March 28, 2008

Vol. VII, Number 10

This Week in Washington

1. NIH Holds Summit on HIV Vaccine Research and Development

2. PACHA Holds 35^th Meeting

3. CDC Releases 2006 HIV/AIDS Surveillance Report

4. CDC Releases NCHHSTP 2007 Annual Report

Announcements

1. Upcoming Connecting to Care Training: April 29-May 1, Washington, DC

2. Registration Open for AIDSWatch 2008

3. Global Conference on Methamphetamine Accepting Abstracts

4. HRSA Provides 2008 Ryan White HIV/AIDS Program Meeting Information

5. Kaiser Family Foundation Releases Update HIV/AIDS Fact Sheet

This Week in Washington

1. NIH Holds Summit on HIV Vaccine Research and Development

On Tuesday, March 25^th, The National Institute of Allergy and Infectious Disease (NIAID) convened an HIV Vaccine Summit. The event was titled, “AIDS Vaccine Research: A re-evaluation.” The meeting was called after clinical trials testing a Merck HIV vaccine candidate were halted in September due to safety concerns. The summit brought together leaders and key staff of the National Institutes of Health (NIH) and over 300 experts in the scientific community to examine the current direction of HIV vaccine research. The discussed the optimal balance between basic vaccine-related research and development efforts designed to advance promising vaccine candidates into clinical trials as well as how to optimally use animal model research to support vaccine research.

The complete summit was webcast and can be viewed at: http://www.macrovolt.com/live/dgi_032508/.

The recommendations and outcomes of the summit meeting point towards a major shift in strategy. After the summit, it became clear that a greater emphasis and investment must go towards basic laboratory research, while continuing to build on scientific discoveries to date including human clinical trials. Currently 47% of NIH’s vaccine research budget goes to basic laboratory research and 38% goes towards clinical trials of vaccine candidates in humans. The summit also focused on the overall need for increased funding for the National Institutes of Health and HIV/AIDS research.

During the summit Dr. Anthony Fauci, Director of NIAID said, “We need to turn the knob toward basic scientific discovery, nobody should be unclear about that,” and Carl W. Dieffenbach, head of NIAID’s Division of AIDS, acknowledged that the summit marks a change in approach.

While the summit indicates a “mid-course” evaluation and change in direction, it is important to note that the focus of the meeting was strategizing on how to move forward in the most successful and promising way towards finding an HIV vaccine. Significant progress has been made in the extremely challenging field of HIV vaccine research. While the Merck results were disappointing to all in the field, the trial is not considered to be a failure and will undoubtedly provide valuable information as the results are fully analyzed. This is a critical moment for scientists, advocates, and members of the community to come together and remember that HIV vaccine research is essential in the fight against AIDS along with prevention, treatment, and care. 

Please read the AIDS Vaccine Advocacy Coalition’s (AVAC) response to the summit at: http://avac.org/pdf/summit_commentary_mar2008.pdf.

2. PACHA Holds 35^th Meeting

The Presidential Advisory Council on HIV/AIDS (PACHA) held its 35^th full Meeting on Tuesday and Wednesday, March 25-26, at the Department of Health and Human Services (HHS). Welcome and Opening Remarks were given by PACHA Co-Chair, Marilyn A. Maxwell.

Dr. H. Westley Clark, the Director of the Center for Substance Abuse Treatment (CSAT) gave the opening presentation on HIV/AIDS activities at the Substance Abuse and Mental Health Services Administration (SAMHSA).  He noted that CSAT, the Center for Mental Health Services (CMHS) and the Center for Substance Abuse Prevention (CSAP), comprise the three operational parts of SAMHSA providing funding for direct services for the prevention and treatment of alcohol and other drug abuse and mental health disorders.  SAMHSA funds more than $111 million annually for Minority AIDS Initiative (MAI) projects.  In particular Dr. Clark noted that CSAT’s MAI grants are awarded to community based organizations with two or more years of experience and which target African American, Latino/Hispanic and other racial or ethnic communities highly affected by both substance abuse and HIV/AIDS.  As a whole, targeted outreach grants and Targeted Capacity Expansion TCE/HIV grants served a combined 40,918 clients.

Dr. Clark reported that SAMHSA had secured $416,895 in funding during fiscal years (FY) 2005 – 2007 to distribute rapid testing kits to CSAT and CSAP grantees.  The goal of the program was to incorporate the new rapid HIV tests to facilitate early diagnosis of HIV among at-risk minority populations involved in substance abuse and/or living with a mental health disorder and to increase referrals to sustained quality counseling, treatment, and other supportive care services for people diagnosed with HIV.  He did not say how many cases of HIV had been reported as a result of the rapid testing initiative. 

Dr. Clark also noted that SAMHSA’s authorization law requires that states with an AIDS case rate of 10 or more per 100,000 individuals must set aside a percent of the Substance Abuse Prevention and Treatment (SAPT) block grant to establish 1 or more projects for early intervention services for HIV.  In FY 2008 21 States, Puerto Rico and the U.S. Virgin Islands were required to set aside $56.77 million in HIV funding.  These funds were spent on HIV early intervention projects including counseling, HIV testing, and referral services.  Those states are also being encouraged by SAMHSA to use part of their set-aside to purchase rapid HIV test kits.   Dr. Clark also noted that the Mental Health HIV Services Collaborative (MHHSC) Program awards 16 grant sites a total of $8.4 million to provide HIV-related mental health services.

Dr. Kevin Fenton, MD, PhD, FFPH, Director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), then gave a presentation on the current state of the HIV/AIDS epidemic in the United States. He explained the mission of the NCHHSTP is to “maximize public health and safety nationally and internationally through the elimination, prevention, and control of disease, disability, and death caused by HIV/AIDS, Non-HIV retroviruses, Viral Hepatitis, Other Sexually Transmitted Diseases, Tuberculosis, and Non- Tuberculosis Mycobacteria.” The center’s priorities for FY 2008 involve publishing a series of papers and reports on research, surveillance, the social determinants that impact HIV, and the NCHHSTP 2020 strategic plan. They also plan to develop a national mobilization on Program Collaboration and Service Integration.

In his remarks Dr. Fenton focused on the reduction of health disparities as a personal priority. He also spent time emphasizing the increasing impact HIV/AIDS is having on the MSM community. He stated, “During 2006, 43% of adult and adolescent AIDS Cases were MSM.” He added that we must work to address the possible “drivers” of the increased numbers in the MSM community. Some of those drivers include “safe sex fatigue, HIV treatment optimism, substance abuse, changing demographic characteristics, and evolving sexual networks.” Dr. Fenton noted some of the prevention challenges that we face in the domestic HIV/AIDS epidemic are: ¼ of the HIV positive individuals in the United States are undiagnosed, MSM remain at increased HIV risk, African Americans and other communities of color are at increased HIV risk, HIV complacency due to effective treatments exists, and the stigma and misinformation surrounding HIV/AIDS still persists. There have been a few noted accomplishments that Dr. Fenton brought to the attention of PACHA: decreased HIV/AIDS cases among the injection drug user community, among females, pediatric cases down to 37 in 2006, and an increased number of people who have been tested for HIV.

Steven Young, Director of the Division of Training and Technical Assistance, HIV/AIDS Bureau, Health Resources and Services Administration (HRSA) gave a presentation on “Implementing the New Ryan White HIV/AIDS Program.” Mr. Young presented in place of Deborah Parham Hobson, the HRSA Associate Administrator who heads the HIV/AIDS Bureau.

Mr. Young reviewed the goals and new features of the Ryan White HIV/AIDS Treatment Modernization Act of 2006, which reauthorized and effectively replaced the Ryan White CARE Act.  He noted that unlike previous reauthorizations of the CARE Act, the 2006 Act sunsets the Ryan White program on Sept. 30, 2009.  Mr. Young noted the goals of the new Ryan White program are to serve the neediest first (underinsured or uninsured people and people lacking financial resources), to focus on life-saving and life-extending services (core medical services), to increase prevention efforts, to increase accountability at all levels, and to increase flexibility (changes in funding formulas so that “dollars follow the epidemic”).

Looking to the future, including after the current Act sunsets, Mr. Young noted emerging issues.  These included the shortage of clinicians and Ryan White grantee staff; clinical issues, including Hepatitis C, increased cost of care; retention of people with HIV/AIDS in care; HIV testing; the fiscal viability of grantees and service providers; health care financing and state health care reform efforts.

On Wednesday March 26^th, Carl W. Dieffenbach, Director of the Division of AIDS and the National Institute of Allergy and Infectious Disease presented on the future direction in prevention research. Following his presentation, Dr. Kathryn Anastos, Professor at the Montefiore Medical Center presented on the role of Women’s empowerment in containing the HIV epidemic. William Steiger, Ph.D, Director of the Office of Global Health Affairs, gave a PEPFAR update as the final presentation.

Presentations are not yet available online, but will be shortly at http://pacha.gov/meetings/.

3. CDC Releases 2006 HIV/AIDS Surveillance Report

On Monday March 24^th the CDC released the 2006 HIV/AIDS Surveillance Report: Cases of HIV infection and AIDS in the United States and Dependent Areas. The report contains updated data on HIV/AIDS and AIDS cases, deaths, persons living with HIV/AIDS, AIDS diagnosis, and reported cases of AIDS, HIV/AIDS, and HIV infection (not AIDS). The report can be found at http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006report/pdf/2006SurveillanceReport.pdf.

In this report, CDC states that the number of reported cases of HIV infection in 2006 based on 45 states and 5 U.S. dependent areas with confidential name-based HIV infection reported was 52,878. The five states not included in this number are Hawaii, Maryland, Massachusetts, Montana, and Vermont. For the first time the reported cases of HIV figure includes the following seven newly reporting states: California, Delaware, Illinois, Maine, Oregon, Rhode Island, and Washington. In 2005 the comparable number of reported HIV cases was 35,537 based on 38 states. The number of reported cases in a year is a separate piece of data from the number of new infections occurring during a year, which is the HIV incidence number, and the number of cases diagnosed during the year. The report’s commentary notes that the reported cases do not represent incidence. The number of reported cases also does not account for delayed diagnosis and reporting time, but is still an important piece of surveillance data. The HIV/AIDS community is still awaiting the CDC’s release of new HIV incidence estimates.

On March 28^th, CDC released the following letter announcing the release of the annual surveillance report:

4. CDC Releases NCHHSTP 2007 Annual Report

On March 26, 2007, the Centers for Disease Control and Prevention's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) published the Fiscal Year 2007 Annual Report "A New Beginning." The Center defines its goals broadly as, “reducing health disparities, increasing program collaboration and service integration, and maximizing global synergies by ensuring better collaboration across programs and more holistic and comprehensive prevention services for those in need.” The report contains a more detailed description of the makeup of NCHHSTP and its programs, as well as the policy and scientific developments in 2007.

Among its accomplishments in FY 2007, NCHHSTP lists a “Heightened National Response to the HIV/AIDS Crisis Among African Americans”, which included an expanded reach of prevention areas, increased opportunities for diagnosis and treatment, developing new and effective prevention interventions, and mobilizing broader community action. The report also lists other initiatives and undertakings launched in 2007 including a new national HIV testing program and new screening recommendations; expanded evidence based prevention interventions, expanded partner therapy, HPV vaccine monitoring, continued action to eliminate syphilis, increased chlamydia screening to prevent infertility, and continued public health interventions to combat viral hepatitis.

The report also outlined the center’s global efforts. Through the Global AIDS Program (GAP), CDC partnered with PEPFAR to help combat HIV/AIDS in more than 120 countries throughout the world. GAP also supported increased testing, tuberculosis prevention and treatment support, prevention of congenital syphilis prevention, and global viral hepatitis support.

On the scientific front, NCHHSTP has been researching detecting drug resistant forms of HIV in order to inform future evaluations of trends as well as prevention and treatment programs. The Center also compiled data from Project START, which demonstrated the effectiveness of a sexual risk reduction intervention for young incarcerated men. The Collaborative Injection Drug Users Study III/Drug Users Intervention Trial found that peer education interventions providing information, risk reduction skills, and behavior modification can reduce injection risk behaviors. The Center also released two studies of STD prevalence, one on HPV in women, and the other in Chlamydia and gonorrhea.

The report then reviewed the global scientific research, including mortality rates among antiretroviral clinics in Malawi, opt-out testing in Botswana, and diagnosis of HIV-1 infections in children and infants using dried blood spots.

Finally, the report outlines 2007 Center publications, guidelines, recommendations, budget, and performance indicators.

For more information and to access the report, please go to http://www.cdc.gov/nchhstp/.

Announcements

1. Upcoming Connecting to Care Training: April 29-May 1, Washington, DC
AIDS Action Foundation has an upcoming Connecting to Care “Train the Trainer” session scheduled for April 29-May 1, 2008 in Washington, DC. The goal of the training is to introduce the Connecting to Care curriculum to professionals who are in a position to carry out trainings and workshops and continue sharing the model with service providers and others working with HIV-infected clients.  This is an opportunity to learn the Connecting to Care curriculum on addressing unmet need, receive the materials used in the trainings, and prepare to deliver workshops/trainings to Ryan White HIV/AIDS Program grantees, HIV administrators, community planning bodies, and other HIV care and service providers.  The training is supported by a cooperative agreement with HRSA/HAB. Limited scholarships are available to participants traveling to the session from outside of the Washington, DC Metro area.

The Connecting to Care training “Strategies for Connecting People to Care: Addressing Unmet Need in HIV” is a hands-on learning module that aims to help training participants strengthen existing community-based programs and design new ones that connect HIV positive people to medical care.  The training is based on research conducted in communities across the country and uses workbooks that capture best practices and give participants useful examples.  The flexible two-day curriculum reviews the research and provides practical applications of best practices from successful programs.  Training sessions can also be tailored to assist providers serving two specific communities: currently and formerly incarcerated individuals and those living in rural communities.

For registration information contact Dea Varsovczky at dvarsovczky@aidsaction.org

2. Registration Open for AIDSWatch 2008

Registration is now open for AIDSWatch 2008, taking place in Washington DC from April 28-30, 2008. AIDSWatch is a grassroots advocacy program, organized by the National Association of People With AIDS (NAPWA), which brings HIV positive people and their supporters to Washington DC to meet their elected Members of Congress. AIDSWatch participants are given the opportunity to educate their legislators on the need for an improved governmental response to the domestic HIV epidemic. This year’s AIDSWatch will focus on the need for improved treatment accessibility, science and evidence based prevention, and increased appropriations for HIV/AIDS programs.

NAPWA says, "We invite all persons infected and affected by HIV in America to join us in 2008 to allow your voice to be heard in our nation's capital. Please revisit the website frequently for updates about the 2008 program and registration."

To learn more and to register, please visit: http://napwa.org/index.php?option=com_content&task=view&id=19.

3. Global Conference on Methamphetamine Accepting Abstracts

The 2008 Global Conference on Methamphetamine: Science, Strategy, and Response will take place on September 15-16 in Prague, Czech Republic. This will be the first ever global conference on methamphetamine. Abstract submissions are now being accepted for the following topic areas: pharmacology, research, trafficking, treatment, policy, mental health, global markets, HIV, Hepatitis, community education, law enforcement, women, epidemiology, harm reduction, public health, MSM sexual risk, injection drug use, and others.

Individual proposals for presentations are welcome and presentation formats may include individual papers, reports on research in progress, round table discussions, and workshops. If you are interested in presenting, please send a 250 word proposal along with a short bio to: abstracts@globalmethconference.com. If you have any questions, please contact Luciano Colonna at Luciano.colonna@globalmeth.com. The deadline for abstracts is April 2, 2008.

4. HRSA Provides 2008 Ryan White HIV/AIDS Program Meeting Information

On March 6, 2008, the Health Resources Services Administration HRSA announced that the 2008 Ryan White HIV/AIDS Program Meeting website was now live.  The website will allow participants to register, submit workshop and poster abstracts, and reserve hotel rooms.

HRSA states that the meeting will be held August 25-28, 2008 in Washington, DC and is being co-sponsored by HRSA/HAB and the American Academy of HIV Medicine (AAHIVM).  Once again, two meetings will occur simultaneously: 1) the Grantee Meeting; and 2) the 11th Annual Clinical Update.  The Clinical Update is sponsored by the International AIDS Society-USA (IAS-USA).  The meeting theme, "New Era, New Act," reflects a focus on implementing the 2006 Ryan White legislation as well as ongoing efforts to seek ever better ways to deliver HIV care to the underserved.  We make a difference for over half a million people each year and owe much of our success to our creativity and adaptability to change.

The conference website provides all the information you need to get ready for the meeting, such as: key deadline dates; instructions for registering and submitting abstracts for workshops and poster sessions; and reserving hotel rooms.

Access the site at:
http://www.ryanwhite2008.com/

5. Kaiser Family Foundation Releases Update HIV/AIDS Fact Sheet

On Friday March 28^th the Kaiser Family Foundation released their annually updated fact sheet on the HIV/AIDS Epidemic in the United States. The Fact Sheet can be found at http://www.kff.org/hivaids/upload/3029_08.pdf.

The AIDS Action Weekly Update

The Weekly Update is written with the interests of our members in mind. If you are interested in membership with AIDS Action, we invite you to contact aford@aidsaction.org.

AIDS Action works to end the HIV epidemic by advancing public policies that prevent new infections, provide care for people living with HIV, and support the search for a cure. AIDS Action serves as the national voice for AIDS service organizations, health departments, and a diverse network of community-based organizations across the country, working with and for people living with and affected by HIV.

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