UNITED STATES: Study sees differences in how US Hispanics get HIV

Differing patterns of HIV transmission among US Hispanics suggest the need for more tailored prevention messages targeting this community, federal officials said.

A Centers for Disease Control report based on data from 33 states in 2005 found an association between how Hispanics become HIV-infected and where they were born.

Infection through male-to-male sexual contact was more common among those born in South America (65 percent of HIV cases), Cuba (62 percent) and Mexico (54 percent) than among Hispanics born in the United States (46 percent), the report said.

More Hispanics born in the Dominican Republic (47 percent) or Central America (45 percent) became infected through high-risk heterosexual sex than did US-born Hispanics (28 percent).

Puerto Rico-born Hispanics had a greater proportion of HIV infections due to IV drug use (33 percent) than did those born in US states (22 percent). In addition, immigrant injection drug users born in Cuba, Mexico, and Puerto Rico reported less HIV knowledge than did US-born IDUs, the report found.

“In terms of the prevention messages, if you are looking at Hispanics, you can’t look upon them as a monolithic group. You have to think about the various subcategories,” said Dr. Ken Dominguez, a CDC epidemiologist and co-author of the report.

The report’s findings are attributed in part to cultural and socioeconomic differences among Hispanic subgroups. “We’re a very diverse community,” agreed Dennis deLeon, president of the Latino Commission on AIDS in New York.

For Hispanic males, the main mode of HIV transmission was male-to-male sex (61 percent), followed by heterosexual sex (17 percent), and drug injecting (17 percent). For Hispanic women, 76 percent were exposed through heterosexual sex and 23 percent through drug injecting, CDC said.

Hispanics, who make up 14 percent of the US population, face disproportionate HIV rates, trailing blacks with the second-highest rate among all US racial and ethnic groups, the report noted. “The rate of HIV diagnosis for Hispanic males is about three times higher than the rate among white males. And for Hispanic females, it’s about five times higher than among white females,” said Dominguez.

The report, “HIV/AIDS Among Hispanics – United States, 2001-2005,” was published in CDC’s Morbidity and Mortality Weekly Report (Will Dunham, Reuters)

UNITED STATES: Merck’s new AIDS drug has promise – If it isn’t too pricey

The Food and Drug Administration is expected soon to approve Isentress (raltegravir), a new AIDS drug from Merck & Co. While the drug will be a welcome addition to the current arsenal of HIV medications, activists are watching closely to see how the company prices it.

Merck has not commented on pricing while it awaits the FDA’s decision. But if the price is set at the high end, “there’s no way the system could handle that,” said Lanny Cross, a former director of New York’s AIDS Drug Assistance Program and a consultant to the National Alliance of State and Territorial AIDS Directors.

Merck in the past has shown sensitivity to patients’ financial needs, said Martin Delaney, an AIDS activist with the Fair Pricing Coalition. He added, however, that in pricing negotiations, Merck executives have been “arguing they need to get profitability.” He said Merck has said it has spent nearly $2 billion on HIV drug research, and it has indicated that Isentress would be priced in line with the new drugs Prezista (Johnson & Johnson) and Reyataz (Bristol-Myers Squibb), which each cost about $9,500 a year wholesale.

According to the Kaiser Family Foundation, 20 out of nearly 60 US AIDS Drug Assistance Programs (ADAP) saw their budgets cut in fiscal year 2006, when they supplied the AIDS drugs taken by almost 100,000 US patients. ADAPs financial wellbeing, therefore, could affect Merck’s ability to set a high price for Isentress.

Last month, an advisory panel said study data support FDA approval of Isentress for patients who have failed on other HIV treatments. However, once the drug is approved, doctors could prescribe it off-label to patients at any phase of treatment. Merck is currently conducting late-stage trials of Isentress with treatment-naïve HIV patients; results are expected by the end of 2008.

Most other AIDS drugs fight HIV by interfering with protease and reverse transcriptase. Isentress will be the first drug to target integrase – the third enzyme essential for HIV’s replication in the body’s cells. (Sarah Rubenstein, Wall Street Journal)

AUSTRALIA: Dramatic upswing in number of HIV cases reverses earlier decline

A report by Australia’s National Center for HIV Epidemiology and Clinical Research (NCHECR) finds that new HIV diagnoses have increased by nearly a third in recent years, from 763 cases in 2000 to 998 in 2006.

According to the report, presented Wednesday at the Australasian Sexual Health Conference at the Gold Coast, New South Wales (NSW) was the only state to have its HIV infection rate remain level; in fact, it decreased to 5.9 infections per 100,000 people. Victoria’s rate increased from 2.9 per 100,000 in 1998 to 5.6 in 2006.

Don Baxter, executive director of the Australian Federation of AIDS Organizations, noted that NSW is the only state to continue to invest heavily in HIV prevention programs. “Victoria started disinvesting in AIDS from the mid ’90s [and] there is now general consensus that [a reduction] in funding for AIDS in Victoria has contributed to the rates being higher nationally.”

HIV/AIDS diagnoses were higher among homosexual men than any other group, and at least five times higher among persons born in sub-Saharan Africa than for the Australia-born population.

Chlamydia remained the most frequently reported notifiable infection, with 232 cases per 100,000; most infections involved people ages 20-29. (Bellinda Kontominas, Sydney Morning Herald)

CAMBODIA: Casual sex among Cambodia’s MSM an HIV timebomb

Men who have sex with men (MSM), but who may not consider themselves to be homosexual or bisexual, account for just 4 percent of Cambodian men but represent a serious challenge to AIDS control efforts.

Aggressive condom promotion and sex education campaigns largely targeting Cambodia’s sex industry have helped lower the country’s overall HIV prevalence to 0.9 percent of the 11.5 million population from a peak of 3.7 percent in 1997. But prevention messages have failed to reach MSM, who are now the group most vulnerable to HIV.

“There is a very serious concentrated epidemic among MSM,” said Tony Lisle, Cambodia’s UNAIDS country coordinator. “All the messages are around heterosexual behavior, particularly brothel-based sex work.”    

HIV prevalence among MSM is 8.7 percent – nearly 10 times the general prevalence rate. Rapid rises in other STDs indicate that fewer MSM are practicing safe sex. “The hidden MSM population is significant, and if we don’t avert new infections the MSM epidemic could contribute significantly to the overall [HIV] prevalence rate,” Lisle said. “There is a lot of stigma and discrimination. [MSM] would never identify themselves and that makes prevention very difficult,” said Lisle.

“MSM are at a higher risk of becoming infected with HIV because they usually don’t understand how it is transmitted. They think HIV only occurs among men and women who have sex and don’t use condoms,” said Sum Thy of Family Health International, which has surveyed thousands of men on their sexual behaviors.

Lisle is encouraged, however, by the establishment of a national MSM working group that is attempting to coordinate prevention programs and slow the rate of new infections. (Chan Soratha, Agence France Presse)

SOUTH KOREA: US entrepreneur tells condom experts: Size matters

At a conference in Seogwipo on South Korea’s Jeju Island this week, more than 100 representatives of condom manufacturers, government standards bodies, and aid groups examined 42 pages of specifications and testing requirements for condoms. Standards are crucial because condom failure could mean the spread of diseases and unwanted pregnancy.

“Our job is to do away with inferior condoms,” said Eng Long Ong, chair of the meeting and deputy head of the Malaysian Rubber Export Promotion Council. The council estimates that 13 billion to 14 billion condoms are manufactured each year.

Frank Sadlo, founder of TheyFit, which he said makes the world’s first custom-fit condoms, told delegates that updated standards should allow for greater variation in condom size. He noted that many men, given a choice, prefer condoms smaller than the standard minimum 6.3 inches. More than half order those less than 5.12 inches. Sadlo acknowledged that varying condom size would require standards and test equipment that could take another year for approval.                  

Ian Mantondo, an advisor to the Malawi Health Ministry, said the issue of condoms breaking in Africa had more to do with poor manufacturing than the size of men’s penises. He said female condoms are becoming more popular in Africa, where they are often distributed for free to empower women to take control of disease prevention.

Michael Reece, Director of the Center for Sexual Health Promotion at Indiana University, said more comfortable condoms result in more men using them. The five-day meeting is the 24th such conference since 1975. (Burt Herman, Associated Press)

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