We, South African advocates, are alarmed to see the AIDS Healthcare Foundation (AHF), an American-based chain clinic and pharmacy that has led the charge in PrEP Denialism, participate at the Durban Aids Conference. The AHF has consistently opposed PrEP using faulty science and fear mongering and has failed to accept extensive research that has clearly and repeatedly shown PrEP to be safe and efficacious. South Africa can only allow evidence-based health policy and implementation. Denialism thrown in the face of facts and research can never be allowed again. As South Africans, we know too well the human cost of misinformation about HIV and of waiting too long to implement life-saving, evidence-based HIV interventions.
The press waited until Oct. 15 , 1982 -- 17 months after the first reported AIDS cases -- to ask President Reagan's press secretary about the "gay plague." By that time, there had been 593 reported cases in the U.S., and 243 deaths.
Q: Is the President being briefed on the Ebola outbreak in Africa? And will it be addressed at the Africa summit and/or alter the Africa summit in any way?
MR. SCHULTZ: Yes, we continue -- well, no, it will not alter the summit, but we do continue to monitor the outbreak of the Ebola virus in Guinea, in Liberia, Sierra Leone and Nigeria closely. The President is indeed receiving regular updates, including speaking with his Homeland Security and Counterterrorism Advisor Lisa Monaco as early as yesterday before departing Washington.
The U.S. government, including the Departments of State, Health and Human Services, Centers for Disease Control, USAID and the Department of Defense, continue to provide a range of support and assistance to those countries and multinational organizations responding to the outbreak.
This includes the provision of personal protective equipment and other essential supplies, public health messaging and technical expertise. We've actually been engaged in this outbreak since March.
Q: Larry, does the President have any reaction to the announcement -- the Centers for Disease Control in Atlanta, that AIDS is now an epidemic and have over 600 cases?
MR. SPEAKES: What's AIDS?
Q: Over a third of them have died. It's known as "gay plague." (Laughter.) No, it is. I mean it's a pretty serious thing that one in every three people that get this have died. And I wondered if the President is aware of it?
MR. SPEAKES: I don't have it. Do you? (Laughter.)
Q: No, I don't.
MR. SPEAKES: You didn't answer my question.
Q: Well, I just wondered, does the President --
MR. SPEAKES: How do you know? (Laughter.)
Q: In other words, the White House looks on this as a great joke?
MR. SPEAKES: No, I don't know anything about it, Lester.
Q: Does the President, does anybody in the White House know about this epidemic, Larry?
MR. SPEAKES: I don't think so. I don't think there's been any --
Q: Nobody knows?
MR. SPEAKES: There has been no personal experience here, Lester.
Q: No, I mean, I thought you were keeping --
MR. SPEAKES: I checked thoroughly with Dr. Ruge this morning and he's had no -- (laughter) -- no patients suffering from AIDS or whatever it is.
Q: The President doesn't have gay plague, is that what you're saying or what?
MR. SPEAKES: No, I didn't say that.
Q: Didn't say that?
MR. SPEAKES: I thought I heard you on the State Department over there. Why didn't you stay there? (Laughter.)
Q: Because I love you, Larry, that's why. (Laughter.)
MR. SPEAKES: Oh, I see. Just don't put it in those terms, Lester. (Laughter.)
Q: Oh, I retract that.
MR. SPEAKES: I hope so.
Q: It's too late.
"The main news is that in the PARTNER Study so far there have been no transmissions within couples from a partner with an undetectable viral load, in what was estimated as 16,400 occasions of sex in the gay men and 14,000 in the heterosexuals."
"Working with the governor, I'm proud to say we're taking a big step forward to cap the rent contribution for HIV and AIDS clients of supported housing, folks with HIV and AIDS, who are struggling as it is and need some stability in their lives. I've believed in this 30 percent rent cap for a long time. The city will pay approximately two-thirds of this cost, something Mayor Bloomberg was unwilling to do, but I think is necessary. And Governor Cuomo and I have discussed this matter, and we're working on a final agreement for the state to join us in this effort."
P4P4P to Address the Gardner HIV Cascade ChallengeThe Gardner cascade is well known to the HIV care community, but it represents a humbling pox on our HIV care system because it shows the very disappointing reality of HIV outcome. Despite the availability of powerful drugs for virtually all patients, only about 28% of the estimated 1.1 million Americans with HIV infection have achieved the goal of no detectable virus. The major issues accounting for this disappointing outcome are lapses in care at each step of the cascade -- testing, enrollment in care, retention in care, and adherence to ART. Many articles have been written about this cascade and have described possible methods to address each step, but none have clearly achieved a major advance.The potential breakthrough in this stalemate is P4P4P, or "pay for performance for patients," which provides financial or other reward for patients to get tested, engage care, stay in care, and achieve viral suppression. It is now being studied in a controlled trial in Washington, DC, and Bronx, New York.The reason for optimism is that P4P4P seems to have worked well in virtually all areas of chronic care that are dependent on patient adherence, including hypertension, diabetes, smoking, obesity, and measurement of INR. This approach to medical management of chronic disease is controversial, so it is not included in HIV guidelines or polite discussions, even though it is low-cost and virtually always works. Instead, we spend long hours and great resources to achieve this goal by other methods.It is anticipated that the well-controlled National Institutes of Health-sponsored trial of P4P4P will impart validity and acceptability to this rarely discussed topic.