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Vaccinations: Winning Faith, Trust and C …

Vaccinations: Winning Faith, Trust and Credibility  

A look at the history of global pandemics 

By Shubha Kerkar MD, FIDSA, FACP, AAHIVS 

The possibility of control and eradication of the current global pandemic of coronavirus (SARS-CoV2) is now a distinct reality because of two promising vaccines that have shown safe and effective performance in preventing 95 percent of infections in preliminary data of phase 3 trials. 

How will these vaccines work? 

Vaccination prepares the human immune system to combat specific infections. In addition to the very basics, such as barriers to exposure with facial covering/masking, physical distancing and handwashing, vaccination is a powerful tool in the armamentarium of defenses against COVID-19.  

Both the Pfizer and the Moderna vaccines are based on a novel platform using “messenger” RNA to create vaccines (mRNA). They do not use the live virus or even any particle of a virus. They do not affect or interact with our DNA in any way. mRNA never enters the nucleus of the cell, which is where our DNA (genetic material) is kept.  

The cell breaks down and gets rid of the mRNA soon after it is finished using the instructions.  

COVID-19 mRNA vaccines give our cells instructions to make a harmless piece of “spike protein, which is found on the surface of the virus that causes COVID-19. COVID-19 mRNA vaccines are given in the upper arm muscle. Once the instructions (mRNA) are inside the muscle cells, the cells use them to make the protein piece. In a placebo-controlled clinical trial where 30,000 to 40,000 volunteers in vaccinated vs. unvaccinated groups, there was a total of 100 infections, five in the vaccinated group and 95 in the placebo group. All volunteers who received the vaccine experienced no serious side effects, thus proving safety and efficacy.  

What does history tell us? 

In the real world, however, vaccines are only as good as the ability to be accepted by everyone. Winning faith and trust in vaccines depends on the credibility of the doctors, scientists and experts, and their ability to educate and help calm fears.  Once accepted, then the details of how to administer to the entire world population are practical challenges.   

 History tells us that vaccine strategies have successfully eradicated some of the deadliest infections on Earth, including smallpox, polio and measles, in times of scarce resources. The concept of vaccination was first noticed by the famous Dr. Edward Jenner in 1796 when he gave “lymph fluid” obtained from a milkmaid who had cowpox to James Phipps and established that he developed protection from smallpox.   

 In 2020, we celebrated the 40th anniversary of the eradication of smallpox, a deadly disease causing global pandemic for thousands of years. Worldwide vaccination was carried out in an era of no computers, no internet, no easy overseas transportation – all on foot – and simply targeting the worlds population one person at a time.  Of course, now, the challenges are different. 

What are we seeing today? 

Today, as I look around, not everyone is willing to accept vaccination as a silver lining in the dark cloud of this global pandemic. Perhaps there is no clarity, only doubt and mistrust, due to misinformation filtering through the current geopolitical scene, civil conflicts and social media, thus creating confusing layers. 

I remind all to look back in history: When Dr. Jonas Salk discovered the polio vaccine, 70 million mothers stood in line to get their children vaccinated – even before the benefits were confirmed.  Infantile paralysis was a devastating condition seen every year prior to that. Thanks to the polio vaccine – and the trust in that vaccine  today, it is part of childhood vaccination, providing 100 percent effectiveness in preventing polio. 

It is not just us here in the valley, our state or county. We must focus and be part of collaborative international cooperation and the contribution of global intelligence and unite in celebrating this great discovery. We must educate ourselves, gather all the courage and will to educate and counsel each other, and slowly win faith and trust in the possibility of prevailing in this battle against the COVID-19 pandemic. 

Dr. Kerkar is director of infectious diseases at Desert AIDS Project and an infectious disease consultant at Desert Regional Medical Center and Eisenhower Health. For more information on vaccinations visit www.cdc.gov/vaccines. 

Image of DAP care provider

Shubha Kerkar, MD, MS

Physician, FACP, AAHIVS, FIDSA

Shubha has been performing infectious disease consultation since 1991 and has the distinction of having been a part of DAP since 1993 when she joined us as a part-time infectious disease consultant. Her practice is primarily focused on inpatient or hospitalized patients at both Desert Regional Medical Center and Eisenhower Health where she cares for individuals with serious infectious diseases. Once these patients recover and leave the hospital they continue on their path to a healthier life by transitioning to Shubha's office-based skilled management program at DAP. Click here to learn more about Dr. Kerkar.

More HIV Care with Updated HIVMA Guideli …

More HIV Care with Updated HIVMA Guidelines

Dr. Tulika Singh noticing more equity in HIV care

(Palm Springs, CA) November 12, 2020 – Significant additions to nationally accepted HIV care guidelines will help more patients receive excellent care, and will help stop new infections, according to Dr. Tulika Singh, DAP director of research.

The HIV Medicine Association of the Infectious Diseases Society of America updated its care guidelines for people with HIV (PWH). DAP’s Dr. Singh was one of only eight co-authors who worked on this important resource that will have a national impact on PWH. This is the first update since 2013.

“It is a one-stop shop for primary care guidance for all HIV clinicians!” says Dr. Singh. “Patients benefit when they get the best care.”

Significant additions in four areas address vital health issues facing PWH, and the teams caring for them. They include:

  • guidance for physicians treating transgender and non-binary patients with HIV,
  • leveraging Undetectable = Untransmittable (U=U) as part of patient education,
  • care for aging with HIV over 50, and
  • care standards for rapid start antiretroviral treatment.

DAP Health is an established authority in these areas, offering patients access to excellent and compassionate care, regardless of insurance. These updated HIV primary care guidelines used by thousands of clinicians in the U.S. will enable better care for patients, even if they never come to DAP.

“This will help clinicians all over who might need more experience and resources in these areas,” says Dr. Singh.

Transgender and Non-Binary Patients Added

This is the first time these guidelines approach HIV care for transgender and non-binary patients, a group disproportionately affected by HIV and who face extra barriers in healthcare.

“HIV care for transgender and non-binary patients is special, and it needs to be treated so,” says Dr. Singh, who was the second lead for this section of the report.

According to a study by UC Riverside, only 15% of transgender and non-binary individuals reported it was easy to find a provider with sufficient knowledge and experience on issues related to transgender people.

“Education and experience in this area are helpful to reduce bias, and that is important,” says, Dr. Singh. “We want to establish trust and enable transgender and non-binary patients to be fully engaged in their care.”

U=U and Rapid Start ART

Other important affirmations affecting health outcomes for PWH include treatment as prevention, starting antiretroviral therapy (ART) as soon after an HIV diagnosis as possible, and aging with HIV.

Even though effective HIV treatment reduces the level of HIV to "undetectable" levels and makes PWH incapable of transmitting HIV to their sexual partners, many clinicians are not sharing this information with PWH. These guidelines address U=U as well as the stigma it can prevent.

According to the update:

“Clinicians should emphasize that adherence to antiretrovirals not only improves the patient’s health but prevents HIV transmission to others. Undetectable = Untransmittable messaging is welcomed and encouraged by communities with HIV and should be part of routine messaging in the clinic as a means to mitigate stigma. The primary reason for treatment failure, particularly among patients who take initial regimens, is suboptimal adherence to care or treatment regimens.”

Dr. Singh says how quickly patients start ART also affects transmission rates and points to why doctors haven’t been as effective they’d like in stopping new cases.

“Despite having extensive experience in HIV treatment and care, caregivers struggle to reduce high HIV prevalence and rising HIV incidence rates, due to delays in starting ART,” Dr. Singh says. “This is due to previous protocols and practicing traditional HIV medicine.”

DAP recently won designation as a Rapid ART Implementation Site, standing with just 10 other healthcare organizations in the U.S. The Award for Special Projects Of National Significance was won in a competitive grant process and is bestowed by the Health Resources and Services Administration (HRSA). Read more here.

About Desert AIDS Project

DAP Health (DAP) is a humanitarian healthcare organization in Palm Springs, CA offering a combination of medical, dental, counseling, social services, support groups, alternative therapies, in-house pharmacy and lab, and other health and wellness services. DAP’s sexual health clinic offers STI testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and HIV and HCV testing. DAP’s Get Tested Coachella Valley campaign, the nation’s first region-wide free HIV testing and access to care initiative, was recognized by the White House for helping to bring about an AIDS-free future. DAP has earned a “Four Star” rating from Charity Navigator for the twelfth consecutive year – landing DAP in the top 6% of nonprofits rated. The distinction recognizes that we exceed industry standards in terms of our financial health, accountability, and transparency.

For more information, visit www.desertaidsproject.org

About U=U & Prevention Access Campaign

Prevention Access Campaign is a health equity initiative to end the dual epidemics of HIV and HIV-related stigma by empowering people with and vulnerable to HIV with accurate and meaningful information about their social, sexual, and reproductive health. Find out more here.

Undetectable = Untransmittable (U=U) is a growing global community of HIV advocates, activists, researchers, and over 990 Community Partners from 102 countries uniting to clarify and disseminate the revolutionary but largely unknown fact that people living with HIV who are on treatment and have an undetectable viral load cannot sexually transmit HIV.  

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Uncovering New Reasons for Hope

Uncovering New Reasons for Hope  

Weekend Wrap Message – Saturday, October 31, 2020, from David Brinkman, Desert AIDS Project CEO 

Gratitude for a successful Desert AIDS Walk 2020 

COVID could not stop Desert AIDS Walk 2020, as this community laced up last weekend and walked to end HIV, support our COVID Clinic, and increase healthcare equity for all. With some slight reimagining, this community came together for the tradition safely and with a lot of love. 

We are so thankful to everyone who walked this year, as well as our sponsors who supported us.  

Sandie Newton hosted an NBC Palm Springs special broadcast featuring reasons this event is more important than ever. And to keep with tradition, you can hear the Palm Springs Gay Men’s Chorus performing the opening song, beautiful rendition of “Rise Again”. 

Preventing Flu During COVID 

With a third wave of COVID upon us while flu season is also starting, many risk becoming co-infected with both viruses if they have not received their influenza vaccination.  

“It’s an especially important year to get your flu vaccine, says to Dr. David Morris, our chief medical officer. He and his team are concerned about our hospitals becoming overwhelmed with cases that could be prevented with a flu shot. Anyone who is interested in talking to someone about COVID and the flu should call our COVID Hotline at (760) 992-0407You can learn more in this DAP Talks.  

DAP Study: One Shot Every Two Months for Viral Suppression 

For some PLWHA, taking medication in pill form every day is difficult, and it can cause poor adherence that harms their health and puts others at risk. DAP Health is committed to offering more options for antiretroviral treatment (ART), and we are one of the few health centers in the U.S. working on a study using only six ART injections per year for viral suppression, with ViiV Healthcare. You can read more here

ViiV SOLAR Study at DAP: Injectable ART …

ViiV SOLAR Study at DAP: Injectable ART every 2-Months

Diversity was key in choosing participants

(Palm Springs, CA) October 29, 2020 – DAP Health is one of the few health centers in the U.S. working on a study using only six injections per year for maintaining viral suppression in people with HIV (PWH). The SOLAR study with ViiV Healthcare begins in November and will last one year.

At this time, the participant panel is complete, and no applications are being accepted.

For some PWH, taking medication in pill form every day is difficult, and it can cause poor adherence that harms their health and puts others at risk. Traditional HIV meds can also lead to side effects with long term use.

Participants in the SOLAR Study at DAP will receive intramuscular (IM) injections of CABENUVA every two months for HIV treatment.  This regimen is not publicly available, but it holds a lot of promise for DAP patients, according to Dr. Tulika Singh, DAP associate chief medical officer.

It was important to Dr. Singh that the SOLAR Study at DAP includes participants who are usually underrepresented in HIV research: cisgender women and transgender women.

“With the help of this study, we are able to start closing a research gap,” said Dr. Singh, “and we can contribute to serving these patient groups better.”

Specifically, this phase IIIb, randomized, multicenter, parallel-group, non-inferiority, open-label study will evaluate the efficacy, safety, and tolerability of switching to long-acting Cabotegravir plus long-acting Rilpivirine from a Bictegravir single tablet regimen in HIV-1 infected adults who are virologically suppressed.

Once-Monthly CABENUVA is Available in Canada

Health Canada approved a once-monthly version of CABENUVA for use there in March. CABENUVA is the first and only complete long-acting regimen for the treatment of HIV-1 infection in adults to replace traditional antiretroviral therapy.

About DAP Health

DAP Health (DAP) is a humanitarian healthcare organization in Palm Springs, CA offering a combination of medical, dental, counseling, social services, support groups, alternative therapies, in-house pharmacy and lab, and other health and wellness services. DAP’s sexual health clinic offers STI testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and HIV and HCV testing. DAP’s Get Tested Coachella Valley campaign, the nation’s first region-wide free HIV testing and access to care initiative, was recognized by the White House for helping to bring about an AIDS-free future. DAP has earned a “Four Star” rating from Charity Navigator for the twelfth consecutive year – landing DAP in the top 6% of nonprofits rated. The distinction recognizes that we exceed industry standards in terms of our financial health, accountability, and transparency.

Visit www.desertaidsproject.org to learn more.

About ViiV Healthcare
ViiV Healthcare is a global specialist HIV company established in November 2009 by GlaxoSmithKline (LSE: GSK) and Pfizer (NYSE: PFE) dedicated to delivering advances in treatment and care for people living with HIV and for people who are at risk of becoming infected with HIV. Shionogi joined in October 2012. The company’s aim is to take a deeper and broader interest in HIV/AIDS than any company has done before and take a new approach to deliver effective and innovative medicines for HIV treatment and prevention, as well as support communities affected by HIV. For more information on the company, its management, portfolio, pipeline and commitment, please visit www.viivhealthcare.com.

About GSK
GSK is a science-led global healthcare company with a special purpose: to help people do more, feel better, live longer. For further information please visit www.gsk.com.

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DAP Patients Joining ANCHOR Study for An …

DAP Patients Joining ANCHOR Study for Anal Health

(Palm Springs, CA) October 21, 2020 -- There are only four places on the entire West Coast where people living with HIV / AIDS (PLWHA) can participate in The ANCHOR Study, and DAP Health Center is one of them. HPV-related anal cancer disproportionately harms PLWHA, especially cisgender gay men and transgender women. Unfortunately, prevention, treatment and support are difficult for them to find. Now, DAP patients can receive long term screenings and treatment, thanks to our designation as an ANCHOR Study site.

DAP medical and research clinicians worked hard to earn a place in this groundbreaking project. ANCHOR Study seeks to stop cases of preventable anal cancer in PLWHA by establishing testing and treatment protocols.

There are 40 participants enrolled at DAP so far, and “the team is welcoming more,” according to Dr. David Morris, chief medical officer. Participants are paid $100 per study visit to compensate for time, effort, and travel expenses.

For many DAP patients living with HIV, screening and treatment for a variety of cancers is part of their continuum of HIV care. If they take part in ANCHOR Study, they will monitor and support their anal health with top doctors and researchers, staying in contact for five-to-eight years. They will be contributing to groundbreaking scientific research that will help save lives in the future.

Living with HIV puts many of our patients at higher risk for anal cancer, even if they are on successful antiretroviral therapy (ART). ANCHOR Study aims to show treatment of pre-cancerous cells will lead to a reduction of 75% of incident HPV-related anal cancer.

Anyone interested in the ANCHOR Study is invited to contact Greg Jackson, DAP research coordinator, at (760) 992-0445 or gjackson@desertaidsproject.org. To read more about ANCHOR Study at DAP click here.

More about ANCHOR Study

"No one knew that cervical cancer was preventable before the use of Pap smears became widespread in the 1960s and cut the incidence of the disease by 80 percent."- Dr. Joel Palefsky, Principal Investigator

While deaths from AIDS are way down, anal cancer among people living with HIV is on the rise. We think that anal cancer can be prevented by routine screening and removal of precancerous cells. This strategy has reduced cervical cancer rates by 80%. But to get the insurance companies to cover routine anal cancer screening and preventative treatment, we need to prove that this strategy actually prevents cancer. The best way to show that is to recruit people with High Grade Squamous Intraepithelial Lesions (or HSIL for short) into a study and assign them randomly to a treatment arm or a monitoring arm. We then follow everyone for five years to compare the rates of cancer in both study arms. At the end of the study we’ll know whether screening and treatment of HSIL are effective strategies in preventing anal cancer. We’ll also learn a lot about HPV and other risk factors and why these sometimes cause cancer.

About Desert AIDS Project

Desert AIDS Project (DAP) is a humanitarian healthcare organization in Palm Springs, CA offering DAP Total Care – a combination of medical, dental, counseling, social services, support groups, alternative therapies, in-house pharmacy and lab, and other health and wellness services. DAP’s sexual health clinic, The DOCK, offers STI testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and HIV and HCV testing. DAP’s Get Tested Coachella Valley campaign, the nation’s first region-wide free HIV testing and access to care initiative, was recognized by the White House for helping to bring about an AIDS-free future. DAP has earned a “Four Star” rating from Charity Navigator for the twelfth consecutive year – landing DAP in the top 6% of nonprofits rated. The distinction recognizes that we exceed industry standards in terms of our financial health, accountability, and transparency.

Visit www.desertaidsproject.org to learn more.

 

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DAP Patients Will Get HIV Meds Quicker U …

DAP Patients Will Get HIV Meds Quicker Under New Rapid ART Program

Palm Springs, CA (September 3, 2020) -- DAP has reached an important milestone in the fight to end HIV, winning designation as a Rapid ART Implementation Site, standing with just 10 other healthcare organizations in the U.S. The Award for Special Projects Of National Significance was won in a competitive grant process and is bestowed by the Health Resources and Services Administration (HRSA).

By joining this national demonstration project and collaboration with HRSA, DAP will share its 36 years of experience in the fight to end HIV, and it will boost resources for its HIV testing and treatment programs for people in the Coachella Valley.

For a three-year period, DAP will continue to build and share its best practices for making sure PLWHA receive antiretroviral therapy (ART) quickly after receiving an initial HIV diagnosis, or immediately after requesting it if they had stopped ART for any reason.

It’s a surprise to many, but people are still developing and even dying from AIDS in 2020, right here in the Coachella Valley. Our early intervention program had 160 referrals for attempts to find patients who had stopped filling their ART prescriptions, ceasing their HIV treatment without explanation. (Based on calendar year 2019)

Falling through the cracks means that some patients whose bodies had stabilized with life-saving HIV meds have stopped taking them, sometimes for five years or more. And for others, it means not starting therapy at all after receiving an HIV diagnosis.

Without accessing care, they are waiting until they are sick from HIV-related illnesses before attempting to resume ART and primary care.

Waiting to begin or resume ART always leaves a dangerous gap of time that could result in catastrophe, such as failing to ever adhere to medication therapy, or even death. Another consequence is the effect on others as sex partners are put at risk for HIV.

This collaboration with HRSA seeks to remedy the problem with a protocol that provides ART ASAP:

  • Same day as HIV diagnosis (some exceptions)
  • Quickly after request is made to resume therapy

The vast majority (about 80 percent) of new HIV infections in the U.S. in 2016 were transmitted from the nearly 40 percent of people with HIV who either did not know they had HIV, or who received a diagnosis but were not receiving HIV care. (CDC)

According to Dr. Tulika Singh, DAP Associate Chief Medical Officer, not all physicians are permitted to treat their patients without administrative obstructions that derail health outcomes.

“Despite having extensive experience in HIV treatment and care, caregivers struggle to reduce high HIV prevalence and rising HIV incidence rates, due to delays in starting ART,” she says. “This is due to previous protocols and practicing traditional HIV medicine,” like having to do unnecessary lab work or jumping through hoops with insurance.

“No more!” says Dr. Singh.

Greater access for ART through this project will be enabled by DAP’s referral and linkage networks, with extensive arrangements with regional medical centers, community clinics and individual providers, in addition to this grant.

“We are able to provide rapid start ART for newly diagnosed persons living with HIV as early as the same day of diagnosis,” she says. “This will help us get to UN 90-90-90 goal sooner than anticipated and help our patients age in a healthy way.”

The Courage To Resume ART
Given what we know about the health consequences of stopping ART, the public health argument is strong for offering the resources to resume therapy quickly and without delay.

When it comes to why people fall out of care, “Every situation is so different,” says C.J. Tobe, Director of Community Health at DAP.

Poverty affects most DAP clients, but it affects PLWHA uniquely. They might cope with denial, depression, and suicidal ideation. Stigma is often made worse by rejection from loved ones, and drug and alcohol abuse are more likely to increase.

But other factors may include housing insecurity, unemployment, lack of transportation, and fear of government due to immigration status. Being a recent transplant to the Palm Springs area from other parts of the U.S. also can also be a reason.

“People are also dying by not accessing all the things you need to make the medication keep working,” says Tobe.  “There’s a lot that goes into getting that treatment, starting with walking through those doors.”

In addition to ART, DAP helps patients thrive with HIV with access to social services they are eligible for, ensuring they receive needed food, housing, transportation, and home health care support if they need it.

U=U Helping End The Epidemic

The more people who are on treatment and undetectable, the fewer new transmissions there will be. According to Prevention Access founder Bruce Richman,

“We need access to treatment and removing barriers, not just for the wellbeing of people living with HIV,” he says. “But also, to prevent new transmissions.”

About Desert AIDS Project

Desert AIDS Project (DAP) is a humanitarian healthcare organization in Palm Springs, CA offering DAP Total Care – a combination of medical, dental, counseling, social services, support groups, alternative therapies, in-house pharmacy and lab, and other health and wellness services. DAP’s sexual health clinic, The DOCK, offers STI testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and HIV and HCV testing. DAP’s Get Tested Coachella Valley campaign, the nation’s first region-wide free HIV testing and access to care initiative, was recognized by the White House for helping to bring about an AIDS-free future. DAP has earned a “Four Star” rating from Charity Navigator for the twelfth consecutive year – landing DAP in the top 6% of nonprofits rated. The distinction recognizes that we exceed industry standards in terms of our financial health, accountability, and transparency.

Visit www.desertaidsproject.org. 

About U=U & Prevention Access Campaign

Prevention Access Campaign is a health equity initiative to end the dual epidemics of HIV and HIV-related stigma by empowering people with and vulnerable to HIV with accurate and meaningful information about their social, sexual, and reproductive health. Find out more here.

Undetectable = Untransmittable (U=U) is a growing global community of HIV advocates, activists, researchers, and over 990 Community Partners from 102 countries uniting to clarify and disseminate the revolutionary but largely unknown fact that people living with HIV who are on treatment and have an undetectable viral load cannot sexually transmit HIV.  

About UNAIDS 90-90-90

Removing barriers to ART is in support of UNAIDS 90-90-90, the global plan to end AIDS as a public health threat by 2030.

The goal is that globally,

90% of all people living with HIV will know their HIV status, and  

90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and

90% of all people receiving antiretroviral therapy will have viral suppression.

According to its 2020 update, “the response could be set back further, by 10 years or more, if the COVID-19 pandemic results in severe disruptions to HIV services.”

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D.A.P. Revises HIV Prevention Guidelines

For Immediate Release
April 25, 2017
Contact: Tom Tarr, Director of Client Development
Tel: 760-656-8460
Email: ttarr@desertaidsproject.org

Desert AIDS Project revises its prevention guidelines in light of support for new research

Desert AIDS Project joins other national HIV prevention organizations by embracing a recent policy statement of the National Association of State and Territorial AIDS Directors (NASTAD). That policy titled, “Risk of Sexual Transmission of HIV from Virally Suppressed People Living with HIV” affirms the related scientific evidence and aligns prevention policy with that of many in the public health community.

“Recent research has shown that treating people with HIV and helping them maintain an undetectable viral load (less than 200 copies/ml) prevents the sexual transmission of HIV,” said Bruce Weiss, Director of Community Health at D.A.P. “The studies demonstrated no new transmissions occurred when the HIV positive partner was virally suppressed. This provides an additional prevention strategy for HIV-positive persons and their sexual partners which can also help end new HIV infections.”

In light of this new research, D.A.P. now recommends the following to prevent new HIV infections:

  • 1. Commitment to ongoing treatment for HIV – ongoing treatment for individuals with HIV is vital to the success of this prevention strategy
  • 2. Regular healthcare and viral load testing – staying healthy and regular testing is necessary for individuals utilizing this prevention strategy
  • 3. Steps need to be taken to prevent Sexually Transmitted Infection (STI)
    • Because of rising STI rates in the Coachella Valley, D.A.P. recommends that individuals having sex with more than one partner continue to use condoms. Condoms are the only proven strategy to help prevent new infections of STIs such as Syphilis, Gonorrhea and Chlamydia.
    • Regular STI testing is also recommended at least every three months for those having sex with multiple partners, in order to detect infections early and ensure proper treatment.

“We’re excited about the confirmation of effectiveness that the research provides and the prevention community has embraced,” said David Morris, MD, Medical Director at D.A.P. “But to be effective, it’s important that people commit to taking their medicine as directed, as well as seeing a healthcare professional for regular monitoring and care. Without this commitment, this prevention strategy becomes ineffective.”

“It is important to increase awareness of this prevention strategy,” said Karen Mark, MD, Ph.D., Chief of the Office of AIDS in the Center for Infectious Diseases at the California Department of Public Health. “We’ve made great strides in our efforts to prevent new HIV infections. This strategy can play a key role in ending or reducing HIV-related stigma and allow partners to select prevention methods that work best for their relationships.”

For more information about D.A.P.s policy, the NASTAD position, and related research, please visit these pages:

NASTAD Policy: Risk of Sexual Transmission of HIV from Virally Suppressed People Living with HIV
PARTNER Study: How to Interpret the Zero Transmission Results
HPTN 052: Study Summary

About Desert AIDS Project

Desert AIDS Project (D.A.P.) is a Federally Qualified Health Center in Palm Springs, CA offering D.A.P. Total Care – a combination of medical, dental, counseling, social services, support groups, alternative therapies, in-house pharmacy and lab, and other health and wellness services.  D.A.P.’s sexual health clinic, The DOCK, offers STD testing and treatment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and free HIV and HCV testing. D.A.P.’s Get Tested Coachella Valley campaign, the nation’s first region-wide HIV testing and access to care initiative, was recognized by the White House for helping to bring about an AIDS-free future.  D.A.P. is rated a “Top 20 HIV Charity” by About.com. Visit www.desertaidsproject.org, www.thedockclinic.org, and www.gettestedcoachellavalley.org to learn more.

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Printable version: Desert AIDS Project Press statement Viral Suppression Prevention Strategy 04.25.2017

D.A.P. tests new treatment for drug-resi …

Desert AIDS Project is studying a new treatment for a very pervasive sexually-transmitted infection (STI) that’s now become drug-resistant.

Under the direction of Dr. Steven Scheibel, D.A.P. is studying the efficacy, safety, and side effects of a drug that combats Nesseria gonorrhoeae, the bacteria that causes gonorrhea.

Gonorrhea is the second most common STI and a major source of morbidity worldwide. Without treatment, it can cause infertility, cervicitis, proctitis, urethritis, pelvic inflammatory disease, and pharyngitis. Babies grow outside the womb in some women and the infection makes both genders more susceptible to HIV, according to GlaxoSmithKline, sponsor of the study. They go on to say:

“The ability of Neisseria gonorrhoeae to develop resistance to antimicrobials has complicated the management of the disease, leading to an urgent need for new treatment options.”

D.A.P. is one of eight medical centers testing the new drug, called GSK2140944. The study invites 60 adults with gonorrhea infection to take a single dose of either 1,500-mg or 3,000-mg of GSK2140944. The study wants to know if the smaller or the larger dose works best. The study last about a week with two scheduled visits. On the first visit, doctors will dispense the drug and gather baseline information from the study subject. A follow-up visit, called the Test-of-Cure visit, occurs between day 4 and 8 and determines the subject’s response to the drug. That includes success, failure, and adverse effects. Although there are two scheduled visits, bad reactions to the new drug will be monitored until they are resolved.

So far, D.A.P. has enrolled three subjects in the study, to meet the six-subject goal for each site. Our clinical administrators are working on identifying additional subjects. “Right now, though, we have more subjects than any other site and we’ve enrolled them quickly,” says Rod Hagan, D.A.P.’s Clinical Research Coordinator. D.A.P. began accepting subjects about six weeks ago, while other sites have been at it since January. “We have a concentration of people in the Coachella Valley, who need support in fighting gonorrhea infection, so our services have to be cutting edge and we must be fast out of the blocks,” Dr. Scheibel states.

Although the name of the drug sounds like a chemical weapon from an action hero comic strip, the problem and the need for an immediate answer is very real.

According to the study protocol, a variety of antimicrobial agents have been used over the years for the treatment of gonorrhea. Effective treatment options for gonorrhea have diminished rapidly because of the emergence and worldwide spread of antimicrobial resistance to many drugs previously used or considered the first line. The study goes on to list six drugs that patients are taking to almost no effect.

“Azithromycin was the big tah-dah,” Rod says. “But N. gonorrhoeae has become resistant to it and there’s nothing else in the pipeline. Without a new treatment, it could be like it was at the turn of the century again and it could be fatal.”

D.A.P. is trying to keep that from happening. We’re participating in this study and several other clinical trials that aim to improve the lives of patients and clients living with HIV. The search for a new antimicrobial is one of five that D.A.P. has conducted in the past 12 months. Those studies include Medication Therapy Management, a study on HIV, aging, and the brain, a study that searches for a milder antiretroviral that we’ve called Switch, and a new treatment for anal dysplasia. These studies represent a new function we’ll perform for the HIV community here and abroad. Beyond those in disadvantaged communities in the Coachella Valley, many others — nationally and globally — will benefit from our findings.

“Our search for a new treatment for this drug-resistant strain of gonorrhea is one of the most important things we can do,” Dr. Scheibel says. “We have to get out in front of this challenge because it threatens us locally and globally.”

 

Exciting breakthrough in treating dyspla …

Dr. Steven Scheibel, Medical Director at Desert AIDS Project, believes he’s found a new way to treat the conditions that can lead to anal cancer. The new therapy uses human papillomavirus (HPV) vaccines in conjunction with an immune-boosting cream to kill anal dysplasia, which is often a gateway to anal cancer. This therapy promises to be an alternative to surgery as well as a way to address soaring rates of HPV and resulting dysplasia, which weighs so heavily on gay men and those with HIV.

Dr. Scheibel, along with Dr. Praveena Yetur of LabCorp in Monrovia, wanted to treat anal dysplasia, which manifests as lesions in the anal cavity. These lesions can range from mild to severe and may morph into cancer. Working with a 55-year-old man with moderate to severe anal dysplasia, the patient was given imiquimod cream followed by injections of an HPV vaccine called Gardasil. By intervals of three to four weeks, the treatments were delivered over a two-year period. “The patient was screened for high-risk HPV on a weekly basis and had multiple biopsies to identify possible dysplasia,” Dr. Scheibel says. “The result was no virus and a normal anal Pap smear.”

Treatment for HPV and anal cancer is essential at D.A.P. because they pose growing threats to many of our patients. HPV is the most common sexually-transmitted virus circulating today, with up to 75% of sexually active people contracting it in their lifetimes, according to Boston Medical Center’s website. Medical experts agree that HPV infection is even higher in people with HIV. And, although anal cancer is still relatively rare, its prevalence is growing fast, particularly among men who have sex with men (MSM) and those who are HIV-positive, says BioMedCentral.com.  In fact, anal cancer among MSM with HIV is rising at 80 times the rate of the general population, Dr. Scheibel reports. Therefore, D.A.P. is busy searching for answers to HPV, anal cancer, and other clinical issues that challenge our patients.

HPV also is a key factor in head and neck cancer, for which we offer free screenings to clients, staff, and the general public once a year through the Annette Bloch Cancer Care Center. Dr. Scheibel leads a movement to increase clinical research performed under our roof and has made notable headway in the area of HPV and anal dysplasia. The treatment has shown so much promise that Dr. Scheibel will present his findings at “HPV 2015,” the 30th International Papillomavirus Conference in Lisbon, Portugal, held September 17-21.

Researching disease and sharing results with international colleagues, is not new to the internist, who specializes in infectious disease and is AAHIVS credentialed as an HIV Specialist. Dr. Scheibel has done clinical research on HIV and AIDS for decades and was a researcher as well as co-founder and Associate Medical Director of the Community Health Network in Rochester, N.Y., in 1989. He’s been on teams whose work is cited in books such as “Public Health Behind Bars: From Prisons to Communities.” Dr. Scheibel has presented at the Conference on Retroviruses and Opportunistic Infections, the Symposium on Cell Biology of Virus Entry, and he’s traveled to such cities as San Francisco, Casablanca, and Yokohama, Japan, to appear at the International Conference on AIDS.

Nevertheless, presentation at the HPV conference is special, says Rod Hagan, D.A.P.’s Clinical Research Coordinator: “If we could demonstrate a potential treatment for dysplasia that would prevent the need for the invasive surgical solutions that are out there, then this is huge. And getting the rate of HPV among our patients in line with that of the general population… yes, the potential of this is pretty exciting.”

 

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