WORLD AIDS DAY

World AIDS Day 2008: Much accomplished, much to do

By Dr. Anthony S. FauciCNN Contributor

(CNN) -- When we commemorated the first World AIDS Day on December 1, 1988, we had little to celebrate.

The number of reported AIDS cases in the United States was nearing 80,000 and rising rapidly. Untold thousands more in this country were living with the human immunodeficiency virus, or HIV. Globally, AIDS cases already had been reported from more than 135 countries. An AIDS tsunami clearly was looming, but we had few defenses at our disposal.

For those of us caring for people with AIDS, it was a dark time. We had just one anti-HIV medicine in our pharmacies, AZT, a drug that the virus rapidly defeated by mutating and developing resistance. Lacking other medicines to slow the relentless replication of HIV and its destruction of a person's immune system, we did our best to help our patients by managing to the extent possible their AIDS-related infections and complications. But the life span of most of the patients was measured in months.

Two decades later, much has changed. An unprecedented research effort has led to more than two dozen anti-HIV drugs, more than for all other viral diseases combined. Taken in proper combinations, these medications have dramatically improved the prognosis for people living with HIV by increasing their life span by at least a decade and providing the possibility of a normal life span with continued therapy.

Scientifically proven prevention approaches -- education and outreach to at-risk populations, voluntary HIV testing and counseling, condom distribution, prevention of HIV transmission from mother to baby, harm reduction approaches for drug abusers, mass-media campaigns and the screening of donated blood -- have been deployed with great success in the United States and many other countries.

Innovative programs such as the President's Emergency Plan for AIDS Relief and the Global Fund for HIV/AIDS, Tuberculosis and Malaria, as well as the efforts of nongovernment organizations, have reached millions of people in low- and mid-income countries worldwide with HIV-related services, at a scale unimaginable a few years ago. And gradually -- but too slowly -- we have begun addressing AIDS-related stigma in this country and abroad.

Much has been accomplished in the fight against HIV/AIDS from scientific, medical and public health standpoints. However, now is no time to rest on our accomplishments or our laurels. The statistics of the HIV/AIDS pandemic tell us that much more needs to be done.

Around the world, a staggering 2.7 million people were infected in 2007 alone. Globally, 33 million people are living with HIV infection, most of them in the developing world. In the United States, more than 1 million people are living with HIV. And 56,000 more people are infected each year in the U.S., driving HIV prevalence rates in some of our communities to levels that rival those seen in sub-Saharan Africa. Gay and bisexual men, and African-Americans in general, are disproportionately affected. The true ground zero of the HIV epidemic in the United States is in those communities.

What is the way forward? First, even in the face of a world economic crisis, the global community must scale up the delivery of proven HIV therapies and prevention services. In low- and middle-income countries, less than one-third of people in need of anti-HIV therapy are receiving it, and only one in five people at risk of HIV infection have access to prevention services.
All around the world, access to HIV services -- and medical care in general -- remains a challenge in many poor communities. The global community must sustain our commitment to investing resources for medicines, clinics, as well as training and salaries for doctors, nurses and community health care workers to provide care for HIV/AIDS and other diseases in the settings where they occur.

Here in the United States, more than one-fifth of people living with HIV are unaware of their infection and not receiving appropriate care for their own health or the prevention services that would help them avoid transmitting the virus to others. A frequent scenario is that people learn of their infection status only when they have advanced symptoms of HIV disease, when their health may by irreparably damaged.

Now is the time for the medical community and policymakers to embrace U.S. guidelines for all Americans aged 13-64 to be tested in routine medical care. Barriers to implementation of HIV testing guidelines, such as state laws that mandate counseling with testing or not paying for routine medical care, must be removed.

Meanwhile, we also must continue to invest in the next generation of treatment and prevention modalities. Encouragingly, new means of preventing HIV infection are emerging from well-designed and well-implemented clinical research trials.

One exciting concept is pre-exposure prophylaxis or PrEP, giving preventive doses of anti-HIV drugs to individuals who are at an increased risk of HIV infection. This still-experimental strategy is based on the concept that if HIV replication can be inhibited immediately following exposure to the virus, permanent infection might be thwarted. Multiple clinical studies of PrEP are under way in the United States and in populations around the world. Ongoing research to develop microbicidal gels or creams to be applied before sex offer the hope of people being able to protect themselves from HIV infection in situations where saying no to sex or insisting on condom use is not an option.

Finally, a preventive HIV vaccine remains the greatest hope for halting the relentless spread of HIV/AIDS. We must solve the mystery of how to prompt the human body to produce a protective immune response against HIV, which natural infection with the virus seems unable to do.

Historically, it has taken decades to find effective vaccines to combat most infectious diseases. Researchers usually experienced numerous setbacks and disappointments before reaching success, yet they persevered. Finding a safe and effective HIV vaccine demands an equally intense resolve.

On this World AIDS Day, we should be proud of the many scientific advances that have been made in the fight against HIV/AIDS. But it is hardly a time for self-congratulation. Rather, we must understand that our work is just beginning. Developing HIV interventions and delivering them to the people who need them will require scientific and public health vision, and dedication from all sectors of society, in good times and bad.

Unconvetional Approaches to HIV Prevention

Most people know that condoms prevent the spread of HIV and sexually transmitted diseases (STDs).

Unusual campaigns to promote condom use are being launched in places where condoms are less popular. But in many parts of the world, condoms aren't very popular. Here are five novel campaigns launched by nonprofit organizations and condom companies to encourage wider use.

1. A ring tone to remember
In India, people stigmatize condoms and refuse to wear them because they believe only prostitutes must use prophylactics. Leave it one of the world's richest men to find a solution -- the Bill and Melinda Gates Foundation donated money for a national condom ring tone.
An a cappella group sings "Condom, Condom" -- in the style of doo-wop like the contagious pop song "Barbara Ann" -- when one receives a phone call. Despite its bubblegum sound, officials hope that the people who have the condom ring tone appear smart and responsible.

Since the ring tone's August launch, more than 60,000 people downloaded it. Yvonne MacPherson, country director of the BBC World Service Trust (which the Gates foundation funded), sums it up best when she said to the Associated Press: "A ring tone is a very public thing. It's a way to show you are a condom user and you don't have any issues with it."
Right, nothing attracts the amorous attention like announcing loudly that you have a condom.

2. Perks you right up
Ethiopians claim they hate condoms because the smell of latex sickens them. To combat the odor, DKT International, a United Sates nonprofit, created coffee condoms. These dark brown condoms allegedly (I'm not testing the products) taste and smell like the favorite coffee of Ethiopia -- the macchiato, an espresso with cream and sugar.

One college student claimed the smell reminded him of the beauty of Ethiopian women (it's not clear if that's a compliment). These condoms bolster national identity because
Ethiopians claim to have invented coffee. DKT International also created flavored and scented condoms for Indonesia (durian fruit) and China (sweet corn).

3. Condom trees
In western Australia, the rate of HIV infection is the highest in the nation. When public health nurses were looking for an effective way to distribute condoms, someone suggested trees.
Young people in the countryside hang out under trees, making it the perfect place for nurses to hang condom-filled canisters.

Over 3,000 condoms are taken each month. Residents said grabbing condoms from trees was convenient and private. Additionally, officials in Australia piloted programs where Aboriginal teens sold packets of condoms and kept half of the proceeds. Official tout these programs as a success because STD rates have lowered, yet nurses wonder how they will convince people that they shouldn't have multiple partners. Maybe a monogamy tree is in the outback's future.

4. Scare tactics
Perhaps some safe sex programs skirt the issue -- unprotected sex causes HIV, which leads to AIDS and often death. It's not surprising that a condom company would resort to scare tactics. The Tulipan Company launched its "Be Careful" ads in Argentina.

Showing skeletons positioned in flagrante delicto, these ads make no bones about how important it is to wear a condom while engaging in coitus.
No word if the skeleton ads have had the desired impact, though the graphic skeletons appear more popular than recent Trojan ads, which depict men as swine.

5. Spray-on protection
Since his teens, Jan Vinzenz Krause struggled to find a condom that fit correctly. He thought the pursuit of the perfect prophylactic was hopeless -- until he went to the carwash.
Inspired by the spray-on soap and wax, the German Krause developed a spray-on latex condom, which he claims always fits perfectly and feels natural.
However, many men find the design off-putting; the spray-on condom comes in a hard phallic case.

Men slide themselves into the cylinder and layer on the latex, providing full coverage.
The Jolly Joe, as Krause dubbed it, frightened many men during the testing phase -- they only put the case on their fingers. (Spray on gloves anyone?)

Others felt the loud hissing wasn't sexy and the latex takes too long to dry -- three minutes.
Krause explains to Time, "It needs to be ready in five to ten seconds." So for now, Krause is waiting for a quicker-drying latex.

Doing Double-Duty From D.C. to N.Y.

This past weekend, AACAA did double-duty leading mass-impact, outreach events in both Washington, D.C. and New York, N.Y.

In D.C., volunteers converged on the grounds of RFK Stadium for The Stone Soul Picnic. Stone Soul attendees were very responsive to our mission to stop the spread of HIV/AIDS. Hundreds of visitors dropped by AACAA’s table to obtain educational pamphlets and free condoms for their friends and family. Overall, AACAA volunteers distributed well over 8,000 condoms. It was great to see both young and old doing their part to stop the spread of HIV/AIDS in the D.C. community. New AACAA volunteer, Jared Lucas noted that "The Stone Soul Picnic was an excellent backdrop for our efforts providing great food and great music throughout the day."

4 hours north of Washington, AACAA Board members Felicia Gordon and Dionne Fraser conducted a street outreach on 125th Street and Lennox Avenue in the heart of Harlem. The weather was perfect for some (Felicia) and hot for others (Dionne). We were joined by Giliane Joseph, a Harlem doctor studying for her medical board exam. At about 2 p.m., significant excitement and energy developed around our efforts. Dionne observed: “We handed out condoms to residents who were as young as 15 and as old as 70. The psychology of passers-by is interesting to behold. People are generally shy about accepting the booklet and condoms but as more people take the condoms, more people find it acceptable. Then it becomes a tidal wave. The group that seems most rigid about accepting condoms tend to be middle-aged and married. We try to ask them to pass the condoms to someone else who might need them, but this does not always work.” In total, AACAA distributed over 4,000 condoms to Harlem residents in less than three hours.

Report: Black U.S. AIDS rates rival some African nations

LOS ANGELES, California (CNN) -- The AIDS epidemic among African-Americans in some parts of the United States is as severe as in parts of Africa, according to a report out Tuesday.

"AIDS in America today is a black disease," says Phill Wilson, founder of the Black AIDS institute.

"Left Behind - Black America: A Neglected Priority in the Global AIDS" is intended to raise awareness and remind the public that the "AIDS epidemic is not over in America, especially not in Black America," says the report, published by the Black AIDS Institute, an HIV/AIDS think tank focused exclusively on African-Americans.
"AIDS in America today is a black disease," says Phill Wilson, founder and CEO of the institute and himself HIV-positive for 20 years. "2006 CDC data tell us that about half of the just over 1 million Americans living with HIV or AIDS are black."
Although black people represent only about one in eight Americans, one in every two people living with HIV in the United States is black, the report notes.
The report uses just-released data from UNAIDS and existing CDC and Census data to highlight grim statistics:
• AIDS remains the leading cause of death among black women between ages 25 and 34. It's the second-leading cause of death in black men 35-44. Explainer: AIDS: A black disease »

• In Washington, more than 80 percent of HIV cases are among black people, that's one in 20 residents. iReport: AIDS in Washington's older population
"Five percent of the entire population (in DC) is infected... that's comparable to countries like Uganda or South Africa," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN for the recent "Black in America" documentary.
According to this report, if black Americans made up their own country, it would rank above Ethiopia (420,000 to 1,300,000) and below Ivory Coast (750,000) in HIV population. Both Ethiopia and the Ivory Coast are among the 15 nations receiving funds from the President's Emergency Plan For Aids Relief. The United States has given about $15 billion to PEPFAR nations in the past five years. Tell us: What's your experience being black in America?
The Black AIDS Institute says it's not criticizing the federal government for helping poorer countries cope with the AIDS epidemic. Rather, it's saying the "AIDS epidemic [in the U.S.] is not getting the kind attention that it merits." Watch more on the new report on AIDS and African-Americans »
Wilson says more needs to be done to prevent the spread of HIV in this country. The report states that the U.S. government "increased spending on HIV prevention, treatment and support programs for low-income countries dramatically, at the same time that domestic remained all but flat." Dr. Sanjay Gupta on genes, African-Americans and HIV risk »
"Peggy" found out 10 years ago that she was HIV positive. The fact that she's asked us to not use her real name is an example of the stigma that's still attached to having the virus that causes AIDS, especially in the African-American community.
"I don't really talk to many other people about it, 'cause I guess maybe, they don't want to talk," says the 27-year-old Lake Charles, Louisiana, woman. Others like her, she says, are still too ashamed to admit they have HIV. AC 360 Blog: The cavalry is not coming to save us
Marvelyn Brown, 24, of Washington, is more open about her status. She learned she had HIV when she was only 19, after one time of unprotected sex while in a monogamous relationship.
Brown has told her story in a book, "The Naked Truth, " and to CNN in last week's special report, "Black in America." She regularly addresses community groups, trying to help educate blacks about the risk of of HIV and AIDS.

Jump Up! D.C. Caribbean Carnival

For the 6th year in a row, AACAA participated in D.C.'s Caribbean Carnival. Our largest contingent of volunteers so far this year descended upon the top of the parade route to widely distribute condoms, females condoms and educational material during one of the most festive cultural events in the District.

Thanks to the 2 dozen volunteers who, collectively, help distribute thousands of condoms to Carnival attendees. If only one of those condoms helps prevent the transmission of HIV or encouraged someone to make condom use a standard personal predactice, then the effort was worth it.

African American Coalition Against AIDS Re-Launches AIDS Education and Awareness Website

(Washington, D.C.) – In advance of National HIV Testing Day, the African-American Coalition Against AIDS (AACAA) has launched www.stophivaids.org to help combat the spread of HIV/AIDS and ramp up awareness of the risks faced by African-Americans.

"This marks an important moment in our ongoing effort to combat the spread of HIV/AIDS. Our hope is to expand the reach of our organization by taking advantage of the enormous power of the internet to educate all African Americans – a community that has been quietly experiencing escalating rates of HIV/AIDS infection," said Felicia Gordon, Senior Board Member of AACAA.

AACAA's programs and efforts are focused on the particular needs of the African-American community. Utilizing an aggressive Street Outreach Program, AACAA volunteers disseminate condoms and educational materials to targeted neighborhoods including public housing complexes, shopping centers, barbershops and hair salons.

AACAA recently reached a milestone by distributing 1 million condoms to residents in impacted neighborhoods throughout Washington, D.C., Baltimore, and New York City as part of their on-the-ground work. With the launch of their new website, AACAA hopes to reach an on-line audience to help further promote fact-based information about HIV/AIDS while encouraging African Americans to get tested and know their status.

"An estimated 1 in 20 residents in Washington, D.C. are now HIV positive. Overcoming the myths and misconceptions about HIV/AIDS is critical in the battle to stop the spread of this disease in the Black community," said Kristen Clarke, Founder and Executive Director of AACAA. Clarke observed that "through our grassroots outreach program and our new website, we hope to advance our efforts to encourage testing, promote the importance of prevention and distribute condoms and fact-based educational material to those most vulnerable to this epidemic."

The Harlem Shake

AACAA Board Members Dionne Fraser and Felicia Gordon handed out 5000 condoms on a balmy Saturday afternoon. Harlem is our usual destination for outreach (though our next outreach will be in Brooklyn in August). We began our outreach on 125th Street and Lennox Avenue, ground zero of Harlem. This intersection is well traveled and truly represents the future and past of Harlem, with a Starbucks to prove it. We discussed the ramifications of this epidemic with passers-by and music bootleggers. Many individuals were shy about taking condoms, which we found surprising but when we discussed statistics and not being shy about taking care of oneself, they often became emboldened.

The saddest moment came when a young man approached us and said "I wish you had been giving these out 15 months ago." When we asked why he said it was because he just had a daughter. He was 19 years old! We taken aback and the sadness and regret in his eyes won't be easy to forget. The black community remains vibrant and beautiful. This outreach was pure pleasure, despite the blazing heat. We only wish that we could reach more young people.

We Never Forget About our Brothers & Sisters Across the River

On Sunday June 8, 2008, AACAA MPH Student, Andrella Smith of Howard University, spent several hours representing the organization by conducting outreach to the Anacostia community in the Southeast section of Washington, DC. This outreach project was a big success in large part because the vast majority of residents reached were unaware how serious the HIV and AIDS epidemic is here in the District. Many expressed shock and outrage about the staggering rates of infection in the District while others simply refused to believe that as many as 1 in 20 persons in the District are HIV positive. The outreach project took place in the neighborhoods immediately surrounding the Anacostia Metro Station We fielded questions from and distributed free condoms to as many 150 people.

Many people believe that the organization is doing an excellent job for this community and expressed concerns about the need for more HIV and AIDS prevention-based projects in the area. Other were grateful for AACAA's work observing that too often people forget about he Anacostia community. Overall, Anacostia residents are eager to learn about the HIV and AIDS epidemic and how it is affecting the lives of both men and women, young and old of color.

Black Men & the XXL Condom Dilemma

It's mid-May and we are now in the middle of our spring outreach season. As always, the communities that we reach through our work are so excited to see volunteers passing out free condoms and educational material on HIV/AIDS but we are starting to observe some interesting patterns. More and more Black men are expressing reluctance to take our condoms insisting that they need extra-large condoms. We try to explain that, when used correctly, latex condoms will fit anybody but this does not seem to resonate. In some respects, it seems that we have to give in and do a little ego-stroking which seems worth it if at the end of the day it means that more Black men will use condoms.

We recently put in a request with our condom provider to make XXL condoms available. Because of our request, they are now making XXL condoms available to organizations like ours which is wonderful! The struggle continues.....