World AIDS Day - December 1st, 2010 - Universal Access

December 1, 2010 is the 13th annual commemoration of World AIDS Day. This year, for a change, there is actually some good news! A drug in use for treatment of HIV/AIDS since 2004, Truvada, has been shown to significantly reduce the risk of contracting HIV when taking preventatively. We're talking VERY significantly. When taken daily, it was more than 90% effective. Now of course the study only included gay men, but scientists are hopeful that it will prove equally effective in other populations at risk, such as women, intravenous drug users, etc. (And the company hasn't even announced if they will apply for approval from the FDA - at this point this is just very promising research.)

This discovery comes on the heels of another advance, this past summer, when a vaginal microbicide, long sought after as a realistic way for women to protect themselves against heterosexual transmission of HIV, finally proved effective, after many years of failure with other drugs. (The vaginal microbicide was 54% effective amongst women who used it regularly, and the testing process is proceeding slowly due to funding issues.)

So it would seem that we are making some real advances, at least on the pharmaceutical front. But drugs for prevention and treatment are absolutely useless if they do not reach the people who need them. Most of the people who get HIV/AIDS these days are not people of means, people with access to health care, people who are empowered around their sexuality. They are poor people, especially poor women, living in poor countries. They are children, who are not born in settings where mother to child transmission can be prevented. They are prisoners, and drug users who cannot get the means they need to protect themselves (condoms, clean needles). Which is why the theme of this year's World AIDS Day is Universal Access.

The key to ending the global health crisis of AIDS is access to prevention, treatment, and care. (I would include in this concept access to education and decent birthing conditions.) Only about 5 million of the 33 million people with AIDS actually receive anti-retrovirals. Every year 3 million children contract HIV, and another 330,000 children die from it. AIDS isn't the problem here. Lack of access is the problem. Just as malaria isn't really a problem - lack of bed nets and medication is the problem. And how many American or Canadian children do you know who die of diarrhea? The solutions are in our grasp.

Here is an interesting article from the NY Times about why exactly it took so long for researchers to figure out that this drug (actually a combination of drugs), which has been around for years, would be effective in a preventative way, and not just as a treatment.

An AIDS Advance, Hiding in the Open

For you science-loving people, here is the original study about the Truvada trial, from the New England Journal of Medicine.

And for World AIDS Day, here's a nice little video from the folks at the great UK AIDS/HIV organization Avert.

Long-term Hormone Replacement Therapy Doubles Risk of Dying from Breast Cancer

From the top:

-Back in the day (from sometime in the '30's, up until about 2002), many women used what is called Hormone Replacement Therapy (HRT). HRT has consisted of either estrogen alone, or estrogen in combination with progestin. Although they entail different health risks, for the purposes of this brief background I will consider them together. HRT was primarily used to alleviate discomfort during and after menopause (hot flashes, insomnia, vaginal dryness, etc). However, thanks to aggressive and deceptive marketing by the pharmaceutical industry, it was also widely thought to prevent heart disease, osteoporosis, dementia, and in general to be an elixir of youth. Many, many women took it, often for many, many years.

-In 2002, the results of a very large (16,000 women) long term (5 year) study, known as the Women's Health Initiative (WHI), were released. The results were so dramatic, the study was halted before completion, and the women in the study taking HRT were told to stop, because their health was at risk. The study had found that the women were actually at increased risk of breast cancer, blood clot, stroke, and, later analysis showed, dementia.

-Use of HRT fell off dramatically. Although so far it is only an epidemiological link, breast cancer rates have also dropped significantly during the same period.

-Data from WHI are still being studied. The point of today's post is to draw your attention to a new study, just published in JAMA, which shows that not only does long-term use of HRT increase the risk of getting breast cancer, the women who get it are actually twice as likely to die from it, due to poorer detection by mammography, more positive lymph nodes, and larger tumors. A previous study had showed a similar increased mortality rate from lung cancer.

-I don't think the pharmaceutical industry will ever be held accountable for the damage they've done with HRT, for the lives that have been lost. Of course the American public bought into it, by accepting menopause as a pathology. Hopefully we have learned some important lessons, which cannot bring back our loved ones, or help those now dealing with the consequences, but which we can use going forward. Menopause is not a disease. But as long as we (in the US) have a for-profit medical industry, with the pharmaceutical industry consistently ranking as the most profitable industry in the nation, and a political system in which legislation can essentially be bought and sold, the HRT incident will not be the last of its kind. It certainly wasn't the first: didn't we learn anything from thalidomide, or DES, and isn't baby formula still being sold and aggressively marketed to women in the developing world, as well as here in the US?

-Standing for women, against the forces of big pharma and medical device manufacturers, is the National Women's Health Network. Since 1975, they've not only advocated for us in Washington, they also get information out to the public in readily available, understandable form. Subscribe to their newsletter, and, if you can, send them some financial love.

For some additional reading about HRT and WHI, check out these links.

Long-term HRT doubles risk of dying from breast cancer

History of HRT and how WHI broke the truth

HRT and dementia

Oh, by the way, the estrogen in the most popular forms of HRT (Prempro, Premarin) comes from the urine of pregnant horses. Get it? Pregnant Mare Urine. Here's a little video about it, narrated by Mary Tyler Moore:

Are You Using FAM To Try To Conceive?

A reporter from New York Magazine is seeking interview subjects for an upcoming article. She would like to speak with women who are using Fertility Awareness to achieve pregnancy. Your comments can be anonymous, if you prefer. Click on her name to send her an email:

Vanessa Grigoriadis

I will let you know when the article eventually appears, and of course what I think of it!