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Chains step into HIV/AIDS prevention

BY Alaric DeArment

Stopping a viral pandemic of any kind presents a major challenge that historically has often taken decades or even centuries, as occurred in the cases of polio and smallpox. But stopping or even slowing a pandemic is made all the more difficult when people who carry the virus face stigma and ignorance from their families, communities and governments.


This has been the case with HIV and AIDS, and has been a major barrier to prevention efforts, including promoting safe-sex practices and getting people tested. The problem is serious enough that United Nations’ secretary-general Ban Ki-moon called stigma the single most important barrier to public action. But a new pilot program announced last month hopes to reduce stigma by bringing HIV testing to the retail pharmacy.


Walgreens is partnering with health authorities and service organizations to provide pharmacist-administered testing for the virus that causes AIDS, the retail pharmacy chain said.


The company is participating in a Centers for Disease Control and Prevention pilot with Greater Than AIDS and other organizations and local officials to expand HIV testing services and connect more people with the virus to treatment and care.


Working with Greater Than AIDS, health departments and local AIDS organizations, Walgreens provided free HIV testing at 47 stores in 20 cities to support last month’s National HIV Testing Day. About 1.1 million people in the United States are living with HIV, but nearly 1-in-5 don’t know they have it; and between 55,000 and 58,500 people become infected with the virus each year, according to the CDC.


Through the first phase of the two-year program, select Walgreens pharmacies in Chicago and Washington, D.C. — and a select Take Care Clinic in Lithonia, Ga. — are offering free HIV testing. The CDC plans to use pilot results from select pharmacies and in-store clinics in urban and rural areas identified as highly impacted by HIV to develop a model that pharmacists and nurse practitioners can use to implement HIV testing throughout the nation.


Retail pharmacies have been offering testing for diseases ranging from high cholesterol to cancer for years, but offering HIV testing presents a whole new realm of possibilities and challenges.


HIV testing traditionally has taken place at physicians’ offices and community health centers, but offering it at the pharmacy — not to mention a Food and Drug Administration panel’s recent endorsement of the over-the-counter approval of the over-the-counter OraQuick in-home HIV test — expands the range of services people can get with a simple walk to the neighborhood store.


At the same time, while any chronic disease tends to be a private and emotionally charged issue, HIV is especially so, considering the long history of stigmatization of people with the virus due in part to its frequent association with intravenous drug users; lesbian, gay, bisexual and transgender people; and sex workers. 


According to a CDC article published in 2006, medical systems’ treatment of HIV as an “exceptional” disease has helped to feed stigma, resulting in infected people often not getting tested until they’re already sick. That year, the CDC released revised recommendations to regard HIV/AIDS as a treatable disease, and one of the goals of the Walgreens-CDC pilot program is to reduce the stigma associated with the virus. Perhaps making HIV testing something people can do at the same place they buy cold medications, magazines and toothpaste rather than at a clinic can help make it seem more routine.


But if routine HIV testing is to become a common feature at retail pharmacies, there are some other considerations as well. In addition to anonymity, it’s important to provide services like prevention counseling and referrals, as well as counseling and emotional support for patients who test positive. Stigmatized or not, HIV remains a life-threatening and life-changing disease. According to the CDC article, while 70% of people tested at publicly funded sites received their results and test information, fewer received counseling or referrals, and the figures were even lower for people tested in private settings. The FDA Blood Products Advisory Committee also expressed concern about lack of access to counseling when recommending OTC approval of the OraQuick test.

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Despite penalties, counterfeits continue

BY Alaric DeArment

Another prescription drug-related crime is drug counterfeiting, which got significant attention in March 2011 when CBS News’ “60 Minutes” reported on the problem, including a tour of a drug counterfeiting operation.


In March, the Senate passed S. 1886, the Counterfeit Drug Penalty Enhancement Act, which toughens punishments for criminals who produce and traffic counterfeit medications, drawing praise from the National Association of Chain Drug Stores.


Still, the problem hasn’t disappeared. In May, the Food and Drug Administration warned that a counterfeit version of Teva’s attention deficit hyperactivity disorder drug, Adderall, was circulating online. One of the most common avenues for the distribution of counterfeit drugs is through rogue Internet pharmacies. In March, Portland, Ore.-based LegitScript, a company that verifies online pharmacies, published a report indicating that at least one-third of such rogue pharmacies were operating under the domain name registrar Internet.bs.

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Rx drug abuse rises in high school students

BY Alaric DeArment

News broke last month that officials in the South American nation of Uruguay were planning to possibly legalize marijuana. Meanwhile, activists in Colorado have sought to legalize the drug in that state, while Chicago’s city council decriminalized possession of small amounts of marijuana and reduced the penalty to a ticket.


Supporters of legalization or at least liberalization of marijuana laws argue that it would take control of the marijuana trade out of the hands of drug cartels. But in recent years, one of the most rapidly growing problems with drug abuse hasn’t involved cannabis or heroin or cocaine, but prescription drugs — a trend that has been implicated in both drug overdoses and pharmacy crime.


According to the National Institute on Drug Abuse, part of the National Institutes of Health, Abbott’s opioid painkiller, Vicodin (hydrocodone and acetaminophen), and Teva’s attention deficit hyperactivity disorder drug, Adderall (amphetamine aspartate, amphetamine sulfate, dextroamphetamine saccharate and dextroamphetamine sulfate), are the most commonly abused drugs after marijuana among 12th-graders, while the National Education Association Health Information Network estimated that 1-in-5 high school students have used a prescription drug without a doctor’s prescription. This includes 1-in-12 high school seniors who have abused Vicodin and 1-in-20 who have abused Purdue Pharma’s painkiller, OxyContin (oxycodone). Meanwhile, between 1999 and 2008, opioid painkillers were the leading cause of unintentional drug overdose deaths, dwarfing the rates of cocaine and heroin, according to the institute.


Still, several policy-makers and companies have sought ways to confront the problem. Last month, New York Gov. Andrew Cuomo announced a plan — calling it the first in the country — to create an all-
electronic registry that would enable doctors, pharmacists and law enforcement to track controlled substances to prevent excessive prescription and refill requests. “This landmark agreement will help put a stop to the growing number of fatalities resulting from overdoses on prescription drugs,” Cuomo said. “We have seen too many untimely deaths as a result of prescription drug abuse, and today New York state is taking the lead in saying enough is enough.”


But in addition to preventing drug abusers from illegally getting their hands on prescription medicines, another step to combatting the problem involves education. At the end of last month, the NEA HIN and Purdue Pharma announced the release of a set of cross-curricular lessons aimed at middle-school students designed to discourage prescription drug abuse. “We know that 20% of high school students have reported that they have taken a prescription drug without a doctor’s prescription,” NEA HIN executive director Jerry Newberry said. “This behavior endangers student health and can interfere with academic success. NEA HIN welcomes our partnership with Purdue Pharma to help teachers inform students about the risks of misusing prescription medication.”

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