In his State of the Union address on Tuesday night, President Donald Trump announced his administration’s plan to rid the United States of new transmissions of HIV by 2030.

“Together, we will defeat Aids in America and beyond,” the president told the nation.

At a follow-up media briefing on Wednesday morning, leading federal health officials outlined just how that mission might be accomplished.

“We’re going to diagnose all people as early as possible, we’re going to treat the infection rapidly and effectively, we’re going to protect those at highest risk, we’re going to respond to any outbreaks with overwhelming force, and we’re going to create a public health work force throughout this country with the specific goal of reducing new diagnoses by 75% within five years and by 90% within 10 years,” said Admiral Brett Giroir.

He’s assistant secretary of the US Department of Health and Human Services.

Over 1 million Americans are currently living with HIV.

High-risk communities

Federal government scientists have been coordinating for months on the new plan, which combines broader efforts to stem transmission of HIV with better treatment for people who are already infected.

Getting more people tested for the virus is vital, Giroir told reporters Wednesday.

“We have tremendous strategies of how we can detect and bring people into treatment early,” he said, “and we know 90% of new infections are transmitted by people who are undiagnosed and not in effective care.”

But new infections often cluster in certain “high-risk” communities, added Dr Robert Redfield, director of the US Centers for Disease Control and Prevention.

In 2018, “there were a little over 38 500 new infections in the United States,” he said. To help pinpoint where the need for testing and treatment was greatest, “we actually lifted the number of infections in each county, and that allowed us to sort of rank the counties in terms of how they were contributing to the annual infections in America.”

Redfield said he was “shocked” to see that just 48 out of 3 000 counties in the United States accounted for half of all new HIV infections.

“It showed we had a very geographically focused outbreak, that if we could augment the capacity of those 48 counties to respond to new infections we could drastically reduce the number of new infections,” he said.

HIV researchers and patient advocates have long known that the virus hits certain groups hardest, most notably gay and bisexual men of colour. Communities with high levels of this subgroup may benefit the most from targeted interventions, experts say.

Then there’s the issue of treatment – both to prevent new infections and control existing infections.

One recent advance has been the emergence of drugs like Truvada, which are used for both treating active infection and as “pre-exposure prophylaxis” (PrEP) — a preventive strategy for people deemed at high risk for infection.

Dr Anthony Fauci directs the US National Institute of Allergy and Infectious Diseases and has long been on the forefront of the fight against HIV/Aids.

Speaking at the Wednesday briefing, he stressed that “if you treat an individual and bring their viral load to below detectable levels, they will not transmit their virus to another individual.”

“We know pre-exposure prophylaxis works in more than 97% of the cases,” Fauci said. So, “if you put those two together, you could theoretically end the epidemic as we know it. That’s our goal.”

Crucial step

The path to such hope has been an arduous one.

In the 1980s and 1990s, HIV/Aids became a seemingly unstoppable epidemic. The virus crippled the immune systems of otherwise healthy people, leaving them vulnerable to lethal “opportunistic” infections.

Millions of people worldwide have died from HIV, but the advent of potent antiretroviral drug cocktails in the mid-1990s revolutionized care, keeping viral levels down to undetectable levels and stopping the onset of Aids.

HIV transmission levels also fell sharply, although thousands of new infections still occur in the United States each year.

Brian Mustanski directs the Institute for Sexual and Minority Health and Wellbeing at Northwestern University’s Feinberg School of Medicine in Chicago. He agreed that the elimination of new cases of HIV infection by 2030 is possible – given certain conditions.

“If we are going to end HIV transmissions in the US, we need research to help understand how to effectively deliver the right interventions to the right communities at the right time,” he said.

“Every 44 minutes, a 13- to 29-year-old gay or bisexual man in the US gets diagnosed with HIV,” Mustanski added. “These diagnoses are disproportionally among young men of colour — the only group in the US to show increases in the rate of annual diagnoses. Any plan to end HIV transmission in the US must centere on the needs of young gay and bisexual men of color in order to be successful.”

Mustanski believes that any plan aimed at eradicating HIV transmission within a decade must make PrEP available to these underserved communities.

“We have highly effective approaches to preventing HIV transmission today, but they are not effectively reaching the communities who need them most,” he said.

More must also be done to raise HIV testing rates, because undiagnosed carriers of HIV are more likely to infect others.

“Only a quarter of sexually active teen gay and bisexual boys have ever had an HIV test,” Mustanski noted. “As a result, only about half of young people in the US who are HIV-positive know their status, which is the entry point to lifesaving treatment that can also eliminate transmission.”

Community outreach aimed at encouraging safe sex behaviours is another crucial step in getting transmissions down to zero, he said.

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Forests are changing in ways that could mean they emit more gases that contribute to smog, acid rain and respiratory problems, a new study suggests.

“This study has profound implications for future air quality. Human activities, such as fire suppression, fertilizer use and climate change, are causing forest populations to shift from stands of trees that do not emit these gases to those that do,” said study leader Jonathan Raff.

Gases hard to detect

These gases, known as reactive nitrogen oxides, are produced by bacteria in soil that feed on naturally occurring ammonium and on nitrogen fertilizers from industrial and agricultural sources. They then enter the atmosphere.

As forests change, higher levels of nitrogen oxides are to be expected, the study suggests. This could make it more difficult for some regions to meet national air quality standards, Raff said in a university news release. He is an associate professor of public and environmental affairs at Indiana University in Bloomington.

These gases are easy to miss because they are hard to detect, according to Ryan Mushinski, a postdoctoral researcher. “A lot of people also simply don’t think about soil as a significant producer of harmful air chemicals,” he added.

Some trees promote release of nitrogen oxides; others don’t, according to the study.

Maple, sassafras and tulip poplar are among the trees that bolster release of the smog-causing chemicals. They push out other species, such as oak, beech and hickory, whose microbes absorb reactive nitrogen oxides rather than releasing them, according to the study.

Researchers used data from a USDA Forest Service inventory to review soil data from 78 000 forest plots across country.

Greater use of controlled burns

Indiana, Illinois, Michigan, Kentucky and Ohio are the states likely to have the highest emissions of nitrogen oxides from forest soil, according to the study. Higher emissions are also expected from forests along the Mississippi River and some regions of the eastern US.

The US Environmental Protection Agency (EPA) regulates and monitors nitrogen oxide levels.

Mushinski, however, said current rules won’t curtail rises in soil emissions, since air quality standards do not regulate fertilizer use or nitrogen deposition.

Besides stronger regulation, Mushinski suggests allowing greater use of controlled burns. These fires are an effective way to clear out tree species that help create the soil that emits nitrogen gases, he said.

“It’s difficult because people really like trees such as maples and poplars,” Mushinski said. “But without greater awareness or policy changes, we’re not going to see a reduction in the harmful gases they encourage.”

The report was recently published in the Proceedings off the National Academy of Sciences.

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Health authorities previously warned that more than two million children have not been vaccinated.

As concerns mount over how screen time and social media affect children, parents are given suggestions.

As a highlight of his 2019 State of the Union address, President Donald Trump on Tuesday announced his administration’s plan to rid the United States of new transmissions of HIV by 2030.

“In recent years we have made remarkable progress in the fight against HIV and Aids,” Trump told the nation. “Scientific breakthroughs have brought a once-distant dream within reach. My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.”

“Together, we will defeat Aids in America and beyond,” the president said.

More than 1 million Americans are currently living with HIV.

Federal government scientists have been coordinating for months on the new plan, which combines broader efforts to stem transmission of HIV with better treatment for people who are already infected.

In a recent speech, US Health and Human Services Secretary Alex Azar II described the project’s goals. If the plan succeeds, the United States will, “become a country where the spread of HIV has been effectively halted, because every American with HIV/Aids is receiving treatment and every American at risk for HIV is engaged in the right, proven prevention strategy,” Azar said.

The path to such hope has been an arduous one.

In the 1980s and 1990s, HIV/Aids became a seemingly unstoppable epidemic. The virus crippled the immune systems of otherwise healthy people, leaving them vulnerable to lethal “opportunistic” infections.

Millions of people worldwide have died from HIV, but the advent of potent antiretroviral drug cocktails in the mid-1990s revolutionized care, keeping viral levels down to undetectable levels and stopping the onset of Aids.

HIV transmission levels also fell sharply, although 40 000 new infections still occur in the United States each year.

One recent advance has been the emergence of drugs like Truvada, which are used for both treating active infection and as a “pre-exposure prophylaxis” (PrEP) – a preventive strategy for people deemed at high risk for infection.

High risk groups

Communities deemed at high risk include gay and bisexual men, especially those of colour, said Brian Mustanski. He directs the Institute for Sexual and Minority Health and Wellbeing at Northwestern University’s Feinberg School of Medicine in Chicago.

“If we are going to end HIV transmissions in the US, we need research to help understand how to effectively deliver the right interventions to the right communities at the right time,” he said.

“Every 44 minutes, a 13- to 29-year-old gay or bisexual man in the US gets diagnosed with HIV,” Mustanski added. “These diagnoses are disproportionally among young men of color – the only group in the US to show increases in the rate of annual diagnoses. Any plan to end HIV transmission in the US must centre on the needs of young gay and bisexual men of color in order to be successful.”

Mustanski believes that any plan aimed at eradicating HIV transmission within a decade must make PrEP available to these underserved communities.

“We have highly effective approaches to preventing HIV transmission today, but they are not effectively reaching the communities who need them most,” he said.

More must also be done to raise HIV testing rates, because undiagnosed carriers of HIV are more likely to infect others.

“Only a quarter of sexually active teen gay and bisexual boys have ever had an HIV test,” Mustanski noted. “As a result, only about half of young people in the US who are HIV-positive know their status, which is the entry point to lifesaving treatment that can also eliminate transmission.”

Community outreach aimed at encouraging safe sex behaviors is another crucial step in getting transmissions down to zero, he said.

Carl Schmid II is deputy executive director of the AIDS Institute, a public policy and advocacy organization. Speaking to The New York Times, he described the administration’s plan as “very bold” and said it “could be one of [Trump’s] greatest achievements,” if the president and Congress supply enough funds.

The overall goal of stopping HIV’s spread by 2030 is achievable “if we increase testing, treatment and prevention,” Schmid said.

According to the Times, many high-level health officials worked quietly over the past few months to ready the plan for announcement Tuesday by the president.

Key players included Dr Brett Giroir, the assistant secretary for health at the Department of Health and Human Services; Dr Robert Redfield, director of the US Centers for Disease Control and Prevention; Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases; and Dr George Sigounas, the head of the Health Resources and Services Administration, which is responsible for community health centers and the Ryan White HIV/Aids Program.

A University of Oklahoma team from the Geographical Ecology Group has published a new study in the journal Ecology on the nutritional preferences of diverse insect communities from Texas to Minnesota. The OU team conducted 54 experiments in both grazed and ungrazed grasslands to determine the salt cravings of insects and the types of insects that crave salt. The OU team found that insects not only crave salt, but will search for it in their grassland habitats.

A new U of T study suggests that globally we’re growing more of the same kinds of crops, and this presents major challenges for agricultural sustainability on a global scale.

A new Duke University-led study provides the first detailed record of the diving behavior of Cuvier’s beaked whales in U.S. Atlantic waters.

Mark Clements reached his mother’s Exmouth home before paramedics arrived to treat her broken hip.

There could be an added bonus to keeping your cardiovascular health on track – a heart-healthy lifestyle can also prevent type 2 diabetes, researchers say.

And it’s better to prevent type 2 diabetes than to have to treat it, the Ohio State University researchers added.

Factors to measure heart health

“Healthy people need to work to stay healthy. Follow the guidelines. Don’t proceed to high blood sugar and then worry about stopping diabetes,” said study leader Dr Joshua Joseph, an endocrinologist at the university’s Wexner Medical Center, in Columbus, Ohio.

For the study, the researchers assessed diabetes among more than 7 700 participants in a stroke study.

The investigators used the American Heart Association’s “Life’s Simple 7” factors to measure heart health. That well-known tool assesses physical activity, diet, weight, cholesterol, blood pressure, blood sugar (glucose) and tobacco use.

Participants who were in the recommended ranges for at least four of the seven heart health factors had a 7% lower risk of developing diabetes over 10 years, according to the report.

“What’s interesting is when we compared people who had normal blood glucose and those who already had impaired blood glucose,” Joseph said.

A stitch in time…

“Those in normal levels who attained four or more guideline factors had an 80% lower risk of developing diabetes. Those who were already diabetic or prediabetic and met four of the factors had no change in lowering their risk for diabetes,” he said in a university news release.

The findings show that people need to take steps to prevent diabetes before they’re at risk, he explained.

By the time diabetes is diagnosed, people need high-intensity interventions that focus on physical activity and diet to promote weight loss and, possibly, medications, Joseph added.

According to Dr K. Craig Kent, dean of the College of Medicine, “This research adds to our collective understanding about how physicians can help their patients prevent a number of serious diseases, including heart disease, cancer and now diabetes.”

Nearly one-third of Americans have prediabetes or diabetes, according to the US Centers for Disease Control and Prevention.

The study results were published in the journal Diabetologia.

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