ANNUAL MEETING HIGHLIGHTS, NOVEMBER 13, 2016

The Annual Meeting of Beyond AIDS, and an open Board meeting of the Beyond AIDS Foundation, were held on Sunday, November 13. The central meeting place was in Redlands, California, supplemented by conference call participants from across the country.

Two of the topics discussed at the Annual Meeting, legislative activities in California this year, and reports from the International AIDS Conference in Durban, South Africa, have already been reported in separate articles. 

A special feature at the meeting was a report from Richel Strydom, the current Treasurer, about her recent work in the small African country of Lesotho (pronounced "lesutu"), which is entirely surrounded by South Africa.


Dr. Strydom, a native of South Africa, is also a Loma Linda Preventive Medicine resident. She did a residency rotation at the Maluti Adventist hospital in July 2016. She expressed appreciation to Loma Linda University and to the hospital for the opportunity. The HIV prevalence rate for ages 15-49 in Lesotho is estimated at 23.4%, second highest in the world, with higher rates in females under age 40. Partly as a result, there is a high rate of cervical cancer.

The Health Ministry adopted a “test and treat strategy” to take effect the month she was there, and she attended the introductory training. HIV meds will be offered immediately after a positive test result. This strategy, already implemented in the U.S., was endorsed by UN AIDS in 2015, but Lesotho is the first country in sub-Saharan Africa to implement such guidelines. Assistance has been assured from the Elisabeth Glaser Pediatric AIDS Foundation, and from the U.S. government President's Emergency Plan for AIDS Relief (PEPFAR) fund.

Richel discussed a plan for cervical cancer testing – every 5 years for sexually active women. However, Pap testing and high risk HPV screening are not yet routinely available there. She gave presentations at the hospital and at the school of nursing, on the importance on cervical cancer screenings, using a more primitive technique, visual inspection during a pelvic examination with acetic acid application to the cervix to identify abnormal tissue. Women with positive findings currently need to be referred by the hospital elsewhere for biopsy and treatment. She also assisted in HIV and TB care, prevention, and community education.

At the Foundation Board meeting (which followed the Annual Meeting), Dr. Strydom was presented with a certificate for having recently completed a 2-year part-time fellowship with the Beyond AIDS Foundation. Her research study, a survey of state and regional AIDS Directors, is still ongoing.

 Also still pending completion is an earlier survey of local jurisdictions in California concerning their practices for HIV partner services.

The Foundation recognized Michael Weinstein, President and founder of the AIDS Healthcare Foundation, for its annual Nettie Award, citing his courageous and innovative advocacy for HIV prevention and treatment. The award is to be presented in Los Angeles in December.

Cesar Reis was accepted as a new fellow, and Camila Araujo as a new intern. Their first duties will involve helping to complete research studies. They have also expressed interest in helping to organize an educational webinar under guidance from Beyond AIDS Vice-President Jeffrey Klausner. Further information and the application form for the Beyond AIDS Foundation's internship and fellowship program is available on the Beyond AIDS web site.

BEYOND AIDS 2016 LEGISLATIVE ACTIVITIES, CALIFORNIA

Beyond AIDS legislative activities for 2016 have focused on California. We supported a new bill that passed and was signed. In addition, we supported a voter initiative that failed, and continued follow-up on a bill that had passed recently but had not been implemented.

AB 2439 (Nazarian) will establish a pilot program to study HIV testing in hospital emergency departments. This passed, was signed into law, and will take effect January 2017. The bill was sponsored by the AIDS Healthcare Foundation and supported by Beyond AIDS. It was watered down from originally requiring all ERs to offer HIV testing. In its final version, it established a study at up to 4 hospitals to determine effectiveness.

Proposition 60, a statewide voter initiative also sponsored by AIDS Health Care Foundation, would have required condoms for adult film industry, and testing at employer expense. Beyond AIDS was named in TV ads and listed as a supporting organization in the voter booklet sent to millions of Californians. Beyond AIDS activists Gary Richwald and Jeff Klausner were both named in the booklet as spokespersons. It failed to pass at the November 8 election, 53 – 47% against with another million votes to be counted.

OSHA CA (Cal-OSHA)’s interpretation of the bloodborne pathogen standard issued years ago for healthcare institutions is that it also requires condom use for workers and employees that are exposed. The industry (producers, but with support from some actors) has fought this for years, initially stating that the actors were independent contractors and not employees, however they were found to be employees in a court case. Their fear is that if condoms are portrayed, fewer films will be sold.

Those involved in the industry, as well as the HIV/AIDS community, are also sensitive to anything involving the government telling anyone how to have sex. However, this argument fails to distinguish bedroom from "industrial" sex. From a public health perspective, we were disappointed that organized medicine (CMA) opposed the initiative out of concern for excessive litigation, because it would have allowed citizens to sue the companies. The power to sue was added to the wording because no one seems to want to enforce rules requiring condoms or involving this industry. Los Angeles voters approved a proposition similar to this one a few years ago, but there has been no enforcement; and Cal-OSHA only acts on complaints.

Beyond AIDS has been in favor of condom requirements for the adult film industry for years, and has been working on this issue for a long time. Several years ago, Denise Bleak and Ron Hattis attended CAL OSHA hearings, but no regulation was ever issued. Peter Kerndt was also an early champion. CAL OSHA has been dragging its feet, but now is talking about once more holding hearings. This issue is important not only to protect workers, but to set a standard for safe sex, since millions of people watch porn and are tempted to emulate what they see. Monica said that this may be a national issue, not just a California thing.

The number of actors in the industry over time is actually fairly large, with considerable turnover, and each performer may have thousands of exposures. There is potential transmission to the general community.

Follow-up of AB 466 of 2013, HIV Test Offering in California Primary Care Clinics

This bill passed in 2013, and has been in effect since January 2014. This law requires HIV testing to be offered if doing blood tests for something else, and if there is no recent test result on record. However, there was virtually no effort to inform the clinics or providers affected, and many still do not know about or follow it. Beyond AIDS has reached out to the California Primary Care Association and received a recent encouraging message from Dr. Mike Witte, Chief Medical Officer. The issue has also been raised at the California Public Health Medical Leadership Forum, of which Ron Hattis is Secretary.

For 2017, Beyond AIDS will look for opportunities to support any legislation and regulations in California, other states, and federally, that could enhance the control and prevention of HIV/AIDS.

IMPRESSIONS FROM DURBAN, SOUTH AFRICA: 21ST INTERNATIONAL CONFERENCE ON AIDS, JULY 18-22, 2016

Deanna Stover, Beyond AIDS Foundation President, and Marsha Martin, Advisory Council member, represented Beyond AIDS at this conference in South Africa. They discussed their impressions at the Beyond AIDS Annual Meeting, November 13, 2016.

Marsha Martin reported that the conference had been in Durban before, in 2000. This was an opportunity to come back and see how things have moved along after 16 years. There were about 20,000 attendees, and the mood was optimistic and people were feeling good. Treatment is available, much more is being done. Science is being used on the ground. At the earlier International AIDS Conference in Durban, this was not the sentiment.

Marsha coordinated a satellite conference call/meeting with a new organization she is working with – a global network of black people working on HIV, including UN AIDS, leadership of the conference, and a network of professionals from organizations working in Africa and with African Americans. National and local people need to be involved, not from the outside but from the inside, and including vertical leadership. The resources exist to impact the epidemic, so the challenge is to harness them and improve outcomes.

The message behind key populations – gay males, injection drug users, sex workers, and transgender persons – was evident. These “key populations” have been emphasized in the latest funding, including the recent announcement of a $100 million U.S. government’s PEPFAR (Presidential Emergency Fund for AIDS Relief) grant, at a high level UN meeting in June. This can be understood, because these groups have been ignored by some governments. However, there was some tension between these groups and those working with women and girls, who now account for 62% to 71% of new cases in various countries. Two years ago, the Dreams Initiative, funded by PEPFAR, the Gates Foundation, and other NGOs, had emphasized young women and girls in east and southern Africa, and is ongoing. Most transmission in Africa, unlike in the U.S. and some other developed countries, is among heterosexuals.

Martin said that there was a consensus that after 15 years of PEPFAR, the time has come for national “ownership” of the epidemic, with local governments and national NGOs taking more responsibility. Collaborations and partnerships need to be established.

Deanna Stover addressed maternal child transmission rates, which have decreased in South Africa, through the use of community health workers – from the “community.” Six countries reported that they now had no or almost no perinatal transmission. Deanna attended discussions on PrEp (pre-exposure prophylaxis) for discordant partners, and treatment as prevention. Funders spoke about the future of funding and the need to have outcome metrics moving forward. Overall, she said it gave a profound overview of the epidemic, and of the challenges for the future.

Ron Hattis, who did not attend, mentioned that if the prevalence rate could be gradually be reduced, particularly through successful “test and treat” programs, the current high levels of funding could eventually be reduced; if not, they will be needed indefinitely.

Jeff Klausner also did not attend, but mentioned that there was a sobering presentation in Durban regarding the “real world” effectiveness of “test and treat” in KwaZulu-Natal (the South African province in which Durban is located), funded by French ANRS group. The outcome was that fewer than 1/3 were virally suppressed in one year, and incidence did not decrease, compared with a control group. This was a well-done trial and speaks to the limitations of “test and treat” and the need for additional strategies such as newborn circumcision and PrEP. The weaknesses of the effort appeared to be in keeping the positive patients on treatment.