From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which – in their view – remains woefully underused.

Marketed in the United States as Truvada, and sometimes available abroad in generic versions, the pill has been shown to reduce the risk of getting HIV from sex by more than 90 percent if taken daily. Yet worldwide, only about a dozen countries have aggressive, government-backed programs to promote the pill. In the U.S., there are problems related to Truvada’s high cost, lingering skepticism among some doctors and low usage rates among black gays and bisexuals who have the highest rates of HIV infection.

“Truvada works,” said James Krellenstein, a New York-based activist. “We have to start thinking of it not as a luxury but as an essential public health component of this nation’s response to HIV.”

A few large U.S. cities are promoting Truvada, often with sexually charged ads. In New York, “Bare It All” was among the slogans urging gay men to consult their doctors. The Los Angeles LGBT Center – using what it called “raw, real language” – launched a campaign to increase use among young Latino and black gay men and transgender women.

“We’ve got the tools to not only end the fear of HIV, but to end it as an epidemic,” said the center’s chief of staff, Darrel Cummings. “Those at risk have to know about the tools, though, and they need honest information about them.”

Truvada in the U.S.

In New York, roughly 30 percent of gay and bisexual men are using Truvada now, up dramatically from a few years ago, according to Dr. Demetre Daskalakis, a deputy commissioner of the city’s health department.

However, Daskalakis said use among young black and Hispanic men – who account for a majority of new HIV diagnoses – lags behind. To address that, the city is making Truvada readily available in some clinics in or near heavily black and Hispanic neighborhoods.

“We like to go to the root of the problem,” said Daskalakis, who personally posed for the “Bare It All” campaign.

According to the U.S. Centers for Disease Control and Prevention , Truvada would be appropriate for about 1.2 million people in the U.S. – including sex workers and roughly 25 percent of gay men. Gilead Scientific, Truvada’s California-based manufacturer, says there are only about 145,000 active prescriptions for HIV prevention use.

Under federal guidelines, prime candidates for preventive use of Truvada include some gay and bisexual men with multiple sexual partners, and anyone who does not have HIV but has an ongoing sexual relationship with someone who has the virus.

An international approach 

Abroad, a few government health agencies – including those in France, Norway, Belgium, Kenya, South Africa, Brazil and some Canadian provinces – have launched major efforts to promote preventive use of Truvada or generic alternatives, providing it for free or a nominal charge. In Britain, health officials in Scotland and England recently took steps to provide the medication directly through government-funded programs, though in England it’s in the form of a trial limited to 10,000 people.

Truvada was launched in 2004, initially used in combination with other drugs as the basic treatment for people who have HIV, the virus that causes AIDS. It is primarily spread through sex.

Controversy arose in 2012 when the U.S. Food and Drug Administration approved Truvada to reduce the risk of getting HIV in the first place, for what’s called pre-exposure prophylaxis, or PrEP. It blocks the virus from making copies and taking hold. Critics warned that many gay men wouldn’t heed Truvada’s once-a-day schedule and complained of its high cost – roughly $1,500 a month.

Gilead offers a payment assistance plan to people without insurance that covers the full cost. Some cities and a few states – including Illinois, Massachusetts and Washington – also help cover costs. Activists have pressed Gilead to make its copay program more generous in light of its profits from Truvada.

“There’s no reason it has to cost so much,” said Krellenstein.

Gilead spokesman Ryan McKeel, in an email, said the company is reviewing the copay program.

“Like those in the advocacy community, we are committed to expanding access to Truvada for PrEP to as many people as possible,” he wrote.

In June, the FDA approved a generic version of Truvada, which is likely to push the price down, but it won’t be available in the U.S. for a few years.

The Truvada debate has taken many twists, as exemplified by the varying stances of the Los Angeles-based AIDS Healthcare Foundation – a leading HIV/AIDS service provider. In 2012, the group unsuccessfully petitioned the FDA to delay or deny approval of Truvada for preventive use. The foundation’s president, Michael Weinstein, belittled Truvada as “a party drug” and warned it would increase the spread of sexually transmitted infections by encouraging men to engage in sex without condoms.

But last year, the foundation, while still skeptical about some Truvada-related policies, urged Gilead to cut its price to make it more available.

“We have no dispute about its ability to prevent HIV transmission,” said spokesman Ged Kenslea. He noted that the organization’s 40 pharmacies across the U.S. handle many Truvada prescriptions.
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Three people in South Sudan have died of a suspected viral hemorrhagic fever and 60 of their contacts are being monitored for any infection, the World Health Organization said Monday.

Ebola, Marburg and yellow fever are among viral hemorrhagic fevers that have caused deadly outbreaks in Africa. More than 11,300 people died during the worst outbreak of Ebola, a highly contagious disease, which mainly affected Guinea, Liberia and Sierra Leone from 2013 to 2016.

The three people in South Sudan — a pregnant woman, a teenage girl and a boy — all died in December and were from the same village in Yirol East county in the eastern Lakes State. But there had been no known contact among them.

No tissue or blood samples were collected from their bodies for analysis, and South Sudan health authorities reported the cases on Dec. 28, the WHO said in a statement.

“The outbreak of suspected viral hemorrhagic fever in South Sudan could rapidly evolve, and critical information including laboratory confirmation of the etiology of disease is needed to direct response efforts,” it said.

National health authorities and WHO are investigating and have found evidence of zoonotic hemorrhagic illness in goats and sheep in the area, including some deaths, as well as deaths among wild birds at the time, it added.
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The death toll from an outbreak of listeria in South Africa has jumped beyond 60 in the past month, health authorities said Monday, adding they had closed a poultry abattoir where the bug that causes the disease had been detected.

Since monitoring of the outbreak began last January, 720 laboratory-confirmed cases of food poisoning due to the disease, also known as listeriosis, have been reported, the National Institute of Communicable Diseases (NICD) said.

That was up from 557 in December, since when recorded deaths had risen to 61 from 36.

A food microbiologist said the “alarming” outbreak appeared to be the biggest ever recorded and could spread further if it was not tackled urgently.

“Of the documented outbreaks globally that we know of … our numbers are way above any of those other cases,” said Dr. Lucia Anelich, who runs her own food safety consultancy.

The Department of Health said it had closed a poultry abattoir operated by Sovereign Foods in the capital Pretoria after detecting listeria there, and had banned the facility from preparing food in December.

The department said it did not yet know whether this abattoir was the source of the outbreak, which the NICD said was still unknown.

Sovereign Foods, which delisted from the Johannesburg stock exchange in November, said the prohibition on the abattoir was lifted Monday after the listeria bacterium was not found in the latest samples from the plant.

“Despite being declared clean and free of the listeria bacterium, we are further strengthening steps to render products safer than they already are,” said Sovereign Foods head of production Blaine van Rensburg.

Listeria food poisoning is a bacterial infection that can be treated with antibiotics if diagnosed in time. The bacteria can be found in animal products including cold cut meats, poultry and unpasteurized milk, as well as fresh fruits and vegetables.

The disease can cause flu-like symptoms and diarrhea, and in more severe cases spread from the intestine to the blood, causing bloodstream infections, or to the central nervous system, causing meningitis.

Anelich said a listeriosis strain known as ST6 had been identified in nine out of 10 of the South African cases. That should make tracing the source easier, “because now we know that it probably originates from one processing facility.”

A health department official said the strain was not drug-resistant and that the deaths were due to delays in diagnosis, meaning cases were not treated in time.
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In 2012, Britons delighted in the spectacular opening ceremony of the London Olympics celebrating British history. One of the curtain-raiser’s most popular sequences, drawing loud applause, involved 1,800 dancers and 320 hospital beds honoring the country’s National Health Service.

Six years on, and Britons are more likely to moan about the world’s largest single-payer health care system than praise it.

According to patients, doctors and analysts, the NHS is buckling and close to collapse, with emergency departments over-burdened, hospital wards full and all nonessential operations — more than 55,000 of them — suspended because of a winter surge in demand.

Fueled in part by unseasonably cold weather, an especially virulent flu strain and cuts in social care, leaving hospital beds occupied by the elderly who have nowhere else to go, the winter crisis has brought home to the country the fragile state of the NHS.

Last week, an 81-year-old pensioner suffering chest pains died after waiting four hours for the ambulance service to respond to her emergency call. Patients are being left on gurneys for hours in drafty corridors waiting for beds to become free, and hospitals in the northeast are reporting an outbreak among patients of the gastroenteritis norovirus, dubbed the vomiting bug.

Politics involved

Norman Lamb, a former health minister, blames “tribal politics” for failing to deliver “a solution to the existential challenges facing the NHS and social care.”

“The winter crisis of the past few weeks is unfortunate proof that the current situation is unsustainable, and these pressures will only get worse as we contend with an aging population and rising demand for care and treatment,” he said.

British Prime Minister Theresa May has apologized for the suspension of non-urgent operations and for some emergency departments having to turn away all but the most grave cases, but she insists there isn’t a crisis and the government is on top of things.

Asked during a BBC interview Sunday if she could remember a worse winter crisis, May said, “The NHS has actually been better prepared for this winter pressures than it has been before.” She added, “You mentioned operations being postponed. That was part of the plan.”

May pointed to top-up funding of $450 million announced last month. But her own health minister, Jeremy Hunt, has hinted much more needs to be done to restore the world’s fifth largest employer, and argues it would be better if NHS funding were set on a 10-year time frame.

More than 90 lawmakers have signed a letter calling for a cross-party convention to discuss how the NHS can be funded to cope with a graying population that lives longer. The Center for Policy Studies warned Sunday that money from general taxation won’t be enough to fund the growing pressures of an aging population and increasing demand. “Alternative, additional sources of revenue for the NHS” need to be identified, it argued.

Long view needed

Lord Saatchi, a coauthor of the CPS report, said a long-term funding plan not tied to short-term political objectives is needed.

“The wonderful dream of the NHS is turning into a recurring winter nightmare, and leaving it alone is a recipe for long-term catastrophe,” he said.

The NHS lags behind many of Europe’s other health systems — most funded by a mixture of private and public means — when it comes to medical outcomes. Britain has the most overweight young adults in Europe, with 29 percent of women under 25 classified as obese. Obesity, depression and dementia are all on the rise.

Analysts say the NHS can take partial credit for the rise by about 10 years in life expectancy during the past half century. But it is ill-equipped to deal with one of the spin-offs of increased life expectancy — chronic ill-health.

The service’s annual budget has risen over a hundredfold since its founding in 1948 — its annual budget is $170 billion, about 10 percent of the country’s GDP. But chronic care costs now account for more than 80 percent of the NHS budget. Some analysts are forecasting that treating patients suffering Type 2 diabetes alone will account for 25 percent of the NHS budget by 2025.

The frontline NHS emergency departments are taking more of the strain as other services are cut, including walk-in clinics — 40 percent of which have been closed in recent years. The service is woefully short of family doctors and nurses, whose salaries have been cut, and it is finding it hard in the wake of the Brexit referendum to recruit more from Europe, which supplies a large proportion of the NHS’s junior doctors and nurses.

 
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A group of disabled Egyptians is not letting the lack of having lost a leg get in the way of playing football. They have formed a team they hope will be a part of a soccer league for people with special needs. Faith Lapidus reports.
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The unpredictable and aggressive nature of wolf-dog hybrids makes them difficult to keep as household pets. But the founders of the Lockwood Animal Rescue Center in California say the dual nature of these animals makes them ideal therapists for combat veterans who suffer from PTSD. VOA’s Genia Dulot has more on the “Wolves and Warriors” program.
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A remote island volcano in Papua New Guinea has begun spewing ash into the air, forcing the evacuation of more than 500 residents, media and nonprofit groups said.

Kadovar Island, a 365-meter (1,197 feet) tall volcano on the north coast of PNG, was thought to be dormant until it began erupting Jan. 5.

“It’s just a continuous emission of volcanic ash at the moment,” Cheyne O’Brien, a forecaster at the Darwin Volcanic Ash Advisory Centre, told Reuters by telephone Sunday.

The ash clouds have been thrown up steadily to a height of 2,133 meters (7,000 feet), forming a plume that is traveling west-northwest, he added.

The plume does not yet pose a hazard to aviation, but a change in wind direction could hit operations at PNG’s Wewak airport, O’Brien said.

All the residents of the island have been evacuated with no loss of life, U.S.-based charity Samaritan Aviation, which operates seaplanes to remote areas of PNG, said on Facebook.

The eruption may become explosive, bringing a risk of tsunamis and landslides, domestic online media Loop PNG quoted the Rabaul Volcanological Observatory as saying.

There are no confirmed records of a previous eruption of Kadovar, said Chris Firth, a volcanologist at Macquarie University, but scientists speculate it could have been one of two “burning islands” mentioned in the journals of a 17th-century English pirate and maritime adventurer, William Dampier.

Dampier may have recorded the last eruption of Kadovar during a voyage in search of “Terra Australis,” the southern continent once thought to be mythical, Firth said.

Volcanologists are interested to observe its behavior now, Firth added. 

“It’s hard to predict what might happen, as there’s nothing to compare it to,” he said.
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The World Health Organization classifies alcohol as a “group 1 carcinogen.” That means there is convincing evidence it can cause cancer in humans. But new research shows how alcohol can damage the body on a genetic level. VOA’s Kevin Enochs reports.
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Health experts say the influenza season in the United States is proving to be more severe than usual, with about twice the number of people reporting flu-like illness to their doctors compared with the same time last year.

The Centers for Disease Control and Prevention said that in the week ending December 23, 36 states reported widespread flu. The agency said that nearly 2,500 people have been hospitalized for flu-related symptoms and that 13 children have died of the virus in the current season, which started in October.

The CDC said that across the nation, about 5 percent of patients saw their doctors for flu-like symptoms in the week ending December 23, compared with 2.2 percent of patients doing so during the same week in 2016.

Hospitals in California are particularly overwhelmed, with some Southern California pharmacies running out of flu medication. Health officials told the Los Angeles Times on Friday that 27 people younger than 65 had died of the flu in California since October. Only three people died of the flu in the same time period a year ago.

Medical experts say this year’s strain of influenza may just be peaking early in the season. By February last year, flu deaths had gone from the three reported in December to 68.

Experts say it is also possible that this year’s dominant strain, H3N2, is more resistant to treatment than some others. Health officials say more people may be getting ill because the vaccine is less effective against H3N2.

Los Angeles County’s interim health officer, Jeffrey Gunzenhauser, told the Times that this strain of flu causes more hospitalizations and more deaths than other strains that respond better to treatment. He said influenza is especially dangerous for the elderly, who are at greater risk of developing pneumonia or other complications along with the flu — conditions that could be fatal when combined.

Gunzenhauser said vaccination against influenza lowers one’s chances of catching the flu or being a carrier. Also, if the flu does later strike someone who has been vaccinated, his illness is likely to be less severe.

The stakes are low, Gunzenhauser said, noting that the worst side effect from the shot is likely to be “a sore arm.”
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Veteran U.S. astronaut John Young, who walked on the moon and even smuggled a corned beef sandwich into orbit during one of his six missions in space, has died at age 87, NASA said Saturday.

Young, a former Navy test pilot, in 1972 became the ninth of 12 people ever to set foot on the moon.

“We’re saddened by the loss of astronaut John Young,” the National Aeronautics and Space Administration said on Twitter.

The time and cause of Young’s death were not immediately clear.

Young became one of the most accomplished astronauts in the history of the U.S. space program. He flew into space twice during NASA’s Gemini program in the mid-1960s, twice on the Apollo lunar missions and twice on space shuttles in the 1980s.

He retired in 2004 after 42 years with the U.S. space agency.

​Moon mission

The Apollo 16 mission in April 1972, his fourth space flight, took Young to the lunar surface.

As mission commander, he and crewmate Charles Duke explored the moon’s Descartes Highlands region, gathering 90 kilograms (200 pounds) of rock and soil samples and driving more than 26 kilometers (16 miles) in the lunar rover to sites such as Spook Crater.

Recalling his lunar exploits, Young told the Houston Chronicle in 2004: “One-sixth gravity on the surface of the moon is just delightful. It’s not like being in zero gravity, you know. You can drop a pencil in zero gravity and look for it for three days. In one-sixth gravity, you just look down and there it is.”

Young’s first time in space came in 1965 with the Gemini 3 mission that took him and astronaut Gus Grissom into Earth orbit in the first two-man U.S. space jaunt. It was on this mission that Young pulled his sandwich stunt, which did not make NASA brass happy but certainly pleased Grissom, the recipient of the snack.

Astronaut Wally Schirra, who was not flying on the mission, bought the corned beef sandwich on rye bread from a delicatessen in Cocoa Beach, Florida, and asked Young to give it to Grissom in space. During the flight, as they discussed the food provided for the mission, Young handed Grissom the sandwich.

NASA later rebuked Young for the antics, which generated criticism from lawmakers and the media, but his career did not suffer.

Rehearsal for moon landing

His May 1969 Apollo 10 mission served as a rehearsal for the historic Apollo 11 mission two months later in which Neil Armstrong became the first person to walk on the moon.

Young and his crew undertook each aspect of that subsequent mission except for an actual moon landing.

Young’s fifth space mission was as commander of the inaugural flight of NASA’s first space shuttle, Columbia, in 1981. In 1983, he became the first person to fly six space missions when he commanded Columbia on the first Spacelab trek, with the crew performing more than 70 scientific experiments.

He never went to space again. Young had been due to command a 1986 flight that was canceled after the explosion of the shuttle Challenger earlier that year. He ended up as the only person to fly on space shuttle, Apollo and Gemini missions.

Young was born September 24, 1930, in San Francisco and grew up in Orlando, Florida. After receiving a degree in aeronautical engineering from the Georgia Institute of Technology in 1952, he entered the Navy and graduated from its test pilot school. NASA picked him in 1962 for its astronaut program.
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Emergency authorities in Australia have released a virtual reality program recreating potentially catastrophic bushfire scenarios.  The project aims to encourage residents in the state of Victoria to prepare for extreme danger.  

“This emergency warning is being issued for Hare Creek.  There is a bushfire at Hare Creek that is out of control.  The bushfire is traveling in a north-westerly direction towards Upper Hare Creek,” says the program’s warning.

The virtual reality programs have three different scenarios.  They show how residents who leave it too late to respond to an advancing bushfire can face disastrous consequences.  

Officials say the technology allows Australians to get a taste of the type of hostile conditions they might face and helps them make better decisions.  The simulation urges homeowners to decide early whether to leave, seek shelter, or stay and defend their property.

South-eastern Australia, one of the world’s most fire-prone regions, has been preparing for a scorching weekend with temperatures forecast as high as 45 degrees Celsius.

Victoria state Emergency Management Commissioner, Craig Lapsley, says the bushfire risk in some areas will be extreme.

“Obviously it is about heat, it is about fire.  We are going to see a fire today that is going to be hot, dry and windy, and with a wind change late in the day that if we had fires running in the afternoon the wind change will change the direction of the fires and traditionally that is where we lose most of our property after the wind change.  So it is one of those days that has got everything in it.  Look after yourself, your neighbors, your family, your friends,”  Lapsley said.  

Australia’s most deadly bushfire killed 173 people in Victoria in 2009.  However, Australia’s deadliest natural hazard is extreme heat.  More than twice as many victims lost their lives in the heatwave that preceded the so-called ‘Black Saturday’ blazes.  It is the very young, the infirm, and those over the age of 75 who are most risk from searing temperatures. Heat-related illness, which can occur when body temperature exceeds 37.8°Celsius, includes dehydration, cramps, heat exhaustion and heat stroke.  The consequences can be catastrophic, resulting in heart attacks, brain damage and death.

Firefighters have been predicting one of the worst fire seasons on record.  They say warmer conditions have been coupled with a very dry winter.

 
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