" . . . an HIV-Free Generation"?! Really?

This Sunday, May 18, is the annual AIDS Walk in New York City.  This is a big event: last year, some 30,000 people participated in this 10K "non-race" in Central Park and nearby neighborhoods and raised roughly $5.5 million toward HIV/AIDS causes locally and elsewhere.

Coincidentally, a leading health policy research journal Health Affairs published articles in its March issue on HIV topics.  One of them, highlighted on the cover, has the title "Policy Choices for an HIV-Free Generation."

What a concept, to even imagine an HIV-free generation!  Accompanying articles talk about a concept almost as startling, growing old with an HIV+ condition.  How times have changed for these people.

This topic is close to our heart.  The first person we knew who died of AIDS passed away in the spring of 1983, near the very beginning of this tragic epidemic.  We have lost at least a dozen other friends through the years and even the husband of a cousin.  In a sign of the changing fortunes of this population, however, the last two HIV+ people we knew never developed AIDS itself and lived into their 70s, approaching the lifespan of the overall population.  We wrote of this at the passing of one of them in late 2012.  At that time, we were deeply moved that Bob and Michael could have pretty much normal, active lives while taking their anti-retroviral medications.  We are touched anew by the current attention this health condition is receiving and by the striking results of the now more than 15-years' worth of anti-retroviral treatments.  What dramatic outcomes there are.

First (in order, but not priority), combination anti-retroviral therapy, known as cART, more than pays for itself economically.  Researchers at the University of Southern California and at Bristol-Myers Squib analyzed the added life expectancies against the $12,000+ annual cost of the treatment.  They conclude that patients' added lifespan has an estimated value several times greater than the cost of the therapy.  Further, their study indicates that since the people are healthier while taking the ART and since it has preventive qualities, it should be started early, before the infection evolves into a more serious symptomatic condition.  The phrase taking hold is "test and treat", don't wait until people's infection rating gets worse before starting treatment.

In addition, as we just noted, the cART is "preventive".  It's not a vaccine, which just has to be administered once.  It's a continuing treatment over potentially many years.  But it works.  So the next step is to use it as a prophylactic for partners of infected individuals.  Treating them can keep them from getting infected in the first place.   This is also worthwhile economically, to say nothing of how it is stabilizing to the daily lives of the individual and the partner couple.  Other analysts in the Health Affairs issue estimate that cART has prevented 13,500 infections per year since it was introduced broadly in 1996.

All of this is not a signal that the war against this brutal health condition has been won.  Numerous issues remain.  There is still a social stigma.  HIV+ people need employment, but often face obstacles to getting a job.  Now that many are getting older and trying to lead more normal lives, they may well face obstacles to forming social relationships: they're both older and HIV+.  Further, as people enjoy the benefits of cART, they may get less cautious in their sexual practices and even lax in taking the meds themselves.  This is the situation known to economists as "moral hazard"; people who know they have added protection may take more risk.  Separately, financing their treatment can get tricky as the Affordable Care Act (ACA) meshes with the long-standing federally funded Ryan White Program and numerous state versions of Medicaid, many of which are being restructured.  At the same time, it's estimated that the ACA will facilitate HIV testing for as many as 500,000 people in just the next three years, surely a big help.

Among other lingering concerns, all the good news we describe here pertains to the United States.  A look at a few of the organization who share in the proceeds of AIDS Walk New York gives an idea of the variety of other AIDS-related issues that remain.  Among nearly 40 groups all together, funds go to Keep a Child Alive, which provides anti-retroviral drugs to African children; Africa Tikkun provides education and social services to children and families in South African villages; and AID for AIDS assists people in Latin America and the Caribbean.

Still, even with the caveats we state, we can see that the wider testing in the US and the recognition of the benefits of early administration of cART indeed create the plausibility of a generation free of HIV in the US.  We hear so much about the troubles in medical care delivery these days, and it's nice to stop and recognize a genuine triumph for potentially millions of people.

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Visit the AIDS Walk website: http://www.aidswalk.net/newyork .  DONATE!!

The Health Affairs articles are here: http://content.healthaffairs.org/content/33/3.toc .  The issue is aimed at the impact of the Affordable Care Act on outreach to HIV/AIDS patients and the jail population.  We have not yet examined the latter material.  The HIV/AIDS articles we found most interesting include "Living with HIV and Growing Old" a portrait of a particular gentleman, two articles on the costs and benefits of early cART treatments and the policy summary.  All of it is helpful and accessible to general readers.

Fracking and Methane: Response to a Comment

In a Comment to the "Follow-up on Fracking" post below, Reader Chris Johnson calls us to task for not mentioning the methane issue.  This Reader Chris is quite right.  It is an important consideration.  If fracked gas wells and/or pipes have leaks, methane will escape.   Methane is the main chemical component of "natural gas".   It has good uses in making fabric, plastics, anti-freeze and fertilizer, among others.  But if it leaks uncontrolled into the atmosphere, it acts as a greenhouse gas that is at least as harmful as carbon dioxide.  Recent academic research, cited by our favorite author on these topics, Russell Gold, in a February Wall Street Journal blog article, suggests that methane emissions are quite sizable.  Indeed, he describes that using natural gas as fuel for transportation in cars and trucks, because it can leak out, may not be any better for the climate than regular gasoline.  However, in the confined space of a power plant producing electricity or a home producing heat, natural gas does have significant net benefits over coal and fuel oil.

Another important point is one we alluded to in our original article.  Building the fracking wells themselves and then transporting the gas must be done carefully.  If the cement shell of the well cracks, methane will escape.  Notably, the leakage of methane does not come from the inherent design of the fracking wells, but rather from flaws in the materials and construction of wells and pipeline.  These can be fixed by the oil companies, or better yet, prevented by careful construction in the first place.

All this underscores our basic conclusion yet again.  Use less energy to begin with.  But we can use natural gas quite effectively in electricity plants and furnaces, as long as the gas is obtained through safe fracking practices.  This is important to know.

Source: http://blogs.wsj.com/corporate-intelligence/2014/02/14/despite-leaky-methane-is-natural-gas-is-still-worth-the-switch/

Some Follow-Up on Fracking

In response to our Earth Day article on fracking, three helpful readers posed questions about natural gas and fracking or gave us additional information resources.  This topic is a hot one and press reports and journals present new material nearly every day.  To wit:

1.  Reader Chris wants to know what difference fracking has made in US production of petroleum and natural gas.  In other words, is it such a big deal in our overall energy supply situation?

The answer is "plenty" of difference.

See this graph of production data from the Department of Energy's Energy Information Administration (shaded areas are recession periods).

This includes crude oil, natural gas, coal, nuclear, hydroelectric and other renewables; you can see the upturn in 2007, a pause during the Great Recession and since then a sharp uptrend.  Earlier years had seen at best a flat pattern in these production numbers, with crude oil in particular falling consistently.

Now, if we are producing more of our own energy, are we then using more energy?  Well, no.  What our increased production has meant is a pronounced decline in imports, as visible here:

In fact, the amounts imported during 2013 have returned to 1997 levels.  So the new production from fracking has already eased our dependence on foreign energy producers.

2.  Our article mentioned the potential for exporting fuels.  Reader Carolyn wants to know how it might work to export natural gas.  There are two aspects to the reply, one physical and the other regulatory.

From the physical standpoint, it obviously sounds impractical to ship natural gas in ships across oceans, doesn't it?  A quick Google on "how to export natural gas" brings us to a whole discussion by Shell Oil Company, which in fact does just that around various parts of the world.  They do it by chilling the gas into a liquid form; there are liquefaction plants in seaport cities and gas arrives at those plants via pipeline.  The gas is super-cooled to -260 degrees Fahrenheit (-162 degrees Celsius); this shrinks the volume some 600 times and produces a clear, toxin-free liquid, known as liquefied natural gas or LNG, which is easily shipped in tankers.  At the receiving end, it is heated at "regasification" plants and sent off in pipelines to final users.  The U.S. has imported lots of natural gas this way for decades.  [Source: http://www.shell.com/global/future-energy/natural-gas/liquefied-natural-gas/what-is-lng.html]

Now, the reverse is happening in the U.S.  Several liquefaction plants for exporting are either in the planning or construction stages in Louisiana, Texas, Maryland and Oregon.  But there is an important regulatory constraint:  according to a recent USA Today article, exporting natural gas requires a "public interest" ruling from the Energy Department if the buyers are located in countries where we do not have a free trade agreement.  So shipping to Europe, China, India and Japan, among others, must undergo extra regulatory processes.  Altogether, 31 plants have applied for this approval and the ones just mentioned have received at least a conditional OK.  One in Louisiana, owned by Cheniere Energy, is in final construction stages and should open next year. [Source: http://www.usatoday.com/story/news/nation/2014/04/07/us-natural-gas-exports-to-begin/7204925/]

3.  Reader Mary, who lives in Colorado, calls our attention to a very informative website, www.studyfracking.com.  While the material is geared specifically to Colorado, much of the information is general and is accompanied by extremely helpful diagrams and pictures.  For instance, one of the diagrams is a cross-section showing how much farther below ground fracking occurs, compared with the location of groundwater.  Mary's own comments highlight one of the benefits of fracking that we also mention, the good jobs the drilling industry provides that can help people move up and succeed economically.

4.  We can elaborate on a couple of other points in our article.  One, we referred briefly to earthquakes that might be caused by fracking.  The U.S. Geological Survey announced last week that it plans to map "manmade earthquakes" in more detail, since the rate of seismic activity has increased in the last few years when fracking has been taking place.  The earthquakes are small, with Richter Scale magnitudes of around 3.0, but there are more of them.  Notably, the quaking seems to result from disposal of the wastewater used in the fracking, not from the fracking itself.  So all this bears keeping up with.  Source: [http://online.wsj.com/news/articles/SB10001424052702303948104579535991486675268]

Two, we can point out that our general concluding mandate, "use less energy!" need not mean we have to feel deprived.  Here is a picture of a new BMW vehicle, the i8, which will be on sale in the U.S. in the fall.  It is a plug-In hybrid made of carbon-fiber reinforced plastic; this material is as strong as steel and weighs markedly less, more than offsetting the added weight of the necessary lithium-ion batteries.  While carbon fiber has been used in cars before, such as Lamborghinis and McLarens, this is the first adaptation of mass production for a carbon fiber body shell.  This sports car goes from 0 to 60 mph in 4.2 seconds, the same as a Porsche 911, but its gas mileage is 50-60 mpg, similar to a Toyota Prius.  Now, we won't all want to buy one; the price will evidently be something like $135,700.

We describe this to highlight that these environmental issues are technological.  Engineering and chemistry can work on them.   So innovation can advance products to meet new issues of the day and we don't have to sit in the dark and creep along in a slow car to save fuel.  We can still have fun.  [Source: http://online.wsj.com/news/articles/SB10001424052702304677904579535612915387656]