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There’s been a lot of progress in the fight against AIDS over the past 30 years, but as the 30th World AIDS Day is observed on Dec. 1 — people still die from the disease. And others are newly infected every day even though the tools are available to end the epidemic.

Fear, stigma and ignorance. The World Health Organization says these are the reasons the AIDS epidemic is not over because doctors can treat HIV, the virus that causes AIDS. 

With treatment, no one needs to die from AIDS, and those with the virus can’t give it to someone else. In addition, with prevention therapy, no one needs to get infected.  

Dr. Jared Baeten, an HIV specialist at the University of Washington, spoke to us via Skype and says even with these tools we’re not there yet.

“… because the ability to deliver those at the scale and with the coverage needed to be able to get HIV to go away is not nearly where it should be,” said Baeten. 

Nearly a million people still die every year from AIDS. Professor Steffani Strathdee at the University of California San Diego says one of the biggest challenges is that HIV often affects people on the fringes of some societies around the world.  

“There are populations all over the world that are underserved and these include injection drug users and sex workers, in particular,” Strathdee said.

It also includes men who have sex with men, transgender people, prisoners and the sexual partners of these people. Professor Strathdee says people who are hungry or need shelter are more concerned about their immediate needs than they are about HIV.

“My research and research in this field really shows you have to address the whole person and their needs in order to address HIV as one of their health concerns,” Strathdee said.

Strathdee says unless this happens, countries will have to bear the heavy social and economic costs of AIDS.

In addition, Baeten says testing and treatment have to be available to everyone.    

“The biggest thing that we’ve learned for preventing HIV in the last decades is that there is no magic bullet, but when you put a whole bunch of really good things together and it has exactly the kind of impact that a magic bullet can give you,” Beaten said 

Scientists say using these tools, educating people and getting more people into treatment will reduce stigma, and then, when a vaccine comes along, we can finally put an end to AIDS.
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Tremendous progress has been made in efforts to wipe out polio around the world. Before a global eradication program began 30 years ago, about 350,000 children became paralyzed from polio each year. The figure dropped to 28 in 2018. 

Nevertheless, Helen Rees, chair of the World Health Organization’s emergency committee, said Friday that polio remained an international threat. She said every available health strategy must be used to prevent the wild polio virus from spreading across borders. 

“The fear is that we might well see a resurgence, that we could see exportation again and a reversal of all of the work and all of the country global efforts that have gone into trying to eradicate polio,” Rees said. “And we certainly cannot allow that to happen.” 

Polio remains endemic in Afghanistan, Pakistan and Nigeria. Rees said that over the last few months, there has been a worrying exportation of the wild polio virus to and from Pakistan and Afghanistan. 

“We have got widespread, positive environmental sampling in Pakistan,” she said. “And in Afghanistan, because of the more difficult situation there in terms of security, we are unable to access probably as many as a million children for vaccination.”  

Separately, there is good news from the African region. The director of WHO’s polio eradication program, Michel Zaffran, noted that the wild polio virus has not been seen in Nigeria since it was last detected more than two years ago. 

If this keeps up, he said, the regional certification commission could be able to declare the wild polio virus eradicated from the African region at the end of 2019 or early 2020. He said $4.2 billion would be needed over the next five years to see the last of this disease. 

Polio, which has no cure, invades the nervous system and can cause irreversible paralysis within hours. The WHO says polio is transmitted from one person to another through the fecal-oral route, or less frequently by a common vehicle like contaminated food and water. Fever, fatigue, headache, vomiting, stiffness in the neck and limb pain are among polio’s symptoms. 
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Ahead of World AIDS Day, Uganda is recruiting women to participate in a trial of an injectable antiretroviral drug to replace Truvada, a daily pill that has low adherence by users. The trial will assess if the new drug – Cabotegravir – can further reduce the risk of acquiring HIV. Halima Athumani has more from Kampala.
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Former New York Mayor Michael Bloomberg’s charity has announced a $50 million donation to help fight the nation’s opioid epidemic.

Bloomberg Philanthropies said over the next three years it will help up to 10 states address the causes of opioid addiction and strengthen prevention and treatment programs. Its initiative involves a partnership with the Centers for Disease Control and Prevention, The Pew Charitable Trusts, Johns Hopkins University and Vital Strategies.

Bloomberg, who has been considering a 2020 Democratic presidential bid, was expected to discuss the funding Friday during his keynote address at The Bloomberg American Health Summit in Washington. A spokeswoman said there was “no stated link” between his political aspirations and the $50 million investment to fight opioids.

Bloomberg’s charity said CDC data shows there were more than 70,000 U.S. drug overdose deaths last year, including more than 47,000 from opioids, the highest numbers on record. It said those numbers are a leading factor in the decline of U.S. life expectancy over the past three years.

Bloomberg called the sobering numbers part of “a national crisis.”

“For the first time since World War I, life expectancy in the U.S. has declined over the past three years — and opioids are a big reason why,” he said. “We cannot sit by and allow this alarming trend to continue — not when so many Americans are being killed in what should be the prime of their lives.”

He said in a statement he hoped his charity’s work in Pennsylvania, one of the states hardest hit by the opioids crisis, would lay the groundwork “for more effective action across the country.”

The partnership focuses on identifying new approaches to tackle opioids and plugging gaps in current treatment and prevention programs. Staff members from partner organizations will support state and local programs to reduce opioid-related deaths, and successful initiatives and guidelines will be replicated elsewhere, with the goal of creating a model for the rest of the nation.

Pennsylvania Governor Tom Wolf said he was “deeply grateful” for the financial and technical resources his state will receive through the partnership with Bloomberg Philanthropies.

“From our first responders and health care professionals to teachers and social service providers, heroes across our commonwealth are saving lives and protecting residents in our communities every day from this awful scourge,” Wolf, a Democrat, said in a statement issued by the Bloomberg charity. “We are doing everything we can to help them, and I am confident that this partnership will mark a turning point in our efforts.”

The Drug Enforcement Administration said this month in its National Drug Threat Assessment that heroin, fentanyl and other opioids continue to be the highest drug threat in the nation.

Bloomberg, who has been an independent, a Republican and a Democrat, declared lifetime allegiance to the Democratic Party and outlined an aggressive timeline for deciding whether to run for president in an interview with The Associated Press this month. He has regularly criticized President Donald Trump and spent a fortune to help elect Democrats in the midterm elections.
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Top administration officials are debating whether to create a stand-alone Space Force to handle space defense or a Space Force that falls within the Air Force, officials tell VOA.

Either option requires congressional approval, which could prove difficult with a Democratic-led House and a Republican-led Senate.

An Oct. 26 memo obtained by VOA directs that the Department of Defense create the “optimal organizational construct to meet (the president’s) intent.” 

The memo, signed by Executive Secretary of the National Space Council Scott Pace and National Security Council official Earl Matthews, instructs the Pentagon to focus on whether the Space Force is most efficient as a new independent department or as “a separate service within the Department of the Air Force, along the lines of the U.S. Marine Corps within the Department of the Navy or the U.S. Coast Guard within the Department of Homeland Security.”

Support in the House

This latter organizational structure has bipartisan support in the House, but the former has often been seen by Democrats as an expensive solution. 

Vice President Mike Pence and Deputy Secretary of Defense Patrick Shanahan met Thursday to discuss how to build the first new military branch since 1947, as President Donald Trump has directed. 

A National Space Council official told VOA Thursday the October memo does not represent a shift in White House guidance. 

“The direction to create the U.S. Space Force remains exactly the same, and the Space Council is continuing to work with the departments and agencies responsible for implementing the president’s direction to develop the sixth branch of the Armed Forces,” the official said.

Space Command next?

Officials say the president also intends to establish a U.S. Space Command, a move already directed by Congress.

The U.S. military is organized into 10 combatant commands based on either geography, such as Indo-Pacific Command and European Command, or unified functions, such a Transportation Command and Cyber Command.

This new, 11th combatant command would oversee space defense much like U.S. Cyber Command oversees cyber defense. Space Command is expected to start in mid-2019 with initial operation capability.

Officials familiar with Space Force deliberations have raised concerns to VOA that a new military branch could duplicate the work of the new combatant command. They say a separate military service may not be needed once the combatant command is fully operational. 

“You don’t see a Cyber Force in addition to Cyber Command,” one official said on condition of anonymity.

Cost estimates for the Space Command have been modeled after the creation of U.S. Strategic Command, which was set up in the early 1990s. The biggest expense will be the creation of a new headquarters for the combatant command in order to make room for providing new capabilities, according to one official.
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Three tiny rocks brought back from the moon in 1970 by the unmanned Soviet Luna-16 mission sold for $855,000 on Thursday at a New York auction. 

They’re the only documented lunar rocks in private hands, Sotheby’s auction house said. The U.S. collector who bought the rocks was not named. 

The sellers, also from the U.S., bought the rocks for $442,500 at a Sotheby’s Russian space history sale in 1993. That was the first time that a piece of a celestial body had been offered for sale to the public.

The rocks originally had been given to the widow of Sergei Pavlovich Korolev, the former director of the Soviet Union’s space program, by the Soviet government in recognition of her husband’s work.

It is extremely rare for authentic lunar samples to come on the market. All samples collected by American astronauts are deemed the property of the U.S. government — except one.

Last year, a bag used by Apollo 11 astronaut Neil Armstrong to collect moon dust was sold by Sotheby’s for $1.8 million, netting a hefty profit for its owner. 

A Chicago-area woman, Nancy Carlson, bought the bag, which had been misidentified, at an online government auction for $995. After she sent it to NASA for identification, the space agency confirmed that it had been used by Armstrong and still contained moon dust. 

NASA fought to keep the bag but lost a court fight in 2016. 
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The number of uninsured children in the United States has increased for the first time in nearly a decade, placing it at 3.9 million in 2017, according to a report Thursday from Georgetown University’s Center for Children and Families. 

Nationally, the number of uninsured children increased by an estimated 276,000 in 2017, from a historic low of 4.7 percent in 2016 to 5 percent last year. Experts say about 75 percent of the newly uninsured children are clustered in states that did not expand Medicaid such as Florida, Texas and Georgia. 

Under President Obama’s Affordable Care Act, Florida and other states could take federal funding to help pay for health coverage for nearly 900,000 people, but the Republican-led Legislature in Florida voted against it. The vast majority of states have already expanded Medicaid and increased the number of residents eligible for its coverage. 

Joan Alker, executive director for Georgetown’s Center for Children and Families, has written the report for the last eight years and said she’s never seen the rates of uninsured children go up in all 50 states, which happened last year. 

Better economy, low unemployment

She said that what is perhaps most concerning is that the uninsured rate among children increased despite an improving economy and low unemployment rate that allowed more children to get private coverage through their parents. 

The study blamed the increases on the Trump administration’s repeated attempts to prompt an overhaul of publicly funded health care. There were major efforts to repeal Obama’s Affordable Care Act and cut Medicaid, and the children’s CHIP insurance funding also ran out and hung in the balance for months before Congress extended it. 

“There was a lot of confusion among families as to whether these public coverage sources were available,” Alker said.  

At the same time, the Trump administration slashed funding for advertising and enrollment counselors to help sign people up for these health insurance programs. The country’s enrollment decline was not just in Medicaid and CHIP, but also in Obamacare, or the federal marketplace where parents can purchase private health insurance and often receive a subsidy to help pay for it. 

The report noted that many of the children who do not have health insurance are eligible for coverage but just aren’t enrolled. 

‘More of a fluctuation’

Ed Haislmaier, a senior research fellow with the Heritage Foundation, a conservative think tank, said the figures were statistically insignificant. 

He did agree that there were dips in Medicaid enrollment and through the Obamacare marketplace, but noted there’s no enrollment cutoff for Medicaid, meaning families can sign up their children year-round. 

“It’s really more of a fluctuation. There’s no policy driver there,” he said, saying he didn’t think marketing cuts had any impact. 

In Florida, the uninsured rate went from 288,000 in 2016 to 325,000 in 2017.

Florida has one of the highest rates of uninsured residents in the country, and also has had the highest number of enrollees purchasing insurance through the Obamacare federal marketplace. However, Medicaid expansion in Florida is likely off the table for this upcoming legislative session. Incoming Gov.-elect Ron DeSantis, a Republican, is against it. His opponent, Democrat Andrew Gillum, campaigned heavily on his support to expand Medicaid coverage for more residents. 

The report also expressed concern that strict immigration policies and enforcement were making many immigrant families leery of enrolling, even if their children were eligible for health coverage. “We think it’s really this national unwelcome mat regarding public coverage,” Alker said. 
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The expansive court case seeking to hold drugmakers responsible for the nation’s opioid crisis has a new complication: How does it deal with claims covering the thousands of babies born addicted to the drugs?

Attorneys representing the children and their guardians want their claims separated from the federal case in Cleveland that involves hundreds of local governments and other entities such as hospitals. They told a skeptical panel of judges in New York on Thursday that they have different legal issues, a need for faster relief because the babies need services in the first years of their lives. They also told the judges that as it is, they lack the leverage to exact a settlement from drug companies.

Babies, unlike governments or businesses, have been directly harmed by the actions of drugmakers and are entitled to their own payments, said Scott Bickford, a lead lawyer for the children and their guardians.

Bickford said more than 150,000 babies were born in opioid withdrawal from 2012 through 2016, and that the number grows each year

Federal cases consolidated

He said initial hospital stays for babies born to an opioid-addicted mother can cost $200,000 to $250,000 more than other infants born without complications. 

“Then you have to address their developmental and learning problems,” Bickford said in a Tuesday interview. “A lot of them have organ problems. A lot of them have problems we don’t even know about.”

Drug manufacturers and distributors oppose creating a new structure for the lawsuits over the children and judges on the Judicial Panel on Multidistrict Litigation hearing the matter in New York on Thursday wondered what good it would do.

Opioids — including prescription painkillers, heroin and synthetic substances including fentanyl — killed nearly 48,000 Americans last year, according to the U.S Centers for Disease Control and Prevention. The cost of treatment, providing an overdose antidote, foster care, jail stays, ambulance runs and addressing a growing homeless crisis have added up for governments and taxpayers. Studies have found that opioid addiction also has depleted the workforce, harming the economy.

More than 1,400 plaintiffs have had their federal cases consolidated under a single judge. They include county and local governments, hospitals, unions, American Indian tribes and individuals. Hundreds of others have sued in state courts. Cleveland-based federal Judge Dan Polster has been pushing the parties to reach a settlement.

Children need a voice

The judicial panel’s chairwoman, Judge Sarah Vance, said it’s unlikely any settlement would be reached without considering the children.

“It’s hard for me to see how the defendants are going to settle if they’ve got 150,000 children unhappy because their needs are unmet,” Vance said.

Angela Vicari, a lawyer for the drug manufacturers, told the judge that she wasn’t aware of the lawyers for the babies seeking to negotiate.

But lawyers for the children said they don’t have a voice in the committee of plaintiffs’ lawyers leading the case, making it hard to request the information from the industry that they believe would help prove their case. Attorney Kevin Thompson said it’s essential to request information on any industry laboratory studies on the impact of drugs passed from mothers to children.

Lawyers also worry that any settlement reached by government agencies won’t go to help the people who have been hurt. “They end up paving a road with that,” Bickford said.

Other plaintiffs in the omnibus opioid litigation have not objected formally and did not speak in court Thursday, but some are cool to the idea of separating the cases involving the children. One of the lead lawyers for the local governments, Paul Farrell Jr., said he is trying to get help for children born with opioid dependency and have prenatal care funded by the drug industry.

He said in an interview that the plaintiffs share a goal: holding drug manufacturers liable for the crisis. Unless that happens, he said, no one will get the payouts they’re seeking.

“You’ve only got to shoot the pig once,” he said Tuesday.

Indian tribes allowed to go it alone

Lawyers representing the children and their guardians say there is precedent for their request to go it alone, after Polster granted the American Indian tribes a separate test trial for their claims. In August, the judge denied similar status for the cases brought on behalf of babies.

That decision prompted the lawyers to ask the panel of judges to put their cases under another judge in West Virginia or Illinois.

A ruling is expected in the next several weeks.
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After repeated food poisoning outbreaks linked to romaine lettuce, the produce industry is confronting the failure of its own safety measures in preventing contaminations.

The E. coli outbreak announced just before Thanksgiving follows one in the spring that sickened more than 200 people and killed five, and another last year that sickened 25 and killed one.

No deaths have been reported in the latest outbreak, but the dozens of illnesses highlight the challenge of eliminating risk for vegetables grown in open fields and eaten raw, the role of nearby cattle operations that produce huge volumes of manure and the delay of stricter federal food safety regulations.

A contested aspect of the regulation, for example, would require testing irrigation water for E. coli. The Food and Drug Administration put the measure on hold when the produce industry said such tests wouldn’t necessarily help prevent outbreaks. Additional regulations on sanitation for workers and equipment — other potential sources of contamination — only recently started being implemented.

FDA Commissioner Scott Gottlieb said he thinks the combination of rules, once fully in place, will make vegetables safer to eat.

“I don’t think any one element of this is going to be the magic bullet,” Gottlieb said.

Health officials say improved detection may make outbreaks seem more frequent. Still, that is intensifying pressure on growers and regulators to prevent, catch and contain contamination.

Prevention

It’s not yet known how romaine got contaminated in the latest outbreak.

The spring outbreak was traced to romaine from Yuma, Arizona. Irrigation water tainted with manure was identified as a likely culprit, and investigators noted the presence of a large animal feeding operation nearby.

Subsequently, growers in Arizona and California adjusted an industry agreement to expand buffer zones between vegetable fields and livestock. The industry says the change was in place for lettuce now being grown in Yuma, which hasn’t been implicated in the latest outbreak. But Trevor Suslow of the Produce Marketing Association said there isn’t consensus about the exact distances that might effectively prevent contamination.

He noted specific buffer zones aren’t required by the new federal rules on produce safety.

“They look to the industry to determine what is the appropriate distance,” Suslow said.

Growers in Yuma also started treating irrigation water that would touch plant leaves with chlorine to kill potential contaminants, Suslow said. But he said such treatment raises concerns about soil and human health.

Meanwhile, the proximity of produce fields to cattle operations is likely to continue posing a problem. Travis Forgues of the milk producer Organic Valley noted consolidation in the dairy industry is leading to bigger livestock operations that produce massive volumes of manure.

Testing

Already, the industry agreement in Arizona and California requires leafy green growers to test water for generic E. coli.

But James Rogers, director of food safety research at Consumer Reports, said it’s important to make water testing a federal requirement. Since romaine is often chopped up and bagged, a single contaminated batch from one farm that skips testing could make a lot of people sick, he said.

Teressa Lopez of the Arizona Leafy Greens Marketing Agreement also said federal regulation can ensure greater compliance, even though the industry agreement has stricter measures.

Despite industry measures implemented after a spinach outbreak more than a decade ago, health officials note d this month there have been 28 E. coli outbreaks linked to leafy greens since 2009.

The produce industry says the failure to prevent the Yuma outbreak could also reflect the limitations of testing water for generic E. coli.

Elizabeth Binh, a food science expert at Cornell University, said the tests look for the amount of fecal matter in water. The problem is, “some feces has pathogens in it, some feces doesn’t,” said Binh, who is part of a federal program helping farmers comply with the new produce regulations.

Testing for specific E. coli strains that are harmful is more difficult, and doesn’t rule out the possibility of other harmful bacteria, Binh said.

Containment

Whole-genome sequencing is making it easier to detect outbreaks, which is pressuring the produce industry.

The FDA warned against all romaine last week because it said it was able to identify it as a likely source early enough. The agency narrowed its warning to romaine from California’s Central Coast after the produce industry agreed to label romaine with harvest dates and regions, so people know what’s OK to eat.

The labeling is voluntary, and the industry said it will evaluate whether to extend it to other leafy greens. Gottlieb said improving traceability would allow targeted health alerts that don’t hurt the entire industry. The FDA recently hired a former Walmart executive who used blockchain technology to improve traceability in the retailer’s supply chain.

Stephen Basore, director of food safety at a Florida romaine grower, said he expects more regulations and self-imposed industry guidelines.

“Anytime there is an issue, the immediate response is saying our protocols aren’t enough,” he said.
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Suicides and drug overdoses helped lead a surge in U.S. deaths last year, and drove a continuing decline in how long Americans are expected to live.

Overall, there were more than 2.8 million U.S. deaths in 2017, or nearly 70,000 more than the previous year, the Centers for Disease Control and Prevention said Thursday. It was the most deaths in a single year since the government began counting more than a century ago.

The increase partly reflects the nation’s growing and aging population. But it’s deaths in younger age groups — particularly middle-aged people — that have had the largest impact on calculations of life expectancy, experts said.

The suicide death rate last year was the highest it’s been in at least 50 years, according to U.S. government records. There were more than 47,000 suicides, up from a little less than 45,000 the year before.

​A general decline

For decades, U.S. life expectancy was on the upswing, rising a few months nearly every year. Now it’s trending the other way: It fell in 2015, stayed level in 2016, and declined again last year, the CDC said.

The nation is in the longest period of a generally declining life expectancy since the late 1910s, when World War I and the worst flu pandemic in modern history combined to kill nearly 1 million Americans. Life expectancy in 1918 was 39.

Aside from that, “we’ve never really seen anything like this,’’ said Robert Anderson, who oversees CDC death statistics.

In the nation’s 10 leading causes of death, only the cancer death rate fell in 2017. Meanwhile, there were increases in seven others: suicide, stroke, diabetes, Alzheimer’s, flu/pneumonia, chronic lower respiratory diseases and unintentional injuries.

An underlying factor is that the death rate for heart disease, the nation’s No. 1 killer, has stopped falling. In years past, declines in heart disease deaths were enough to offset increases in some other kinds of death, but no longer, Anderson said.

The CDC’s numbers do sometimes change. This week, CDC officials said they had revised their life expectancy estimate for 2016 after some additional data came in.

What’s driving this?

CDC officials did not speculate about what’s behind declining life expectancy, but Dr. William Dietz, a disease prevention expert at George Washington University, sees a sense of hopelessness.

Financial struggles, a widening income gap and divisive politics are all casting a pall over many Americans, he suggested. 

“I really do believe that people are increasingly hopeless, and that that leads to drug use, it leads potentially to suicide,’’ he said.

Drug overdose deaths also continued to climb, surpassing 70,000 last year, in the midst of the deadliest drug overdose epidemic in U.S. history. The death rate rose 10 percent from the previous year, smaller than the 21 percent jump seen between 2016 and 2017.

That’s not quite a cause for celebration, said Dr. John Rowe, a professor of health policy and aging at Columbia University.

“Maybe it’s starting to slow down, but it hasn’t turned around yet,’’ Rowe said. “I think it will take several years.”

Accidental drug overdoses account for more than a third of the unintentional injury deaths, and intentional drug overdoses account for about a tenth of the suicides, said Dr. Holly Hedegaard, a CDC injury epidemiologist.

Other findings

The CDC figures are based mainly on a review of 2017 death certificates. The life expectancy figure is based on current death trends and other factors.

The agency also said:

A baby born last year in the U.S. is expected to live about 78 years and 7 months, on average. An American born in 2015 or 2016 was expected to live about a month longer, and one born in 2014 about two months longer than that.
The suicide rate was 14 deaths per 100,000 people. That’s the highest since at least 1975.
The percentage of suicides from drug overdose has been inching downward.
Deaths from flu and pneumonia rose by about 6 percent. The 2017-2018 flu season was one of the worst in more than a decade, and some of the deaths from early in that season appeared in the new death dates.
West Virginia was once again the state with the highest rate of drug overdose deaths. The CDC did not release state rates for suicides.
Death rates for heroin, methadone and prescription opioid painkillers were flat. But deaths from the powerful painkiller fentanyl and its close opioid cousins continued to soar in 2017.
The CDC did not discuss 2017 gun deaths in the reports released Thursday. But earlier CDC reports noted increase rates of suicide by gun and by suffocation or hanging.

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