'Steady' doesn't mean 'safe'
However the prevention messages were aimed squarely at encouraging condom use in casual sex. As a result, 86 per cent of new HIV cases among gay men in Amsterdam are now occurring within steady, committed relationships. |
The misunderstanding of the potential dangers of hepatitis C (HCV) is causing many high-risk Americans to forego testing and treatment, according to a landmark survey commissioned by the American Gastroenterological Association (AGA).
HCV, a virus that attacks the liver, infects four times as many Americans as HIV. It is expected to kill more Americans than HIV by the year 2010.
"Hepatitis C can be detected with a simple test, yet it is estimated that the vast majority - 70 per cent - of four million Americans infected with HCV do not know they have the disease," said Dr Mitchell L Shiffman, from AGA's new hepatitis C education effort.
Hep C is a potentially life-threatening viral disease of the liver transmitted through blood and blood products. Over time, chronic infection can lead to cirrhosis, liver failure, and liver cancer.
This new study, from Harris Interactive, used a sample of 493 people infected with HCV, 1,226 not infected with the condition and 415 physicians.
The review findings indicate the need for increased awareness and education about HCV, the most common blood-borne disease in the US. Only half of the general public believes it is a public health threat, while more than 80 per cent recognise HIV poses a serious threat. In contrast, physicians and hepatitis C sufferers surveyed view HCV as a threat on a par with HIV.
The survey, part of AGA's 'Be Hep C S.M.A.R.T.' (Shattering Myths And Reinforcing Truths) campaign, identified a need to reinforce some truths about the disease and to educate the public and healthcare providers about the prevention, diagnosis and treatment of hepatitis C.
Messages like; 'there is no vaccine for hepatitis C' and 'HCV is spread through blood-to-blood contact' need to be reinforced.
"Since my diagnosis with hepatitis C in 1999, I have been dedicated to sharing my story and encouraging others to do the same so that we can bring the attention to this disease that it deserves," said David Marks, from the 'Be Hep C S.M.A.R.T.' campaign. "Until people with hepatitis C unite and speak up, this disease will remain a silent epidemic."
However, HCV is now curable - not just treatable. But while over half of hep C cases can now be cured with treatment, 34 per cent of Americans and 17 per cent of hep C sufferers are unaware that medications are available to treat the disease.
"With the newest prescription treatment combination, at least 50 per cent of patients have a sustained virological response. Clinical research now suggests that this response, where the virus can no longer be detected in the patient's blood, is permanent. I consider it to be a cure," said Dr. Michael Fried, from 'Be Hep C S.M.A.R.T.'
Side-effects remain a big hurdle in the treatment of HCV. 61 per cent of hep C patients on treatment said they wanted ways of reducing the side-effects. And of the patients who received treatment, 21 per cent did not complete therapy because of a 'bad reaction to treatment'.
"Patients believe that hepatitis C therapy is more difficult than is actually the case as newer, more tolerable treatments have come to market with fewer side effects," said Fried. Laurence Gibson
In the UK, National Hepatitis C Day is 1 July: see news.
Many people who are HIV-infected report that "life is better" after they receive their diagnosis, according to the finding of Aids researchers.
"We don't know for sure why this is," said lead investigator Dr Joel Tsevat of the Veterans Healthcare System in Cincinnati, Ohio.
Tsevat and colleagues presented their survey findings at the annual meeting of the Society of General Internal Medicine in Vancouver. Tsevat and co-investigators found a number of correlations between improved quality of life after receiving a diagnosis of HIV infection, including fewer financial worries, fewer disclosure worries, increased optimism related to treatment outcome and various spirituality factors.
In the study, Tsevat and colleagues interviewed 449 patients at various stages of HIV infection between February 2002 and February 2003. After being asked to compare their quality of life before and after receiving an HIV-positive diagnosis, about a third (32 per cent) of participants reported that their life was better after diagnosis, and 26 per cent said their life was "about the same." Only 29 per cent thought their life was worse after diagnosis.
After HIV diagnosis, patients were more likely to participate in non-organised religious activities such as meditation or prayer, said Tsevat. With the increase in spirituality, participants expressed sentiments such as they felt they were here for a reason, or that they had a purpose in life.
Tsevat explained: "An improvement in clinical status after diagnosis and the initiation of highly active antiretroviral therapy (HAART), is certainly important, but we don't know if their specific symptoms correlated with their feelings. They may have been given a better hope for survival...and there is also a decrease in the number of opportunistic infections," he added.
Tsevat acknowledged that the next step is to design interventions for the two-thirds who did not report an improved quality of life. "They may need better treatment, better coping skills, clergy interventions. It certainly won't be a one-size-fits-all approach," Tsevat said. "We plan to re-interview these patients over the next 12 to 18 months to find out if their opinions have changed about their quality of life, and if so, why they changed."
 Mangabey: had early HIV |
The strain of HIV largely limited to Africa appears to have first infected humans in the 1940s, and the current epidemic involving this strain may have originated in 1955-1970 as a result of war, researchers said last month.
By comparing HIV-2 samples taken from people, with SIV samples taken from sooty mangabeys, researchers estimate that the two subtypes of HIV-2 that became epidemics first infected humans around 1940-1945.
Study author Dr Anne-Mieke Vandamme of Katholieke Universiteit Leuven in Belgium said the jump of HIV-2 from sooty mangabeys to humans may have been a result of bushmeat slaughtering or hunting - the same process that may have enabled HIV-1 to infect humans.
Researchers also discovered evidence suggesting that Guinea- Bissau, the presumed site of origin of HIV-2, experienced a significant increase in new HIV-2 infections in 1955-1970. "And that epidemic continues today," Vandamme said.
The African region experienced a war of independence against the Portuguese in 1963-1974. "The fact that the dramatic spread of HIV-2 in the region coincided with this event suggests that war may have encouraged an increase in infections in the region," Vandamme and colleagues said.
War may have spawned a regional HIV-2 epidemic by increasing the number of people who received unsterile injections in hospitals, the authors suggested. Reports from the region note that army-trained doctors started campaigns to inoculate residents of Guinea-Bissau. Indeed, the first reported cases of HIV-2 in Europe occurred among Portuguese soldiers returned from the independence war, the authors wrote.
The safer-sex message seems to have endured better in the Netherlands than in the UK. Whereas 45 per cent of British gay men reported having at least one experience of unprotected sex last year, in Holland the figure was only 25 per cent.