Monthly shots control HIV as well as pills in 2 big studies
By CARLA K. JOHNSON
AP Medical Writer
Friday, March 8
SEATTLE (AP) — Monthly shots of HIV drugs worked as well as daily pills to control the virus that causes AIDS in two large international tests, researchers reported Thursday.
If approved by regulators in the United States and Europe, the shots would be a new option for people with HIV and could help some stay on treatment. Instead of having to remember to take pills, patients instead could get injections from a doctor or nurse each month.
“Some people will be thrilled” at the convenience, said Mitchell Warren, executive director of AVAC, an AIDS advocacy group.
Condoms remain the most widely available and inexpensive form of HIV prevention. Pills taken daily can keep HIV levels so low the virus is not transmittable to sex partners, but not everyone takes them as prescribed.
The shots could improve how well some people stick to treatment, perhaps helping those who have trouble remembering to take daily medicine to keep infection at bay.
There are other potential benefits. Getting shots at a clinic can lend more privacy to patients worried about the stigma of filling an HIV prescription at a pharmacy, said Dr. Susan Swindells of the University of Nebraska Medical Center in Omaha, who presented results Thursday at an HIV conference in Seattle.
Cost will be an issue “to make sure that everyone has access to this medication,” said Dr. Hyman Scott of the San Francisco Department of Public Health, who was not part of the study. It’s not clear how much the shots would cost. HIV pills can cost a patient up to thousands of dollars monthly , depending on the drug combination, insurance coverage, rebates and discounts.
And there will be concerns about patients missing a monthly shot, which could lead to drug-resistant strains of the virus. It will be “a good option for some people,” Scott said.
Whether monthly shots will also work to protect users’ sex partners hasn’t been studied yet, but there is reason to think they will, said experts at the conference.
The shots are a long-acting combo of two HIV drugs — rilpivirine, sold as Edurant by Johnson & Johnson’s Janssen, and ViiV Healthcare’s experimental drug known as cabotegravir.
ViiV Healthcare paid for the research. The drugmakers are seeking approval later this year in the United States and Europe.
One study included 616 people who were taking pills to treat their HIV infection. The other study enrolled 566 people who hadn’t yet started treatment, so they first got pills to get the virus under control.
In each of the studies, half the participants switched to the shots while the rest stayed on pills. After nearly a year, 1 to 2 percent of people in both groups had traces of virus in their blood, whether they got shots or pills. That shows the shots worked as well as the standard pill therapy. A few people withdrew from the studies because of pain after the injections.
The studies were done in Europe and North America and in nations including Argentina, Australia, Russia, South Africa, South Korea, Sweden, Japan and Mexico.
“We don’t have experience rolling out an injection in the real world,” said Warren, the AIDS advocate. He said the next challenges will be how to deliver the shots and whether patients will remember to come back monthly. “These are big questions.”
Follow AP Medical Writer Carla K. Johnson on Twitter: CarlaKJohnson
The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
Could a booster shot of truth help scientists fight the anti-vaccine crisis?
March 8, 2019
Author: Lee McIntyre, Research Fellow Center for Philosophy and History of Science, Boston University
Disclosure statement: Lee McIntyre recently attended a conference that was sponsored by the Ministry of Health of Italy.
Partners: Boston University provides funding as a founding partner of The Conversation US.
The recent outbreak of measles cases in Clark County, Washington – which has been linked to a plummeting vaccination rate in this hotbed of anti-vaccination activism – makes clear that conspiracy theories, fear, and misinformation know no partisan bounds. The Governor has declared a state of emergency and sent public health officials out to talk to parents – sometimes one on one – as more than 60 cases have now been reported.
Now imagine what might happen if the government itself had embraced an official anti-vaccine policy.
As a philosopher of science who has studied science denial, I know that science denial is a world-wide phenomenon. Although some anti-science claims like evolution denial are particularly virulent in the U.S. (outstripped only by Turkey), it’s not just America that faces this problem.
This can be both a blessing and a curse. While it’s sad to know that the forces behind science denial are larger than any one culture or political party, it’s good to know that if we study what is happening elsewhere, it may help us learn how to fight science denial in general.
One of the first lessons to be learned from this “metastasis” of science denial is how dangerous it is not to fight back. As we’ve seen with climate change in the U.S., science denial isn’t limited to fringe groups – if it isn’t fought in the trenches of corporate interest and ideology, it can spread not only to the general population, but to government too, with horrible policy consequences. But it matters too how we fight back, which I believe is illustrated perfectly by what is happening with the anti-vaccination movement.
The anti-vaccination crisis in Italy
First, it is important to state the facts: the hypothesis that vaccines cause autism was based on a fraud. Andrew Wakefield’s bogus 1998 study has been debunked numerous times and, in the end, it was learned that the whole thing arose not from sloppy science or a mistake, but from what some called deliberate manipulation of the data based on an undisclosed conflict of interest. Wakefield’s paper was retracted and his medical license was stripped. Yet still the generalized fear of vaccines has survived and taken hold among a world-wide audience of parents who are confused and suspicious – and love their children just as much as the rest of us.
At a recent scientific conference in Rome, I learned of a public health debacle that has been brewing in Italy for years.
In 2012, an Italian court ruled there was a link between autism and the measles mumps rubella vaccine; this was overturned in 2015. By that time, however, vaccination rates in Italy had fallen to 85 percent – well below the 95 percent rate that public health officials consider essential for “herd immunity.” As one prominent researcher, Roberto Burioni, put it “Italy’s measles vaccination coverage was on par with Namibia, lower than Ghana.”
Then, just as in Washington state today, measles cases started to rise. In 2016, there were 850 measles cases in Italy. By 2017, this had grown to 5,000. By that point, Italy accounted for 34 percent of all the measles cases in Europe, and 89 percent of the measles cases in Italy were made up of people who hadn’t been vaccinated. In response, health minister Beatrice Lorenzin introduced a compulsory law that parents had to vaccinate their children for daycare and school, with shots against ten diseases, including the MMR. Over time, the vaccination rate increased.
Then, in June 2018, the Five Star Movement came to power and formed a coalition government with the Hard-Right League, which found support in Deputy Prime Minister Matteo Salvini, who was anti-vaccination. Distrustful of experts and institutions, steeped in conspiracy theories, and emphasizing the importance of “personal freedom,” Salvini claimed that vaccines were “useless and in many cases dangerous.” During the campaign some in the Five Star Movement had maintained that compulsory – and state-funded – vaccines amounted to “free genocide.”
Then in August 2018, the new government sought to overturn the law to make vaccines compulsory, in favor of allowing parents to “self-certify.” As measles cases continued, there was some hedging and the government agreed to keep the law in place for another year. In December 2018, Giulia Grillo, the new health minister, announced that all 30 members of the Higher Health Council advisory panel would be fired. Soon after, the director of Italy’s National Institute of Health (ISS), Walter Ricciardi, resigned in protest over the Italian government’s “anti-scientific” vaccine stance.
What is the best way to fight back against such rank ignorance, when it appears at the highest levels of government?
Unfortunately, some of the defenders of science themselves have chosen to engage in what I would call “post-truth” tactics. In a 2014 television interview, then-health minister Beatrice Lorenzin made the claim that 270 kids in London had died of measles in 2013, due to anti-vaccination efforts. Except that this wasn’t true. Was this a mistake? A lie? In any case, it was dangerous, because when the truth came out it only further undermined public confidence in getting reliable information from the government.
What lesson might we learn from this? Some might condone lying in such an emergency. It must be tempting, in the face of willful ignorance and misinformation, to cut corners and pretend there is no such thing as scientific uncertainty. But this too is a lie, and undermines the very tool we need most to fight back against science denial, which is a better understanding of how science works and why its claims are reliable.
One should not pretend that vaccines are 100 percent safe. There have been isolated cases of negative reactions, sometimes even leading to death. These, however, represent such a small risk – as compared to the much larger one of dying from childhood diseases like measles or whooping cough – that unless a child is immuno-compromised, it doesn’t make sense to forego vaccines. Indeed, because there are immuno-suppressed children out there, one might say that it is the obligation of the rest of us whose children are not in such a risk group to make sure that our own children are vaccinated.
Although it might lead to a more difficult conversation, I believe that embracing uncertainty and doubt as a strength, rather than a weakness, of science is a better strategy for fighting science denial in the long run.
Any scientist who understands inductive reasoning knows that no empirical hypothesis can ever be 100 percent proven. And scientists can also make mistakes. But does this justify the assertion that all hypotheses are equally likely to be true? Or that all risks are equal? No. Lack of certainty does not mean that there is no such thing as likelihood or probability, for these are precisely the measures against which scientific conclusions are evaluated.
Scientific claims are based on evidence. Scientists’ beliefs are justified (warranted) because they fit with the facts. Although this may not reach the level of truth because no scientific belief can ever be proven or confirmed, it is significant that this is where scientists aim. So why squander this and begin to use post-truth tactics in the defense of science? When we lie about the certainty of science, it only raises the suspicions of a community that may be disinclined to trust scientists in the first place.
In my view, what we need most to fight science denial is a better understanding of how science works. Not just more knowledge of scientific conclusions, but of the process by which scientific theories are tested and justified in the first place. Rather than pretend that science (or scientists) are perfect – that there is no such thing as cognitive bias or that conflicts of interest never arise – why not embrace what is most special about science, which is that in science there are transparent community standards by which we may discover and correct any error?
As they go house to house, this is at least part of what public health officials in Washington might try to explain to anti-vaccine skeptics. When we take the time to explain the science behind vaccines – rather than belittle every doubt – might this not be the most effective strategy of all?
In this post-truth age, some have claimed that it is impossible to change anyone’s mind with evidence, that even empirical belief is based on our identity. If you belong to the tribe of vaccine-deniers it must be difficult to accept the idea that – by rejecting the consensus view of science – you may be risking your child’s life.
But might scientists also be tribal? If so, let it be around belief in the creed that binds them, which embraces both openness to new ideas and a resolve to test them. The scientific attitude consists of basing our beliefs on evidence, and being willing to change those beliefs as new evidence comes in. Instead of “lying in service of the truth,” let this be what guides us.
Paul Braterman, Hon. Research Fellow; Professor Emeritus, University of Glasgow:
We scientists do ourselves great harm by emphasising the inherent uncertainty of our conclusions. The same uncertainty applies with equal force to all our knowledge about the world.
We can and should say that we are as certain as we can be about anything about vaccination (or evolution or climate change or anywhere else that the enemies of reason are busy raising doubts). We shall also emphasise that refraining from vaccination is also a decision. A suitable form of words might be “If you do not get your child vaccinated,.you are exposing her to much greater risks than if you do.” Having framed the debate in this way, we can then move on to discussing evidence.
Sex trafficking in the US: 4 questions answered
March 8, 2019
Hotels and motels along major highways are common spots for sex trafficking.
Author: Monti Datta, Associate Professor of Political Science, University of Richmond
Disclosure statement: Monti Datta does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Partners: University of Richmond provides funding as a member of The Conversation US.
New England Patriots CEO Robert Kraft’s criminal charges in a suspected sex trafficking case in southern Florida draw new attention to this serious problem.
Sex trafficking, as the federal government defines it, is “the recruitment, harboring, transportation, provision or obtaining of a person for the purpose of a commercial sex act” by means of “force, fraud, or coercion.” This is a form of modern-day slavery. Found in massage parlors, escort services, residential brothels and street prostitution, some might be victims for weeks and others for years.
As someone who studies human trafficking, I feel that it’s important for the public to understand how it manifests in the U.S. today. While there’s still a great deal that is unknown about sex trafficking, research studies and nonprofits have been able to gather telling data on this industry’s victims and perpetrators.
Where does sex trafficking happen?
Sex trafficking tends to occur in motels and impoverished neighborhoods along the interstate highway system as well as in major urban centers. Some of the busiest corridors of the interstate include I-5 in the West, I-95 in the East and I-80, stretching from coast to coast.
The nonprofit Polaris operates the National Human Trafficking Hotline, which takes tips on sex and labor trafficking. Although the Polaris data are not from a random-sample survey, they shed light on types of sex trafficking in the U.S. In 2017, Polaris received more than 6,000 hotline tips about sex trafficking across America. Among these data, the top venues for sex trafficking included illicit massage parlors, hotels and motels, and residential brothels.
The National Association of Truck Stop Operators has partnered with the U.S. Department of Homeland Security’s Blue Campaign. The National Association of Truck Stop Operators offers trainings to help truckers, truck stop owners and employees identify the signs of human trafficking, such as malnourishment, lack of eye contact and disorientation.
Hotel chains like Marriott are training their employees as well.
Who are the victims?
Reliable data on the number of sex trafficking victims in the U.S. are hard to come by.
In the U.S., studies show that most victims of sex trafficking are women and young girls. They are, on average, 19 years old.
Risk factors for sex trafficking include a history of child abuse, substance abuse, poverty, involvement in child protective services, involvement in juvenile detention and prior sexual exploitation.
Runaway and homeless youth are especially at risk for sex trafficking. A study conducted in Philadelphia, Washington, D.C. and Phoenix found that 14 percent of homeless youth identified themselves as victims of sex trafficking. Among these sex trafficking victims, 33 percent identified as LGBTQ.
A young person is more likely to meet her trafficker for the first time online rather than in person, due to the rise of social media.
Who are the traffickers and the johns?
Men who purchase commercial sex come from all walks of life.
One comparative study on men and their lifetime history of paying for sex found that 4.9 percent of men in Tampa, Florida, said they had ever paid for sex. Among those men who paid for sex in Tampa, men aged 41 to 70 were most likely to pay for sex, making up about 13 percent of the total.
Traffickers include mom-and-pop operations, crime rings, gangs and cartels. Sometimes, when a victim of sex trafficking has been groomed enough, she becomes “the bottom,” helping her trafficker recruit other victims.
Research shows that modern-day slave holders have a complicated mindset, condescending and paternalistic, not necessarily one of pure evil. Slaveholders can think they are doing a favor to the enslaved, by taking care of them, giving them food and shelter, and even “protecting” them from a world in which they would otherwise be disposable.
How much money does the commercial sex economy generate?
A 2014 study of sex trafficking in seven major U.S. cities found that revenues from underground commercial sex ranged from US$39.9 million in Denver to $290 million in Atlanta.
Although many experts suspect that major sporting events, like the Super Bowl, might encourage the demand for commercial sex, preliminary research suggests the effect is negligible.
The breadth of sex trafficking in the U.S. has prompted federal responses. The FBI has organized Operation Cross Country, a collaboration of dozens of field offices and hundreds of local law enforcement organizations. In October 2017, Operation Cross Country XI conducted a nationwide sting leading to the freeing of 84 minors and the arrest of 120 traffickers.
A national discussion on sex trafficking is growing after Kraft’s arrest. With better data collection methods and a stronger national coordinated effort, I believe that the U.S. could eventually come closer to the day when modern slavery is no more.
Trump to tour tornado devastation in Alabama
By JILL COLVIN
WASHINGTON (AP) — President Donald Trump headed to Alabama on Friday to survey the damage from a deadly tornado that devastated a small town, killing nearly two dozen people.
Trump was expected to tour rural Lee County in eastern Alabama, where 23 people died Sunday in a massive EF4 tornado that carved a path of destruction nearly a mile wide with 170 mph (270 kph) winds.
It was one of at least 38 tornadoes confirmed to have touched down across the Southeast in a deadly weekend outbreak.
As he left Washington, Trump said he expected to meet with Gov. Kay Ivey and people who “got hit very hard by the tornadoes.” He also planned to thank first responders.
Trump has said he’s instructed the Federal Emergency Management Agency to give Alabama “the A Plus treatment” as the state recovers.
The Alabama damage was officially deemed a disaster on Tuesday, with Trump ordering federal aid to supplement the ongoing state and local recovery efforts.
Ivey has also signed a disaster assistance agreement with FEMA and ordered state flags flown at half-staff until sunset Sunday.
The Beauregard, Alabama tornado was the deadliest to hit the U.S. since May 2013, when an EF5 twister killed 24 people in Moore, Oklahoma.
The dead included four children and a couple in their 80s, with 10 victims belonging to a single extended family. Several people in Georgia were also injured by twisters that also extended to Florida and South Carolina, according to the National Weather Service.
Trump had said earlier this week that the country was “sending our love and prayers to the incredible people of Alabama” and that “whatever we can do, we’re doing.” He was traveling to politically friendly territory for him: Alabama supported Trump by a wide margin in the 2016 presidential election.
The president’s reaction to natural disasters at times has seemed to vary with the level of political support he’s received from that particular region.
In the months after wildfires ripped through California, Trump threatened to cut off federal aid unless the state embraced forest management policies he championed.
“Unless they get their act together, which is unlikely, I have ordered FEMA to send no more money. It is a disgraceful situation in lives & money!” Trump tweeted.
He also engaged in a sustained back-and-forth with lawmakers from hurricane-whipped Puerto Rico, repeatedly blaming the territory for its problems and noting how much money recovery efforts had cost the federal government.
The administration at one point considered redirecting disaster aid from places like Puerto Rico and California to pay for the president’s long-promised border wall. The administration ultimately chose to target other sources of federal dollars.
Alabama and several other Southern states could soon be under threat of more severe storms — including tornadoes — with a new system expected to reach the South this weekend, according to forecasters.
Trump had already been scheduled to fly south Friday for a weekend at his private Mar-a-Lago club and will be heading there after the tour.
Follow Colvin on Twitter at https://twitter.com/colvinj