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DON'T BE IN THE DARK ABOUT HEPATITIS C, SYPHILIS AND HIV

Simple Free Tests Both Insure You Are Disease Free
or Alert You To Early Treatment and Cure

What the Rubberman Wrote by Michael Harney

Tax season has passed and whether you had to pay or not - all of us in Buncombe County can get something free of charge, tests for Hepatitis C, syphilis and HIV, at the Health Department or the Western North Carolina AIDS Project (WNCAP), guaranteed to pay individual and public health dividends whether the results are positive or negative, and thanks to a pot of tax dollars allocated by the North Carolina Department of Health and Human Services (NCDHHS).*

Need more convincing? The Optimal Management of HIV Disease & Hepatitis Clinical Conference (OPMAN XXV) held in Orlando Florida March 17-19, included sessions about the national effort to identify, test, and treat-to-cure the estimated 3.5 million or more people in this country living with the virus known as hepatitis C (HCV) – 75% of whom are thought to have been born between 1945-1965, many of them infected before mandatory blood screening for HCV began in 1992. Within the other 25% are additional people who have ever shared needles or related injecting equipment, and a smaller group who acquired the virus sexually. The recommendation for testing also goes for those of us who may have contracted syphilis – a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum – whether we have a recent infection, or have been living with it, sometimes without symptoms, for years.  

There is great concern about the upsurge in syphilis cases across the U.S. and in North Carolina, especially among men who have ever had sex with another man – but don’t count yourself out if that does not describe you. Syphilis masks itself in dermatological (skin) manifestations which may not stand out to a physician doing a basic health care screening. Has your doctor ever offered to test you for syphilis? Perhaps an unusual rash has appeared on your body; perhaps a small painless sore in your privates? Are you having visual changes or eye irritation causing you to visit an eye doctor or specialist? Read all about the many symptoms of syphilis by visiting www.cdc.gov, then clicking on “S” under the index at the top of the page. Scroll down to “Syphilis”. There, you’ll find the Fact Sheet in order to learn more.  

Syphilis is no joke, but can be treated and cured at all stages, even if one has had it for years. Self diagnosis is not enough. Testing is the only way to know for sure. And what would keep you from just getting tested anyway? If your doctor doesn’t seem interested, a simple call to the Buncombe County Department of Health and Human Services (local health department 250-5109) is the easiest way to set an appointment to get tested, and may be a good return on your tax dollars!

As for HCV, there are new, fairly simple treatments to cure it in 8-12 weeks for most people, with few side effects. This is unlike the old treatments for hepatitis C that someone you may know tried taking in the past, often with great misery and little to no success. There is some initial blood work to identify the genotype of hepatitis C in the body, which helps the provider know which medication to prescribe. Not all doctors may feel confident in treating patients with these medications, but it is not as hard as they may fear. The websites www.hcvguidelines.org and www.hep-druginteractions.org are quite helpful and comprehensive. Additionally, the manufacturers of these successful therapies have patient assistance programs to help pay for what insurance companies may not agree to cover https://www.nastad.org/sites/default/files/Hepatitis-and-PAPs-CAPs-Resource-Document_8.pdf 

There is also great information about HCV at the www.cdc.gov website, but this time click on the “V” for “Viral Hepatitis”, down the page a good way, where you’ll find the link to a list of risk factors which may increase your interest in being tested. Remember, it’s free and can be done at the same time you get tested for syphilis.  

So, what’s stopping you?  

Taxes may have been due by April 18th, but you are due the best health care possible all year long. Get your return today!  

Michael Harney is a prevention educator with WNCAP and helps operate NEPA@WNCAP – one of the local needle exchange programs in the region.
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*Just a note: Not all North Carolina counties have free hepatitis C testing. The Western North Carolina AIDS Project (WNCAP 252-7489) does HIV/HCV and syphilis tests for free too, but they are only for screening purposes, and not confirmatory and diagnostic, as would be the blood tests provided at the health department. 
Find out more about WNCAP HERE
The International AIDS Conference is the largest conference on any global health issue in the world.  It was first convened during peak of the AIDS epidemic in 1985, and continues to provide a forum for intersection of science, advocacy, and human rights.

Michael Harney, affectionately known as "the rubberman"
is pictured here as he represented Western Carolina and WNCAP this year.

Below are his reports from Amsterdam and what is happening with AIDS and 
July 25, 2018
What The Rubberman Wrote by Michael Harney
Report from Amsterdam – 22nd International AIDS Conference – July 23-27, 2018 

Amsterdam, a city of 900,000 inhabitants, is again host to the International AIDS Conference. There are 15,000 people attending from 160 countries around the globe, all here 
“Breaking Barriers – Building Bridges” together.
In 1992, because the United States had imposed a travel ban prohibiting entry by people living with HIV, this highly scientific and social issue-oriented conference moved from its originally scheduled city of Boston, to Amsterdam. 

The HIV travel ban was lifted during the Obama administration, allowing the conference to be held in Washington D.C. in 2012, but questions by HIV activists have recently arisen about the feasibility of San Francisco/Oakland hosting the 2020 conference, due to the Trump administration’s ban on people entering the United States from a variety of nations for a variety of demographic reasons, impacting the rich diversity of this gathering which traditionally features interactions among researchers, clinicians and marginalized communities such as MSM, People Who Inject Drugs, Sex Workers, Transgender people, and other constituencies confronting HIV, Viral Hepatitis and Tuberculosis worldwide.
Planners and officials from the International AIDS Society (IAS) who are responsible for this conference, will have to make the final decision.
Prior to the opening of the 22nd International AIDS Conference, there were satellite meetings held around the city. The U=U Pre-Conference was one of them. It is a global movement launched by the Prevention Access Campaign and its Executive Director Bruce Richman. "U=U" stands for Undetectable=Untransmittable, and the father of the science on which it is based is Dr. Pietro Vernazza, who along with his colleagues recognized this connection over a decade ago and created what is known as the “Swiss Statement”.
https://www.soaaids.nl/en/STIs/most-common-stis/hiv/swiss-statement 

The Swiss statement says that HIV-positive people who have been successfully treated are no longer infectious in terms of sexual practice if:
They have had an undetectable viral load for six months or longer
They are undergoing treatment and adhere to it
They have no other STIs
Under these conditions, serodiscordant couples can consider whether to stop using condoms.  

As a “ground breaking”, “game changer”, “hugely important campaign based on a solid foundation of scientific evidence” that an undetectable HIV viral load (which the research defined as less than 200 copies per milliliter) equals an untransmittable virus through sexual contact, it is seen as a way to reduce stigma and discrimination that for the entire pandemic have unfairly burdened the estimated 77 million people who have lived with HIV. 
Dr. Anthony Fauci, Director of the United States National Institute of Allergy and Infectious Diseases since 1994, gave the keynote speech at the pre-conference meeting. He stressed that the PARTNER and HPTN 052 studies, and especially for MSM the Opposites Attract study, have established the science that zero transmissions occur among sexual partners when “U” really does stay Undetectable! 
This, though, places continued responsibility upon people who live with the virus to stay adherent to their life-sustaining antiretroviral treatment (ART), and to remain engaged in healthcare, including monitoring of viral load. 

There is so much more to the conversation, and several resources may be found at www.PreventionAccess.org; #UEQUALSU; and #YouCantPassItOn  T-shirts worn by some had these messages: Facts Not Fear/Science Not Stigma; Celebrate/Activate/Implement; and UEQUALSU.org /Don’t U Worry.

The United States-based Association of Nurses in AIDS Care (ANAC), and the National HIV Nurses Association of the UK and the Netherlands, ICAP and other global nursing associations are also supporting U=U.  
The Western North Carolina AIDS Project (WNCAP) in collaboration with the North Carolina AIDS Action Network (NCAAN), has created an informational card related to this movement, and North Carolina has updated the rules that make up the HIV Control Measures under the Public Health law, part of a much wider effort to decriminalize HIV throughout the U.S. and the world. All of which relates to this widely supported and highly visible theme at AIDS2018 in Amsterdam.  
10A NCAC 41A .0202 CONTROL MEASURES – HIV http://ncrules.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2041%20-%20epidemiology%20health/subchapter%20a/10a%20ncac%2041a%20.0202.html 
Many more topics are being discussed, as usual, at this amazing conference. Issues related to adolescent girls and young woman (AGYW) lead many of the sessions. People with transgender experience are highly visible, as are harm reductionists, and more than at any other time, youth are fully engaged in all aspects of the gathering this week. 

Outside the conference there is much to do in Amsterdam. A visit to the Museumplein and the Rijksmuseum offer options of seeing some of the great works by Rembrandt van Rijn, and Vincent van Gogh. Hash is said to be available at about $20 for three grams…but that has yet to be verified. Canals surround the city, and flowers are everywhere. That's it for now.
Back with more along the way. Signing off from Amsterdam and the 22nd International AIDS Conference… Michael Harney – The Rubberman  



Notice the tulip of Amsterdam 
next to the AIDS awareness ribbon


July 27, 2018 
What The Rubberman Wrote by Michael Harney 
Report from Amsterdam – 22nd International AIDS Conference – July 23-27, 2018

Anyone connected to the Internet or social media, may find comprehensive coverage of the 22nd International AIDS Conference starting at the official website www.aids2018.org and moving through the hundreds of tangents it offers, by viewing recorded sessions and exploring delegate presentations.  
Though it sometimes seems everyone around the world is connected this way, that may not be so. Equality and equity do not exist everywhere - and not just having to do with social media. Luckily, however, there are many ways of networking with one another here in Amsterdam this week, encouraging continued relationships once back home in our respective countries.

A major focus at this conference is on adolescent girls and young women who face great challenges to safe and healthy lives free from violence and risk of HIV. The organization She Decides www.shedecides.com is “a global movement to promote, provide, protect and enhance the fundamental rights of every girl and woman…to do what she chooses with her body…”. Connect and see what this organization is providing and how to become involved.

Among many women leaders heard at the conference, Reina Buijs, Director General for International Cooperation at the Dutch Ministry of Foreign Affairs, spoke about the importance of teaching decision making skills and comprehensive sex education to girls and boys, including not only potential physical and emotional risks of sexual activity, but also the pleasure that is possible when it is consensual.
At Mtv SHUGA www.mtvshuga.com people under 25 and some of their complex relationships are the focus of what has become a successful campaign to address sexual health, gender identity, teenage pregnancy, relationship violence, and transactional sex. The series is televised throughout 79 countries around the world, and through 270 social media connections. It is supported by the Bill and Melinda Gates Foundation, Mtv Staying Alive, and Marie Stopes International, just to name a few. High-incidence countries of Africa are the settings in which the dramatized stories are explored, but the messages transcend these particular youthful experiences. Supportive resources are made available live during the episodes, and may be of interest to community members of western North Carolina and others. 

In the region known as Eastern Europe and Central Asia (EECA), Teenergizer, created by activist Yana Panfilova, is working to “create a world where every teenager can realize her or his potential…free from discrimination in all areas, including HIV…where the rights of teenagers and youth do not have to be defended because they are fully respected”. The website will open in Russian, but may be converted to English by clicking the EN at the top right side of the page http://teenergizer.org/en . “#Chase the Virus, Not the People”. Youth Outright, an Asheville-based organization might find a good connection with these teens and young adults.

Prior to that was the powerful Thursday morning plenary presentation by Dr. David Malebranche, openly gay and HIV positive clinician and Associate Professor of Medicine at Morehouse School of Medicine in Atlanta. His discussion of the state of HIV among same-gender loving African-American men in the United States showed the vast differences in access to HIV care compared to whites in the general population; a lower use of PrEP for HIV prevention due to factors such as marketing, affordability, and accessibility; and the alarming statistic that the 16% rate of viral suppression in this population is far less than the 34% rate nationally. Dr. Malebranche suggested one intervention to know about is Thrive SS www.thrivess.com which is a “peer support model…to address issues that many people of color living with HIV face…to aid them in building a local network that is self-sustaining, uplifting and mutually beneficial.”

We heard from researchers, scientists and other presenters that we are not meeting the 90/90/90 goals for 2020, to have 90% of people living with HIV around the world know their status; of those people, that 90% get into care and have access to antiretroviral therapy (ART); and that 90% of those people reach a sustained viral suppression. In actuality, doing the math, this translates to 90% diagnosed/81% in care/73% virally supressed…far from getting control of this pandemic!  
Worse is the cascade related to TB: 60% diagnosed; 53% in care and being treated; and 45% controlling the infection. According to the World Health Organization’s Key Facts Report 2016, Tuberculosis represents 40% of the 1 million deaths among people living with HIV around the globe annually, and is one of the top 10 causes of death worldwide. “Ending the TB epidemic by 2030 is among the health targets of the Sustainable Development Goals”.

With so much work left to be done to address TB, HIV, and other health challenges, this is not the time for governmental entities and donor agencies to give up or decrease efforts to address community needs or funding of initiatives that have come so far in the nearly 40 years we have dealt with HIV/AIDS. Former United States president Bill Clinton in his conference address, stressed that there cannot be a “Brexit” on HIV/AIDS funding and attention.  
He was interrupted by protesters who shouted their demands: Sex Work Is Work! Decriminalize sex work!; and that as former president he use his power to make the changes necessary to include key populations in all HIV interventions, and that inclusively they be heard; also, that the 2020 International AIDS Conference be moved from San Francisco/Oakland due to the Trump administration’s stance on migrant populations and his relationships to tyrants around the world who criminalize and endanger vulnerable people most affected in this epidemic. 
“No Muslims? No Drug Users? No Sex Workers? No inclusion? Go to hell – No AIDS Conference in Trump America”.  

International AIDS Society administration obtains advance agreements from speakers and protesters alike that such demonstrations can occur during presentations, so that all points of view can be heard.
On another front, and seemingly odd, speaking with Cedric Charvet, Project Officer of Correlation, the European Harm Reduction Network, and Jason Farrell, formerly of Positive Health Project in New York City (New Amsterdam!) there is not a large injecting drug using population or “problem” in the Netherlands. Most who would use heroin or cocaine, smoke it instead. Needle exchange is made available, but mostly serves foreigners visiting the country, and the safe drug consumption facilities just don’t see many injectors at all. There are few overdoses either, though there is growing fear that with Fentanyl entering Europe, there may be a future increase in overdoses. Meth use is found mostly among visiting gay men, some of whom may “slam” it – using needles. 
Lastly for this report, during the Positive Flame event, Princess Mabel van Oranje of the Netherlands - a single mother of two – interviewed Timothy Brown, the only man in the world cured of HIV, who said he is now taking PrEP to protect himself from a possible re-infection. Who’d a thunk it!?  
Pre-exposure Prophylaxis (PrEP – Truvada®) is still the only once-a-day pill approved by the FDA to prevent HIV transmission for men and women who do not currently have HIV and wish to reduce the risk of acquiring it https://www.cdc.gov/hiv/basics/prep.html There are hopes to have future options, including “PrEP on Demand” injectables that might be administered infrequently over a year, or other pills taken orally, or implants. (See Prévenir trial results www.poz.com/article/new-hiv-infections-new-french-study-ondemand-prep )

The Rapporteurs are making their end-of-conference presentations, but the work is just beginning for some, and continues for others. In the role as the Rubberman, much work still needs to be done. The basics must continue: condom distribution, needle exchange, comprehensive education, and testing. With your support, involvement, and philanthropy – in all the ways it is given – western North Carolina shall continue to be the model of prevention and care that it is known for.








Thank you again and again!
Signing off from 
the International AIDS Conference
 2018 in Amsterdam, I looking forward
 to meeting with you stateside. 
Michael Harney – The Rubberman  
May be reached at:
 wncap@wncap.org or  828-252-7489 ext. 311