NEW HIV THERAPY

The World Health Organization’s new recommendation that people with HIV begin treatment with

antiretroviral drugs sooner rather than later doesn’t go far enough, according to a prominent immunologist at the University of California, San Francsico Medical Center.

On Sunday, the WHO changed its position on how long people should wait before they start taking ART, a trio of virus-fighting drugs known as the HIV cocktail. In 2010, the health experts said treatment should begin after the number of CD4 immune system cells dropped below 350 per cubic millimeter of blood. Now they say the threshold should be 500 cells per cubic mm of blood. The health agency estimated the change would increase the number of people eligible for ART from 9.7 million to 26 million and avert 3 million deaths by 2025, according to a statement.

But even that is not enough, said Dr. Arthur Ammann, who has been fighting the HIV epidemic since 1981.

Ammann said the new recommendations are dangerously limited. Instead of measuring a patient’s CD4 cell count, doctors should just begin treatment immediately following an HIV-positive diagnosis.

“You’re keeping people from going on treatment that are deserving of treatment,” he said. “They deserve to have antiretoviral drugs if they’re available.”

Anmmann’s views are in line with the recommendations of the U.S. Department of Health and Human Services.

But Dr. Monica Alonso, an HIV advisor for WHO and the Pan American Health Organization, replied that there is insufficient data to support Ammann’s recommendation.

“All WHO recommendations are based on evidence,” Alonso said in an email. “Currently there is no evidence to support a ‘test and treat’ approach to all patients.” She  added that WHO now recommends treatment for infected subpopulations, such as pregnant women, irrespective of CD counts.

Ammann has been treating people with HIV for more than 30 years. He co-diagnosed the first child with AIDS in San Francisco, an event he said “changed my career.” Around 2000, he decided to shift gears from the lab bench to the villages where HIV does the worst damage.

“Clinical research gave us the results we needed, but treatment wasn’t being implemented in the poorest regions of the world,” he said.

Ammann formed a non-profit organization called Global Strategies, whose mission is to provide ART to those countries most in need, such as Liberia, Zimbabwe, and the eastern Democratic Republic of the Congo.

These countries are also too impoverished to afford the CD4 cell-counting machines that are needed to make the diagnoses that fit the WHO’s recommendations. Even if they did have the machines, they couldn’t afford to provide patients with ART, he said.

Ammann suggests that the WHO’s guidelines are based on economics rather than medicine.

“They say these countries can’t afford to treat all of their patients, but that’s not really true,” he said. “Antiretroviral treatment used to cost $10,000 to 12,000 a year per patient, but now that same treatment costs $100.”

The WHO declined to respond to that charge, but emphasized that the testing guidelines were based on extensive input from outside experts around the world.

But Ammann said it’s still not enough.

“There’s never been an infectious disease or cancer in modern medical history where treatment has been withheld until the patient gets sicker,” he said. “You’re basically looking at the patient and saying, ‘I know you’re HIV-infected. I have medicine to treat you. But I’m going to let you progress to worsening of the disease until I give you the drug.’”

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Wayne Rooney not for sale, will remain at Manchester United

Manchester United’s new manager David Moyes addressed the media for the first-time since taking over at Old

Rooney

Trafford.

And it wasn’t your average press conference.

Hundreds of reporters, photographers and film crews packed into the event, as Moyes’ eagerly awaited first few words as United boss declared the clubs intent to keep hold of want-away striker Wayne Rooney.

“Wayne is not for sale. He is a Manchester United player and will remain a Manchester United player.”

Then when asked if Rooney has asked to leave, Moyes repeatedly mentioned how well Rooney is training and dodged the question. Never stating if the England international had asked to leave the club.

Moyes added that he has had several meetings with Wayne Rooney and his representatives and hopes he will become Manchester United’s record goalscorer one day.

“I see a glint in his eye. He looks happy, he looks like he will knuckle down and get himself right,” Moyes said. The new United boss also commented on Rooney’s form on the practice pitch. “He is training brilliantly well… I’m looking forward to working with him.”

And of course this won’t be the first time Moyes has managed Rooney, with the former Everton boss nurturing England’s top talent as a teenager.

“I have known Wayne since he was 16, when he was at Everton. It is a little bit of deja vu. He is training really well, he is coming back in good shape.”

So will Rooney really stay at United? Or is this just a ploy by Moyes and the club to up his price in the transfer market?

Both are likely, United are certainly not going to give up one of their biggest assets easily. But Moyes did not confirm that Rooney has either asked to leave the club or stated his intent that he wants to stay at Old Trafford.

That is the big factor here, what is the point of keeping an unhappy player at the club? United may not get the anywhere near the best out of him. So should they cash in?

But the news wasn’t all about Rooney, as Moyes discussed how he plans to manager United to more success in the coming years.

“All I can do is do what David Moyes has done before. I’ll continue the traditions of the club. I am very fortunate that I am taking over the champions of England and I do hope that I can do a great job here in time.”

However despite all the other updates from United’s new manager, the main news reverberating around the soccer world this afternoon will be that Wayne Rooney is not for sale and that Manchester United want to keep their prolific striker.

What Wayne Rooney thinks about that, well, that’s another matter entirely that I’m sure will come out in the coming days and weeks

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Bartoli routs Lisicki to win Wimbledon title

LONDON (Reuters) - Marion Bartoli overwhelmed an out of sorts Sabine Lisicki 6-1 6-4 on a sun-drenched Centre Court to win her first Wimbledon title on Saturday. 

Frenchwoman Bartoli, seeded 15th, took full advantage of a desperately nervous performance by her German opponent who knocked out defending champion Serena Williams in the fourth round.

Lisicki, the 23rd seed, broke Bartoli's serve in the opening game of the match but the Frenchwoman hit straight back and took advantage of 14 unforced errors by the German to secure the opening set in 31 minutes.

 Lisicki's booming serve never functioned smoothly and Bartoli, seeded 15th, kept the ball away from her dangerous forehand to move within one set of her first grand slam title.

Lisicki left the court to try to compose herself and held serve in the opening game of the second set but she wasted four break points in Bartoli's first service game and the Frenchwoman pounced to break for a 2-1 lead.

Struggling to hold back tears, Lisicki dropped her serve again to trail 4-1 and Bartoli had three match points at 5-1.

The German bravely saved them, however, and suddenly found her form, breaking Bartoli to trail 3-5 and holding serve comfortably to raise hopes of an unlikely comeback.

But the 28-year-old Bartoli regrouped and held serve to love, sealing her first grand slam title on her fourth match point with her sixth ace.

(Reporting by Ed Osmond)

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NSA leaks raise concerns on background checks

WASHINGTON (AP) — Before Edward Snowden began leaking national security secrets, he twice cleared the hurdle of the federal government's background check system — first at the CIA, then as a systems analyst at the National Security Agency.

Snowden's path into secretive national security jobs has raised concerns about the system that outsources many of the government's most sensitive background checks to an army of private investigators and pays hundreds of millions of dollars in federal contracts to companies that employ them.

"You can't outsource national security," said Robert Baer, a former CIA veteran who worked in a succession of agency stations in the Mideast. "As long as we depend on the intel-industrial complex for vetting, we're going to get more Snowdens."

The company with the biggest share of contracts is under a federal investigation into possible criminal violations involving its oversight of background checks, officials familiar with the matter told The Associated Press. They spoke on condition of anonymity because they were not authorized to discuss the investigation.

Even with fresh congressional scrutiny, the federal government appears wedded to the incumbent screening system. Nearly three-quarters of the government's background checks are done by private companies, and of those, more than 45 percent are handled by the U.S. Investigations Services, or USIS, according to the U.S. Office of Personnel Management, the agency overseeing most of the government's background checks.

USIS, which started out with 700 former government employees in 1996 and is now run by a private equity fund, dominates the background check industry, taking in $195 million in government payments last year and more than $215 million already this year.

The OPM turned to private security screeners in the late 1990s because of growing backlogs that were snarling the government's hiring process. A force of 2,500 OPM investigators and more than 6,700 private contract screeners has sliced into those backlogs, reducing the time it takes on average for background screening by 9 percent in 2010.

As of 2012, more than 4.9 million government workers held security clearances. Senior federal appointments are still carefully investigated by FBI agents, and the FBI and the CIA still maintain strong in-house screening staffs to vet their own sensitive positions.

But privatization efforts started during the Clinton administration keep farming out work to contractors. The Defense Department turned over its screening work to OPM in 2004 and even intelligence agencies that conduct their own investigations relegate some checks to private companies.

The OPM's success has come with mounting government expenditures. The average cost of a background investigation rose from $581 in 2005 to $882 in 2011, according to the Government Accountability Office. At the same time, a $1 billion "revolving fund" paid by federal agencies for most background checks has remained off-limits to outside audits. The White House pledged only recently to provide money for an inspector general's office audit of the fund in the 2014 budget.

The inspector general appointed to watch over the OPM, Patrick McFarland, said at a Senate hearing last month that there were problems with Snowden's most recent screening before he was hired to work for defense contractor Booz Allen Hamilton Inc. as an NSA computer systems analyst. McFarland did not specify the problems, but he said Snowden was screened and approved last year by USIS.

McFarland's office, aided by the Justice Department, is investigating whether USIS exaggerated the extent of its internal reviews of background checks, said two government officials who spoke on condition of anonymity because they were not authorized to discuss details of the two-year inquiry.

Ray Howell, a spokesman for USIS, declined to confirm or discuss the investigation. The company recently said in a statement that it was "not aware of any open criminal case against USIS." Howell did say the company "is cooperating and will work closely with the government to resolve the matter."

Sen. Claire McCaskill, D-Mo., cited the "criminal investigation" of USIS during a June 21 hearing by a Senate Homeland Security and Governmental Affairs subcommittee. Drew Pusateri, a staff spokesman, said McCaskill "stands by her characterization to the subcommittee that we were informed the company is the target of criminal investigation." McCaskill and other senators are pressing for more answers on Snowden's screenings and USIS' performance.

The Washington Post reported that the investigation is focused on whether USIS skipped mandatory internal reviews for at least half its cases between 2008 and 2012 and did not notify the OPM. USIS said it performed nearly 2 million background checks for the government in 2011 alone. The Post also reported, citing anonymous sources, that McFarland's office is considering advising the OPM to sever its massive government contract with USIS.

USIS is one of three top security companies — the others are KeyPoint Government Solutions Inc. and CACI Premier Technology Inc. — working under a five-year contract with the OPM worth a total of $2.4 billion.

The inquiry into USIS' conduct is unusual in its focus on an entire company, but law enforcement authorities repeatedly have zeroed in on individual background check investigators in recent years for falsifying reports. At least seven private contract and 11 government investigators have been convicted since 2005, authorities said. Currently, authorities are probing nearly 50 separate cases of alleged falsification by screeners.

The prosecutions have included a young CIA background investigator sentenced to two months in jail in 2010 for fabrications in 80 different reports, and two USIS screeners convicted separately in January and in April for making false statements in background check reports. One convicted USIS screener, Bryan Marchand, had not conducted the interview or obtained the record in more than four dozen reports he submitted to federal agencies, according to the U.S. attorney's office in Washington.

But even as Congress raises alarms about background check problems, it still pushes for speedier screenings. The OPM said the only realistic response is using more workers from private companies.

"Our contractor workforce permits us to expand and contract operations as the workload and locations dictate," said Merton Miller, OPM's associate director of investigations, during a congressional hearing last month.

A series of spot checks on the OPM's screening system in 2009 and 2010 by McFarland's office hinted at lapses by USIS and other private companies. The inspector general warned the OPM that USIS did not flag misconduct issues to OPM within the required time frame.

When OPM was warned that contractors weren't double-checking that documents were valid, the agency responded by modifying its requirement to eliminate the record-check requirement.

A spokeswoman for OPM, Lindsey S. O'Keefe, said the agency adopted 12 of 14 recommendations for improvements.

Baer, who underwent numerous screenings as a CIA operative and whose wife once worked as a background investigator, said that private contract screeners are often paid low wages and pressured by their bosses to meet crushing deadlines — working conditions that could lead to sloppy investigations and cover-ups. Several former background investigators have sued government contractors in recent years for lost overtime and other wages.

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Cautious toward Middle East, Obama gets second chance in Egypt

By Steve Holland and Tabassum Zakaria

WASHINGTON (Reuters) - When President Barack Obama sat down with his top national security aides this week to determine how to react to a military takeover in Egypt, he had a tough choice to make.

He could denounce what had taken place as a coup launched against a legitimately elected president in Cairo and suspend U.S. military aid. Or he could embrace the move as a reaction to popular discontent with the Muslim Brotherhood-controlled government.

That he chose a middle ground, urging a swift return to civilian government and ordering a U.S. review of aid, reflected fear among his advisers that to publicly take sides could help to fuel violence by allowing militants to cite American interference, and that a balanced reaction was needed to maintain diplomatic flexibility.

But it also said a lot about Obama's approach to the Arab Spring: Tread carefully without carrying a big stick.

Obama's play-it-safe style of diplomacy, a reaction to a war in Iraq that he feels should never have been fought, has allowed him to prevent putting further American troops in danger. It has also left him open to criticism that he has let festering disputes in the region languish, gotten involved too late to shape events and in the process ceded Washington's traditional Middle East clout.

And not being seen to condemn a military overthrow of a democratically elected government could also undermine U.S. officials when they preach about the importance of human rights and democratic reforms elsewhere.

The revelations by former U.S. spy agency contractor Edward Snowden about allegedly extensive secret surveillance by the United States of the citizens and governments of foreign countries, both allies and those not so close, has already hurt the U.S. image abroad in recent weeks.

Obama's national security aides on Thursday pressed Egyptian officials to move quickly to a democratic government after the military takeover that ousted President Mohamed Mursi, the White House said on Thursday.

"Members of the president's national security team have been in touch with Egyptian officials and our regional partners to convey the importance of a quick and responsible return of full authority to a democratically elected civilian government as soon as possible," a White House statement said.

Elsewhere in the Middle East, the United States participated - with reservations - in the coalition effort that led to Muammar Gaddafi's ouster in Libya. But Obama has taken a cautious approach to Syria's civil war, where more than 100,000 people have died and hundreds of thousands have fled as refugees.

He has let France, Britain, Turkey and U.S. Arab allies take the lead and reluctantly agreed last month to send light arms to Syrian rebels.

"It is very easy to slip-slide your way into deeper and deeper commitments," the president told PBS anchor Charlie Rose in justifying his cautious approach to Syria.

"President Obama has demonstrated this persistent detachment as it relates to the unraveling in the Middle East. And I keep thinking there are these key inflection points over the last couple of years that would make it impossible for him to be so detached, but I've been proven wrong every time," said Dan Senor, who was Republican presidential nominee Mitt Romney's top foreign policy campaign adviser last year.

Only the longest-running drama in the Middle East, the Israeli-Palestinian conflict, is getting maximum attention by U.S. diplomats, with Secretary of State John Kerry in the midst of shuttle diplomacy there and hopeful the two sides will get into direct talks at long last.

Publicly at least, Obama has yet to get personally involved in Kerry's effort.

ANOTHER SHOT?

While U.S. officials reject any suggestion they have not paid enough attention to the Middle East, there is no doubt that the Obama administration has been in the midst of a pivot toward the Asia-Pacific region and preoccupied with events at home, from overhauling U.S. immigration laws to expanding healthcare.

And White House officials, no doubt reflecting their boss' stance, frequently speak of the limits of U.S. ability to shape home-grown Arab revolutions that have swept North Africa, Syria and Yemen.

Mursi's overthrow in Egypt offers what amounts to a second chance for Obama, whose withdrawal of U.S. backing helped ease long-time President Hosni Mubarak from power in 2011 in the face of massive street protests. Washington then prodded Egyptian parties to embrace democracy.

Obama could, for example, increase U.S. non-military assistance - now only about $250 million of the total $1.5 billion Cairo gets annually - and send envoys to help advise on a transition back to civilian rule.

But to what extent Egyptians will listen to the American side remains an open question.

"In Egypt right now it's hard for the United States to be very hands-on because Egyptians universally feel the stakes are remarkably high, so the willingness to listen to external voices, the ability to rise over the storm of Egyptian politics is very hard," said Jon Alterman, director of the Middle East program at the Center for Strategic and International Studies think tank.

American officials had been aware that Egypt was on the brink of trouble based on the growing numbers showing up to protest Mursi's government. Washington had grown frustrated that the Egyptian leader seemed unable to make critical political and economic decisions, even when it involved the arguably lenient conditions tied to an aid program from the International Monetary Fund.

There had been some consideration of whether U.S. officials should call on the Muslim Brotherhood to have a meeting to figure out a path forward for Egypt's government and get some stronger people around Mursi to help him.

All that fell apart when the crowds surged and the military moved in.

The Obama administration might have misjudged the public mood when the U.S. ambassador to Egypt, Anne Patterson, said recently that street demonstrations were not the way to bring about change. Her remark was interpreted by many in Egypt as backing Mursi. She was ridiculed in signs hoisted around Cairo.

"Instead of coming out much earlier and firmer on the issue of Muslim Brotherhood democratic transgressions, they sent a very confused message. They sent the message that we were essentially backing and supporting the Mursi government and that has undermined our credibility," said Aaron David Miller, who served six U.S. secretaries of state as a Middle East expert.

U.S. officials said a full reading of Patterson's remarks makes clear she was not taking sides in Egyptian politics.

Any perceived missteps on Egypt thus far do not appear to be causing Obama trouble at home. Members of Congress from both sides of the aisle are holding back from attacking the president and instead focusing their ire at the Muslim Brotherhood, which they feel bungled the chance to solidify democracy there.

"It is so sad that the promise of the Egyptian Arab Spring was not fulfilled by the Egyptian Muslim Brotherhood. Let us hope that the next steps in Egypt's transition are truly reflective of the hopes and dreams of the vast majority of the Egyptian people," said Democratic Senator Barbara Boxer of California.

(Additional reporting by Patricia Zengerle. Editing by Warren Strobel and Philip Barbara)

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