“We are in the process of finalizing both the n-PEP [non-occupational post exposure prophylaxis] document and our communication to local health departments regarding ‘client acknowledgment’ forms,” said Kelly Niebel, acting spokesperson for the MDCH. She said the new n-PEP policy should be finalized sometime this month.

n-PEP is a prescription of anti-retroviral medications given to a person within 72 hours of an exposure. The prescription is a 28 day course and is considered highly effective in preventing HIV infection. The Centers for Disease Control and Prevention in Atlanta issued national guidelines on the chemical prevention in 2005, while the World Health Organization issued international guidelines in 2006.

In December of 2009, a Michigan Messenger investigation found that access to the life saving medications was dependent on one’s location in the state. The MDCH said it did not have a “written in stone” policy on the issue, which allowed local medical care facilities to define their own policies, independent of federal and international standards.

Shortly after the Michigan Messenger report broke, Amna Osman, director of Division of Health, Wellness and Disease Control, told Messenger that the state would have a new policy by “early” 2010. However, by the end of 2010, the policy remained bogged down in bureaucratic red tape. In February of this year, Michigan Messenger reported that e-mails obtained through the Freedom of Information Act showed that the policy had been delayed in the office of one attorney in the MDCH legal department.

On Friday April 1, the MDCH sent a letter to local health departments advising them to review forms that misstated the state’s HIV disclosure law. The move came six weeks after advocates raised concerns about civil rights issues associated with the use of those documents.

The continued delay of development of an n-PEP policy was widely criticized by advocates.

“When it comes to HIV exposure, delays cost lives. The old saying at the height of the HIV/AIDS crisis was, ‘An ounce of prevention, because there is no cure.’” said David Holtz, executive director of Progress Michigan. “Refusing to take the necessary action to make sure that every person exposed to HIV has access to preventative medicine is unconscionable and inexcusable. It’s a delay that costs Michiganders their health and their lives, and costs Michigan’s taxpayers untold amounts of money to fight a disease that could – and should – have been prevented.”

“What is the reason for this delay?” asks James Krellenstien, who runs the website pepnow.org.”It is truly unbelievable that State of Michigan still does not have any n-PEP policy. One must wonder how many unnecessary HIV seroconversions took place due to this inexcusable delay in policy. But one question that keeps coming back to me, is what does the state department of health have to figure out? The scientific research is unequivocal; n-PEP can reduce the probability of HIV seroconversion significantly after exposure to HIV through sexual, injection drug or other routes. As I have said before, human biology does not change when one crosses state lines, so the fact that the state cannot even issue preliminary guidelines for a lifesaving treatment is truly mind boggling.”

The continued delay has prompted Equality Michigan to reach out to the MDCH, says Emily Dievendorf, policy director of the group.

“There is no question that the delay in the policy has allowed unnecessary harm to continue,” said Dievendorf. “I believe in the creation of quality public policy, and if the Michigan Department of Community Health has real policy development and implementation issues to work out, I am eager to address those concerns at the earliest opportunity. I look forward to nurturing a productive and open partnership with the Department of Community Health to best ensure the health of Michigan citizens.”

“I wish our state health department was more proactive in these issues,” says Mark Peterson, a director for the group Michigan Positive Action Coalition. “Any statement the state makes along the lines of the CDC guidance is good for the community and for physicians. I don’t understand why they have not adopted the CDC guidelines.”

During the entire debate over the issue, MDCH officials have consistently said health professionals should follow the CDC guidance while the state finalizes its policy.

While the state continues to struggle with developing a cohesive policy on n-PEP, Neibel says the department is keeping abreast of a newly approved use of anti-retrovirals in prevention. The new procedure is called Pre-Exposure Prophylaxis, or PrEP. In this procedure, people at risk for HIV infection take an anti-retroviral drug called Truvada daily. If taken daily, the medication was shown in a recent study to have about a 90 percent ability to prevent infections. The study also found that contrary to popular belief that using the medications in this way would lead to an increase in risky behavior, the study found that daily use of Truvada actually resulted in increased condom use by the men in the study.

The CDC released interim guidance on the use of PrEP earlier this year. Those guidelines apply only to men who have sex with men as no similar study has been conducted in relation to heterosexuals or intravenous drug users.

But now the swine flu has Wal-Mart under scrutiny for a very different reason: Accusations that the retailer is leaving employees infected with swine flu little choice but to come to work, due to its punitive sick leave policies.

Citing a report by the National Labor Committee, the Institute for Southern Studies’ argues on its blog Facing South that Wal-Mart is essentially contributing to the spread of swine flu by making it financially prohibitive for employees to miss work when they fall ill.

Employees of the Arkansas-based retail giant — even its food handlers — feel they have no choice but to work when they’re sick. That’s because the company gives workers demerits and deducts pay for staying home when they’re sick or caring for sick children.

It gets worse:

The situation is particularly difficult for Wal-Mart workers who are single parents. The NLC reports on an instance in which an employee got a call from her four-year-old’s preschool telling her to pick up the child, who had a fever of 103 degrees F. Despite the fact that the employee had already worked for four hours that day, she got a demerit point for leaving and lost her wages for the rest of the day.

The report says: “Parents have no choice but to load their children up with Motrin and Dimetap to mask their symptoms so they can go to school.”

Which, of course, leads to a vicious circle of other children at school becoming sick, and spreading it in their families. Not to mention the misery of a sick child facing a full day of school.

What’s particularly interesting is that Wal-Mart includes on its Website some information about swine flu, including frequently asked questions. Here’s the answer to “What should I do if I get sick?”

Stay away from others as much as possible to keep from making others sick. Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events and public gatherings.

Unless you work at Wal-Mart. Then, you’d better make it in for your shift if you don’t want your pay docked or possibly lose your job. From Facing South:

Wal-Mart has a demerit system that punishes workers who cannot come to work due to illness. Employees who miss a day due to sickness receive a one-point demerit and lose eight hours of wages.

Employees with more than three absences a six-month period face discipline, and a fifth absence — even for a sick day — will result in what the company calls “active coaching” by management.

A sixth absence leads to what Wal-Mart calls “Decision Day,” when a worker can be either terminated or put on a year-long trial period during which time he or she can be fired for any infraction and cannot be promoted.

The swine flu sometimes can cause people to miss an entire week or more of work. At Wal-Mart, that could get you fired.

Somehow, I don’t think that’s what the Center for Disease Control was hoping for this flu season, as it tries to contain a life-threatening virus. Wal-Mart’s labor policies have long been contentious, but this one could actually create a public safety issue. If these allegations are true, it may be time for public health officials to step in somehow, perhaps with fines for the retailer for keeping flu-stricken employees on the job. And let’s not just pick on Wal-Mart; it’s very possible that other low-wage retailers and business are doing the same thing. Maybe the best option in the absence of any government action is for customers to walk away. Is a bargain really worth it if employees are forced to work while sick with the flu — and potentially help to spread an unusually dangerous virus?

Although Smithfield is still denying that its hogs could possibly have been the source of the virus, I came across this illuminating document from the Center for Disease Control that details just how hazardous such Concentrated Animal Feeding Operations, known as CAFOs, are — and why they’re tightly regulated in the United States.

U.S. regulations “require CAFOs to carry a permit and to develop nutrient-management plans designed to keep animal waste from contaminating surface water and groundwater,” according to the CDC.

I don’t know if Mexico has comparable regulations, but according to Mexico’s La Jornada (quoted by David Kirby in The Huffington Post):

Clouds of flies emanate from the lagoons where Granjas Carroll discharges the fecal waste from its hog barns – as well as air pollution that has already caused an epidemic of respiratory infections in the town.

If this is the case, it sure doesn’t sound like strict health or environmental rules there are being enforced.

According to the CDC:

People who work with livestock may develop adverse health effects, including chronic and acute respiratory illnesses and musculoskeletal injuries, and may be exposed to infections that travel from animals to humans. Residents in areas surrounding CAFOs report nuisances, such as odor and flies. In studies of CAFOs, CDC has shown that chemical and infectious compounds from swine and poultry waste are able to migrate into soil and water near CAFOs.

Plus, “manure-related discharges at CAFOs include … pathogens, such as parasites, bacteria, and viruses, which can cause disease in animals and humans.”

The World Health Organization confirms that “Humans usually contract swine influenza from infected pigs…”  And even though Smithfield says its pigs aren’t sick, the swine can be asymptomatic, yet still be carriers of the virus (pdf).

Of course, this doesn’t prove that the swine flu came from the Granjas Carroll hog farms — a subsidiary of Smithfield — in La Gloria, Mexico. (The WHO has sent experts down to Mexico to investigate the potential link.) But it does seem to call into question the claims of the Mexican pig farming industry that “pigs are not the cause of the flu that is affecting the country. It must remain clear that the flu problem is caused neither by the proximity to swine operations nor by the consumption of pork meat or pork products.”

The pork industry, worried about declining sales, has asked the WHO to change the name of the disease so as to protect the industry’s reputation; the health organization, however, insisting that the disease does come from pigs, has declined.

For a more detailed account of the development of this story and its latest twists and turns, check out Tom Philpott’s excellent reporting at Grist.

Announced Tuesday, the $55 million initiative “aims to raise public awareness by stressing a critical statistic: One American is infected with HIV, the virus that causes AIDS, every nine and a half minutes,” Heywood writes. Most of that funding will go toward a five-year public education campaign, complete with radio commercials, online ads and airport banners. But what’s got some advocates in a huff is not the concept but the content: They say it’s reminiscent of the Bush administration’s push to highlight abstinence, monogamy and condoms as central themes of their AIDS education effort — a message that critics say is contradictory, and therefore confusing.

“Ugh–yep–looks like more of the ‘ABC’ message that was created under Bush 2,” Mark Peterson of the Michigan Poz Action Coalition wrote in an email, referring to Abstinence, Be Faithful, use Condoms…

[T]here are many different definitions of monogamy. This assumes anyone in a polyamourous relationship or those who do not conform to a [C]hristian puritan relationship norm is at more risk —that is ONLY true if one of the partners has HIV to pass to someone else and that can happen between monogamous couples too.”

Indeed, a newly launched Website includes the prominent headings: “Focus on Abstinence,” “Focus on Monogamy,” and “Focus on Condoms.” And not all AIDS advocates think that’s such a bad thing.

Craig Covey, CEO of the Michigan AIDS Coalition in Ferndale, took a different tact on the new national AIDS/HIV plan “This seems to be it could be quite inclusive,” he said. “I think for all practical purposes, abstinence, monogamy and safe sex practices are good to talk about.”

After eight years in which the Bush administration trashed science to favor a political agenda, these blogger are saying that Kennedy would be a most injudicious choice, since he’s just as liable to politicize science as the other guys did, only from the left.

The crassest example was Kennedy’s error- and slander-filled “investigative” article in Rolling Stone magazine, in which he voiced the discredited claim that the Centers for Disease Control and drug companies had conspired to poison American children with the mercury-containing preservative thimerosal in vaccines.

During the campaign, anti-vaccine advocates asked Obama and Sen. John McCain to comment on whether they thought parents should have the right to skip vaccines they feared. McCain hemmed and hawed, while Obama said he thought children should get all the recommended vaccines. Obama apparently was influenced on this by his senior adviser Michael Strautmanis, who reportedly has an autistic child. Sources in the autistic parents’ community say that Strautmanis set Obama straight about the lack of any link between vaccines and autism.

If this is true, Kennedy would be a surprising choice.

Correction: The original version of this post should have listed Obama adviser Michael Strautmanis as having an autistic child, not David Axelrod. We regret the error.

The nonpartisan, nonprofit group issued a “report card” grading 15 federal agencies on their communication policies. Some agencies, it found,  “stifle communication” even if their policies encourage free speech. Other agencies simply have weak policies regarding communication with the media.

The Centers for Disease Control, for example, was found to have the best media policy, one that allows scientists to state personal views and review press releases about their own research. But the agency poorly implemented the policy.

According to the study released today, the agencies with the best communication policies, and which most effectively implemented them, were NASA, the National Institute of Standards and Technology (NIST) and the National Oceanic and Atmospheric Association (NOAA). The Union of Concerned Scientists has commended NASA for improving its media policy after a political appointee in the agency reportedly censored leading climate scientist James Hansen, director of NASA’s Goddard Institute for Space Studies.

The agencies with the worst policies include the Environmental Protection Agency, the Fish and Wildlife Service (within the Dept. of Interior), the Occupational Safety and Health Administration (OSHA) and the Consumer Product Safety Commission (CPSC).

The report card is below. The full report can be found here (pdf).