Mexican sex workers want place at AIDS conference

MEXICO CITY (Reuters) - A global AIDS conference that opens in Mexico City on Sunday is meant for people infected with HIV, but transsexual sex worker Elma Delea cannot get inside.

She will be protesting on the fringes of the six-day biennial event.

"They (Mexican health authorities) said they had no money for everyone who wanted scholarships. We are very angry," said Elma Delea, as she stood at the junction of Calle de Alfredo Chavero and Calzada San Antonio Abad, a stretch of road where transsexuals wait all night to be picked up by customers in passing cars.

Her friends nodded, citing other explanations given by organizers, such as not being able to speak English.

Some 25,000 people are expected at the event, which draws scientists, international agencies, government officials, non-government organizations and the media.

But people most at risk of the disease, such as sex workers, homosexuals and intravenous drug users, are least visible. Most are poor and cannot afford registration fees.

"The conference is a place to exchange opinion but now, only those in power have a say," said Elvira Madrid, an activist working for the rights of sex workers in Mexico City.

At one point, passengers in a passing car hurled eggs at the group standing on a street corner, narrowly missing.

"This is common. One time, some men shot paintballs at us, and it hit my thigh," said Orchidia Montenegro, as her colleague Martha de Juarez nodded in agreement.

SHUNNED IN HOSPITALS

Those infected by HIV say they are shunned in hospitals.

"We are told to stand far away and open our mouths from three feet away," said another sex worker. "And when they do examinations, they use the same tools without disinfecting first."

The AIDS virus infects 33 million people globally, 1.7 million in Latin America. In Mexico, $23 million was spent on keeping blood safe in 2005 and $5 million on prevention and care among men who have sex with men, but less than $1 million on sex workers.

"Interestingly, although prostitutes are considered to be victims, they are also viewed as wanton, debauched and morally weak," reads a UNAIDS report on sex workers.

Delea, who had been hoping to speak at the conference, said it was important for society to acknowledge sex workers, starting with the police, who often detain prostitutes when they find them with condoms. This makes it harder for the workers to practice safe sex.

"We also want the government to reduce prices on HIV drugs, which are 13 times more expensive than in Brazil, Guatemala and Honduras," said Delea, who heads the sex worker group Angeles en Busqueda de la Libertad or Angels In Search of Freedom.

Prostitution is illegal in Mexico but widely tolerated everywhere from grimy street corners to swanky brothels. Police can easily be bribed to turn a blind eye to sex workers.

Delea's group wants to coach women on how they can protect themselves when customers refuse to use condoms.

"We have to be very creative when using condoms. We have to start looking at them as tools of eroticism instead of disease prevention," said transvestite sex worker Chrisna.

"We are able to put condoms on our customers with our mouths without them even knowing, so that they even think we have swallowed their semen. But we have it in a bag to go," she said with a laugh.

U.S. Panel Questions Prostate Screening

The blood test that millions of men undergo each year to check for prostate cancer leads to so much unnecessary anxiety, surgery and complications that doctors should stop testing elderly men, and it remains unclear whether the screening is worthwhile for younger men, a federal task force concluded yesterday.

In the first update of its recommendations for prostate cancer screening in five years, the panel that sets government policy on preventive medicine said that the evidence that the test reduces the cancer's death toll is too uncertain to endorse routine use for men at any age, and that the potential harm clearly outweighs any benefits for men age 75 and older.

"The benefit of screening at this time is uncertain, and if there is a benefit, it's likely to be small," said Ned Calonge, who chairs the 16-member U.S. Preventive Services Task Force. It published the new guidelines today in the Annals of Internal Medicine. "And on the other side, the risks are large and dramatic."

The task force and other groups concluded previously that it was unclear whether the benefits of the prostate-specific antigen, or PSA, test outweigh the risks. The new review of the scientific literature found no evidence to alter that assessment for younger men. It did find enough new data to recommend for the first time against screening for older men.

"We felt with sufficient certainty that your risk of being harmed exceeded your potential benefits starting at age 75," Calonge said.

The recommendations come at a time when doctors are increasingly questioning whether many tests, drugs and procedures are being overused, unnecessarily driving up health-care costs and exposing patients to the risks of unneeded treatment.

"There is this idea that more is always better, and if a test is available we should use it," said Howard A. Brody, a professor of family medicine at the University of Texas Medical Branch at Galveston. "A lot of times, we're doing more harm than good."

The guidelines address perhaps the most important and contentious issue in men's health, and were praised by officials at several leading medical groups, including the National Cancer Institute and the American Cancer Society. But they drew strong criticism from others who are convinced that routine screening is necessary.

"I think they're really missing the boat," said William J. Catalona, a professor of urology at Northwestern University. "It's a disservice to patients. A lot of men die from prostate cancer, and there's just an overwhelming amount of evidence that screening saves lives."

Each year, prostate cancer is diagnosed in more than 218,000 U.S. men. About 28,000 die of it, making it the most common cancer and second-leading cancer killer among men.

The PSA test, which measures a protein in the blood produced by prostate tissue, has significantly increased the number of prostate cancer cases being diagnosed at very early stages. But it remains unclear whether that translates into a reduction in the death rate from the disease. Prostate cancer often grows so slowly that many men die from something else without ever knowing they had it.

Because it is not clear precisely what PSA level signals the presence of cancer, many men experience stressful false alarms that lead to unnecessary surgical biopsies to make a definitive diagnosis, which can be painful and in rare cases can cause serious complications.

Even when the test picks up a real cancer, doctors are uncertain what, if anything, men should do about it. Many men simply are monitored closely to see if the tumor shows signs of growing or spreading. Others undergo surgery, radiation and hormone treatments, which often leave them incontinent, impotent and experiencing other complications.

"People say, 'What's the harm in screening?' In fact, there are several ways in which screening can actually be harmful," said Howard L. Parnes of the National Cancer Institute.

Since the task force issued its previous recommendations in 2002, at least eight new studies have been published. Among them was a large Swedish review that found that men age 65 and older who were treated for prostate cancer were no more likely to survive than those who were not.

"If therapy isn't providing meaningful benefit, then how could screening provide benefit?" Calonge said. "And we know that the therapy produces significant harms."

Men younger than 75 should be carefully counseled about the potential risks associated with the test and the lack of evidence about any benefit before getting it, the panel said.

Men at high risk for prostate cancer, such as African Americans and those with a family history of the disease, are the most likely to benefit from PSA screening. But the panel concluded that the evidence remains inconclusive for those men as well.

Several other experts said that the new recommendations strike a careful balance, and that they hope they might discourage large-scale screenings where the risks and benefits are not carefully laid out.

"I think they are right on target," Parnes said.

Others were highly critical, noting that prostate cancer death rates have plummeted in many countries after they instituted widespread PSA screening.

"We have seen a dramatic drop in mortality," said J. Brantley Thrasher, chairman of the urology department at the University of Kansas and a spokesman for the American Urological Association. "They're not paying attention to that."

Others objected to setting an age cutoff, saying men should be evaluated individually.

"Men are living a lot longer and healthier these days. I play golf with 84-year-old guys who beat me all the time," said E. David Crawford, a professor of surgery and radiation at the University of Colorado at Denver. "You have to individualize treatment. If a 75-year-old man is found to have high-grade prostate cancer, it's going to kill him, and we can intervene and do something for him."

Two large studies are underway -- one in the United States and one in Europe -- to answer the question of whether screening reduces mortality.

"If it turns out that PSA screening and aggressive treatment saves lives, maybe all the harm that it has caused is worth it," said Otis W. Brawley, chief medical officer at the American Cancer Society. "If PSA screening does not save lives, then it's clearly not worth it. We just don't know yet."

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Kaiser Daily HIV/AIDS Report

Science & Medicine | Human Growth Hormone Could Reduce Fat Deposits Caused by HIV Treatment, JAMA Study Finds

[Aug 04, 2008] Low doses of human growth hormone can reverse some of the abnormal fat distribution caused by HIV treatment and lower the risk of cardiovascular disease, but the hormone could increase the risk of side effects in people who have early stages of diabetes, according to a study published in the Journal of the American Medical Association and presented Sunday at the XVII International AIDS Conference, the Los Angeles Times reports.

According to the Times, about 40% of males and 16% of females who take antiretroviral drugs develop visceral fat in the stomach, neck and cheeks, which is associated with higher levels of cholesterol and triglycerides and can increase the risk of heart attacks and stroke. Such patients typically have abnormally low levels of growth hormones, and researchers had hoped that replacing those hormones with genetically engineered human growth hormone might reverse the effects, the Times reports. However, previous studies using higher levels of the hormone produced "unacceptable" side effects, including tissue swelling and joint pain, according to the Times.

The study, led by Steven Grinspoon of Harvard Medical School, involved 56 people with HIV who had fat deposits in their stomachs and low blood levels of the hormone. Half of the people received daily doses of 0.33 milligrams of the hormone -- less than the two to four milligrams used in previous studies -- and the other half received a placebo. During the 18-month study, stomach fat dropped by 8.5% in people receiving the hormone, compared with 1.6% with the placebo group, the Times reports. However, tests showed some elevation of blood sugar in patients receiving the hormone, particularly among those who had abnormal glucose tolerance tests at the beginning of the study. The researchers did not study cardiovascular risk among the patients.

Grinspoon said the hormone produced good results but would have to be used carefully to avoid inducing diabetes (Maugh, Los Angeles Times, 8/4). He also said use of the hormone is "not a panacea" (Tanner, AP/Google.com, 8/3). Grinspoon added that future trials should involve a diabetes drug, such as metformin, to reduce side effects (Los Angeles Times, 8/4). New antiretrovirals that produce fewer side effects also are needed, according to Grinspoon.

Jeffrey Lennox, an AIDS expert at Emory University, said that although there were fewer side effects with lower doses, the results of the study were "disappointing." Lennox said the results suggest hormone injections at best have limited use for treating fat abnormalities associated with HIV treatment (AP/Google.com, 8/3).

Certain Drugs And Skin Care Products Can Increase Your Sensitivity To The Sun

It was a day outdoors like many others and you had slathered on the sunscreen only to end up with a wicked sunburn. What went wrong? The answer may lurk in your medicine cabinet. Certain drugs and other substances can increase the skin's sensitivity to ultraviolet light and cause the skin to burn in less time or at a lower intensity of sunlight than it would normally.

Sunburn is a serious matter. Exposure to the sun's ultraviolet (UV) rays is a known risk factor in skin cancer skin cancer. The American Cancer Society estimates there will be 59,940 new cases of melanoma, the most serious form of skin cancer, in 2007. The death rate has increased 50% since 1973. WebMD talked with two experts about medications that heighten your risk for sunburn and how to stay safe in the sun.

The Leading Culprits

• Diuretics.Hydrochlorothiazide (HCTZ) is a commonly used diuretic ("water pill") used to treat high blood pressure high blood pressure . Combination drugs, which contain HCTZ, include Maxide, Dyazide, Hyzaar, and Zestoretic.


• Antibiotics. Tetracycline drugs, which include Sumycin, Tetracyn, and Vibramycin, are used to treat bacterial infections. Quinolone drugs like Cipro, which gained attention during the anthrax scare, and sulfa drugs, such as Bactrim, also heighten sun sensitivity. Cipro and Bactrim are antibiotics often used for urinary tract infections.


• Skin care products. Retin-A, alpha hydroxy acid, and microdermabrasion products used to minimize wrinkles and improve skin tone make the skin more susceptible to sun damage.


• Heart medications. Amiodarone, marketed under the brand name Cordarone, is used to treat abnormal heart rhythms.


• Diabetes Diabetes medications. Glipizide, sold also under the brand name Glucotrol, is an oral medication for type 2 diabetes. Other related drugs include Amaryl and glyburide.


• NSAIDs (nonsteroidal anti-inflammatory pain drugs). NSAIDs include over-the-counter pain relievers such as Advil, Aleve, Motrin, and the prescription drug Celebrex.


• Balsam of Peru. This herbal ingredient is often used in perfumed products and aftershave lotions.

Shedding Light on the Subject

Heightened sensitivity to sun, or a phototoxic reaction, occurs when ultraviolet rays interact with certain chemicals in medications. Even after you have stopped taking a drug, its effects may linger. "Depending on the type of drug and how long you've been taking it, it can remain in your system from one to five days," says Bill Bailey, RPh, director of specialized care centers for Medicine Shoppe in St. Louis. "To be on the safe side, always ask the pharmacist about the effects of your medications on sun exposure. They'll go online and get current, accurate information," he says.

You don't even have to go out in the sun to experience the complications of medications. You could easily get sunburned in a tanning salon, says dermatologist Craig Eichler, MD. "There have been some bad cases. Tanning booths primarily emit UVA rays, and that's what medications mainly interact with."

And here's another little-known fact about UV rays: They penetrate water. "Swimmers don't realize they can get sunburned under water," says Eichler. Water also reflects UV rays, which can add to your exposure.

SPF, UVA, UVB, and Some Good News

There's a debate over whether sunscreens with high SPF ratings provide any more protection than one rated SPF 15. "I recommend SPF 15. The stronger sunscreens often give people a false sense of security," says Bailey.

Eichler says SPF 15 blocks 92% of UVB rays, while SPF 30 blocks 97%.
"SPF 15 is fine for going to and from the store, but use SPF 30 for longer sun exposure or if you're taking medications."

Whether you use sunscreens with SPF 15 or 45 ratings, you're buying protection from UVB rays, says Eichler, who is with The Cleveland Clinic Florida in Naples. For protection against UVA rays, a product must contain one of the following active ingredients: zinc oxide, titanium dioxide, or avobenzone (Parsol 1789). "A problem is that these ingredients aren't stable for a very long time."

That's one reason he's glad to see that the FDA has just approved ecamsule, a broad-spectrum sunscreen that has been marketed since 1993 as Mexoryl SX in Europe and Canada. It protects against both UVA and UVB rays and has an SPF 15 rating. It is expected to become available in the U.S. over the counter sometime in the fall as Anthelios SX.

Protecting Yourself

Eichler recommends reapplying sunscreen every couple of hours and making sure to use enough. "Most people use at best half of what they need. If you put it on too thin, it doesn't give you protection." The American Cancer Society says the average adult should use about a palm-full of sunscreen to cover the arms, legs, neck, and face.

The key to effective sunscreen use is to reapply it often. Bailey advises applying it one-half hour before you go into the sun, and every half hour you're exposed. "Sunscreen wears off when you're sweating or in the water. Remember to cover your hands and feet with sunscreen, too."

Both experts tell WebMD you can't rely on sunscreen alone. Wear a hat, cover up, and avoid reflected rays from sand, concrete, and metal, which can reach you even if you've blocked the sun with an umbrella. Also stay out of the sun during the peak hours of 10 a.m. to 3 p.m.

Health Buzz: Earlier HIV Treatment and Other Health News

Earlier HIV/AIDS Treatment Suggested

New guidelines for treating HIV and AIDS patients with antiretroviral medications suggest earlier therapy might be more effective, according to findings presented this weekend at the International AIDS Conference in Mexico City. The guidelines, written by the International AIDS Society-USA Panel, suggest starting therapy before immune-system CD4 cell counts decline to fewer than 350 cells per microliter. Experts say that additional factors, such as the existence of other diseases like hepatitis B or C and cardiovascular risk, should be taken into account when considering when to start antiretroviral therapy.

The Centers for Disease Control and Prevention recently estimated that about 56,300 new HIV infections occurred in the United States in 2006—a figure 40 percent higher than the former estimate of 40,000 infections each year. The revised estimate is the result of a new and improved calculation method.

Also, a report from the AIDS Vaccine Advocacy Coalition, issued at the AIDS conference, explores the possibility of whether taking daily medication can prevent HIV infection. In June, after the CDC reported an increase in false positives on certain oral fluid tests, U.S. News offered a caution about rapid HIV tests.

DNA Fingerprinting Helped ID Anthrax Source

DNA fingerprinting techniques allowing experts to identify unique parts of genetic code were integral in helping law enforcement officials track the 2001 anthrax mailings to Fort Detrick in Frederick, Md., the Associated Press reports. These techniques ultimately led authorities to a very specific type of anthrax overseen by Bruce Ivins, the lead suspect in the investigation. What remains unknown is how Ivins could have distributed anthrax through the mail or how he kept it a secret. Ivins committed suicide last week before a possible indictment on murder charges. Five people were killed in the attacks.

Last week, U.S. News's Kevin Whitelaw explained this unsatisfying end to the anthrax investigation.

What Eric Shanteau's Cancer Means for All Men

Eric Shanteau, a 24-year-old swimmer from Lilburn, Ga., received staggering news a week before the Olympic trials: He had testicular cancer and needed surgery. He could have—some doctors have reportedly argued he should have—abandoned his Olympic dreams to aggressively pursue treatment, Adam Voiland reports. Instead, Shanteau chose to delay surgery, with stunning results. He swam in the trials and won a spot on the American team with - an upset second-place finish in the 200-meter breast stroke. Now the world will be watching closely when Shanteau takes to the pool in Beijing. Comparisons to Lance Armstrong, the American cyclist who managed to transform testicular cancer into a source of motivation and strength, are inevitable.

U.S. News provides information about the causes, incidence, and risk factors for testicular cancer. You can find the latest in men's health news and advice in Voiland's On Men blog.

An Athlete’s Legal Aid: Caffeine

A recent survey of British athletes showed that 33 percent of track and field athletes and 60 percent of cyclists consumed caffeine for the purpose of boosting performance, Katherine Hobson reports. Most studies have indeed shown that caffeine enhances performance by as much as 20 percent, but because the people getting caffeine in a controlled trial can probably feel it, it's possible they could be imagining the athletic boost. Read more of Hobson's column to see whether you should start downing the Pepsi.

U.S. News's Nancy Shute covered the pros and cons of caffeine last year. Also, Hobson previously reported on another legal performance aid: sleep.

—January W. Payne

Ailing political columnist Robert Novak retires

Chicago Sun-Times political columnist Robert Novak has announced his immediate retirement following the diagnosis of a brain tumor, the newspaper reported on its Web site Monday.

It said Novak described his prognosis as "dire."

"The details are being worked out with the doctors this week, but the tentative plan is for radiation and chemotherapy," the newspaper quoted Novak.

Last month, Novak, 77, was cited for hitting a pedestrian with his car on a Washington street. It was shortly after the accident that he was diagnosed with a brain tumor.

Novak teamed up with Rowland Evans to write a column that was first distributed by Publishers Newspaper Syndicate on May 15, 1963, with the New York Herald-Tribune as the flagship paper. When the Herald-Tribune folded in 1966, the Chicago Sun-Times became their home newspaper. Evans died in 2001.