IRIN News on Tuesday examined the resettlement of refugees from Myanmar, some of whom are living with medical conditions such as tuberculosis or HIV/AIDS. According to IRIN News, as of January 2009, the Myanmar resettlement program had resettled 43,000 refugees since the program began in 2004. According to the Office of the United Nations High Commissioner for Refugees, the program is expected to resettle an additional 13,000 refugees this year. UNHCR first identifies refugees who want to resettle, and then other countries decide which individuals and families to accept. The International Organization for Migration then coordinates transportation, cultural orientation and language lessons for the refugees.

According to Mohammad Razwari, an IOM physician at Pawo Hospital in Thailand, all refugees must undergo a health assessment and receive medical clearance before resettlement. He said the assessment “identifies any health problems or health risks as well as determin[es] whether the patient is safe to fly and that they are not a health hazard to other travelers.” Razwari said that all HIV-positive refugees receive awareness training before resettlement and that any refugees with TB or psychological issues receive treatment before departure. He said, “All those with medical problems receive adequate treatment first and then are allowed to depart.”

Although many countries choose to resettle refugees with significant education or skills, other countries — such as Denmark, Finland, the Netherlands and Norway — “actually seek out refugees with serious medical conditions,” Kitty McKinsey, UNHCR senior regional public information officer for Asia and the Pacific, said, adding that such countries select refugees “strictly on humanitarian grounds.” According to IRIN News, the U.S. has accepted more than 14,000 refugees from the border area between Myanmar and Thailand since 2004. Tim Scherer, refugee coordinator in Thailand for the U.S. Department of State, said that the U.S. accepts people from Myanmar for resettlement “based on their legitimate refugee status, and this includes even those with serious medical disabilities” (IRIN News, 4/28).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

The British Columbia Court of Appeals this week is hearing a case to decide whether certain sections of Canada’s Controlled Drugs and Substances Act that prevent injection drug users from accessing services at the supervised drug-injection facility Insite in Vancouver, British Columbia, are constitutional, Toronto’s Globe and Mail reports (Stueck, Globe and Mail, 4/28).

Insite, which is funded by the British Columbia provincial government and has received research funding from the Canadian government, includes booths for IDUs to inject drugs as well as room in which users can be monitored for overdoses. Vancouver has one of the highest illegal drug use rates in North America, with as many as 12,000 IDUs in the Vancouver metropolitan area, 30% of whom are HIV-positive and 90% of whom have hepatitis C. When the facility opened in September 2003, it received a three-year exemption from CDSA, which bans heroin use, to conduct a pilot study on the site’s role in reducing drug use and crime in Vancouver’s Downtown Eastside (Kaiser Daily HIV/AIDS Report, 8/8/08). The exemption was extended to the end of 2007 and later to June 30, 2008.

Two individuals last year initiated court proceedings to allow Insite to continue operation after June 30, 2008. B.C. Supreme Court Justice Ian Pitfield in May 2008 issued a ruling in the case, saying that certain sections of the CDSA relating to drug possession and trafficking are inconsistent with the Canadian Charter of Rights and Freedoms. “The blanket prohibition contributes to the very harm it seeks to prevent,” Pitfield wrote in his ruling, adding, “It is inconsistent with the state’s interest in fostering individual and community health and preventing death and disease.”

In his ruling, Pitfield gave the Canadian government until June 30, 2009, to rewrite the CDSA possession and trafficking provisions, which would enable Insite to continue operation. Insite received a constitutional exemption in the interim allowing the facility to continue to operate until the CDSA sections were rewritten. The federal government appealed Pitfield’s ruling on June 3, 2008.

Robert Frater, an attorney for the Canadian government, on Monday argued that the federal government is not required to provide a supervised drug-injection facility, such as Insite, for IDUs. “It should be stressful to break the law,” Frater said, adding, “The government is under no obligation to provide (its citizens) with a safer way of breaking the law.” Insite attorney Joseph Arvay said the CDSA “stands between ill people and the health care they need” and “deprives [IDUs] of their rights to life and security of person” (Globe and Mail, 4/28).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Using HIV-positive people’s social network is “an efficient, high-yield” method of contacting their partners who are at high-risk for the virus and providing them with testing and other HIV-related services, CDC researchers said in a recently published study, Reuters Health reports.

For the study, which appears online in the American Journal of Public Health, researchers led by Lisa Kimbrough documented the results of a social networks project that took place between October 2003 and December 2005. For the project, nine community-based organizations in seven cities signed up 422 recruiters. The initial recruiters were HIV-positive, and later recruiters could be HIV-negative but at a high-risk for HIV. The most commonly self-reported behavioral risk factor was having had high-risk heterosexual sex at 46%. The average age of the recruiters was 41.7, and 60% were HIV-positive. Sixty-three percent were men, and 61% were black.

Recruiters referred peers, known as network associates, into the study. On average, the number of network associates referred and tested per recruiter was 7.4. The report found that of the 3,172 network associates referred, 177, or 5.6%, tested HIV-positive and two-thirds were connected to HIV care and services. According to the study, the HIV prevalence among those tested as a result of the project was about five times greater than the prevalence found in other CDC-funded counseling, testing and referral projects.

The researchers said that this was a “significant public health achievement, because persons who learn that they are HIV-positive tend to reduce their high-risk behaviors to avoid infecting others and have the opportunity to access medical care and other services to improve their personal health.” They added that the social networking strategy was more effective and a better use of staff time at contacting undiagnosed HIV-positive people, compared with the common approach of partner counseling and referral services (Reuters Health, 4/29).


An abstract of the study is available online.

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

The ancestors of the simian immunodeficiency viruses (SIVs) that jumped
from chimpanzees and monkeys, and ignited the HIV/AIDS pandemic in humans,
have been dated to just a few centuries ago. These ages are substantially
younger than previous estimates, according to a new study from The
University of Arizona in Tucson, published May 1st in the open-access
journal PLoS Computational Biology.

SIV has crossed over from chimpanzees and sooty mangabeys to humans at
least eleven times, giving rise to several HIV lineages. Although HIV is a
virulent pathogen in humans, SIV rarely causes disease in these species or
the dozens of other African primate species it naturally infects. That
these non-human primates typically remain unaffected after virus exposure
has led to the hypothesis that there had been millions of years of
coevolution between SIVs and their primate hosts.

The researchers, Joel Wertheim and Dr. Michael Worobey, estimated a rate
of virus evolution using viral genetic sequences that had been isolated
from
infected humans, chimpanzees, and sooty mangabeys between 1975 and 2005.
They inferred that the viruses currently circulating in sooty mangabeys
and
in chimpanzees evolved from ancestors dating to 1809 (1729-1875) and 1492
(1266-1685), respectively. Surprisingly, the independently estimated
‘molecular clock’ of the monkey viruses was virtually identical to the
famously swift rate at which mutations accumulate in HIV genomes.

The authors note that unaccounted-for biases could be masking a deeper age
of SIV. They suggest that if these biases do exist, their causes need to
be
investigated because they might also affect the ability to properly
estimate the age of HIV and other viruses.

Citation:
Wertheim JO, Worobey M (2009)
“Dating the Age of the SIV Lineages That Gave Rise to HIV-1 and HIV-2.”
PLoS Comput Biol 5(5): e1000377.
doi:10.1371/journal.pcbi.1000377