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December 9, 2012

Robin Hood says No Cuts to AIDS Programs, Tax Wall Street!


December 9, 2012: International Human Rights Day is tomorrow, Monday December 10th. In honor of that day, and with congress considering devastating cuts that would harm the basic rights of millions of people across the world, actions are being scheduled at congressional offices around the country. Robin Hood will be at many of these actions, joining others in the demand of "no cuts", and calling on congress to tax Wall Street.
People living with AIDS cannot afford budget cuts to lifesaving programs, both in the United States and across the world. A Robin Hood Tax on Wall Street could prevent budget cuts to important programs like the Global Fund, the President's Emergency Plan for AIDS Relief, HOPWA, Ryan White Care Programs, and others.
Check out the list of actions below, and come out to support Robin Hood!

Posted by John S. James at 10:33 PM 1 comments

July 12, 2012

AIDS2012 Conference, July 22-27 -- Washington DC or Anywhere

By John S. James

AIDS2012, the XIX International AIDS Conference, happens this month, July 22-27, 2012, at the Washington Convention Center in Washington, DC. More than 20,000 people are expected to attend. AIDS2012, organized by the International AIDS Society (iasociety.org) and many others, is the largest AIDS gathering in the world. It takes place in different countries, every two years.

Below are some online information sources that can help you follow the conference news, whether you are at the meeting or not.

[Note: in case you happen to be in the Washington area but not attending the conference officially, one part of the conference, the Global Village, is free and open to the public this year. About 250 AIDS-related organizations from around the world will be presenting there, so you can probably find people you want to meet. While there are likely to be scheduled presentations within the global village, it is mainly a place for informal discussions. (See below for how to participate in these and other discussions even if you are far from Washington.)]

All the sites in this article are publicly accessible (although parts of the official site can only be visited by persons attending the conference, who log in with their conference credentials).

Of the hundreds of sites that will report news from the conference and would be worth listing here, we picked just a handful that are most important for our readers to know about.

Official Conference Site: www.aids2012.org

When looking at all the dozens of items and links available on the home page, don't overlook the navigation bar at the top, with links to the official conference blog, and to the Global Village (plus the youth program, and the media center).

The U.S. government's AIDS blog, blog.aids.gov/, has an entry listing the official partners of the IAS for this conference. For the full list, see http://blog.aids.gov/2012/06/how-to-stay-updated-during-aids-2012.html. Some of the partner organizations:
 * The Kaiser Family Foundation will provide official coverage of the conference, including video of some of the major sessions, and daily news reports. For more information see www.kff.org/hivaids/hiv062712nr.cfm.
 * For basic science news reporting, Science magazine (sciencemag.org) is a good place to start, especially Jon Cohen's articles on AIDS.
[But like too many science and medicine journals, some of the articles are for sale for prohibitive individual prices (at profit margins we estimate at 100,000% or greater, compared to the cost of online delivery -- note that the journals seldom pay for any of the research being reported). To see the full text, you need to be rich or be part of an institution such as a university. Usually anyone can see at least an abstract or summary of research article, and sometimes the full text is made free as well. And some some material is free, but only to registered users (registration is free).]
 * The same is true for the Lancet, a medical journal that is also one of the official partners. The Lancet published a number of AIDS articles shortly in advance of the conference, at www.thelancet.com/journals/lancet/issue/vol379no9835/PIIS0140-6736%2812%29X6026-4. Publishing in advance is helpful, since interested persons can read the new information ahead of time and use it to inform many discussions at the meeting.
 * POZ/Aidsmeds (http://poz.com/), and Aidsmap (www.aidsmap.com/), are two other conference partners with excellent news coverage on AIDS, written for persons with AIDS and the interested public. Check their conference coverage before, during, and after AIDS2012.
 * For religious information, check the Interfaith pre-conference meeting, blog.aids2012.org/post/Interfaith-pre-conference-%E2%80%9CTaking-Action-for-Health-Dignity-and-Justice%E2%80%9D.aspx  (This page was hard to find from the main aids2012.org page, which may explain why there were no comments as of early July.)

Satellite Sessions

For officially recognized satellite sessions (both non-commercial, and commercial) see:
aids2012.org/WebContent/File/AIDS2012_Satellites_List.pdf
Sometimes the public can go to these; sometimes a conference badge is required.

Non-Official Sites (not officially connected with the conference)

Of hundreds of news and other sites, we note three:
 AIDS2012 Reunion, www.aids2012reunion.org/  A new organization, focused entirely on this conference for now.
 Project Inform, www.projectinform.org/. One of the first AIDS treatment information organizations, still doing excellent AIDS treatment news coverage.
 NATAP (National AIDS Treatment Advocacy Project), www.natap.org/, especially for important technical/scientific information.

For more conference coverage, you can do a Google search such as:
"aids conference" 2012
This search finds about 2,000,000 pages on this and other conferences -- fortunately listed by Web popularity. The official aids2012.org pages are organized at the top of the search results, quickly followed many non-official websites and page -- so you don't need to scroll through hundreds of official pages first.

Using Twitter to Find Conference Coverage

You don't need a Twitter account. Just go to search.twitter.com and search for whatever interests you. Twitter shows what's going on now, not going far back into the past. Note: Twitter's search will probably show you the "Top" tweets, but let you choose "All" -- which you probably do want to choose. Also note that Google no longer works for finding tweets; Twitter unfortunately revoked Google's access a year ago, to improve its own search instead.

You can search for #aids2012 (best to include the hash mark). This "hash tag" was suggested by the conference, to use in the text of tweets (Twitter messages) in order to bring them to the attention of people searching for information about the conference. But anyone with a Twitter account can use this hash tag in their tweets -- so be aware that spam or misinformation could also be sent this way.

The Global Village is tweeting officially from @gvaids2012 (no one else can send FROM that Twitter address). We haven't seen anyone using the similar hash tag #gvaids2012 as of early July (note the hash mark punctuation instead of the at-sign), but we recommend it and think people will be using it during the conference and a little before. Anyone with a Twitter account can send a tweet from their phone or computer with this hash tag in it, immediately and without waiting for anyone's approval -- a good way to share news instantly within or about the Global Village (as well as with the rest of the world). And if the people running the official @gvaids2012 account like some of these messages, they can re-tweet them to all followers of @gvaids2012 (whether or not those followers ever search for the hash tag). So using a name in this way (with the'@' from the owner of the Twitter account exclusively, and the '#' for the hash tag that anyone can use) gives both an official and an unofficial channel on the subject (the Global Village of AIDS2012, in this case).

Note that anyone in the world can discuss the AIDS2012 conference on Twitter -- no need to be in Washington. (Well, not anyone; some countries ban Twitter.) You do not need a Twitter account nor any prior knowledge to search recent tweets at search.twitter.com, e.g. for #aids2012, or for the Global Village. You do need a Twitter account to send your own tweets, and also to follow others' Twitter accounts (meaning  to receive all the tweets they send).

Each tweet can only have 140 characters -- basically a short sentence. But about a dozen of the 140 can optionally be used for a Web link, so the tweet can tell you about something quickly, and let you click for more information if you want. As of July 11, 2012,m a new tweet is being sent about every two minutes during the workday Washington time, usually pointing you to more information on the Web, and also at the conference.

A major advantage of Twitter is that you can look things up by searching (either for a hash tag, or just for a word in the tweet), and then connect with people who share a mutual interest, whom you might never otherwise have met.

Conferences of the Future

The bottom line is that you can virtually attend AIDS2012, and have input, even if you are thousands of miles from Washington. We believe that conferences will and should continue to evolve in this direction. Eventually the lectures presenting scientific, medical, and other information will be largely online, with important results released any time they are ready, not held up for arbitrary conference or publication dates. Online (or DVD) presentations are better educationally than lectures in auditoriums, since everyone can see the slides and hear the speakers, can rewind if necessary, and can consult outside materials easily. Why should scientific and medical research reports be tied to the great expense of air travel, hotels, and conference admission?

Future physical meetings will be for persons who need to meet face-to-face with particular working groups and individuals. Based on past experience of online communication actually increasing physical meetings, these better-focused conferences could be even larger than the ones today. For those who can travel abroad it will be better to make one international trip to take care of most of one's global meeting needs, than to make separate trips. And for those who cannot travel, online and DVD information will be much better than it is today -- and more important than the physical meetings that are hundreds of times more expensive.

Posted by John S. James at 12:46 PM 1 comments

Researching HIV in WikiLeaks Cables

By John S. James


All 251,287 WikiLeaks "Cablegate" cables have now been released (apparently by opponents of Assange). They are searchable, and 'HIV' is mentioned in 1534 of them. While 107 cables are tagged 'HIV', many other relevant cables are not.

Several specialized search engines will search this huge archive for whatever you want. We used www.CableDrum.net for this article. (Apparently the full text of the cables is indexed in Google, though not in Bing.)

To try CableDrum yourself, visit the site and type HIV into the "Search text" box, then click the Search button. A search might take half a minute or so, but then you should see the Subject of the first 25 of the 1534 cables containing 'HIV'. To read the full text of the cable, click the "Reference ID" on the left of the Subject line.

For this article we decided to look at two issues:
  • What was the U.S. reaction as it became clear that Australia was doing much better than the U.S. in AIDS prevention -- apparently due mainly to very different policies on needle exchange?
  • How did the U.S. embassies see PEPFAR (President's Emergency Fund for AIDS Relief), the outstandingly successful U.S. program to make AIDS treatment available on a large scale to poor countries that otherwise had very little access?
Our research is incomplete, and presented mainly to show you how to use the cable database.

Australia and Needle Exchange

"[Needle exchange programs] have played a vital role in helping prevent the spread of blood-borne illnesses in Australia, according to Paul Dessaur of WASUA. 'In Australia, for instance, the rate of HIV amongst injecting drug users is less than 1 percent, and that is unheard of, and it's purely because we introduced these programs way back in 1986,' he said." [2012, www.cdcnpin.org/scripts/display/NewsDisplay.asp?NewsNbr=59528]

We don't have a comparable U.S. figure for the infection rate among IDUs, but it is probably well over 10 times higher.

Our search for HIV and Australia as tags found nothing. A search for:
HIV Australia
in the full text found 79 cables. Most of them were unrelated, so we tried:
Australia hiv "syringe exchange"
with no result. But:
Australia hiv "needle exchange"
found one result, www.cabledrum.net/cables/09MOSCOW3072, which is relevant (one of only two we've found so far). It described Russia's chief medical officer as "positive about needle exchange
programs, saying that they were proving effective."

Searching for
Australia "needle exchange"
(no need to mention HIV) found 7 results, including the above, plus another relevant cable (www.cabledrum.net/cables/09UNVIEVIENNA64), also dated 2009, referred to the "new USG [United States Government] position: support for needle exchange programs as a method to prevent the spread of HIV/AIDS, and for medication-assisted therapy as part of a comprehensive treatment protocol against narcotic addiction, and continued USG opposition to the term 'harm reduction'." 

What we have not yet done is to read through all the cables mentioning just "needle exchange", "syringe exchange", or with a tag HIV (about 150 cables in all), to find anything that may be relevant.

But already it seems fairly clear already that there is no acknowledgement or discussion of Australia's success with needle exchange anywhere in the text of the 251,287 cables obtained by WikiLeaks. Any such cable would almost certainly include the word 'Australia', and either 'needle exchange' or 'syringe exchange', and we checked all of those cables.

PEPFAR Success

Our work on this search is less complete. Much more remains to be done.

There is no tag for 'PEPFAR' (which seems odd), but the word appears in 587 of the cables. The next step might be to read all places where 'PEPFAR' appears in these cables, to see what is interesting. This would exclude the cable about checking whether the 20 telephones in a new PEPFAR office were working correctly -- and those with only general statement of good intentions, such as:
"USG-Nigeria PEPFAR team submitted the 2010 annual Country Operation Plan (COP) to the Global AIDS Coordinator January 29. The plan builds a partnership for sustainability with the Nigerian Government to continue strengthening ongoing service delivery to patients; renew focus on health systems strengthening; and align activities with the Nigerian National Strategic Framework for HIV-AIDS, 2010-2015. The Plan will also intensify and focus prevention efforts; deepen integration of HIV-AIDS response into the broader health care system; strengthen the health care system at all levels; and expand access to quality services. USAID's proposed FY2010 PEPFAR budget is 249.9 million dollars."

The Surprise

What most surprised us is the lack of perspective in the diplomatic world -- how little attention and actual thinking concern HIV, an epidemic that has killed tens of millions of people including half a million in the U.S. Vastly more attention goes into the drug war -- a shooting war which, in its current form, started a century ago in the U.S., and has been a continuous failure ever since. It still has no victory in sight, only more of the same. The basic flaw may be the same as in other U.S. shooting wars -- the lack of any sane or real mission, since the actual purpose of the war is to create financial opportunities for corporations, contractors, careerists, and other well-placed special interests.

A fundamental problem is that perspective and thinking are dangerous in diplomatic (and other government or corporate) careers; those who think may not last. In theory the thinking will be done at higher levels, but the system is too corrupt for that. So major institutions proceed like zombies, decade after decade and century after century, with results that we see every day.
Posted by John S. James at 12:22 AM 0 comments

April 27, 2012

Truvada PrEP, Gilead, AHF's Bizarre Attack: Our statement to the FDA


Submitted to the FDA today, April 27, 2012, by John S. James, AIDS Treatment News:

I strongly support approval of Truvada for PrEP. In the large iPrEx study of men who have sex with men, "No one in iPrEx acquired HIV infection with a drug level that would have been expected with daily dosing" (Dr. Robert Grant, PI, CROI 2011, http://bit.ly/grjVUg). I reported the details exactly a year ago, at http://aidsnews.blogspot.com/2011/04/hiv-prep-explained-critical-prevention.html

The strongest argument against approval is that the mediocre intent-to-treat results reflect the real world, where people don't take their pills. But approval of a treatment that works close to 100% when used once a day opens all sorts of doors for improvement. For example, communication with patients and with future trial participants can be much clearer and more definitive than communication in the iPrEx trial.

Also remember that much of the epidemic results from relatively few superspreaders. The limit of treatment as prevention is that it's almost impossible to identify and treat them in time. PrEP is better, because these people know they are personally at risk; they are likely to protect themselves if given clear messages and an opportunity to do so, eliminating all transmission through them -- a powerful strategy to fight the HIV epidemic.

AHF Debacle: Does Gilead Really Want Truvada Approved for PrEP?

Events in India (not reported in the U.S. so far) raise this question. The full story is summarized in "Anti-AIDS blitz sees pharma firms locked in ugly battle," at http://economictimes.indiatimes.com/articleshow/2586967.cms

The AIDS Healthcare Foundation campaign against Gilead re Truvada PrEP is a roll-out of a similar AHF campaign run almost four years earlier in India, against Cipla -- and clearly run on Gilead's behalf. AHF spent considerable money on full-page ads in Indian newspapers, apparently to get Cipla in trouble with the Indian government for charging less for medicines in Africa than it did in India. While AHF supposedly paid for the anti-Cipla campaign, Gilead gave AHF a grant for far more, according to The Economic Times article cited above. AHF had no visible motive to go after Cipla, but Gilead sure did; alone among Indian pharmaceutical companies making a Truvada generic, Cipla did not accept Gilead's licensing terms, but planned to fight Gilead's claims in Indian courts.

Why might Gilead secretly campaign today against use of its own drug for PrEP? It is not very hard to see why.

Gilead is stuck because it cannot feasibly charge a different and vastly lower price for the same pill for prevention. It's hard enough to promote prevention; now try adding over $13,000 per year out-of-pocket retail price ($13,816 -- $3,406.79 per 90 tablets, on drugstore.com today). This cost will be out-of-pocket in many if not most cases. The Truvada price is what the market will bear to help save a life, and the market will bear much less to relieve a risk people typically think doesn't apply to them, and don't like to think about at all.

Even 10% of the existing price will be too much for prevention. So there will be no significant market for Truvada PrEP, and no significant profit -- while Truvada for treatment remains an enormous gravy train for Gilead.

And if Truvada for PrEP is approved, Gilead will be the "heavy," consistently blocking control of HIV in the U.S., year after year after year. This will be dangerous for the company, especially in the context of so much need and pressure to reduce medical costs. Similarly, Gilead would be the heavy if it refused to apply for PrEP approval.

The AHF campaign to turn the gay community against Truvada PrEP has failed. But Gilead can get about the same benefit by applying to the FDA and being rejected.

Of course we cannot be sure of Gilead's or AHF's intentions, without reading minds. Maybe Gilead and AHF had a falling out. But in considering this application for Truvada PrEP, you should consider that it may be unlike any other you have ever seen. Whatever Gilead's intentions, the company clearly has strong economic and political incentives for its own application to fail.

John S. James
AIDS Treatment News
www.aidsnews.org


Note to readers: This very controversial FDA Antiviral Advisory Meeting will be May 10, near Washington DC; recently the schedule was changed to allow an extra hour of public comment. You can submit written comments until May 17; however, written comments had to be submitted by 4 pm today to be distributed in advance to the committee members. (We got ours in with less than 10 minutes to spare, due to computer hassles when using a Linux netbook at the FDA site.) Comments will be published by the FDA, but not immediately.

For more information about speaking and/or submitting comments, Google the FDA's docket number,  FDA-2012-N-0218

The AHF has been very active on this issue at the FDA. It has endless money, and it wants to win. We expect an echo chamber at the meeting.


Permalink: http://aidsnews.blogspot.com/2012/04/truvada-prep-gilead-ahf-our-statement.html


Notice re Comments below: Due to a computer problem, all comments submitted before 4:15 pm Eastern time today (April 30) disappeared -- except for #1. Your comment was not rejected. We never saw it. And we could not publish any comment ourselves.

A successful workaround was to change Blogger's 'Comment Location' setting from 'Embedded' to 'Full page'. Comments should work now. (We recommend this solution to anyone who publishes on Blogger, because 'Embedded' has long caused problems with  some browsers. You could lose some but not all comments with no notice, and commenters will think they were rejected when they were not.)

Posted by John S. James at 8:18 PM 3 comments

February 7, 2012

Act Up-Paris on pharmaceutical data exclusivity, ACTA

Please find below Act Up-Paris question to Karel De Gucht, European Commissioner for trade during a European Commission Civil society dialogue meeting* on trade, growth and development, that took place today in Brussels. 

* there was more industry representative than NGOs in the room.

Best, Pauline
-- 

"Mr De Gucht.

I represent Act Up-Paris, an organisation of people living with HIV based in France. But today, I bring you a message from hundreds of groups worldwide that have signed a call of action to denounce the European Commission's deadly trade policy. For four years you have negotiated a bilateral agreement with India, for three years you negotiated ACTA in a total lack of transparency.
You have repeatedly stated that these agreements will will not affect affordable medicines.

Starting on Friday, you will represent E.C during a summit in India.

How can you claim that data exclusivity will not have an impact when the European Parliament itself has asked that this provision not be put in an FTA with developing countries?

How can you state that ACTA and the enforcement provisions in the EU-India FTA will not affect medicines when european customs authorities continue to seize generic medicines in transit, like it happened again last November?

How can you ask India to implement TRIPS-plus provisions and state these will not affect access to medicines when the United Nations, the WHO, UNITAID, the Global Fund, the UN Special Rapporteur on the Right to Health have all condemned these provisions for affected treatment?

The statements of the European Commission have always been vague and aiming at confusing the citizens of Europe and millions of people in need to treatment worldwide. But they are not fooling anyone.

The European Commission speaks only for the profits of a few companies and not for the lives of millions across the world. Your FTA only aims at strengthening pharmaceutical companies monopolies. While the consequences for firms will be more profits, in the real world many people will die because they will not have access to treatments because of their price.

Across Asia, Latin America and Africa protests against the European Union are taking place. Yesterday in London, last Friday in Nepal, AIDS activists asked you to stop this policy that will take peoples lives.

We ask you to stop this deadly trade policy." 
- 
Pauline Londeix
Posted by John S. James at 2:13 PM 1 comments
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