us].

March 9, 2019

PREP Use Among Men in Risk for HIV is Up 35% But Still Too Low


By Tim Fitzsimons
Thirty-five percent of gay and bisexual men at high risk of HIV infection were using PrEP, or pre-exposure prophylaxis, the daily pill that prevents HIV infection, in 2017, according to data released Thursday by the Centers for Disease Control and Prevention. In 2014, just 6 percent of these men used PrEP.
However, despite the nearly 500 percent jump in PrEP use among men who have sex with men, the CDC notes “PrEP use remains too low, especially among gay and bisexual men of color.”
The study was presented Thursday in Seattle at the 2019 Conference on Retroviruses and Opportunistic Infections, a major annual HIV/AIDS conference, and was based on more than 8,000 interviews in 20 American cities. 
The data showed varying use among racial and ethnic groups. More than 40 percent of white gay and bisexual men at high risk of HIV used PrEP in 2017, while only 30 percent of their Latino counterparts and 26 percent of their African-American counterparts did so. The updated data highlights the fact that minorities access PrEP at lower rates than whites, despite being at higher risk of HIV infection.
The data also found high awareness of PrEP, which is also known by its brand name, Truvada, among all gay and bi men: Eighty-six percent of African-Americans know about it, as do 87 percent of Latinos and 95 percent of whites.
“The study’s findings suggest that efforts to increase PrEP awareness and use among populations at risk is working, but it remains underutilized,” according to a press memo distributed by the CDC. The CDC notes that the federal government’s “Ending the HIV Epidemic: A Plan for America,” which aims to reduce new infections by 90 percent by 2030, will rely heavily on ramping up PrEP use. Many people struggle to access PrEP because of its high cost — roughly $2,000 per month list price — and complex insurance procedures.
“Of the estimated one million Americans at substantial risk for HIV and who could benefit from PrEP, fewer than 10 percent are actually using this medication,” the CDC noted, referring to low uptake overall among heterosexual and injection-drug-using populations that are also at high risk of HIV infection.
The CDC said it is funding government and private health organizations’ efforts to spread awareness of PrEP, and “developing new ways to connect gay and bisexual men of color and transgender people to PrEP."

January 23, 2019

Trump Administration Rolled Backwards The Clock for LGBT and People Living with HIV


Last weekend marked the two-year anniversary of Donald Trump’s presidency. In that time, we have witnessed the rollback of rights and protections for LGBT people and people living with HIV that took decades to win. It is difficult, if not impossible, to estimate the full extent of harm now taking place. But it is undeniable that our communities are much more vulnerable to discrimination in health care, social services, employment, education, and access to basic government services.

One of the most shocking moves occurred earlier this month when Secretary of State Mike Pompeo attended the inauguration of Brazil’s new president Jair Bolsonaro. Bolsonaro, a former Army captain and longtime congressman who operated at Brazil’s political margins because of his far-right political views, campaigned on a racist, misogynistic, and homophobic platform. In October 2018, a transgender woman and a drag queen were both murdered, with the attackers in both incidents invoking Bolsonaro’s name. On his first day in office, Bolsonaro signed an executive order prohibiting the country’s human rights ministry from hearing any concerns from the country’s LGBT community.

Image result for pompeo and bolsonaro picture
 Pompeo left, Bolsonaro, right
Despite this, Pompeo tweeted out a photo of himself meeting with Bolsonaro thanking him for a great meeting to “reinforce our shared commitment to democracy, education, prosperity, security, and #humanrights.” Trump, meanwhile, has praised Bolsonaro as a “great leader.” Pompeo’s diplomatic move coupled with Trump’s rhetoric marked an effective end to previous U.S. foreign policy that treated LGBT rights as a foreign policy goal. This shift endangers the safety of LGBT people around the globe.

                                  Image result for pompeo and bolsonaro tweets picture

Other moves that have undermined efforts to fight stigma against LGBT people and people with HIV, include the dismissal, in March 2018, of a Peace Corps volunteer in Cambodia after he tested positive for HIV. After receiving treatment in the United States and learning that he could keep his viral load near zero by taking daily medication, thus making it practically impossible to transmit the virus to anyone else, the 23-year-old told his Peace Corps health officer that he wanted to complete the remaining 18 months of his two-year term. But he was told that the Peace Corps did not accept volunteers who are HIV positive.

In fact, the Peace Corps agreed to stop automatically terminating HIV positive volunteers in 2008 after the ACLU advocated on behalf of a Peace Corps volunteer serving in the Ukraine who had become HIV positive. Under Trump, however, the Peace Corps has reversed this policy change. It also denied pre-exposure prophylaxis, or PrEP, for HIV prevention to Peace Corps volunteers who have requested it.

Domestically, the Trump administration has maintained steady attacks on transgender people. The Federal Bureau of Prisons announced in May 2018 that it will use “biological sex” to make initial determinations in the type of housing transgender inmates are assigned and will place transgender prisoners in facilities that conform to their gender identity only “in rare cases.” This reverses a 2016 policy that housed adult prisoners based on their gender identity, not their birth sex. The move is sure to undermine the safety and security of one of the most vulnerable prison populations and negates decades of progress on LGBT rights and protections that were reflected in 2012’s implementation standards for the Prison Rape Elimination Act.

Despite numerous attempts to implement a ban on transgender troops from serving in the military that has been blocked by the courts, the Trump Administration continues to look for innovative ways to discriminate. On the advice of the Family Research Council, an evangelical organization actively opposed to LGBT rights, the Trump Administration has tried to frame the transgender ban as a military readiness issue, despite evidence showing that transgender individuals are able to carry out their official duties with the same effectiveness as their cisgender counterparts and that there are no medical impediments to their service in the military.

Perhaps the most insidious move by the Trump Administration is its continued efforts to legalize discrimination under the guise of religious liberty. In January 2018, the U.S. Department of Health and Human Services created the Division of Conscience and Religious Freedom under the Office of Civil Rights (OCR). This division was created following a 2017 executive order by President Trump directing agencies to expand religious freedom protections in ways that could increase discrimination against LGBT individuals and same-sex couples. Also in early 2018, OCR collected public comments regarding a new proposed rule stating that “freedom from discrimination on the basis of religious belief or moral conviction…does not just mean the right not to be treated differently or adversely; it also means being free not to act contrary to one’s beliefs.” 

This exceptionally broad language opens the door for health care providers to deny not just general health care services to LGBT people, but also specific services such as STI screening to gay men, fertility treatments to lesbian couples, or gender affirmation treatment to transgender people if the provider holds anti-LGBT religious beliefs.

Taken alone, any one of these initiatives is a horrible step backward. Taken as a whole, though, it will take decades to unravel the damage.

Sean Cahill Ph.D. is director of health policy research for The Fenway Institute and co-author of the policy brief “Trump Administration continued to advance discriminatory policies and practices against LGBT people and people living with HIV in 2018.”

December 13, 2018

Close Sexual Groups/Networks Are Responsible for the High HIV Rates on The Gay Black Community


By Tim Fitzsimons( reports on LGBTQ news for NBC Out.)
Young black men who have sex with men (MSM) face a disproportionate risk of acquiring HIV because of “dense sexual networks” and other structural factors, not high-risk sexual activities, according to a new study conducted by Northwestern University.
The study, which was recently published in the Journal of Acquired Immunodeficiency Syndromes, surveyed MSM in Chicago and found young black MSM in the city are 16 times more likely to have HIV than their white counterparts, despite lower numbers of sexual partners, less unsafe sex and more frequent testing for HIV.
“Our study illuminates how HIV disparities emerge from complex social and sexual networks and inequalities in access to medical care for those who are HIV positive,” said senior study author Brian Mustanski, a professor at Northwestern’s Feinberg School of Medicine and director of its Institute for Sexual and Gender Minority Health and Wellbeing.
“Their social and sexual networks are more dense and interconnected, which from an infectious disease standpoint makes infections transmitted more efficiently through the group,” Mustanski said in a statement shared with NBC News. “That, coupled with the higher HIV prevalence in the population, means any sexual act has a higher chance of HIV transmission.” Other factors that researchers probed were stigma, victimization, traumatic experiences and sexual abuse. Young black MSM reported the highest rates of these risk factors, which, according to study co-author Michael Newcomb, contribute to the “difficulty in establishing viral suppression.”
Young black MSM, according to Newcomb, were also found to be the “most likely to have sex with people of their own race.” This, he added, means “it takes HIV less time to travel around that network, particularly if prevalence is already higher and viral suppression is already lower.” He also noted that there is stark racial and geographical segregation between white and black men who have sex with them in Chicago, which is a contributing factor.
While he Northwestern study looked specifically at Chicago, Mustanski said the higher incidence of HIV among young black MSM can be extrapolated in varying degrees to other parts of the country.
“National data also shows big differences in the rate of HIV diagnosis between black and white young gay men. There are large differences consistently found across different parts of the U.S.,” he explained. “In some cities, it’s three to five times higher; in other cities it’s as much as 20 times higher.”
Mustanski said the difference is particularly pronounced in the South, which is most impacted by new HIV diagnoses. “There is a history of large racial disparities in the South in terms of access to health care, poverty and education,” he said. In 2016, the Centers for Disease Control and Prevention announced that, if trends were to continue, half of all black gay men will acquire HIV in their lifetimes. But some places, like New York City, have made an impact on HIV incidence in black and Latino MSM populations, even while other places have seen disparities worsen.
Newcomb said this new study finally provides data to support what had up to this point been a widely held hypothesis: that the dense, segregated sexual networks of young black men who have sex with men are the main drivers of their higher HIV rates.
Ethan Morgan, a postdoctoral fellow at Northwestern’s Institute of Sexual and Gender Minority Health and Wellbeing and another of the study’s authors, said by learning more about young black MSM social networks, “we can better understand what drives such persistent racial disparities in HIV — and close that gap.”
Phill Wilson, president, and CEO of the Black AIDS Institute said he was not surprised by the study’s findings.
“If I am a black gay man and primarily sexually active with other black gay men, that fact alone puts me at higher risk,” Wilson explained. “If I am a white gay man, and I usually protect myself, and in the heat of a night I have an experience, my price for that experience is not the same as the price is if I am a young black gay man.” Because of “dense sexual networks,” which were pointed out in the Northwestern study, Wilson said a gay black man who “has one slip” by having unprotected sex with another gay black man has a higher chance of a “lifelong diagnosis, and then furthermore, he’s demonized.”
“You have folks who don't have as much information about things like TasP or PrEP or PEP, or even behavioral interventions,” he said, referencing new prevention methods that use HIV medications to eliminate the risk of HIV transmission.
“To be completely honest, the messenger matters, and there’s an infrastructure within black MSM communities,” said Wilson. “We are not going to solve the problem among this population unless and until institutions that are about, and by, and for them are properly, sufficiently supported with the infrastructure they need to succeed.”
Wilson pointed to proactive efforts by African-American community organizations like his own as a solution. Since opening a PrEP clinic, the Black AIDS Institute has increased the number PrEP-using black gay men in Los Angeles County by 50 percent, he said.

July 2, 2018

The Pill With The Capability to Stop HIV is Getting Priced Out of Reach

Public health officials are expanding efforts to get the HIV prevention pill into the hands of those at risk, in a nationwide effort to curb infections. But the officials are hitting roadblocks — the drug's price tag, which has surged in recent years, and changes in insurance coverage that put a heftier financial burden on patients.
Since brand-name Truvada was approved for HIV prevention six years ago, its average wholesale price has increased by about 45 percent. Now, the drug — which rakes in billions of dollars in annual global revenue for its manufacturer, Gilead Sciences — carries a list price of close to $2,000 for a 30-day supply. 
Most insurers cover the pill, also known as pre-exposure prophylaxis, or PrEP. It has been shown to be more than 90 percent effective in HIV prevention when taken daily, according to the Centers for Disease Control and Prevention.
But patients can get stuck with out-of-pocket costs that make the medicine unaffordable.
"If there is an example of the dysfunction in the American pharmaceutical system, it is this case," says James Krellenstein, a member of the AIDS advocacy group ACT UP New York. "We have the most effective tool for ending the HIV epidemic, and one reason we're unable to scale up because it costs so [much] unnecessarily."
As policymakers and the health system debate how to control ever-climbing drug prices, experts say this case underscores how patients are left holding the bag.
Private health plans are making patients responsible for a larger share of drug costs. And more are restricting the use of the "copay coupons" pharmaceutical companies have used to shield patients from out-of-pocket expenses. Insurers say the drug companies use coupons to steer consumers toward pricier meds. One way health plans are limiting their use is by no longer allowing them to count toward patients' deductibles. "This is one more thing that is going to push people off their medications," says Jim Pickett, a senior director at the AIDS Foundation of Chicago.
Jared Wile, who lives in Chicago, started taking PrEP about three years ago when he was dating someone with HIV. Wile, who has a $2,750 deductible, used a coupon to obtain the drug. He never paid anything out-of-pocket, he says.
Gilead waives up to $4,800 in out-of-pocket expenses for commercially insured patients.
That changed for Wile this past May when he learned the coupon no longer counted toward his deductible and that he would have to pay the full cost of the prescription — $1,600 per month — until he hit his deductible. Wile says he felt "blindsided" and stopped taking the medication.
Gilead spokesman Ryan McKeel says the company has made extra efforts to help patients overcome financial barriers. He cites assistance programs for uninsured and underinsured people.
"We have designed our assistance programs with the intent that people can benefit from their full value, and we cannot control the actions or decisions of health insurers," McKeel said via email.
The federal Centers for Disease Control and Prevention estimates that more than 1 million people are at high risk of contracting HIV, but Gilead says only about 167,000 people currently take PrEP.
Beyond the money crunch
Price is one of many barriers — alongside patients' lack of awareness and doctors' hesitation to prescribe — that threaten to exacerbate the already stark disparities in PrEP use and HIV infection rates.
One major disparity is along geographic lines. The South, for example, accounts for over half of new HIV diagnoses but only about 30 percent of new PrEP users, according to data from AIDSVu, which maps HIV disease and PrEP use. HIV rates and PrEP use also vary by race and ethnicity.
"We are not necessarily seeing that those most at risk are the ones starting PrEP," says Kristin Keglovitz Baker, the chief operating officer of Howard Brown Health, a Chicago health center.
Gilead has recently gone all-in with advertising to reach people at risk, including print campaigns and TV ads that will air through the summer. Since 2012, it has spent $28 million to fund U.S. organizations that seek to raise awareness of HIV, says McKeel, the company spokesman.
"We recognize that many people who are at high risk for HIV infection still face challenges in accessing Truvada for PrEP, and we are in regular dialogue with public health officials, advocates and physicians to better understand and, where possible, help to address these challenges," he added.
But price is also an impediment for publicly funded programs, which have limited budgets and are now shelling out more cash for the prevention effort.
"If it was only pennies ... we would be throwing it around," says Joey Mattingly, an assistant professor at the University of Maryland School of Pharmacy. "Because of how costly it is, we have to control it."
Some states — California and Florida among them — have launched PrEP assistance programs that can help patients cover the cost of the medication, along with required lab work and medical visits.
Beyond these state-based programs, some public health departments and HIV service organizations are hiring PrEP navigators to help patients traverse the maze of copays and deductibles and to improve recruitment and retention of new PrEP users.
Washington, D.C.'s health department has doubled down on prevention, and Truvada is key in that effort, says Michael Kharfen, the department's senior deputy director for HIV/AIDS, Hepatitis, STD and TB Administration.
Insurance usually covers PrEP, and patient assistance programs should fill any financial gaps, he says. But when that isn't feasible, the department steps in, distributing free Truvada starter packs to at-risk patients.
Kharfen says the city has in the past three years spent almost a million dollars just on Truvada pills, which it purchases at a discounted rate through the federal 340B program, which benefits certain health care providers that treat low-income people. And because of new publicity efforts, he expects the department will need to buy and distribute more pills — posing a conundrum.
Treating more people is net positive, he says. But "how do we sustain this?"
Medicaid programs generally cover PrEP, so they confront a similar situation. Outreach efforts lead to more beneficiaries who take the drug, but that, in turn, could subject the states' Medicaid budgets to financial hardship.
States are spending millions of dollars on the drug. California's Medicaid program, for example, spent about $50 million in 2017 and expects the costs to continue climbing. But officials said the expense is offset by long-term savings in preventing new HIV cases.
Massachusetts' Medicaid program spent about $22 million on Truvada that same year — about $18,000 per beneficiary, according to a spokeswoman for the agency's Executive Office of Health and Human Services. Those figures don't account for rebates the state receives from Gilead, which are undisclosed and considered proprietary information.
A complex solution and no competition
PrEP is only one part of HIV prevention, so help to pay for the pill is only one piece of the puzzle.
Patients also need regular HIV testing and medical care, which add to the cost borne both by patients and the health system. Some experts warn that Truvada's high price point could financially undermine such broad prevention efforts.
Competition could help.  
A generic version of the drug, manufactured by Teva Pharmaceuticals, is available abroad and gained approval for use last year from the federal Food and Drug Administration. When it becomes available in the United States, it could bring down prices, though it's unclear when that will happen. Gilead's own forecasts reflect that expectation, showing declines in future revenue from Truvada.
"When generics enter, brands lose market share," says David Howard, a health economist and professor at Emory University, who previously worked in the pharmaceutical industry.
For now, though, Truvada is the only PrEP option available in the U.S., he says. "From a company standpoint ... their best strategy is to make as much money as they can."
Kaiser Health News, a nonprofit news service covering health issues, is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente. KHN's coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

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