A Bit More Detail

Assorted Personal Notations, Essays, and Other Jottings

Posts Tagged ‘hiv/aids

[NEWS] Some Monday links

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  • Bloomberg notes continuing anger in Egypt at the cession of two Red Sea islands to Saudi Arabia, and looks at the travails of Sweden’s Greens.
  • The Guardian reflects on the devastation of a generation of artists by HIV/AIDS.
  • Newsweek looks at the gentrification of San Francisco.
  • The Washington Post looks at the American living in Tokyo who is a leading publisher of crime news.
  • Wired notes the travails of subcription music service Tidal.

[NEWS] Some Saturday links

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  • The BBC suggests bird-like dinosaurs survived the Cretaceous catastrophe because they could eat seeds.
  • Bloomberg wonders what lessons Poland has for China’s economy.
  • Bloomberg View examines immigration controversies in Malaysia.
  • CBC notes that Manulife is now providing life insurance for HIV-positive people.
  • Gizmodo reports from the Pyongyang subway.
  • The Guardian notes the sequencing of Ozzy Osbourne’s DNA.
  • The National Post reports that Québec NDP MP Ruth Ellen Brosseau might well be considering a run for the NDP leadership.
  • Newsweek reports on the decision of the Wall Street Journal to run an ad denying the Armenian genocide.
  • Finally, there has been much written after the death of Prince. Some highlights: The Atlantic looks at how he was a gay icon, Vox shares 14 of his most important songs, the Toronto Star notes his connection to Toronto, Dangerous Minds shares videos of early performances, The Daily Beast explains Prince’s stringent control of his content on the Internet, and In Media Res mourns the man and some of his songs.

[NEWS] Some Tuesday links

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  • Bloomberg notes how an economic boom will let Sweden postpone hard decisions, looks at the popularity of the Korean Wave in China, suggests that subsidies are going to be a big issue for cash-short Arab governments, looks at the investigation in Bulgaria of groups which arrest refugees, and looks at the long-term problems of the Russian economy.
  • CBC reports on a Saskatchewan woman who has a refuge for pet rats.
  • Global News illustrates the dire social conditions in the Ontario North, hitting particularly strongly First Nations groups.
  • The Guardian reports on speculation that Neanderthals may have died in significant numbers from African diseases brought by human migrants.
  • MacLean’s notes a study of handwriting styles in ancient Israel which suggest that literacy was reasonably common.
  • The Mississauga News reports on a new PFLAG support group for South Asians in Peel.
  • National Geographic notes the strong pressures on island birds towards flightlessness.
  • Science Mag notes subtle genetic incompatibilities between human women and male Neanderthals which would have hindered reproduction.
  • The USA Today network has a story examining the recent HIV outbreak in Indiana.
  • Vice reports on the huge cleavages within the NDP, something also examined at the CBC.

[LINK] “Decades after Club Med closure, Haiti offers all-inclusive tourism again”

The Miami Herald‘s Jacqueline Charles notes how Haiti is trying to relaunch its tourism industry. In a kinder world, one without the precocious introduction of HIV/AIDS to Hispaniola, Haiti would be a tourism hotspot.

Lucio Garcia-Mansilla had long heard about the former Club Med property tucked along the Haitian Riviera, 123 acres lined with lush vegetation and a mile-long expanse of white sand.

But it wasn’t until decades later — when Haiti’s investment climate began to welcome international brands — that the Argentine founder of Colombia-based Decameron Hotels & Resorts would get there.

As Garcia-Mansilla waited, the property’s fortunes changed, usually not for the better: Club Med, the French resort chain, was boarded up in 1987 as the dual threat of an AIDS epidemic and the fall of the Duvalier dictatorship finished off what was left of Haiti’s once-thriving tourism industry and ravaged the economy. It became a virtual ghost town where weeds and algae replaced partying guests at the swimming pool, and a small maintenance crew kept watch from a utility room. Club Med tried again, reopening in 1997, only to close a year later as the economy tanked.

In 2006, the doors opened again — this time as the privately owned Club Indigo, a beach resort whose patrons were U.N. peacekeepers, locals and visitors from the Haitian diaspora. But it struggled even as it used just half of Club Med’s 400 rooms.

Then came Haiti’s monstrous earthquake in 2010, and after that, an aggressive push by Haiti’s new government to promote tourism as an important way to rebuild the shattered economy. International brands including Best Western, Marriott and Spain-based Royal Occidental Hotels & Resorts and NH Hotel Group signed on as investment opportunities beckoned.

Written by Randy McDonald

March 21, 2016 at 5:03 pm

[BLOG] Some Saturday links

  • Bad Astronomy reports on the discovery of a repeating fast radio burst.
  • blogTO lists the five most exciting neighbourhoods in Toronto, my Dupont Street rating there.
  • Centauri Dreams studies the ecology of space colony agriculture.
  • Crooked Timber notes the contrast between progress on climate change internationally and bizarre rhetoric in the United States.
  • Discover‘s Inkfish reports on a study suggesting scenic environments do keep people healthy.
  • Language Log notes difficulties with accessing Tibetan-medium education in China.
  • Lawyers, Guns and Money notes the authoritarian mindset.
  • Marginal Revolution wonders why labour mobility in India is so low.
  • Steve Munro looks at the TTC’s policy on fares.
  • The Power and the Money’s Noel Maurer notes yet another issue with the Nicaragua Canal.
  • Towleroad notes Hillary Clinton’s apology for praising the record of the Reagans on HIV/AIDS.
  • The Volokh Conspiracy notes an American custody order preventing a mother from talking about religion or her sexual orientation to her children.
  • Arnold Zwicky notes some prominent children’s graphic novels.

[LINK] On PrEP in Canada

Daily Xtra and The Homo Culture were among the first news sources in my Facebook timeline to announce the approval of Truvada for PrEP. Toronto’s Metro was among the many mainstream news sources to carry the news.

A drug that can stop the transmission of HIV is getting within reach of Torontonians who can’t afford its steep price.

Health Canada approved the use of Truvada on Monday as a prevention tool commonly called PrEP, giving people who can’t afford its $830 a month cost hope that they might be able to take it someday soon.

Until now, people using the drug for prevention have mostly been part of a “lucky minority” with “good, private drug insurance coverage,” said Dr. Darrell Tan, an infectious diseases specialist at St. Michael’s Hospital.

“That leaves people with the option of going without or purchasing it out of pocket —which is exorbitantly, prohibitively expensive for the vast majority of individuals,” he said.

Truvada was approved in Canada a decade ago as a management tool for people who already have HIV. Monday’s decision takes that approval further, extending it to include use by HIV negative people who are looking to stay negative.

At roughly the same time, there was also a news report noting the first verifiable report of PrEP failing to protect a user. Aidsmap described how a user in Toronto had the bad luck to get infected with a Truvada-resistant virus in a sexual partner whose HIV was suppressed.

During this time he came in for his regular HIV test and this showed he had acute HIV infection, with a negative test for HIV antibodies but a positive test for the HIV p24 antigen, which shows up sooner. His HIV viral load three days later was 28,000 copies/ml – rather low for acute HIV infection and suggestive that either his PrEP had ‘blunted’ viral replication without stopping infection, or that the highly drug-resistant virus was replicating weakly.

[. . .]

The resistance test showed that the patient had HIV that had no significant resistance to the protease inhibitor class of antiretrovirals. He had one resistance mutation to the first generation NNRTI drug nevirapine, and complete resistance to emtricitabine. He also had extensive resistance to the first-generation NRTI drugs like zidovudine (AZT) and stavudine (d4T), and these mutations also confer some resistance to tenofovir. However he did not have the so-called K65R mutation that confers high-level resistance to tenofovir, and it was estimated that the resistance pattern he did have only confers 1.3-fold resistance to tenofovir, meaning that drug levels 30% higher than those needed for non-resistant virus should have been enough to prevent infection – and he had much higher drug levels than this in the tests. Resistance, however is a complex process and some combinations of mutations can catalyse higher levels of resistance than they would produce alone.

Not relevant to the apparent PrEP failure, but to the spread of drug resistance, was the fact that this patient also had two resistance mutations to the integrase inhibitor drugs and complete resistance to the drug elvitegravir.

Transmission of HIV with integrase inhibitor resistance is very rare, and especially resistance to drugs other than raltegravir, the first integrase inhibitor. The pattern of resistance observed is compatible with the unnamed person who passed on the virus being on a failing regimen of Stribild (the two-class, four-drug combination pill of tenofovir, emtricitabine, elvitegravir and cobicistat). Given that four out of the five first-line HIV drug regimens recommended by the US Department of Health and Human Services are integrase inhibitor-based, and that this drug class is being investigated for use as PrEP, it would be of concern if more integrase inhibitor-resistant virus started to circulate.

The patient himself was put on a potent three-class regimen of dolutegravir, rilpivirine and boosted darunavir and became virally undetectable only three weeks after starting it.

This sort of failure is the sort of failure to be expected in an instance of PrEP failing. It does not undermine the utility of this technique.

Written by Randy McDonald

March 6, 2016 at 9:05 pm

[URBAN NOTE] “The Men Who Want AIDS—and How It Improved Their Lives”

I just came across, somehow, Maral Noshad Sharifi’s Out article looking at a class of young gay men in New York City for whom contracting HIV, even developing AIDS, was a good thing: It gave them the chance to live in a tough world and an expensive city. If anything underlines the inability to isolate HIV prevention from wider issues, of social justice, this surely must be it.

[Tye] Fortner was 22 and homeless when he started feeling weak, with crushing stomach pain and terrible headaches. A sex worker from the age of 16, sometimes too high on crack to remember to use protection, he had been putting off the inevitable for weeks before he finally decided to get tested for HIV. The result came back positive.

“My whole world changed,” Fortner says, recalling the moment six years ago when he received his diagnosis. At first it changed for the worse as he struggled to come to terms with his diagnosis.

But then, it changed for the better.

After years of homelessness and a day-to-day existence, Fortner, now 28, was faced with the tantalizing prospect of a place to sleep, regular meals, and more thorough New York City services provided to people who reach a certain stage of the disease. First he would have to meet their diagnosis requirements; then he would receive help.

“I didn’t know about the services,” he says. “I didn’t know that once you have AIDS you’re entitled to all this other stuff.”

That silver lining was a surprise to Fortner. And while it might seem counterintuitive, contracting the virus has made life easier for other young homeless men in New York City, who in return for developing full-blown AIDS gain a roof over their heads and basic services.

This cruel paradox — having to get really sick in order to enjoy a better, more comfortable life — has not gone unnoticed. “I have experienced people [who are] grateful that they have HIV,” says Sage Rivera, a research associate at the Centers for Disease Control and Prevention who has worked with hundreds of LGBT youth. “It’s sort of like a sigh of relief or an extra boost,” he says. “There are a whole bunch of different names for HIV within the [LGBT] community: ‘the monster,’ ‘the kitty,’ ‘the scratch,’ ‘the gift that keeps on giving.’ So people say, ‘I have the kitty — so now I can get my place. Now I can get hooked up; I can get my food stamps, I can get this, I can get that.’

Written by Randy McDonald

March 6, 2016 at 8:59 pm


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