EXPOSURE FEARED: 40,000 LV clinic patients urged to be tested for viruses

Syringe reuse at Endoscopy Center of Southern Nevada 'common practice'

Forty thousand Nevadans soon will receive word that they might have been exposed to HIV and hepatitis strains B and C in what a federal health official called the largest notification of its kind in U.S. history.

Patients who visited the Endoscopy Center of Southern Nevada at 700 Shadow Lane between March 2004 and Jan. 11 are being urged to get tested for the diseases as soon as possible.

Health officials cautioned them to practice safe sex and use condoms.

At a Wednesday afternoon news conference attended by health officials and doctors from the facility, officials said six people diagnosed with acute hepatitis C in recent months received treatment at the center near Valley Hospital Medical Center. They are believed to have been exposed to the disease when anesthesiologists reused syringes to administer medications.

The Endoscopy Center of Southern Nevada is a high-volume gastrointestinal practice where colonoscopies are frequently performed. Reuse of syringes and vials at the facility was a "common practice" undertaken by everyone from doctors to technicians, health officials said.

The business was investigated for other unsafe practices such as not properly cleaning endoscopic equipment used in colonoscopies and upper gastrointestinal procedures.

The medical facility was open for business Wednesday. It could be subject to sanctions or lose its Medicare contract at a later date, state health officials said.

Dr. Eladio Carrera, a gastroenterologist and internal medicine physician at the center, attended the news conference, but he did not address why he and other staffers did not follow correct medical procedures. In a statement, he expressed concern for patients, then refused to take questions.

Dr. Dipak Desai, the center's administrator, was not at the news event and could not be reached later at the office for comment.

LARGEST SUCH NOTIFICATION

"Las Vegas has the dubious distinction of having the largest patient notification of its kind," one involving the reuse of syringes and consequent spread of disease, said Joseph Perz, an epidemiologist with the federal Centers of Disease Control and Prevention in Atlanta.

Like some Nevada physicians, Perz said, he was stunned by the magnitude of what happened in Las Vegas.

"It certainly is unsettling to think of the scope of this,'' he said. "Let's not forget the impact on people when they receive the notification letter. A lot of people are going to lose sleep.''

Health officials began investigating the endoscopy center in early January after learning of three people who had been diagnosed with hepatitis C, a chronic, potentially lethal blood-borne virus that can cause liver cancer and liver failure.

The three other cases were identified later.

Each of the individuals underwent procedures requiring injected anesthesia at the medical center between June and September 2007. Five underwent the procedures on the same day at the facility, said Brian Labus, the health district's senior epidemiologist.

The health district subsequently notified the Nevada State Board of Licensure and Certification about the hepatitis C cases and the possibility that exposure occurred at the same medical facility.

The board inspects facilities before they accept patients to determine whether they meet construction requirements and health care regulations. The board also evaluates medical facilities to ensure they comply with the law and provide quality patient care.

After a joint investigation by the board and the health district, it was determined that syringes -- not needles -- and the use of vials of anesthesia medication on multiple patients were potential sources of infection.

A syringe would become contaminated by the backflow of blood when patients with a blood-borne disease were injected with medication, health officials said. That syringe, in turn, would be reused to withdraw medication from a different vial. That vial could become contaminated and result in infection.

During the investigation Labus said doctors, nurses and other medical personnel at the facility were asked whether it was the norm to reuse syringes and vials.

"They admitted, 'This is what we were told to do,' " Labus said.

So far there have been no cases of hepatitis B or HIV linked to the endoscopy center that have been reported to the health district.

INCUBANCY MIGHT BE KEY

Dr. Lawrence Sands, director of the health district, said at the news conference that it could be too early in the investigation for reports about HIV to surface, considering the incubation period for symptoms. Depending on an individual's health, symptoms of HIV might not appear for several years.

The incubation period for hepatitis C is six to eight weeks, and only 20 percent to 30 percent of people exposed actually have symptoms, Labus said.

"Hepatitis C is a serious medical condition,'' Sands said.

"As a precaution and in order to take appropriate steps to protect their health, it is important for these people to get tested and for anyone with the illness to seek medical attention.''

Health officials said Wednesday evening they don't believe the hepatitis C cases are the result of colonoscopies or gastroenterology procedures performed at the center, though the state licensing board referenced in its report problems arising from these procedures that could spread infection.

Lisa Jones, chief of the licensure and certification board, said the reuse of syringes and vials of medication were considered more of a public health risk than the fact that endoscopic equipment was not cleaned properly by clinic personnel.

Instead of cleaning one endoscope and then using fresh solution to clean another one, the same dirty solution would be used, the report states. Jones said one batch of cleaning solution should be used for a single endoscope or set of instruments.

But that issue was not raised at the news conference.

"I didn't want to go into too much detail (about the endoscopic equipment) because of time," Jones said in a telephone interview Wednesday evening. "We felt it was significant enough to cite (in the report) as a deficiency."

District Attorney David Roger said his office "will look at all the facts and circumstances of the Health District investigation" before deciding whether criminal charges are warranted.

When asked who would pay the costs of patients getting tested and treated for diseases spawned because of diagnostic procedures, health officials didn't have any immediate answers.

"That hasn't been worked out yet,'' Sands said. "We hope to get that worked out over the weeks that come.''

Dr. Cheryl Hug-English, associate dean of admissions and student affairs for the University of Nevada School of Medicine, said students are taught from their first year of medical school that what transpired at the Endoscopy Center of Southern Nevada "is not an acceptable practice."

"Certainly the standard of care for many years is not to reuse syringes," Hug-English said. "The proper practice is repeated and ingrained that syringes cannot be reused. ... We take this very seriously.''

In residencies, medical students are monitored by program directors on proper practice, she said.

Carrera, accompanied by Drs. Sanjay Nayyar and Clifford Carrol, said in the statement that the center wants "to express our deep concern about this incident to the many patients who have put their trust in us over the years.''

"As always, our patients remain our primary responsibility and we have already corrected the situation.''

Carrera went on to say that the investigation marked the first time "anything like this" has happened at the facility.

He said the center was "officially notified" of the hepatitis C outbreaks Feb. 6 and submitted a detailed plan of correction to the licensing board on Feb. 15.

Jones said the agency conducted an investigation at the facility from Jan. 9 to Jan. 17.

"This is beyond unfortunate,'' Larry Matheis, executive director of the Nevada State Medical Association, said after learning of the possible exposures. "Even in the early days of the HIV epidemic when I was the administrator of the Nevada State Health Division, I don't think we ever had a situation like this. ... I'm sure that's why the red flags went out. It's unusual to have an outbreak of hepatitis C.''

FOLLOW-UP WILL BE NEEDED

Matheis and other Nevada health officials said they couldn't recall such an event involving so many people occurring in the state.

Dr. Don Havins, chief executive officer and special counsel for the Clark County Medical Society, said he was alerted by the health district of the hepatitis C cases but wasn't made aware that five of the six people probably were exposed at the same facility on the same day.

He said that is a major concern because others treated that particular day will need to get tested.

"That's the most important thing right now, getting to those people,'' he said.

Matheis said the issue definitely requires follow up and intensive review.

He said the medical association will send information to all Nevada physicians to alert them about such mistakes. He said there might be a need to review Nevada laws to ensure that measures are in place to prevent future similar incidents.

"The Board of Medical Examiners also should be looking at this as well,'' Matheis said. "This is why we have systems in place, to make sure that patient safety is built-in and redundant practices don't occur.''

Evelyn McKnight, co-founder of Hepatitis Outbreak National Organization for Reform, a national advocacy group, said in an e-mail Wednesday that her heart dropped when she heard that 40,000 Nevadans were being notified they might be exposed to hepatitis C and B and HIV.

McKnight was one of 99 cancer patients infected with hepatitis C while undergoing cancer treatment at a Nebraska oncology center.

"Once again, we have an outbreak that involves two common elements -- an outpatient clinic and the reuse of medical equipment that is intended to be used only once,'' she said. "When we hold our restaurants to higher standards than our doctors' offices, that's a tragedy."

On Wednesday, Angelo Dominic, 76, sat in the medical building that houses the Endoscopy Center of Southern Nevada and shook his head in disbelief. Dominic, now being treated for prostate and heart problems, said he had a colonoscopy at the facility within the last year.

He couldn't believe medical personnel would have reused syringes.

"I was a medic in Korea, and I knew you could never do that," he said.

"I've had to deal with prostate cancer and now I have to worry about hepatitis and HIV. Why can't these people care about other people? Where do they come from?"

SOURCE: ANNETTE WELLS and PAUL HARASIM, Las Vegas Review Journal

Staying safe in the sack - Protection for All

There is an abundance of information out there about safety during straight sex, but what about gay sex? Whether you are gay, bisexual or just curious, you should make sure you know your facts and your options before you have sex.

Q: I know the standard run-of-the-mill issues that come along with straight sex, but I'm bi, so what do I need to know about the risks that come along with gay sex?

A: I think one of the most incorrect assumptions society makes is that people can't contract sexually transmitted infections if they are having sex with someone of the same gender. This is not true. Though it's always a good idea to use protection, we can't always be certain of our partner's STI status, so you should take some precautions to protect both of you.

If you are engaging in lesbian sex, you should be focusing on the use of barriers. Barriers like a dental dam are most effective. According to Brown University's student health website, "dental dams are small, thin, square pieces of latex that are used for oral-vaginal or oral-anal sex.” They are placed between the giver's mouth and the receiver's vulva or anus. If used correctly, these should block the passing of potentially dangerous fluids both from the vagina and from the mouth.

If you don't want to buy dental dams, Brown's website suggests that you can use a latex glove, regular condoms or they also recommend using Saran Wrap. If you choose Saran Wrap, Brown’s website says "it is important that it be non-microwavable because the pores in microwaveable saran wrap are large enough to allow viruses and bacteria to pass through." Who knew?

If you are using sex toys, these also need to be cleaned or protected when going from one person to another. In addition to that, use toys that are made of non-porous and nontoxic materials like silicone. These kinds won't absorb very much fluid, keeping you safer.

For gay men, there are also some things to remember during sex. For male-to-male oral sex, a regular condom can be used to block the spread of fluids from the mouth to the penis and vice versa. If you can't stand the taste of latex, you have the option of using flavored condoms or flavored lubricant. They come in all flavors, so you won’t be stuck with something you find gross.

When having anal intercourse, a condom also should be worn because most infections, like HIV, are most easily spread through anal intercourse. Because most people find that they need a lot of lubricant during anal sex, check to see if you are using the right kind. Oil-based lubricants like Vaseline can ruin the latex of the condom, so make sure that your lubricants are always water-based when condoms are involved.

To be safe when having gay sex, you need to focus on keeping your fluids away from your partner's, as is also true with straight sex. It's just that some of the details are a little different.

SOURCE: Tiffany Harms, dailyevergreen.com

HIV Stigmatization Still Widespread

Stereotypes and misinformation about HIV that are commonplace among the general public are also evident in a surprising number of clinical staff, a study from the University at Buffalo has found. Published in the journal AIDS Patient Care and STDs, Lance S. Rintamaki's study shows that more than 25 years after its discovery, HIV still has the power to generate a broad array of stigmatizing behavior. People infected with HIV have previously labeled dealing with stigma as the most significant social and psychological challenge of the HIV experience and Rintamaki's study shows little has changed.

Sufferers' experiences were categorized by the type of stigmatizing behavior that they experienced most often in the presence of health-care personnel. These categories were: lack of eye contact; assuming physical distance; using disdainful voice tone or inflection; asking confrontational questions; showing irritation, anger, nervousness, fear or panic; taking excessive precautions; scaring, mocking, blaming or ignoring patients; providing substandard care or denying care, and being generally abusive.

Stigmatizing experiences included judgmental behavior and panic on the part of providers when informed of a patient's HIV status, doctors "hermetically sealing" themselves before approaching the patient and patients being told they were going to die. Participants described being blamed openly by health-care providers for their condition. One patient told of being scolded by a phlebotomist; "If you hadn't done this to yourself, we wouldn't have to be going through this!" when he objected to being "poked" painfully several times as she searched for a viable vein to draw blood.

Other reports included the hospital worker who refused to mop the floor in an HIV patient's hospital room, the dentist who turned away a patient because of his HIV status and rough-handling by paramedics. One participant said he had so little eye contact with his neurologist that he couldn't describe the doctor's face. Another participant recounted a nurse's disdain when she delivered his AIDS diagnosis: "It was just so callous and cold the way she said it; 'You have AIDS.' There was no feeling. It's almost like a stone-faced warden or something. No concern."

"Given patients' sensitivity to any indication of bias or discrimination, it's likely that even well-intentioned health-care personnel sometimes engage in behaviors that are interpreted negatively by their patients," said Rintamaki. "The findings from this study give health-care personnel additional insights on what to avoid, or if certain protocols are standard procedure, what to explain further. These approaches might help to prevent misunderstandings."

SOURCE: Kate Melville, scienceagogo.com

Anti-HIV Gel Proven Safe, Tolerable For Women

Newswise — An experimental anti-HIV gel is safe for women to use on a daily basis, according to researchers at the University of Alabama at Birmingham (UAB) and the University of Pittsburgh School of Medicine.

In testing, the gel, called tenofovir, was favorably self-applied and tolerable to non-HIV-infected women, a significant boost to HIV and AIDS prevention efforts focused on next-generation microbicides to reduce infection rates, the researchers said.

The women study participants said if tenofovir gel is approved for the prevention of HIV infection, they would be willing to apply the gel to themselves daily or before sex, whichever is determined the best use.

“The gel is safe to use, and well tolerated by HIV-negative women. That’s a key message in our findings,” said Craig Hoesley, M.D., associate professor in the UAB Division of Infectious Diseases and author on the initial Phase II results. “This sets the stage for larger studies to see if tenofovir can prevent HIV infection.”

The tenofovir Phase II trial results were presented Monday, Feb. 25 at an international microbicides meeting in New Delhi, India. The researchers are part of the U.S. National Institutes of Health-funded Microbicide Trials Network, an international team of researchers devoted to exploring and evaluating anti-HIV microbicides.

“Based on what we have learned we can proceed with greater confidence on a path that will answer whether tenofovir gel and other gels with HIV-specific compounds will be able to prevent sexual transmission of HIV in women when other approaches have failed to do so,” said Sharon L. Hillier, Ph.D., director of reproductive infectious disease research at the University of Pittsburgh School of Medicine and principal investigator on the Phase II study.

Researchers evaluated if tenofovir was safe to use every day for six months, or safe to use prior to each act of intercourse. They found both approaches equally safe. Women in the study were asked to use condoms in addition to the gel.

Researchers found no disruption of liver, blood or kidney function in each group of women using a different gel regimen, including those given a placebo gel that looked and felt identical to the tenofovir gel.

The study included 200 sexually active HIV-negative women enrolled at UAB, Bronx-Lebanon Hospital Center in New York and the National AIDS Research Institute in Pune, India. Participants were age 19 to 50, and 64 percent were married.

In addition to the safety findings, researchers found women in the study significantly willing to follow the gel-apply guidelines. Eighty percent of the women instructed to use the gel within two hours of having sex said they followed instructions, and 83 percent instructed to use the gel daily said they had done so in the week prior.

Hoesley said if the gel were approved to help prevent HIV infection, more than 90 percent of the study volunteers said they would seriously consider using it, regardless of the regimen, to protect their sexual health.

“We asked women ‘How acceptable is this as a prevention option, is it too messy, is it a nuisance, and will you use it?’ Our study showed they will use it and they’re not bothered by the gel,” Hoesley said.

The active ingredient in tenofovir gel is a class of anti-retroviral drugs called nucleotide reverse transcriptase inhibitors, which act against HIV by blocking the virus’ ability to replicate and grow inside the body.

Tenofovir was developed by Gilead Sciences, Inc., of Foster City, Calif.

The Microbicide Trials Network was established in 2006 by the National Institute of Allergy and Infectious Diseases with co-funding from the National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the National Institutes of Health.

SOURCE: University of Alabama at Birmingham, NEWSWISE.COM

Stimulating Thymus Reactivates T-Cell Production

FRIDAY, Feb. 22 (HealthDay News) -- It's possible to stimulate the thymus gland to produce new immune system T-cells in adults infected with HIV, U.S. researchers say.

HIV infection destroys T-cells, which leads to the collapse of the immune system and severe infection. The thymus gland produces T-cells early in life but gradually loses function and becomes mostly inactive in adulthood. That means it's difficult for HIV-infected adults to produce new T-cells to rebuild their depleted immune systems.

It has long been believed that it wasn't possible to reactivate T-cell production in the thymus. The new study, by researchers at the Gladstone Institute of Virology and Immunology and the University of California, San Francisco (UCSF), is the first to show that therapy can help boost thymus function in adults.

The two-year study of 22 HIV-infected adults found that treatment with growth hormone (GH) increased thymus mass and more than doubled the number of newly made T-cells. The results are published in the March issue of the Journal of Clinical Investigation.

"These results represent new proof-of-principle findings that thymic involution can be reversed in humans," study author Dr. Laura Napolitano, an assistant investigator at Gladstone and an assistant professor of medicine at UCSF, said in a prepared statement.

"Improved T-cell production may be helpful for some medical conditions such as HIV disease or bone marrow transplantation. These findings contribute new information to our understanding of T-cell production and are also an important step to determine whether immune therapies might someday benefit patients who need more T-cells," Napolitano said.

However, much more research is needed to determine whether stimulating production of new T-cells actually provides a health benefit for HIV patients or anyone else, the researchers said.

SOURCE: Forbes.com

One in five HIV patients in New York say they never use condoms

Approximately one-fifth of HIV-positive patients report never using condoms with regular or casual partners in a study conducted in New York and published in the February edition of AIDS Patient Care and STDs. Inconsistent use of condoms was associated with the presence of symptoms of depression, and most of the patients reporting unprotected sex had a detectable viral load.

Although the investigators found no link between use of antiretroviral treatment and inconsistent or non-existent condom use in their multivariate analysis, they did find that patients who reported poor adherence to antiretroviral therapy were more likely to never or inconsistently use condoms.

Patients in the study were asked about their sexual behaviour and adherence using an audio computer-assisted self-interview and the results of this interview were made available to their doctors. The investigators suggest that these interviews could be used to identify “a core group of nonadherent patients who do not consistently use condoms, and then deliver targeted intensive psychosocial services and prevention interventions to them.”

Thanks to the success of antiretroviral therapy people with HIV can live, longer, healthier lives. This good health means that individuals with HIV are likely to remain sexually active. Therefore HIV prevention efforts are being focused on people with diagnosed HIV infection and in 2003 the US Centers for Disease Control and Prevention announced an initiative to screen for sexual risk behaviour during HIV clinic appointments.

Investigators wanted to see if audio computer assisted interviews were a successful means of obtaining information about issues including sexual risk behaviour, adherence to antiretroviral therapy, and the presence of depressive symptoms.

A total of 198 patients at two HIV clinics with a predominately Latino population were recruited to the study in 2004. The patients were told that their answers during the computer-assisted interview would be provided to their HIV doctor.

Three quarters of the patients were Latino, 36% were gay/men who have sex with men, and 25% were women.

In the four weeks before the study, 65% reported being sexually active, with 24% reporting a regular partner only, 5% a casual partner only and 35% both a regular and a casual partner.

Of the patients who reported sex with a regular partner, 34% said they didn’t always use condoms and 18% said they never used condoms. Of the patients who said they had had sex with a casual partner, 26% reported not using condoms every time and 15% said they never used condoms. Overall 35% of sexually active individuals reported inconsistent condom use and 19% reported never using condoms.

Women were more likely than men to report never using condoms (32% vs, 15%, p = 0.047), and heterosexuals were more likely than gay men to report not using a condom every time with a regular partner (p = 0.04).

Taking antiretroviral therapy was associated with inconsistent condom use with regular partners in univariate analysis (p= 0.05). But this association disappeared in multivariate analysis that adjusted for age, race, gender and HIV transmission category. In multivariate analysis, the only factors significantly associated with not using condoms were self-reported depression (p = 0.03) and self-reported poor adherence to antiretroviral therapy (p = 0.02).

Of the patients who reported never using condoms with regular partners, 76% had a viral load above 400 copies/ml. All the patients who reported never using condoms with casual partners had a viral load above 400 copies/ml.

“We found that almost one fifth of those who had been sexually active in the past four weeks reported never using condoms with their regular or casual sex partners. Over one third of these patients reported not using condoms every time”, comment the investigators.

“Most patients with recent HIV RNA results who reported unprotected sex…had detectable HIV RNA”, the researchers observe, adding, “the fact that a substantial number of patients with detectable HIV RNA are practicing unprotected sex is a serious concern.”

The investigators acknowledge that their study had some limitations, including the lack of diversity in the population. Nor were the investigators able to say if patients were having unprotected sex with partners of the same HIV status, or if men were adopting “strategic positioning” (assuming the receptive role with men who were HIV-negative or of unknown HIV infection status).

SOURCE: Michael Carter, aidsmap.com

Clueless on STDs, Throat Cancer, and Oral Sex

There's an argument out there that oral sex is not sex. For some grown-ups, it's a way to deny that they're cheating. To some young people, oral sex preserves virginity—technically speaking—and allows for what is perceived as risk-free sexual intimacy. From a medical perspective, however, this is sex—and generally, as practiced, it's unsafe. People seem clueless that sexually transmitted diseases such as herpes, gonorrhea, chlamydia, and human papillomavirus can take hold in parts of the oral cavity during sex with infected partners and that the oral contact can infect the genitals, too. HPV is a particularly scurrilous threat, since it incubates silently in the back of the mouth and is now linked to a dangerous form of throat cancer in both men and women similar to the one that arises in the cervix.

Head and neck cancers, which can attack the mouth, nose, sinuses, and throat, have been diseases of people over 50 with a history of heavy smoking and drinking. Thanks to the decrease in smoking and use of chewing tobacco, these disfiguring cancers are in steady decline. However, this triumph of prevention is clouded by an unexpected increase in oropharyngeal cancer, which develops in the tonsils and the base of the tongue and is apt to show up in those who don't smoke or drink heavily, and in younger people. Earlier this month, researchers from Johns Hopkins reported in the Journal of Clinical Oncology that between 1973 and 2004 there had been a near doubling of the incidence of these HPV-related oral cancers among people in their 40s.

It doesn't take Sherlock Holmes to figure out that this rise in oropharyngeal cancer is linked to changing sexual practices and, in particular, ones that involve bathing the throat with HPV-infected fluid. Increasingly, scientists are implicating HPV-16, and in some cases 18, the same ones that causes cervical cancer. In 2006, a Swedish study of preserved surgical specimens from excised oropharyngeal cancers going back over 30 years identified HPV-16 in less than a quarter of specimens removed in the 1970s. By the 1990s, the proportion was 57 percent. After 2000, it was 68 percent. In 2007, a study published in the New England Journal of Medicine found HPV-16 in 72 percent of oropharyngeal cancers in the United States. Not proof, but based on correlations with sexual behavior, and an abundance of similar findings both here and around the world over the past few years, there is credible if not alarming medical concern that the infection is being acquired through unprotected oral sex.

That our children might be at growing risk for this deadly cancer is particularly unnerving. Health surveys indicate that well over half of American teens now engage in oral sex, with about 10 to 20 percent claiming "technical virginity." Pediatricians will tell you that this behavior is fueled by the adolescents' belief that oral sex is risk-free play, making it more common and acceptable. But few practice it safely. Some of this is anecdotal. But British researchers determined that more than 80 percent of university students ages 16 to 21 failed to protect themselves with condoms during oral sex. This is an age group well known for diligently using them during vaginal sex.

Granted, the major risk for STDs comes with vaginal sex, but the relative ease and growing frequency of oral sex among those engaging in casual "hookups" is a virtual epidemic in the making. Providing our young people with graphic medical information and stern parental and medical guidance is long overdue. As with all sex education, the abstinence message should be foremost and explicit. But it's not enough. They must also know that safe sex applies to sex by mouth, too. And, that's a message for all ages, unless one has a single faithful partner.

Concern about the growing risk of oropharyngeal cancer also bears on the use of the new HPV vaccine, Gardasil, which protects against HPV-16 and 18. Currently it's approved for young women only. Yet men contract, carry, and transmit HPV and develop HPV-related genital cancers, though far less commonly than do women. But, when it comes to HPV-related tonsil and tongue cancer, men are at greater risk than women. This should provide strong impetus for an HPV vaccine that works for men, too—an effort that's taking an inexplicably long time. Before anyone thinks, however, that a cancer vaccine will deliver a free pass on risky behavior, just imagine for a moment what a rip roaring case of pharyngeal gonorrhea might look like. It's not pretty.

SOURCE: Bernadine Healy M.D., USNEWS.COM

5 things you didn't know about HPV

1 Cancer connection: There are more than 100 types of Human papillomaviruses or HPV, the most common sexually transmitted infection in the United States. Most are harmless, but about 30 types put you at risk for cancer. Almost all women will have HPV infections at some point, but very few will develop cervical cancer; their immune systems will usually suppress or eliminate HPVs, says the Centers for Disease Control and Prevention. Only HPV infections that do not go away over many years lead to cervical cancer.

2 How you get it: Through skin-to-skin sexual contact with an infected partner. Transmission by genital contact without intercourse is not common, but it has been reported. Oral-genital and hand-genital transmission of some HPV types is possible, says the American Cancer Society.

3 Common: Infection is very common soon after a woman becomes sexually active. In one recent study, more than 50 percent of college-age women were found to have acquired an HPV infection within four years of first having sex, says the American Cancer Society.

4 Prevention: Abstinence or a long-term, mutually monogamous relationship with an uninfected partner, although it's difficult to tell if a partner who has been sexually active in the past is infected. Correctly using latex condoms greatly reduces the risk, but it doesn't completely protect because areas not covered by a condom. A new vaccine called Gardasil is recommended for 11- and 12-year-old girls before their first sexual contact. Another promising vaccine, Cervarix, is being tested, but hasn't been approved yet. Studies suggest the vaccines can protect against some HPV for at least four years; the need for a booster vaccine is being researched. A controversial Florida bill that would have required all sixth-grade girls to be vaccinated died in the Florida Legislature last year.

5 Guys: HPV also can cause genital warts, penile and anal cancer. It now causes as many cancers of the upper throat as tobacco and alcohol, probably due both to an increase in oral sex and the decline in smoking, researchers say. A vaccine for boys may soon become available, which also would help prevent men from spreading the virus to women.

SOURCE: JODI MAILANDER-FARRELL, MIAMIHERALD.COM

Anti-AIDS gel disappoints, failing to prevent HIV infection in study of African women

Monday, February 18, 2008
By MARILYNN MARCHIONE, AP
chinapost.com.tw

The first anti-AIDS vaginal gel to make it through late-stage testing failed to stop HIV infection in a study of 6,000 South African women, disappointed researchers announced Monday.

The study was marred by low use of the gel, which could have undermined results, they said. Women used it less than half the number of times they had sex, and only 10 percent said they used it every time as directed.

Scientists are still analyzing the results to see if this made a difference. They also plan more tests on a revamped gel containing an AIDS drug that they hope will work better.

The gel used in the current study did prove safe, however, and researchers called that a watershed event.

But for now, the effort is the latest disappointment in two decades of trying to develop a microbicide - a cream or gel women could use to lower their risk of getting HIV through sex. A female-controlled method is especially needed in poor countries where women often can't persuade men to use condoms.

A year ago, scientists stopped two late-stage tests of a different gel after early results suggested it might raise the risk of HIV infection instead of lowering it.

The new study tested Carraguard, a microbicide developed by the nonprofit, New York-based Population Council. It contains carrageenan, which comes from seaweed and is widely used in the food and cosmetics industries as a gel, stabilizer and thickening agent. Lab, animal and early human tests suggested it might prevent HIV and other sexually spread infections.

The latest study was done from March 2004 through March 2007 in Gugulethu, Isipingo and Soshanguve, all in South Africa.

More than 9,000 women, average age 31, volunteered for the study. About 27 percent tested positive for HIV and were disqualified. In all, 6,202 women were randomly given either Carraguard or a placebo gel. Neither the women nor the study staff knew who received what. All received safe-sex counseling and condoms.

Women participated from nine months to two years, with 4,244 completing the study. About 18 percent dropped out, often because they became pregnant and the gel is not known to be safe for use in pregnancy. Another 13 percent could not be found for follow up information.

At the end of the study, there were 134 new HIV infections in the Carraguard group and 151 in the fake gel group - a rate of 3.3 infections per 100 women each year in the microbicide group and 3.7 for the placebo group.

"The results are comparable," with no statistically significant difference, said Khatija Ahmed, a microbiologist who headed the study's Setshaba Research Centre site near Pretoria.

However, women in the study used the gels only 44 percent of the time, and some used it hardly at all. Researchers are still analyzing the numbers to see what that means. If nonuse was far greater in the microbicide group than the placebo group, "it could have had an impact on our final study results," said Barbara Friedland, the study's behavioral coordinator.

A plus: reported condom use doubled, from 33 percent at the start of the study to 64 percent during it. Other sexually spread infections declined.

The study was paid for by the Bill & Melinda Gates Foundation and the U.S. Agency for International Development, or USAID.

Jeff Spieler, an official at USAID, called the trial "groundbreaking work" in a statement. "We have always known that the path to developing a successful microbicide would be a long one."

The Population Council hopes to start tests this year of a revamped Carraguard containing an experimental AIDS drug, MIV-150. The group also has studies under way of a contraceptive version of the gel, Carraguard plus hormones.

Web site allows anonymous warning of STD infections

NEW YORK (Reuters Life!) - A Web site that enables people with sexually transmitted diseases (STDs) to send anonymous email warnings to their partners could help slow a rise in new infections, a New York health official said.

InSpot.org uses the E-Card model to send messages like "I'm So Sorry" to notify people that they may have been exposed to a disease. It also offers information about getting tested and treatment.

"Making use of some of the emerging technologies makes sense," said Sue Blank, of New York's Department of Health and Mental Hygiene.

"We're getting the word out to the community."

Blank hopes the site will help to reduce new syphilis infections in New York which rose by 56 percent during the first half of the current fiscal year.

Users of the site, which went online in San Francisco in 2004, can choose from a selection of messages.

"It provides an easy, convenient, anonymous way for people to be responsible about notifying their partners about a possible exposure to an STD," said Deb Levine, of the San Francisco Internet Sexuality Information Services, which created InSpot with the city's Department of Public Health.

There are 15 million new cases of STDs in the United States each year, according to the Web site. The rise in syphilis in New York mirrors a national trend that shows syphilis has risen sharply among gay and bisexual men in the United States this decade.

Levine said that in San Francisco, syphilis rates have fallen since the site was introduced.

In addition to New York and San Francisco, the Web site is now active in six other U.S. cities. It has also been launched in eight U.S. states, as well as two Canadian cities and Romania.

SOURCE: Edith Honan, Reuters.com

USC students' demand for condom dispensers denied

Since administrators decided against installing condom machines in University of South Carolina residence halls, students will have to go a little further for safety when they want to go all the way.

The Residence Hall Association, representing student residents, took an opinion poll that found most USC students wanted condom machines installed in dorms. Student residents and the RHA alike said the administration's decision was a disappointment.

The school is reluctant to install these machines because the administration fears it will hurt its public image, said Assistant Director of Student Learning Sean McGreevey.

"The university's number one concern is recruitment and retention," he said. "There is a proportion of people out there who will view these machines negatively and the administration has to take that into account."

SOURCE: Kimberly Wexler, www.dailyfreepress.com

Though the school decided against installing in-dorm condom machines this year, the RHA and the administration will continue discussing the possibility of installing them in the future, said RHA President Amanda Pippin.

"I think if these condom machines prevent even one couple from engaging in unsafe sex, then the project of installing them would be worthwhile," she said.

Pippin said the RHA plans to tackle the image issue by installing the machines in areas accessible only to dorm residents, avoiding public bathrooms or dorm lobbies.

"They will only be available and noticeable to the residents of that particular dorm," she said.

USC freshman Ben Orpizcolon said the public's perception of in-dorm condom machines will vary, but the machines will ultimately benefit students. Though residence advisors make condoms available, he said, many people are embarrassed about something so personal.

"It would benefit students and encourage safe sex to have them available in the dorms," he said.

While Northeastern University has condom machines in some residence halls, Northeastern student health representatives would only confirm the school has them and declined further comment.

Boston University Student Health Services offers free condoms in its office waiting area and allows students to purchase up to 20 condoms for $5.

BU spokesman Colin Riley said regardless of image, BU does not need condom machines in dorms because there is no shortage of places that sell condoms on or near campus.

"We believe that our students are mature and able to make these decisions responsibly," he said. "Practicing unsafe sex is a sign of immature and uninformed decision making, especially because condoms are available all over the city."

SOURCE: Kimberly Wexler, dailyfreepress.com

Contraception: It's better to be doubly safe than sorry

A new study indicates that the safe sex message is getting through to Australian women, with nearly 70 per cent of those surveyed currently using contraception and 15 per cent using not one but two contraceptive methods to prevent pregnancy and protect themselves from sexually transmitted diseases.

The study, by Dr Nick Parr and Dr Stefania Siedlecky from Macquarie University's Demographic Research Group, was published recently in the Australian and New Zealand Journal of Public Health.

It uses survey data from more than 3000 women aged between 18 and 44 about their contraceptive use. The variation in the seven most prevalent contraceptive practices between different age groups, marital status, parity, education level, place of residence, birthplace, and Aboriginal or Torres Strait Islander descent was examined.

Results showed that education, cultural factors arising from ethnic background and the nature of sexual and family relationships were all important factors in determining contraceptive choices.

Two-thirds of respondents were using contraception, including more than 15 per cent who used more than one method. The contraceptive pill was the most widely used method (39 per cent), followed by the condom (28 per cent). Interestingly, more than one-quarter of pill users (28 per cent) were using condoms as well.

"Following its introduction in 1961, the oral contraceptive pill was rapidly adopted by Australian women, while the use of other methods, including condoms, declined," explain Parr and Siedlecky. "However, the arrival of HIV/AIDS in Australia in 1982 focused attention on the public health implications of contraceptive use, particularly the importance of condom use. Consequently condom use increased.

"Condoms are the only contraceptive that protect against sexually transmitted infections and HIV/AIDS for both men and women. However, since the condom alone is less effective as a contraceptive than hormonal methods and intra uterine devices (IUDs), the twin goals of preventing the spread of STIs and preventing unwanted pregnancy through the simultaneous use of both the pill and the condom - so-called dual protection - has been advocated."

While the study indicates that the use of the Pill and the increasing use of dual protection methods have been adopted by most subgroups, it appears a more widespread use of condoms is required among particular groups.

"Women under 25 and students were found significantly more likely to use the combination of pill and condom," say Parr and Siedlecky. "This could reflect a greater number of sexual partners in this demographic and the associated greater need for protection against both STIs and unwanted pregnancy.

"However, rising rates of chlamydia and gonorrhea indicate there is still a need for more widespread use of condoms, either as a single method or combined with other methods. High rates of STIs and lower levels of condom use, either alone or in combination, may also be an indication of a greater need for education and access among people living in remote Australia or for those of Aboriginal or Torres Strait Islander descent."

SOURCE: Macquarie University, PHYSORG.COM

Free love isn't

Ah, the swinging 60s and 70s. Those were the days. Sex was an egocentric activity engaged in, solely and indiscriminately, for pleasure.

"Spreading the love" was a humanitarian activity, not a euphemism within the medical community for the increased distribution of STDs among the population. This was all, of course, before the official discovery of AIDS by the Centers for Disease Control and Prevention on June 5, 1981.

After the discovery of AIDS, using protection such as condoms became the expectation and the norm for highly developed societies.

Or did it? Judging by the way college students have sex today, one might think that it was 1972 and not 2008. Several students interviewed admitted to having unprotected sex regularly, though they are informed of the risk involved.

In a random Hodges Library sample, 8 out of 10 students admitted to having unprotected sex at least once.

Some of the comments that were shared regarding their decisions:

"Sex feels better without a condom."

"I was drunk, and it was only one time."

"I haven't gotten anything yet."

"Condoms suck."

"I didn't want to, but she said she was clean."

"I trust him."

News flash: It only takes one unprotected sack session to contract an STD. There is no way to tell if someone is "clean" other than getting tested.

Most males have never been tested. A Pap test (standard yearly procedure for females) only screens for abnormalities. Separate tests are required for most STD diagnoses, including HIV and herpes. Most women do not know this.

Condoms are not a get-out-of-jail-free card. Per the back label of a Trojan, "If used properly, latex condoms will help to reduce the risk of transmission of HIV infection (AIDS) and many other sexually transmitted diseases. Also highly effective against pregnancy."

Many STDs, such as Chlamydia, HPV (Human papillomavirus, aka genital warts), herpes, and HIV, can remain symptom less for months, or even forever. A person can be a carrier, spreading the disease to many others, without ever having a single outbreak.

Alternatively, a person aware that they have the disease can still spread it to others, regardless of whether or not they're having a visible outbreak.

Hold the phone. So are we just supposed to not have sex, ever? Not exactly. But with the STD rate steadily climbing, so is the average sexually active person's risk of exposure. Condoms aren't a guarantee, but they are a fairly sure bet, and certainly better than nothing.

Never engage in unprotected sex outside of a solid monogamous relationship. If you happen to be a swinging single with raging hormones, be a smart swinging single. Get tested regularly. And never dismiss the often overlooked joys of frottage and heavy petting.

SOURCE: Katherine Leone, tnjn.com

Sex with your Valentine

Valentine's Day is fast approaching and among the chocolates and the flowers and the paper hearts, all inscribed with endearing words, there will also undoubtedly be a lot more "love making" happening than usual. Given this fact, National Condom Awareness Week, which has been recognized by the American Social Health Association, occurs annually around Valentine's Day. This year it is being held on Feb. 10 to Feb. 17 and intends to promote the use of condoms as a preventative against unwanted pregnancy as well as some sexually transmitted diseases.

According to research done by staying-alive.org,, 62 percent of young men and women do not use condoms every time they have sex. This is an alarming number considering that the incidence of AIDS stands at about 40,000 newly reported cases each year, 25 percent of which are persons between the ages of 15-29. New York also has one of the highest infection rates as well, second only to the District of Columbia. Given all of these facts, we would think that more than 38 percent of sexually active youths would use condoms before "doing the deed."

Why are there so few consistently responsible youths? We could surely attribute the nonchalance about the topic to the fact that there are several myths about condoms and their use. The top five "Condom Myths" that I have found consistently in my research are as follows:

Myth#1 Condoms break anyway.

Condoms don't break, the users break them. The likeliness of a condom being broken in the package or during intercourse is slim, and the breaks are typically due to human error and possibly a hasty hand. If the condom is put on properly, it should remain in tact.

Myth #2 Condoms don't protect me from STDs.

Condoms are actually very effective in preventing the spread of both gonorrhea and chlamydia as well as the most severe of them all, HIV. While it is never 100 percent fool proof, it has been shown to be "your best bet" in protecting yourself against these life-altering diseases.

Myth #3 Condoms don't fit well. They hamper my pleasure.

Modern times have allowed for the technology to creation condoms that are said to be quite comfortable and may even enhance pleasure during intercourse. It's all simply a matter of taking the time to identify the right fit and moving forward from there.

Myth #4 I'm allergic to latex.

There are alternatives to latex condoms that are just as effective in preventing pregnancy and disease. The most notable is the polyutherane condom, which is made from a plastic derivative. It may typically be a bit more expensive, but not nearly as expensive as the college tuition you would have to pay for the baby that you could potentially have.

Myth #5

Condoms are not that effective.

Condoms, when used properly, are 99.8 percent effective. That leaves you with a 0.02 percent chance of getting pregnant as opposed to a 99 percent chance of getting pregnant by not using one. I think the first alternative makes the most sense.

Now that you are armed with these facts, please be safe always. For National Condom Awareness week, we have a New York based group coming to campus on Wednesday, Feb. 13 to the VC's 2nd floor lobby from 12:30 p.m. - 2 p.m. to share information with students on condoms and emergency contraception.

In addition, the Baruch Health Care Center will have a representative during club hours on Thursday, Feb. 14 to hand out free condoms to ensure that everyone has a safe and very happy Valentine's Day.

SOURCE: Taheera Tm Kee, media.www.theticker.org

Safety is sexy, chlamydia is not

Back in the day it was called VD for venereal disease. And then we had STD for sexually transmitted disease. At present, the medically appropriate term is STI, for sexually transmitted infection.

The terminology changes, as does the awareness about them and the number of people afflicted. With an increase in education and awareness about condoms and STI testing, one might think that the numbers are going down. But the horizon ain't totally rosy. Let's check in on some stats of those with bacterial ants in the pants.

There is some good news, particularly on the increasingly less grim front of HIV/AIDS. New diagnoses of those with the virus have been relatively stable in Oregon since 1997, and they've been taking a slight decline in the last couple of years, hovering around 300 new cases a year in the state, but dipping to 270 in 2006.

Syphilis, too, has been a virtually nonexistent issue with a rate of 1.3 per 100,000 new Oregonians diagnosed with it in 2006. (As my doctor of a mother said, "Jesse, you really don't need to worry about that unless you're doing it with sailors or something.") And Oregon's rate of those newly diagnosed with any infection-for which data is available-is lower than the national average.

In some cases, however, our genital health is a little less jolly. Chlamydia rates, for example, have been on an aggregate rise in our state since a historic low in 1997. The rate then was 184.9 per 100,000 people. In 2006 it was 259.5. The scariest part about this is the fact that while chlamydia is often easily cured with antibiotics, the infection usually occurs with no symptoms, and as a result, often goes undiagnosed. The health consequences can be harsh, especially on women. In a report on recent STI trends, the Centers for Disease Control (CDC) tells us "Up to 40 percent of females with untreated chlamydia infections develop PID, and 20 percent of those may become infertile." The report goes on to say that while chlamydia complications among men are "relatively uncommon," it can, in rare cases, cause sterility.

Gonorrhea rates, while having remained relatively stable in Oregon for the last few years (and even showing signs of going down), have a separate and frightening can of worms to deal with. Long dealt with as an infection cured by antibiotics, a fast-growing number of cases are turning out to be resistant to the leading class of antibiotics used to treat it. Of the cases tested through a CDC surveillance project in 2006, 13.8 percent were found to be resistant. Alternative antibiotics are now being used to treat it, but other drug-resistant strains exist, and alternative antibiotics can often come with higher prices and more side effects.

Not to mention diseases like HPV, which the CDC estimates half of sexually active people will get at some point in their lifetime and which men cannot be tested for. Or genital herpes, which, it's estimated, one out of five adolescents and adults in the United States has. Scary stuff.

Finally, the fact that some rates of new diagnoses are stable is, quite bluntly, not good enough. A total 270 new diagnoses of HIV/AIDS a year in this state is 270 too many.

So what's the deal in our age of supposed enlightenment? Most people are smart enough to not fuck total strangers without protection. Most of us are smart enough to know how to put on a condom, and most of us know that using the withdrawal method is about as safe as taking the MAX out to Gresham.

But having unprotected sex with anybody, no matter how well you know them, is still unprotected and unsafe. Urban myths, like the idea that putting on two condoms means double the protection (uh, not true, by the way) or that you can't contract infections through oral sex, still persist. And condoms are effective, but like everything, they are not 100 percent.

So it bears repeating: If you are sexually active, use protection effectively and get screened for infections regularly. There are enough resources out there to get it done confidentially, cheap and without judgment. If your antsy untested partner is loath to the idea of protection, don't forget that it's not a matter of "Don't you trust me?" It's a matter of protecting yourself as well as your partner, every time, all the time.

SOURCE: Jesse Thiessen, dailyvanguard.com

If you really love her, wear a cover

With Valentine's Day rapidly approaching, couples worldwide are scrambling in order to make the day as romantic and memorable as possible.

Between the methodical plans for candlelight dinners, bouquets of flowers and boxes of chocolates, there are two unwanted gifts distributed regularly that a significant other wants no part of.

These white elephants are unplanned pregnancies and sexually transmitted infections, surprises that are easily preventable.

"Most people are aware that there are a lot of sexually transmitted infections out today, so it's a good idea if you're having sex to use [a condom]," James Almeda, health educator and sexual health and peer education coordinator at Student Health Services, said.

He added that one of the keys to avoiding these diseases is finding out about the partner's past.

"Just because you've been with someone for a long time, you don't necessarily know who they have been with before or if they've been exposed to something," he said. "The problem is you can never tell when someone is infected. They may have never had an outbreak, but can still transmit it."

So what is the best way for students to avoid contracting infections on such a historically passionate holiday?

"You need to use a barrier method like a condom to protect yourself," Almeda said. "Condoms or not engaging in intercourse are most used against STI's."

To stay clear of pregnancies, Almeda said the pill is the most popular form of contraception, but also offered advice for sexually active students.

"I recommend to students that are worried about STI's and pregnancy to use both a condom as well as another birth control method," he said.

However, some students are leery of condoms due to rumors of their ineffectiveness. But according to Kathie Spegel, director of education of East Central Illinois' Planned Parenthood, many condom failures are due to incorrect use.

"Most failure is through user mistakes, not condom failure itself," she said. "Using petroleum based lubrication, instead of water based, will break down the latex. Bubble backing, the use of two condoms at once, causes friction between the two pieces of latex and causes the break."

Other cautionary advice with condom use includes checking for fairly obvious signs. The expiration date on the wrapping should be checked to make sure it is still good. The packaging around the condom should also be checked for tears, since that can be seen as a warning sign for a broken condom.

Some believe certain brands of condoms are more effective than others. According to Almeda, that is not necessarily the case.

"If you look at the research, there's really no one brand that is best for protection. A lot of people have the perception that Trojan is the only brand of condom," he said.

"[Condoms] have to meet a certain effectiveness rate as far as protecting against STI's and pregnancies to be approved by the Food and Drug Administration."

He does warn about the use of specially labeled condoms that are available.

"You can buy condoms… that are made of what is called lambskin, natural skin or sheepskin. They are fine for protection against pregnancy, but they don't provide protection against STI's and HIV," he said.

To further the sexual knowledge on campus, Student Health Services offers the G-Spot, a traveling version of the Health Staff Resource Center. Located weekly at different spots on campus, it supplies students with condoms and a variety of important health information.

"The big focus of the G-Spot is sexual information. We do offer free condoms, but people realize that we have other health resources there too," Almeda said.

SOURCE: Philip P. Lasseigne, Daily Vidette Staff, dailyvidette.com

Condom distribution may stir local controversies

Awareness group to visit several colleges

While they know it may stir up some controversy, representatives from AIDS awareness group Bethany Place plans to pass out more than 6,000 condoms at metro-east colleges next week but not at Southwestern Illinois College.

The giveaway is part of the observance of National Condom Week, according to Katie Barnhart, the Bethany Place community prevention and education coordinator. She said the message is too important not to get out.

"The idea is to get awareness up so people know how to protect themselves," Barnhart said. "The idea was to do five colleges in the five week days because a college campus is a great place to find young single people who are most likely to be sexually active and in need of hearing our message."

McKendree University, Southern Illinois University Edwardsville, Lewis and Clark College and Kaskaskia College agreed to host an safe sex awareness program and the condom giveaway. Southwestern Illinois College approved the group's request to have a table with information about safe sex. But school leaders shot down the request to pass out condoms.

"While Southwestern Illinois College was happy to approve a recent Bethany Place request for that group to set up an information table promoting safe sex on Valentine's Day, which is also National Condom Awareness Day," said SWIC spokesman Mike Fleming. "The college respectfully chose not to allow simultaneous distribution of free condoms. On this occasion and historically if and when we've been asked, we have always declined because we do not see it as a community college charge."

Fleming said "There are likely more appropriate distribution alternatives" than passing out condoms at the college.

"We do not think it is in the best interest of our diverse-taxpayer community to potentially offend any individuals or groups who might question such participation," Fleming said.

McKendree organizer Tami Eggleston, an associate professor of psychology at the school, said she is trying to keep things tasteful and informative at the same time.

"We'll have experts in to talk to people and we'll also have some students making presentations and talk about staying safe." Eggleston said. "Next week is also sexual responsibility week, so this is not all just about condoms. It's also about responsibility. And part of sexual responsibility is making smart decisions."

SOURCE: Scott Wuerz, bnd.com

Study Finds Anti-AIDS Drugs May Prevent HIV Infection

A new study involving monkeys suggests that antiretroviral drugs used to treat HIV could also protect people from getting infected with the virus. The development is being hailed by AIDS researchers. VOA's Jessica Berman reports.

More than 33 million people worldwide are living with HIV. There were 2.5 million new infections last year alone.

Despite years of intensive effort, researchers have been unable to develop a vaccine. But antiretroviral drugs have turned HIV into manageable disease by keeping it from progressing to AIDS.

Now, researchers are finding that these drugs may be a potent weapon against the spread of HIV.

In a study involving monkeys, researchers at the US Centers for Disease Control and Prevention in Atlanta, Georgia used two antiretroviral drugs to prevent transmission of a primate version of HIV.

The scientists injected macaques with single daily doses of the antiretroviral drug FTC and then exposed them once a week for 14 weeks to a primate version of the AIDS virus. In that experiment, the drug reduced the risk of infection 3.8-fold compared to untreated primates.

The researchers then gave oral doses of FTC and another antiretroviral drug, tenofovir, to the monkeys, reducing the risk of infection 7.8-fold compared to untreated animals.

In a third experiment, the macaques were given daily shots of FTC and higher doses of tenofovir before being exposed to the primate HIV virus. Lead researcher Walid Heneine says that provided 100 percent protection, as did another regimen in which the macaques received the FTC-tenofovir combination two to three hours before exposure to the virus and 24 hours after each weekly exposure.

Heneine says the research provides a model for human use.

"The findings from this intermittent study suggests that ultimately it is possible to provide a promising new avenue for future research, where it opens up the floor for a lot of more research for intermittent dosing," said Walid Heneine.

The results of the study were published in the online journal Public Library of Science Medicine.

The Centers for Disease Control is currently conducting HIV prevention trials using antiretroviral drugs in Thailand with injection drug users, Botswana involving heterosexuals and in the United States in the homosexual community.

Lynn Paxton is coordinator of the clinical trials at CDC. Paxton says the notion of antiretroviral drug use to prevent HIV transmission is not new. She points to the use of drugs to prevent the spread of the AIDS virus from pregnant women to their unborn babies.

Paxton says the use of these drugs may soon take its place alongside other HIV prevention methods, such as condoms.

"So, we look upon pre-exposure prophylaxis as potentially a powerful new weapon that we may be able to add to this armamentarium," said Lynn Paxton.

Myron Cohen is with the University of North Carolina's Department of Medicine.

"This is not, like, business as usual," said Myron Cohen. "There are 30 to 40 million people infected. There is an urgent thing for us to have better and better tools."

Cohen commented on antiretroviral prevention therapy in the journal PLoS Medicine.

SOURCE: Jessica Berman, voanews.com

Break it down: Drop guns, wear condoms

Ohio family physician Anthony Atkins, MD, has turned to hip-hop music to reach adolescents with important messages about safer sex, self respect, and prevention of violence.

Anthony Atkins, MD, a family physician working in the poverty-stricken neighborhoods of Lima, Ohio, wanted a way to reach the young African-American males who came to his office with bullet wounds and the 13-year-old girls arriving for prenatal care. He also wanted to find a way to reduce the number of adolescents he saw who had not just one sexually transmitted disease, but multiple types simultaneously.

And then he settled on music.

"These kids listen to hip-hop. They vibe to that. I needed to find a rapper and write out what I saw in a way that the kids would listen," said the staff physician at the Lima Community Health Center.

So, even though he prefers jazz, the 49-year-old doctor started writing lyrics for hip-hop songs and turned them over to local rappers as well as those from Detroit, Chicago and New York. They refined the songs to make them even more relevant for the audience Dr. Atkins wanted to reach.

"They said, 'You're old school, but we know what you're trying to say.' They made it flow better. They made it rhyme," he said.

The result is "LifeStoryz: State of Emergency," a 16-track compact disc that is probably one of the few, if not only, hip-hop releases with a physician credited on the cover. He hands it out to patients or refers them to his MySpace page where four of the songs are posted. He and his rappers also performed at the local high school in September 2006 with the support of the county health department.

"Adolescents think they're bulletproof and invincible. Dr. Atkins makes them stop and think, and he's found a way to do it through music," said Becky Dershem, a nurse practitioner and director of nursing for the Allen County Health Dept. in Lima. "The patients love him, and teenagers respect him a great deal. He's been a real asset to our community."

The music is refreshing. The songs have explicit messages without profanity. The public health themes are clear, but in a language that speaks directly to the intended audience. "Put the gun away," is a song performed by 20-year-old Chicago rapper J-Verse that outlines the consequences -- jail and death -- of being armed. "Strap it up," sung by the 21-year-old Toledo, Ohio-based Miss Behavin, urges women to have enough pride in themselves to demand that men practice safe sex and for men to respect their partners enough to do so.
An eye on making a difference

According to public health officials, it's unclear yet what kind of impact this music has had on the area's health status. Lima, with a 2006 population of 38,219, is nestled in the fairly rural, central-northwest portion of the state. The jurisdiction in general, and particularly the south-side area where the clinic is based, is one of Ohio's poorer locales. Nationally, more than 12% of people live below the poverty line, but it's more than 22% in Lima. The city and the surrounding county's percentage of adults experiencing violence in the past year, 9.3%, is more than double the state's rate of 4.3%, and the region has some of the state's higher rates of HIV and STDs.

But anecdotal evidence suggests that the project may have found real traction.

"Some of the parents say, 'What did you show my kids? Whatever you did, my daughter now says she's not going to have sex,' " Dr. Atkins explained.

Those who have worked with him suspect he is having success because, although he is decades older than those to whom he wants to communicate these messages, he's not so far removed from their world. He grew up in inner-city Detroit and, when faced with a decision about what to do with his life, chose the U.S. Air Force over joining a gang and selling drugs. Both options, he realized, involved the possibility of getting shot, but one would provide his mother with a flag and other compensation if that happened.

After an honorable discharge in 1988, he ended up in a Health Resources and Service Administration program at Ohio State University College of Medicine that aimed to draw students from disadvantaged backgrounds into the health professions. This path led him to medical school. He graduated in 1999. He then completed his family medicine residency in 2002 at Flower Hospital in Sylvania, Ohio, where he received an award for his communication skills and was known for frank talk.

"He could always ask the difficult questions, use real words and get away with it," said Jeanine Huttner, MD, director of the residency program. "He relates incredibly well to people."

The local health status may or may not be improving because of Dr. Atkins musical endeavors, but it is clear that his medical work is making a difference.

In 2003, when he was looking for an underserved area to work in, Allen County Health Partners, which at that time was developing the Lima Community Health Center, was looking for a primary care physician. He's been working there ever since. The facility now has 10 physicians.

Since the clinic opened, the overall death rate in the county has dropped by slightly more than 12%. The African-American death rate was cut by 20%.

"LifeStoryz" has cost Dr. Atkins $7,500 thus far, paid by his extra weekend shifts in the emergency department at Lima Memorial Heath System. He is hunting for ways to distribute his music more widely and working on a second album. He hasn't yet planned for what he'll do if his CDs ever top the charts or even make any money, although local schools would be a likely beneficiary.

SOURCE: Victoria Stagg Elliott, AMNews Staff, amednews.com