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Smartphones to test for AIDS in rural Africa

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The times Of India
01 Sep 2012
JOHANNESBURG:

Researchers are working towards making a smartphone that is capable of carrying out AIDS tests in rural parts of Africa that are the worst hit by the disease, a researcher revealed on Friday.

The team of South African and South Korean researchers have developed a microscope and an application that can photograph and analyse blood samples in areas far from laboratories to diagnose HIV and even measure the health of immune systems.

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Man’s rare ‘heart cancer’ a case study for medical literature

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The Indian Express.
21 Aug 2012

When 42–year–old Dahisar resident Vinod Kumar Tiwari started suffering from bouts of palpitation and breathlessness a few months ago, he thought it was just his age and his physically demanding profession. Tiwari, who works in a plastic moulding factory, hit the panic button when his face and hands also started swelling up.

An X–ray showed that Tiwari had a knot in his heart and further examination indicated that he was suffering from a rare case of primary right heart synovial sarcoma or simply, cancer of the heart.

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Rural A’bad is urban in breast cancer trend

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DNA.
21 Aug 2012

Rural Ahmedabad is going the urban way. It is not only getting rapidly urbanised but is showing ‘urban’ trends in cancer too, a development that has oncologists worried. Data accumulated through research by the community oncology department of the Gujarat Cancer & Research Institute (GCRI) has found that breast cancer tops the list of cancers reported among women in rural areas of Ahmedabad district.

It should be noted that across the country, there are only two rural-based population cancer registries. One is in Ahmedabad and the other is in Barshi, Maharashtra. The Ahmedabad registry covers both the rural and urban parts of the district. Talking about the findings, director of GCRI, Dr Shilin Shukla, said that the data available from the rural registry in Barshi showed that cervical cancer is the most common cancer reported among women of that area.

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U.S. health panel likely to make HIV tests routine

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Times Of India.
21 Aug 2012

(Reuters) – A U.S. health panel may soon make HIV testing as standard a practice as checking cholesterol levels, a move that would fundamentally change how the virus is detected and treated.

The U.S. Preventive Services Task force, a government–backed group of clinicians and scientists, is expected to make a new recommendation on HIV screening available for public comment before the end of the year.

Health officials close to the panel, speaking on condition of anonymity, see it making a positive recommendation for routine screening, updating their current position, issued in 2005, which leaves the decision up to doctors.

Under President Barack Obama's healthcare law, passed in 2010, insurers are required to cover preventive services that are recommended by the task force.

"This would be one of those major sea changes ... moving away from what has been somewhat the segmentation of HIV – either by population, by geography," said Michael Kharfen, chief of community outreach for the Washington, D.C., Department of Health. Kharfen, who worked on the frontlines of the HIV epidemic in New York in the 1980s, recalls when the prognosis for the disease was "practically certain you were going to die.

"It still will take culture change for medical providers, but this will be a tremendous leap," he said.

The HIV/AIDS epidemic remains a significant health challenge in the United States, with an estimated 1.2 million people living with the disease. Of this group, the U.S. Centers for Disease Control and Prevention (CDC) estimates that 20 percent are unaware of their infection.

Nearly 60,000 new cases of the human immunodeficiency virus that causes AIDS are reported nationally every year.

The CDC and other prominent groups have already called for routine HIV screening as a way to reach a much broader population and reduce the stigma some associate with showing up at an HIV clinic. But a recommendation from the task force would carry greater weight, as the U.S. health reform law of 2010 will require insurers to cover preventive services it endorses.

Global health officials have also stepped up the call for earlier treatment of people infected with HIV. New studies show that the latest HIV medications not only can extend the lives of patients for decades but are also one of the most potent ways of preventing their sexual partners from contracting the disease. Early treatment of HIV has been reported to cut transmission risk to uninfected partners by 96 percent.

"All healthcare providers have a responsibility to find cases of HIV because we don't know where they are," said Dr. Lisa Fitzpatrick, who directs the United Medical Center, an HIV clinic in Washington. While doctors in the past focused on higher risk groups such as men who have sex with men, she said, "HIV is in the general population now."

WEIGHING THE EVIDENCE
In 2006 the CDC recommended testing everyone between the ages of 13–64 at least once. They have since been joined by professional groups such as the American College of Physicians and the HIV Medicine Association.

The fact that the CDC and the task force came to different conclusions, even in the face of similar evidence, is likely to have stemmed from differences in their respective missions.

"We are looking at public health. The task force may be looking more at clinical care and the integration of prevention services within the clinical setting," said CDC Executive Director Kevin Fenton.

The task force is charged with weighing the potential harm of a test against its possible benefits. In 2005 the panel was not convinced by the available evidence that widespread screening would have the desired effect of helping prevent new infections by changing the behavior of the patient who tested positive.

"We did not find that evidence at that time compelling enough to say that we were confident that more people would benefit than the people who had HIV detected," said Dr. Michael LeFevre, co–chair of the task force.

"Obviously that was seven years ago," he said, noting that new scientific evidence has since emerged showing that the very treatment of infected people can help prevent them from passing on the disease. He said that will be factored into the panel's recommendation this fall.

THE COST EQUATION
While the task force doesn't factor cost into its considerations, the CDC and other healthcare providers do. Researchers at Stanford University estimate that over a 20–year period, expanding HIV testing to the general U.S. population would reach $27 billion dollars.

A more cost–effective solution proposed by the researchers, and in line with CDC recommendations, would be to do a one–time screening of the general population, followed up by annual testing in areas with greater prevalence of the disease.

Such a strategy would prevent an estimated 212,000 new infections and even lead to long–term healthcare savings, when the lifetime cost of $367,000 for HIV treatment is considered.

Private initiatives have also sought to make HIV screening more accessible and affordable. The CDC has a pilot program with drugstore chain Walgreen Co and other pharmacies for free, rapid HIV tests, whose wholesale cost is about $20 each.

The U.S. Food and Drug Administration recently approved the first over–the–counter, self–administered HIV test from OraSure Technologies, which is expected to sell for $60. A positive result would require follow–up at a doctor's office.

Adding an HIV screening to a routine blood exam would amount to $1.50 per patient.

LeFevre, a primary care doctor in Missouri, cautions that the barriers to testing go beyond the rating of a single agency.

"I can't think of another blood test in all of my practice that carries that baggage," he says of the pre–test consent, counseling, and post–test follow–up that HIV screening requires.

United Medical Center's Fitzpatrick agrees.
"This test is all about talking about sex and facing things about your patient that you feel uncomfortable facing," she said. "For years this was considered a gay disease so doctors did not get into the habit of talking about HIV or thinking that their patients might have HIV because they may not have had gay patients or they might not have known they have gay patients."

Disclaimer: The news story on this page is the copyright of the cited publication. This has been reproduced here for visitors to review, comment on and discuss. This is in keeping with the principle of ’Fair dealing’ or ’Fair use’. Visitors may click on the publication name, in the news story, to visit the original article as it appears on the publication’s website.

Talk of HIV/AIDS Still Taboo for Koreans, Here and Abroad - New America Media

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New America Media, News Report, Peter Schurmann, Posted: Aug 13, 2012


SAN FRANCISCO -- A recent posting on the community page of a Korean-language news site in Los Angeles warned male readers about a female employee at a local Karaoke club. The woman – described as an undocumented immigrant – allegedly resides in Korea Town and moonlights as a sex worker in local bars.

“She uses several names,” the author says, “and works as a maid during the day… she is HIV positive.” While unconfirmed, the comments are a rare and highly public acknowledgement of a problem that most in the Korean community are loathe to discuss openly.

Indeed, even as attendees at the XIX International AIDS Conference in Washington D.C. -- which closed last month -- spoke openly for the first time ever of a possible cure, attitudes among Korean Americans remain steeped in stigma and prejudice.

Among Asian and Pacific Islanders in L.A. County, says Steve Cha, health educator with APAIT Health Center -- which advocates for medically underserved communities impacted by HIV/AIDS – Koreans rank “about seventh or eighth” in terms of infection rates. Filipinos top the list, followed by Thais, Vietnamese and Japanese, respectively.

Los Angeles is home to the largest Korean community outside Korea. Pointing to recent statistics, Cha says APIs in the area made up about 3 percent of total reported cases last year, out of which some “77 individuals” were Korean.

“The data [on Korean American infection rates] might not look like a big issue,” notes Cha. “But the numbers are misleading.”

One reason is because the U.S. Centers for Disease Control lumps together data from the API community, rather than breaking the numbers down by ethnicity. Another has to do with the fact that Koreans, who are not alone in this, are highly reluctant to get tested.

According to Cha, over half of APIs at risk of infection – including sex workers and men who sleep with other men (MSM) -- “have never been tested.” Cha says issues of language, fear of being identified with the sex trade, and fear of alienation are behind the low numbers.

“The Koreans who do come in are often monolingual [speaking only Korean] and are court mandated” to be there, suggesting a connection to sex work, explains Cha.

Statistics show that nationwide, just over 26 percent of Koreans have been tested for HIV, compared to 30 percent for the overall API population, 36 percent for Hispanics and close to 50 percent for blacks. This is despite the fact that among APIs, infection rates are on the rise.

According to the U.S. Centers for Disease Control and Prevention, while the number of new reported cases of HIV infection among Pacific Islanders nationwide declined somewhat in 2010, among Asians there was a 5 percent jump. Asian women in particular, warns the U.S. Department of Health and Human Services, are 20 times as likely to be diagnosed with HIV than White women.

"The science of HIV and treatment is coming along, and everyone is excited," Yvette Calderon, adult urgent-care director at Jacobi Medical Center in New York, told reporters at the Washington conference, the first to be held in the United States in 22 years. "We forget there's a real-life implementation that has to occur."

A “Foreigner” Disease

The stigma that surrounds HIV/AIDS in the Korean American community finds its counterpart in the rampant stereotypes that exist in Korea itself, where for many the disease is still largely associated with foreigners.

An editorial in early July that appeared in the Korea Daily, one of South Korea’s largest print papers, took to task a program aired by the broadcasting giant MBC. Titled, “Shocking Report on Relationships with Foreigners,” the show highlighted the case of a young woman recently diagnosed with the virus. She had, as the show notes, recently been in a relationship with a foreigner.

The editorial’s author, Jae-hyun Roh, acknowledges such concerns as students getting involved while studying abroad. But he blasts the show’s producers for propagating a common belief that Koreans are somehow immune from the disease..

If AIDS is a “foreigners’ disease,” Roh asks, rhetorically, “are Koreans all right?” The article was followed by a social media campaign that drew some 8,000 followers calling for an end to “xenophobia and prejudice.”

During the conference in Washington, South Korea announced that it was lifting long-standing restrictions on inbound travelers with HIV/AIDS. One of eight countries to do so since 2010, it was praised for its decision, though foreigners working in the country – including the high number of English teachers there -- are still required to undergo HIV testing. No similar requirement exists for Koreans working in similar positions.

Voice of America reported in July on a case involving an English teacher from New Zealand suing the government over the testing requirement. “Lisa Griffin contends South Korea uses HIV tests as a proxy for racial discrimination,” the report noted. “She says the mandatory tests stigmatize foreigners as people who are a high-risk for AIDS, which leads to local hostility against them.”

Vincent Crisostomo, a long time community activist who in 2011 helped organize the 10th International Congress on HIV/AIDS (ICAAP) in Busan, South Korea, describes attitudes in the country as “very discriminatory.”

While he admits infection rates are not as high as those found in developing countries around Africa and other parts of Asia, for example, he says that as with Koreans in the United States, taboos and stigma help to obscure the actual number of those living with the disease.

A report put out by the Korea Federation for HIV/AIDS Prevention noted that in 2011 there were 7,656 known cases of HIV infection in South Korea. Of those, some 6,292, or 82 percent were still living at the time.

The report also highlighted the low level of awareness among adults regarding the disease and routes of transmission. It is an ignorance that, for those affected, translates into a social ostracism that often carries with it tragic consequences.

“I’m told,” says Crisostomo, “that the number one killer for those infected with HIV in South Korea is suicide.”

Doesn’t Affect Us

Diana Lee is program manager with the center for Pan Asian Community Services in Atlanta, Georgia, a city that in recent years has seen dramatic increases in its resident Asian population.

It has also seen the sharpest rise in HIV infections in the United States.

“Calls come in [to the center] about immigration issues or other matters,” says Lee, who points out that unlike more established Asian communities in New York and San Francisco, which have been around for generations, Atlanta’s Asian community is still predominantly immigrant.

“Then they ask about HIV.” Lee says a number of the callers are surprised the center even offers such services. “But Asians don’t have HIV,” is something she’s heard more than once.

The center is the first social services agency, and the only one providing HIV/AIDS care, targeting APIs in the southeast region. Lee, who does outreach to try and raise awareness around HIV, says it’s common for her to encounter hostility from fellow Koreans.

“They demand to know why we’re wasting they’re time,” she says, adding many in the community feel the issue “is not something that affects us.”

And when it does, it is cause for shame. Lee points to one client, born in Korea but raised in the United States, who has completely “isolated himself” from family and friends. “He does not reach out… he fears he could transmit the disease. He is depressed and has no social relations.”

Korean culture places a high degree of value on interpersonal connections. They are the bread and butter, so to speak, of society. For someone to be so shut off can be devastating. Worse still, however, is that because of the stigma, a large number of Koreans remain woefully ignorant of where to go and what to do if they are diagnosed.

“They have no idea,” says Lee.

A-Symptomatic Until it’s Too Late

Lee admits that change is “going to take time.”

Both she and Cha with APAIT agree that part of the problem has to do with attitudes regarding sex. “They think of it as a gay disease,” says Cha, who recalls that 70 percent of Koreans in California voted in favor of Proposition 8, which sought a constitutional ban on same sex marriage.

Such attitudes, they say, make it difficult to even broach the subject of HIV/AIDS. For those that do want to reach the community, Cha says the first step is locating stakeholders, which most often means the local church, a “less than chatty environment” when it comes to issues of sexuality.

As far as what it may take to get the message across, Cha offers a somewhat grim prognosis.
“HIV/AIDS is A-symptomatic until it hits you hard, and that may be a metaphor for the Korean American community.”

Aruna Lee contributed to this story. 



Disclaimer: The news story on this page is the copyright of the cited publication. This has been reproduced here for visitors to review, comment on and discuss. This is in keeping with the principle of ‘Fair dealing’ or ‘Fair use’. Visitors may click on the publication name, in the news story, to visit the original article as it appears on the publication’s website.

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