XIX International AIDS Conference: New HIV/AIDS Prevention and Treatment Recommendations
Late last week, in advance of the International AIDS Conference meeting this week in Washington, D.C., the World Health Organization recommended using antiretroviral medicines for people who do not have the infection but are at high risk of transmission. And, in a special issue of the Journal of the American Medical Association published this week, the International Antiviral Society has recommended that all HIV patients be treated with antiretroviral drugs, even when the virus’s impact on their immune system is shown to be small. Research by the Society shows that AIDS can lead to other conditions such as cancer and heart and kidney disease. Read more on AIDS.

HHS Announces Public/Private Partnerships to Improve Care for HIV/AIDS Patients
In a speech at the International AIDS conference last night, Secretary of Health and Human Services Kathleen Sebelius announced four new initiatives to improve care for HIV/AIDS patients in the United States:

• Streamlined drug assistance application programs: The program would simplify the process for acquiring HIV/AIDS drugs for people who are eligible for financial assistance. (See a sample form.)
• UCARE4LIFE: HHS, in partnership with the MAC AIDS Fund, will launch a mobile texting pilot program called UCARE4LIFE to help patients get appointment, medication and other important reminders and tips for managing HIV/AIDS. A two-year pilot project will focus on southern states, where the epidemic is rising fast among young adults.
• Pharmacy Medication Therapy Management: CDC will partner with pharmacy chain Walgreens to develop a medication therapy management program to model how pharmacies can help patients stay on their medications and in care.
• Online Physician Training Programs: The Centers for Medicare & Medicaid Services is working with continuing medical education firm Medscape, to create new training programs to help healthcare providers improve care for HIV/AIDS patients.

Read a summary of news from the AIDS Conference from Kaiser Health News.

Young Adults Undergoing Cancer Treatment Need More Support
A new study by researchers at the University of Michigan Comprehensive Cancer Center finds that young adults with cancer may not be getting all the social, psychological and information support they need. The researchers surveyed 215 newly diagnosed cancer patients between the ages of 14 and 39 and found that, compared to both children and older adult cancer patients, the mid-age patients have a different set of psychosocial needs and issues and were more likely to report insufficient information on infertility, diet and nutrition. The study was published in the journal Cancer. Read more on cancer.

CDC Study Suggests Policy Interventions to Help Reduce Alcohol Drinking Among Women of Childbearing Age
One in two women and one in 13 pregnant women reported drinking in the past thirty days, according to a recent study published in the Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. The researchers say that both pregnant and non-pregnant women of childbearing age who misuse alcohol might benefit from community level policy interventions, such as increased alcohol excise taxes and limiting alcohol outlet density. Read more on maternal and infant health.

High Tornado Fatality Rate Last Year Prompts Strengthened Prevention before Storms
A review by the CDC of last year’s tornado season found that 338 people suffered tornado related fatalities between April 25 and April 28, 2011 in five states, the third highest rate in U.S. history. The CDC found that about thirty percent of the victims were older adults and a quarter of the deaths occurred in mobile homes. The researchers say use of safe rooms is crucial to preventing tornado-related deaths, and that individuals who work or live in a tornado-prone area should develop a tornado safety plan prior to severe weather. Read more on disasters.

The Food and Drug Administration (FDA) has approved the first in-home HIV Test. The test, called OraQuick, does not require a prescription and can detect the presence of antibodies to human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2). HIV is the virus that causes acquired immune deficiency syndrome (AIDS).

Consumers use the test by swabbing the upper and lower gums inside of their mouths, then placing the fluid sample collected in a vial that comes with the kit. Results are available within 20 to 40 minutes. The FDA says a positive result does not mean that an individual is definitely infected with HIV, but that additional testing should be done in a medical setting. And a negative test result does not mean that an individual is definitely not infected with HIV, especially if exposure to the virus was within the past three months.

Clinical studies have found that one false negative result would be expected out of every 12 test results in HIV-infected individuals and one false positive would be expected out of every 5,000 test results in uninfected individuals.

OraSure Technologies, which makes the test, will have a consumer support center open 24/7 to help consumers conduct the test and to make referrals for information on prevention and treatment once the test is completed.

“Knowing your status is an important factor in the effort to prevent the spread of HIV,” said Karen Midthun, MD, director of the FDA’s Center for Biologics Evaluation and Research. “The availability of a home-use HIV test kit provides another option for individuals to get tested so that they can seek medical care, if appropriate.” According to the FDA, the test will be targeted to people who would not otherwise be tested. “There’s a large group of people who are infected, and don’t know it,” says Midthun. “And even if they are engaged in behaviors that would put them at risk of getting HIV, they may be reluctant to visit their doctor or a health care facility to be tested.”

The Centers for Disease Control and Prevention estimates that 1.2 million people in the United States are living with HIV infection. About one in five are not aware they are infected. There are about 50,000 new HIV infections every year. Many of these new infections are transmitted from people who are unaware of their HIV status.

Exercise May Increase Survival Rates for Some Cancer Patients

A review of 27 observational studies published between January 1950 and August 2011 finds that exercise may help improve survival for people with breast and colon cancer. The study was published in the Journal of the National Cancer Institute.

Read more on cancer.

OSHA Begins 2012 Campaign to Protect Outdoor Workers Summer Heat and Sun

The Occupational Safety and Health Administration (OSHA) has kicked off a national outreach initiative to educate workers and employers about the dangers of working outdoors in hot weather. The outreach effort builds on last year's campaign to raise awareness about the dangers of too much sun and heat.

Workers at risk include those on farms, construction workers, utility workers, baggage handlers, roofers, landscapers and anyone else who works outside. OSHA has developed heat illness educational materials in English and Spanish; a curriculum for workplace training; a dedicated website; and a free app that lets workers and supervisors monitor the heat index for a worksite. The app displays a risk level for workers based on the heat index, and worker safety information from National Oceanic and Atmospheric Administration heat alerts.

Read more on worker safety.

Johns Hopkins Establishes New Center for AIDS Research

Johns Hopkins University has been awarded $15 million over the next five years from the National Institutes of Health to establish a new Center for AIDS Research. A major priority for the new center will be to address Baltimore’s HIV epidemic. A report by the Baltimore City Health Department released last year found that despite national advances in HIV prevention and treatment, Baltimore continues to be among the top 10 urban areas in the country in HIV incidence rates.

At the end of 2009, there were 13,048 people in Baltimore living with HIV/AIDS and HIV infections were being diagnosed at a rate of almost one and a half per day. A 2006 study showed that the lifetime expense of treating each new case of HIV in Baltimore costs about $355,000. That expense, according to the Health Department’s report, “puts a significant strain on evolving health care systems, especially in a city like Baltimore with a high poverty rate.”

Read more on HIV/AIDS.

Where you live—your zip code, your neighborhood, and even your home—may have just as much or more impact on your health as what goes on in the doctor’s office. “You can predict the life expectancy of a child by the zip code in which they grow up. This is wrong,” said U.S. Department of Housing and Urban Development (HUD) Secretary Shaun Donovan (as quoted in an opinion piece in today’s Roll Call and in a recent commentary, together with U.S. Department of Health and Human Services Secretary Kathleen Sebelius, “How Housing Matters”).

Recent research on a HUD demonstration project found that poor women who were given the opportunity to live in safer, more affluent neighborhoods had lower rates of obesity, diabetes, psychological distress, and major depression. The Roll Call opinion piece, jointly authored by Raphael Bostic, PhD, Assistant Secretary, Policy Development and Research at HUD and Risa Lavizzo-Mourey, MD, MBA, President and CEO of the Robert Wood Johnson Foundation, looks at the role of housing in health, and new collaborations across sectors that recognize that providing healthier, more affordable housing can lead to significant health outcomes.

NewPublicHealth caught up with Raphael Bostic to get his take on changes at HUD to integrate health in all policies, some of the innovative housing programs from the field and how the health field can better support this work. Bostic addressed similar topics a recent conference hosted by the Federal Reserve Bank of San Francisco, RWJF and The Pew Charitable Trusts.

NewPublicHealth: Why is HUD looking at health and how does this fit with HUD’s more central mission?

Raphael Bostic: One of the things that has really been interesting for us as we’ve looked at our programs and our activities is the intersection between housing and a whole host of other areas—health care, school performance, job attachment—they all seem to be pretty closely linked to how well people were housed. We started down this route to pay specific attention to those intersections, and have that as a central platform in our strategic plan.

We’ve been running a demonstration project called Moving to Opportunity, and some of preliminary results of that study, which started in the early 1990s, suggested that health benefits were going to emerge as one of the biggest benefits of people getting housed well. The experimental research really did guide us in a significant way.

NPH: Did this Moving to Opportunity study represent a turning point in how HUD thought about health and housing?

Raphael Bostic: There’s always been some intuition in this building that housing played a role in health, but the experimental results made it concrete and something that we could act on. It also made it easier for us for us to talk to our partners, our stakeholders and grantees to let them know they should be thinking about health, and to think about how the programs they’re designing affect health. That’s been a good conversation to be able to have and point to real findings that say when people get housed better, they wind up healthier.

We’re starting to see some other efforts in this area as well. Asthma is a huge problem, and a costly problem, especially for young people. The quality of housing and how well the housing is built and kept plays a huge role in the incidence of asthma. There are a number of efforts to have joint interventions where health organizations use their resources to do interventions to get housing up to better quality standards, which will then save them money because they don’t have to treat uncontrolled asthma. That really falls in line with the idea that we have that housing policy is health policy.

NPH: How is HUD’s outlook different now than in the past?

Raphael Bostic: One, we’re thinking much more broadly about what success for our program looks like. It used to be success for us was that someone had a voucher and was in a house. We didn’t look much beyond that to say are other parts of their quality of life changing significantly. This has allowed us to focus much more broadly on what success means.

It has also made us be more proactive in finding partnerships with our sister agencies in the federal government. Our partnership with the Department of Health and Human Services has been significantly strengthened and deepened. Similarly, we’re working closely with Department of Education around educational outcomes—it’s really allowed us to be much more integrated, hopefully to get a holistically better set of outcomes.

NPH: What are some of the innovative programs that are working?

Raphael Bostic: Some of our most basic programs have a viewpoint on health embedded in them. There’s Choice Neighborhoods, which is a program where we take some of the worst of our public housing and we convert it into higher-quality, mixed-income, mixed-tenure (rental and ownership) developments. We take those places where we know health is as bad as it’s going to be from a housing perspective and convert them into places where there’s much healthier lifestyles—you have sidewalks, you have walkable neighborhoods, you have amenities and the like. That’s one where I think we will see significant improvements in health because of the housing policy.

Another initiative is the Sustainable Communities Planning Grant. What we’re trying to do is facilitate and incentivize regional planning and more coordinated development of housing that is more sustainable, more walkable, closer to jobs and helps to make living easier, which should translate into real health benefits.

Our basic programs, including support through the Housing Choice Voucher program, where we help people have some mobility to choose the neighborhood they live in, has allowed people to get away from the neighborhoods that were a source of stress and lack of safety—so we’re seeing significant psychological benefits.

And our Housing Opportunities for Persons With AIDS program has been extremely beneficial. One of the most sobering statistics I heard at our conference in September was that for people with HIV/AIDS, if you had 100 people and didn’t get them quality housing, only 25 were still alive five years later. If you got them housing, 95 of them were still alive three to five years later. Talk about an “aha moment.”

NPH: What challenges does HUD face in looking at health-related effects of its work?

Raphael Bostic: Health is a very specialized field. A lot of the housers aren’t aware of what good interventions look like and they don’t really know who to talk to in getting that information. You wind up with a very siloed atmosphere. I think that’s the biggest challenge, is getting the experts to talk to people beyond the usual suspects and get them to understand that we need to be a broader and more integrated community. We’re trying to start facilitating those conversations about health and housing.

NPH: What can the health sector do to help and to work together?

Raphael Bostic: Figure out what sorts of activities are going on in communities that could be informed by health considerations. There’s a movement afoot where people are trying to get health professionals on planning commissions and on code boards so that when zoning decisions come up, we think about them in terms of their health impact. I think that’s an interesting way to make sure health is thought about in all the situations where it’s relevant.

The partnerships we’ve formed with HHS and other agencies here have been extremely positive—it’s really my hope that those collaborations happening on a national level will eventually diffuse down. If we integrate health and housing policies at all levels, that will be very exciting.

NPH: What other organizations or sectors need to be involved in these collaborations to really make an impact on health?

Raphael Bostic: Community development organizations have become increasingly interested, particularly in minority and low-income areas, in the health of their communities. If there are ways to improve health, it improves employability and a whole host of things. How communities are constructed, how neighborhoods are laid out, and how we plan for new, transit-oriented developments—those are all broader community development concerns that have real positive implications, if done well, for how people are housed. A number of community development professionals get this already. There’s a lot of work to be done. Some studies have showed that how communities are zoned and constructed can have direct impacts on obesity, diabetes, hypertension and other health issues. I think there’s more research to be done to better understand those relationships.

>>Read more on the link between housing and health.

New HHS Funding Increases Access to Medication for People Living with HIV/AIDS

The U.S. Department of Health and Human Services will provide about $50 million in new funding to support AIDS Drug Assistance Programs (ADAPs) in states and increase access to HIV/AIDS care services. ADAPs have had critical funding shortages for several years. Read more on HIV.

Court Decision Allows Compensation for Some Bone Marrow Donors

An appeals court ruled yesterday that bone marrow donors whose marrow is taken from their bloodstream may be compensated for the donation. Compensation for organ donations is a felony offense in the U.S. but the court ruled that because the bone marrow extraction process has changed in recent years—from an actual extraction of marrow to securing the marrow through stem cells in circulating blood—donating marrow is those cases is no longer an organ donation. Compensation could be about $3,000 per donor in the form of a scholarship, housing payment or gift to charity, and will likely increase the number of marrow donors.

Genetic Factors May Help Explain Why Some Smokers Have a Tougher Time Quitting

A new study in the journal Demography studied about 600 sets of identical and fraternal twins and found that adult identical twins—who share the same genes—are much more likely to stop smoking at the same time compared with fraternal twins, who don’t have the same gene structure. During the two-year study, 65 percent of the identical twins quit smoking; among the fraternal twins, the quit rate was 55 percent, which the researchers say suggests there’s a genetic component in their smoking habits, and may require different cessation techniques, such as customization of drug doses or combinations of cessation techniques. Read more tobacco news.

In a year with several milestone treatment breakthroughs, several federal agencies that provide information on HIV/AIDS are refining their sites and targeting messages for distinct audiences to increase the number of people infected with HIV who get tested and start treatment.

The numbers explain the effort. In observance of today's Worlds Aids Day, the Centers for Disease Control and Prevention released an early edition of their monthly health indicators report, Vital Signs, that shows that an estimated 1.2 million people are living with HIV in the United States. Of those, as many as 1 in 5 people don't know they have HIV. CDC recommends that all Americans between the ages of 13-64 be tested for HIV at least once as part of regular medical care. Others at greater risk (those with more than one sex partner, those who inject drugs or men who have sex with men) should get tested once a year or more, so that people who test positive for HIV can begin treatment quickly.

Toward that goal, the National Library of Medicine (NLM) has just redesigned its AIDSinfo page. Changes include:

• Two new categories: Education Materials and Mobile Resources & Tools. Users can also get one-click access to consumer resources such as the AIDSinfo HIV/AIDS Glossary and mobile applications.
• Links to key AIDSinfo fact sheets throughout the sites to improve access to critical information.
• Links to social media tools, such as Facebook and Twitter throughout the websites to make the resources accessible from any page.

NLM has also made changes to its InfoSida site, the agency’s Spanish language web page. Research by staff at NLM found that the primary audience for AIDSinfo is healthcare providers accessing medical practice guidelines, while the main users of infoSIDA are Spanish-speaking people with HIV; their family members and friends; and HIV case managers and outreach workers. Changes to infoSIDA include:

• Creating a distinct Web address for infoSIDA, which makes it easier to find through Google.
• Featuring Spanish-language Education Materials more prominently; research on the site showed that the fact sheets and the HIV/AIDS Glossary were accessed most often.

CDC has also just launched “Testing Makes Us Stronger,” a resource for black gay and bisexual men. Recent studies show that in major cities nearly one in three black gay and bisexual men is infected with HIV, and the majority (59 percent) don't know it. From 2006 to 2009, new infections in young black gay and bisexual men ages 13-29 increased by nearly 50 percent.

The campaign uses images of a diverse range of black men to get the attention of this population (see one example above). The campaign will be featured in targeted online and print media, as well as local outdoor, transit, and print media in cities experiencing high levels of HIV infection among black gay and bisexual men.

Today Is World AIDS Day

A new report from the World Health Organization (WHO), UNICEF and UNAIDS finds that 34 million people worldwide are living with HIV. Increased access to HIV services has resulted in a 15 percent reduction of new infections over the past decade and a 22 percent decline in AIDS-related deaths in the last five years. The number of people receiving AIDS medicine worldwide rose to 6.65 million in 2010 from 400,000 in 2003.

"It has taken the world ten years to achieve this level of momentum," says Gottfried Hirnschall, Director of WHO's HIV Department. "There is now a very real possibility of getting ahead of the epidemic. But this can only be achieved by both sustaining and accelerating this momentum over the next decade and beyond."

Despite the advances worldwide, concerns remain, according to the report:

CDC: Syphilis Cases Down, Other STDRates Up

A new Centers for Disease Control and Prevention report finds that the number of new syphilis cases in the U.S. has fallen for the first time in ten years, but cases of chlamydia and gonorrhea are up. The report also finds that sexually transmitted diseases continue to impact minority groups disproportionately. Read more on sexual health.

Children's Seat Belts Often Don’t Fit Correctly

A parent survey in the journal Academic Pediatrics finds that drivers of four to nine year-old children say their children’s seat belts often don’t fit correctly. The researchers suggest that clinicians should encourage the use of size-appropriate child passenger restraint systems, including car seats and booster seats, instead of seat belts, which may not fit well for this age group. Read more safety news.

United Nations: Dramatic Drop in New HIV Infections and AIDS-Related Deaths

New HIV infections and AIDS-related deaths have fallen to the lowest levels since the peak of the epidemic, according to a new report by the United Nation’s Joint Programme on HIV/AIDS. New HIV infections decreased by 21 percent since 1997, and deaths from AIDS-related illnesses decreased by 21 percent since 2005. Read about a recent effort to usher in a global AIDS-free generation.

Twitter, Facebook and other social media applications are often seen as up-to-the-minute, spontaneous news tools. But at a session this afternoon at the 2011 APHA annual meeting, AIDS.gov’s Miguel Gomez shared a secret: he and his staff meet each week to plan out what they are going to Tweet. They examine what their partners and advocates are talking about in the social media sphere so that they know they are being responsive to relevant topics. And, of course, they respond as needed if circumstances warrant, but this advice was a great kick-off to an engaging session on using social media to communicate, educate, and advocate for public health.

Michele Late is the woman behind @publichealth, APHA’s Twitter account since 2007. With 140,000-plus followers, @publichealth is one of the top health Twitter accounts out there, and TIME magazine said as much in a ranking this past March. Late shared tools such as URL shorteners, analytics tools and Tweet schedulers that she has mastered over the past few years, urging others to take advantage of the many (free!) resources out there that can give Twitter account owners information about their followers. By tracking retweets and other statistics, Late learned what types of posts were most interesting to the @publichealth audience (career-related, health observances and personal health tips are way up there).

Some specific tips Late shared:

• If you put a period if front of an @ reply, it will show up for everyone who follows you (and not just the person you are replying to and anyone who follows them).
• Tweet for all time zones. If you’re on the East Coast, make sure to Tweet in the late afternoon.
• Interact with followers (“otherwise you’re not social – you’re a bulletin board”)

Megan Yarbrough from M+R Strategic Services reminded the audience that if they want to measure their social media success, they should make sure to define their goals in advance. If you don’t know who you want to reach, it’s pretty hard to be strategic and to determine whether you made an impact. And it is also helpful to understand social media algorithms: for example, on Facebook, things such as affinity (“likes”) and the type of content (photos are worth more) are weighted heavily toward your metrics. Yarbrough also reported on a benchmarking survey of Facebook use by non-profits that found:

• Non-profits average 15,000 fans on Facebook pages
• A good way to measure Facebook fans is to look at number of fans compared to number of e-mail subscribers. Non-profits averaged 110 fans/email subscriber.
• For every 1,000 fans, non-profits only had an average of 1.7 likes or comments.

Ever wonder how the CDC strategizes about social media? Former social media guru (now she’s at the National Office for Drug Control Policy) Erin Edgerton shared some tips—in 140 characters—for success. Her advice included remembering to use the principles of good communication, even if you are working on a new or flashy platform; holding on to your content promotion until you have a really good piece to promote, and ensuring that you use people’s ideas and input if you ask for them.

>>Follow our coverage of APHA 2011 on Twitter here and read up from NewPublicHealth here.

Violence Toward Health Efforts Is Rampant in Conflict Regions

The International Committee of the Red Cross has issued a report that finds that care is disrupted for millions in conflict areas because of violence against health workers, facilities and vehicles.

New Truck Fuel Standards Will Reduce Some Pollution

New fuel standards, written by both the Department of Transportation and the Environmental Protection Agency, require semi-trucks from model years 2014-2018 to reduce fuel consumption and greenhouse gas emissions by 20 percent, according to a news release.

FDA Approves Second Once a Day HIV Drug

The Food and Drug Administration has approved a second once-a-day HIV pill, Complera, marketed by Gilead Sciences, Inc. The pill contains three HIV drugs and is expected to help streamline drug therapy for appropriate patients. Reducing the complexity of drug taking can help improve drug compliance—and treatment.

Two Million Eligible Seniors Not Taking Advantage of Medicare Drug Subsidy

The Centers for Medicare & Medicaid Services estimates that more than 2 million people on Medicare could qualify for financial assistance for their drug costs, but have not applied for the subsidy, according to a news release. Eligible individuals would pay no more than $2.50 for generic drugs and $6.30 for each brand name drug. The steps and requirements beneficiaries can take to check if they qualify for the Medicare Low-Income Subsidy Program (also known as LIS or “Extra Help”) can be done by phone or online.

Lifting Weights Helps Smokers Quit and Avoid Weight Gain

A new study in the journal Nicotine and Tobacco Research funded by the National Cancer Institute found that a group of smokers who were given nicotine patches were more likely to quit and to lose weight if they also participated in weight training. A control group that also received patches but didn’t do the training were less likely to quit and more likely to gain weight during the study period, a frequent problem for people trying to quit smoking.