AMA Comes Out For Marriage

In response to the vote in the New York legislature, the American Medical Association has issued a call for the marriage equality across the United States. Via press release from Freedom To Marry:

With the New York State now the sixth – and largest – state to end the exclusion of same-sex couples from marriage, the American Medical Association (AMA) adopted a policy position declaring that excluding same-sex couples from marriage is “discriminatory” and reaffirming existing AMA policy to support relationship recognition of gay and lesbian couples as a means of addressing health disparities faced by those couples and their families. “With this deliberate policy statement by the American Medical Association, the nation’s doctors diagnose the pain and injury that exclusion from marriage inflicts on lesbian and gay couples, their children, and loved ones – and make clear that ending marriage discrimination is the cure,” said Evan Wolfson, founder and President of Freedom to Marry. “The AMA now joins every other mainstream public health organization in America in making the case for providing the freedom to marry – and the critical safety-net that comes with marriage – to loving, committed same-sex couples.”

To Treat Me, You Have To Know Me

From the city of New York.

FDA Approves Hep C Drug

The FDA has approved the first in a new class of drugs that may increase the cure rate for Hepatitis C.

The new drug, Victrelis from Merck, effectively cured more than 60 percent of patients in clinical trials when used along with existing drugs. That compared with 20 to 40 percent of patients cured by the existing drugs alone. “This new medication provides an effective treatment for a serious disease, and offers a greater chance of cure for some patients hepatitis C infection compared to currently available therapy,” Dr. Edward Cox, director of the F.D.A.’s office of antimicrobial products, said in a statement. An estimated 3.2 million Americans have a chronic infection of the hepatitis C virus. The virus can cause serious liver disease, including cirrhosis and liver cancer, though these problems may take decades to develop and may not develop at all.

San Francisco: Earlier HAART Treatment Appears To Reduce New HIV Infections

According to a story posted on AIDSmap.com, San Francisco is seeing a decrease in new HIV infections because HIV+ people are going on medication sooner and therefore have a reduced period of infectiousness.

Dr Das presented more evidence from San Francisco to show a strong correlation between reductions in community viral load and the falling number of HIV diagnoses. The most recent CVL, defined as the average viral load of all HIV positive people being seen for care in the city, went down from approximately 25,000 copies/ml in 2004 to 10,000 copies/ml in 2009. Over the same time, new diagnoses of HIV decreased from 820 in 2004 to 500 in 2009. For CVL to decrease, a number of other things have to happen first, in a ‘cascade’ of events. Firstly, the frequency of testing in the at-risk population must increase; this must result in a lower proportion of undiagnosed cases; those diagnosed must be linked to care, and the majority must start treatment; and the time between diagnosis and viral suppression must reduce. Dr Das said all these indicators were strongly correlated. The average time from diagnosis to the start of treatment shrank from twelve months in 2004 to two months in 2009. The time between diagnosis and achieving an undetectable viral load went down from nearly three years in 2004 to eight months in 2009; and the percentage with an undetectable viral load within a year of diagnosis increased from 26% in 2004 to 82% in 2008.

Last April the San Francisco Department of Public Health adopted the controversial position that newly infected patients should immediately begin HAART therapy upon their diagnosis. Some AIDS activists strongly objected to that, citing the prevailing opinion that HAART treatment should be delayed as long as possible due to the long-term side effects of the medications. Many HIV specialists continue to recommend a closely-monitored delay in treatment, but the above result in San Francisco should not be discounted.

(Tipped by JMG reader Bill)

Mark King On Florida's ADAP Crisis

More than half of the nation's AIDS patients who are on waiting lists to get medications are in Florida. Last week Sen. Bill Nelson wrote both the president and Florida Gov. Rick "Medicare Fraud" Scott, warning of a catastrophic public health crisis over the lack of ADAP funding. In the below clip, South Florida AIDS activist Mark S. King lays out the situation and what can be done about it.

A Cocaine Vaccine?

Scientists are testing a vaccine that causes the body to treat cocaine like an attacking virus and thereby keep it away from the brain.

So far, the vaccine has only been tested on mice, but the results are extraordinary. Mice given the vaccine no longer exhibited any of the hyperactive signs of a cocaine high when they were next given the drug. The vaccine was created by taking just the part of the cold virus that alerts the body's immune system to its presence, and then researchers connected the signaling mechanism to a more stable version of the cocaine molecule.

Once the mice received an injection of the vaccine, they started producing anti-cocaine antibodies which targeted and destroyed any cocaine that then entered their system. Normally, cocaine does not produce an immune response, leaving it free to wreak havoc on the brain and body of whoever takes it. But the cold virus segments taught the immune system to treat cocaine like a hostile invader, offering a nearly impregnable wall of protection from the cocaine's effects.

All kinds of ethical implications are raised by this research, of course. For example, should it be legal for parents to immunize their children against the pleasurable effects of some drugs without ever knowing if that person was capable of responsible use?

CALIFORNIA: Legalized Pot Bill Fails

California's Prop 19, which would have decriminalized the possession of less than one ounce of marijuana, has failed by a wide margin.

The initiative would have eliminated all criminal penalties for adults 21 and older who planted marijuana in a plot of up to 25 square feet or possessed up to an ounce for personal use. It also would have allowed city councils and county supervisors to authorize commercial cultivation and retail sales. But the opposition was broad, according to the poll conducted by Edison Research for the National Voter Pool, a consortium of the major television news networks and the Associated Press. Men and women opposed it. Voters of every race opposed it. The campaign had hoped black and Latino voters would see the measure as a way to end disproportionate arrests of minorities caught with marijuana. The measure drew intense interest. Foreign leaders weighed in. All the top statewide candidates opposed it. The federal drug czar denounced it. And the U.S. attorney general pledged to "vigorously enforce" federal narcotics laws whatever California did.

Prop 19 had been strongly opposed by a consortium of beer distributors.

Researchers Make HIV Breakthrough With Existing FDA-Approved Meds

Scientists at the University of Minnesota believe that two existing FDA-approved cancer medications may work jointly to eliminate HIV infections.

The two drugs, decitabine and gemcitabine -- both FDA approved and currently used in pre-cancer and cancer therapy -- were found to eliminate HIV infection in the mouse model by causing the virus to mutate itself to death -- an outcome researchers dubbed "lethal mutagenesis." This is a landmark finding in HIV research because it is the first time this novel approach has been used to attack the deadly virus without causing toxic side effects. Because decitabine and gemcitabine are already FDA approved, researchers believe that if their research is effective in large animal models, it will be much easier to expedite the development of the drugs for human use.

Researchers found that the drugs caused no cell toxicity and were effective against HIV in levels below "well below" those used for cancer. The drugs are now being reformulated for oral use.

Yale Researchers Discover What Circuit Boys Knew Fifteen Years Ago

Researchers at Yale have published a study touting the horse tranquilizer Ketamine as an effective anti-depressant at low doses. The drug's make-happy effect begins almost immediately, unlike regular anti-depressants which can take weeks to work.

Ketamine, a general anesthetic usually administered to children and pets but perhaps best known as a horse tranquilizer, is also highly effective in low doses as an anti-depressant, according a study published Thursday. Researchers at Yale University wrote in the August 20 issue of the journal Science that unlike most anti-depressants on the market which can take weeks to take full effect ketamine can begin to counter depression in hours. "It's like a magic drug -- one dose can work rapidly and last for seven to 10 days," said Ronald Duman, professor of psychiatry and pharmacology at Yale and senior author of the study. The researchers noted that ketamine was tested as a rapid treatment for people with suicidal thoughts. Traditional anti-depressants can take several weeks to take effect, they noted.

A similar study at the National Institute of Mental Health found that 70% of patients who did not respond to traditional anti-depressants improved within hours of receiving Ketamine. Let's hope the ridiculous War On Drugs doesn't stifle this breakthrough. But don't rush out to self-medicate either, Ketamine remains a Schedule III drug in the U.S. with a penalty for possession of up to five years in prison.

Darth Cheney Leaves Hospital

Former Vice President Dick Cheney was released from the hospital yesterday one month after being fitted fitted with a heart pump called a ventricular assist device.

The battery-powered pump is mainly used for short periods by a heart transplant candidate awaiting a donor organ. Such devices are being studied for use by people with severe heart failure who aren't candidates for transplants. The pump relieves pressure on the heart by rerouting blood. Cheney said last month that he chose the surgical procedure after testing and consultation with doctors.

The machine leaves patients with no discernible pulse or heartbeat. Have all the "undead" jokes already been made?

Study Claims Using HIV Meds As Preventive To Infection Is Safe For Negative Gay Men

A study released at the AIDS 2010 conference in Vienna claims that using widely-prescribed HIV medications as a preventive for new infections (PrEP) is safe for HIV-negative men who have sex with men. Please note that effectiveness in preventing infection results have not yet been released on this study.

Pre-exposure prophylaxis (PrEP) with tenofovir (found in Viread, Truvada and Atripla) is safe for men who have sex with men (MSM), according to a U.S. study presented Friday, July 23, at the XVIII International AIDS Conference (IAC) in Vienna. PrEP is one of the most promising prevention tools on the immediate horizon. With PrEP, HIV-negative individuals take antiretroviral drugs to prevent becoming infected with the virus. The first PrEP studies are testing tenofovir alone (Viread), while several later studies are testing tenofovir plus emtricitabine (Truvada). Currently, all studies are looking at daily ongoing use of the drugs, but future trials are planned with intermittent dosing. The first efficacy results are expected later this year, but researchers from the Centers for Disease Control and Prevention (CDC) in Atlanta presented findings from a safety study at this year’s IAC.

As always, it's important to look at the size and the methodology of this study before making any decisions about your own health care.

RELATED: An unrelated NYC-based survey released last month indicated that the wide availability of PrEP would cause a high percentage of the most at-risk gay men to abandon safer sex practices.

ADAP Waiting Lists Swell

The terrible economy has been especially hard on the ADAP system, the AIDS Drugs Assistance Program that provides life saving medications to the HIV-positive. More people are now on ADAP waiting lists that at any time since the program began.

Eleven states have closed enrollment in the federal program, most recently Florida, which has the nation’s third-largest population of people with H.I.V. Three other states have narrowed eligibility, and two of them — Arkansas and Utah — have dropped scores of people from the program. Last week, because of swelling numbers here in South Florida, the nationwide waiting list surged past record levels set in 2004, to 1,781 people, according to the National Alliance of State and Territorial AIDS Directors. The growth is expected to continue when Georgia starts deferring enrollment in its drug assistance program on July 1. Illinois may soon follow, and New Jersey plans to cut eligibility on Aug. 1, removing 600 of the 7,700 people on its rolls. Louisiana capped enrollment on June 1 but decided against keeping a waiting list. “It implies you’re actually waiting on something,” said DeAnn Gruber, the interim director of the state’s H.I.V./AIDS program. “We don’t want to give anyone false hope.”

In addition to the waiting lists, some states are cutting out drugs that don't directly fight HIV, but treat the many conditions related to the infection. The irony, of course, is that the government will end up paying much more to treat people for opportunistic infections because they don't have access to their meds.

Teabaggers Threaten ADAP Funding

According to a Washington Blade piece just posted by Lou Chibarro, some longtime supporters of ADAP in Congress are reluctant to approve supplemental funding this year for fear of angering the Tea Party. The AIDS Drug Assistance Program keeps tens of thousands of people alive by providing them with free or low cost HIV medications.

William Arnold, executive director of the National ADAP Working Group, said intense pressure on members of Congress to curtail spending by the so-called Tea Party movement has made it difficult to line up support for an emergency supplemental appropriation measure. Arnold and officials with other national AIDS and LGBT organizations say the program is facing a crisis never seen before, where a growing number of low income people with HIV or AIDS may be denied life-saving anti-retroviral drugs in at least 11 states this year because state ADAP affiliates have run out of money. Due to a shortage of funds, the 11 states have been forced to put in place waiting lists for patients who otherwise would have received AIDS medication prescribed by their doctors.

ADAP actually saves the government billions annually because it keeps people with HIV out of the nation's emergencies rooms. But try telling that to the Tea Party, who'd rather see people suffer a painful, lingering death that be accused of funding something like AIDS relief.

The Lazarus Effect

Here is the complete documentary from HBO about the miraculous effect of HAART therapy on Africans suffering from HIV. Clip description:

Executive produced by Spike Jonze, this (RED), HBO & Anonymous Content 30-minute documentary follows the story of HIV positive people in Africa who were at death's door and in as little as 40 days undergo a remarkable transformation to health, when they gain access to the 2 lifesaving pills that cost around 40 cents a day. Directed by Lance Bangs.

Opt-Out Organ Donation For New York?

The New York Assembly is considering a bill that would require residents to opt-out of organ donation. Under the bill, all adults in the state would be enrolled as potential organ donors unless they specifically choose to decline.

New York State Assemblyman Richard Brodsky nearly lost his daughter, Willie, at 4 years old when she needed a kidney transplant, and again 10 years later when her second kidney failed. "We have 10,000 New Yorkers on the list today waiting for organs. We import half the organs we transplant. It is an unacceptable failed system," Brodsky said. To fix that, Brodsky introduced a new bill in Albany that would enroll all New Yorkers as an organ donor, unless they actually opt out of organ donation. It would be the first law of its kind in the United States. "Overseas, 24 nations have it. Israel has it. Others have it. And it works without a lot of controversy," Brodsky said.

Nine out of ten polled New Yorkers say they would donate their organs, but only one in ten has signed up. I can't wait to hear what the teabaggers say about this. The gub'mint is a'comin' fer yer liver! Mandatory harvesting!

HomoQuotable - Sean Strub

"The approach to prevention and treatment of HIV in the U.S. has undergone a radical and dangerous shift over the past few months. The new concept, called 'Test and Treat' (TNT) or 'Testing with Linkage to Care' (TLC) will dramatically increase HIV testing, identify more people with HIV and "link" them to care. Those are worthy objectives.

"The danger is that some policy leaders driving these ideas are more interested in 'treatment as prevention', meaning getting people with HIV on antiretroviral treatment, than they are in providing the best possible healthcare for them. Because antiretroviral treatment makes one less likely to transmit HIV, they believe treating all people with HIV is a good prevention strategy. Neither the state of the science or government guidelines support antiretroviral treatment for every person with HIV, but advocates, public health officials and pharmaceutical companies are promoting the idea.

"There are also plenty of TNT/TLC proponents, aware of the ethical issues, who rightly recognize that treatment should be recommended only within government-established guidelines supported by conclusive science. But when important public health officials announce publicly that they seek to put everyone with HIV on treatment, it is cause for concern and ethically unacceptable without informed consent." - Longtime HIV/AIDS activist Sean Strub, writing for POZ Magazine.

Strub says that the new campaign to begin drug treatment immediately upon an HIV+ diagnosis is more of an attempt to reduce the infectiousness of the public and overlooks the danger and side-effects of long-term HAART therapy. I expressed a similar concern earlier this month.

Obama Mandates Hospital Visitation Rights For LGBT Couples

President Obama tonight ordered the Department of Health & Human Services to prohibit hospitals from discriminating against LGBT couples when it comes to visitations rights.

Administration officials and gay activists, who have been quietly working together on the issue, said the new rule will affect any hospital that receives Medicare or Medicaid funding, a move that covers the vast majority of the nation's health-care institutions. It is currently common policy in many hospitals that only those related by blood or marriage be allowed to visit patients. "Discrimination touches every facet of the lives of lesbian, gay, bisexual and transgender people, including at times of crisis and illness, when we need our loved ones with us more than ever," Joe Solmonese, president of the Human Rights Campaign, said in praising the decision. Obama's actions are the latest attempt by his administration to advance the agenda of a constituency that strongly supported his presidential campaign.

It's not yet clear how gay couples will establish the validity of their relationships to hospitals, as most do not yet have one that is legally recognized. A side effect to this otherwise very welcome move by the president is that it removes one of the most compelling arguments for marriage equality.

UPDATE: Here's the wording from the first section of the order. "Legally valid advance directives" will be required, apparently.

Initiate appropriate rulemaking, pursuant to your authority under 42 U.S.C. 1395x and other relevant provisions of law, to ensure that hospitals that participate in Medicare or Medicaid respect the rights of patients to designate visitors. It should be made clear that designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy. You should also provide that participating hospitals may not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. The rulemaking should take into account the need for hospitals to restrict visitation in medically appropriate circumstances as well as the clinical decisions that medical professionals make about a patient's care or treatment.

NEBRASKA: Women Seeking Abortions Must Undergo Screening For Mental Illness

The Nebraska legislature has passed a bill requiring mental illness screenings for women who seek abortion, purportedly to determine if they were pressured into their decision. The bill had the backing of anti-abortion activists seeking to place additional roadblocks and delays into women's reproductive choices.

Republican Gov. Dave Heineman's office said Monday he will sign the bill Tuesday, along with another groundbreaking abortion measure lawmakers are expected to pass then. That bill would ban abortions after 20 weeks based on the assertion that fetuses feel pain. Both bills are likely to be challenged in court. Abortion rights activists describe the measure passed Monday as a drastic shift in abortion policy that would block abortions by scaring doctors who might perform them. They say the second bill is aimed at blocking late-term abortions in one of the few states where there's a doctor willing to perform them.

The bill requires doctors to look for "physical, psychological, emotional, demographic, or situational risks" to patients seeking the procedure.

On The End Of St. Vincent's

As I mentioned earlier this month, St. Vincent's Hospital in Manhattan's West Village is set to close in bankruptcy very shortly. New York Magazine's David France reflects on St. Vincent's role in the early years of the AIDS pandemic.

The obituary for St. Vincent’s, when it is finally written, will recall that the hospital’s greatest moment—and its darkest—came in the eighties, as it found itself quite awkwardly in the thick of the global AIDS plague. The flood of patients was extreme, spilling into every available bed, then throughout the surrounding corridors, where masking tape marked off virtual rooms. “Every doorway you looked in there was a young man lying in the bed, very, very ill,” recalls Cynthia O’Neal, who first witnessed the devastation in 1987. She was moved to co-found (with the director Mike Nichols) the AIDS services agency Friends in Deed. “It felt like a war hospital. It was very, very affecting, very powerful. I spent a lot of time in those rooms.”

According to France, the success of HIV treatments has contributed to the decline in admissions at St. Vincent's, an ironic end to the place that was ground zero in the greatest tragedy ever to afflict gay men. Read the entire article.

NYC's St. Vincent's Hospital To Close

St. Vincent's Hospital in Manhattan's West Village voted to close itself last night after failing to resolve an estimated $700M in debt. The famed hospital served the gay community as a sort of ground zero during the early years of the AIDS pandemic.

The exact timing for the closing of St. Vincent’s Hospital Manhattan, which has about 400 inpatient beds, was not immediately clear, but the process of shutting down has already begun, and the State Department of Health will become involved to ensure an orderly closing. Elective surgeries are to end by April 14. “The decision to close St. Vincent’s Hospital Manhattan inpatient services was made only after the board, management and our advisers exhausted every possible alternative,” Alfred E. Smith IV, chairman of St. Vincent Catholic Medical Centers, said in a statement. They were unable to come up with a plan, he said, “to save the inpatient services at the hospital that has proudly served Manhattan’s West Side and downtown for 160 years.” [SNIP] With its vote, the board effectively closed the last Roman Catholic general hospital in New York, a beacon in Greenwich Village that has treated victims of calamities from the sinking of the Titanic to Sept. 11. In recent years, its management troubles were worsened by the difficult economics of the health care industry, changes in the fabric of a historic neighborhood and the low profit in religious work.

Gov. Paterson said yesterday that he hopes to salvage St. Vincent's HIV treatment center, but that would require finding a partner.