Home HIV Test -- No 'Live' Counselor

Dan Nainan had never heard of a home test for HIV until a prospective girlfriend insisted that he take one. Apparently, she didn't trust him.
"I'm not some sleaze bag, but she's really suspicious," said Nainan, 31, who works as a comedian. "I'm like, 'Come on, you're kidding me.'"
The test became a sticking point in their budding relationship. "I didn't feel I had anything to be worried about," Nainan said, "but she didn't want to proceed."
He finally gave in and took the test his girlfriend foisted on him, certain he'd test negative. He swabbed his gums -- the test works on saliva -- put the test swab in a test tube and waited as his girlfriend grilled him about his sexual history.
"It was a bit uncomfortable," Nainan said.
Ten tense minutes passed as he watched a deep-pink line appear slowly in a tiny window on the testing device. He prayed it wouldn't be joined by a second line signaling a positive result, and wondered what he'd do if it did emerge.
"I felt like I was taking a pregnancy test," Nainan said.
Do-it-yourself home testing for HIV, the virus that causes AIDS, has arrived.
The OraQuick In-Home HIV Test -- the only one approved for over-the-counter use by the Food and Drug Administration that captures testing and results in one sitting -- hit drug-store shelves two months ago. An earlier HIV home test -- called Home Access -- required a user to prick a finger with a spring-loaded lancet, collect a drop of blood on a test card, mail it to a lab and call in one to seven days for the results.
"This was actually quite easy and painless," Nainan said of the OraQuick test. "It's so much better than what you used to have to do."
Aimed at those who might have avoided getting tested in the past either out of, fear, stigma, worries over confidentiality or inconvenience, the new home test has been hailed as a breakthrough.
"It's hard not to be fully enthusiastic about the test," said Dr. Myron Cohen, director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill. "Everything we do to increase testing has to have some degree of benefit. By identifying and treating people early, we preserve normal life span and excellent health and reduce contagion."
But the new home test, which sells for about $40 and can also be bought online, has generated its share of hand-wringing, too.
"We generally like this thing," said Dan Tietz, executive director of the research and advocacy group AIDS Community Research Initiative of America, or ACRIA. "It decreases some of the barriers to testing. It kind of puts HIV in front of people, but there's a bunch of cautions."
For one, there's what Tietz called the "freaking out by themselves problem" -- for the first time, there's no live counselor present -- not even a voice over the phone -- to deliver the results, offer support and make referrals.
Nainan tested negative for HIV, as he expected he would. Despite some sweat as he waited out the 20 minutes staring at the test window, "I really wasn't nervous," he said.
But for home-testers less certain of their HIV status, or who receive an unexpected result, the do-it-yourself route could be overwhelming, Tietz said. "I think about a young person with very little experience with the health care system who might pick up this test," he added.
Tony Martinez, 40, who works in New York's fashion district, took the home test as an "experiment." "If I didn't know I wasn't HIV positive, the test would be a different ballgame. I put myself back many years ago when I went to a clinic and took the test and was terrified. [The home test] was a lot of steps. I don't think I would have followed the directions in that [terrified] state. Am I really going to read the manual "What Your Results Mean" if the test is positive? It's like asking someone to read a drivers' ed manual after an accident."
In lieu of an in-person counselor, OraSure Technologies, which makes the OraQuick test that the FDA approved in July -- has set up a toll-free 24/7 customer support center with bilingual reps (English-Spanish). They're not certified counselors but have been trained to answer questions about HIV/AIDS, explain how the test works and what the results mean. They can also hook up callers to counseling and care, using the CDC National Prevention Information Network and the HIV Medicine Association, and can also transfer callers directly to a health care professional or agency, said Ron Ticho, senior vice president for corporate communications at OraSure.
"Our representatives go through more than 160 hours of training," Ticho said. Test kits come with instructions, warnings and precautions. Home-testers can find the same test information on OraSure's website, along with the same referral databases the call center uses.
But handing concerns about HIV over to a toll-free number has raised questions.
Much is made of the fact that without a counselor present, even with warnings on the box and inserts and brochures written for a seventh- to eighth-grade reading level, home-testers might not understand that, as with all HIV tests, regardless of the testing method, a positive result is preliminary and needs to be confirmed by a more specific test given at an HIV test site.
This is especially worrying with the home test because although the OraQuick test is the same rapid test that medical professionals have used at testing sites since 2004, it loses some of its accuracy in the hands of consumers: The percentage of results that will be accurately positive drops from 99.3 at a testing site to 92.9 when do-it yourselvers test themselves at home: This means that about one person in 12 could get a false negative.
Another stumbling block is the "window period" -- the time it takes, usually 12 weeks, for the body to develop the antibodies the test detects after exposure to HIV, giving some people a "false sense of safety" that they're HIV negative when they are in fact HIV positive and at their most contagious.
"That's always a huge, really important piece of counseling," said Barbara Adler, manager of HIV counseling and testing at the AIDS Alliance Project at the University of California at San Francisco, where the first HIV test was given 27 years ago.
But, Adler said, sometimes people who received a preliminary positive result didn't return for the results from the confirming test.
"So I don't know if sitting with another human being when they're getting a result is going to help that. I think the person who wants the physical presence of someone else probably won't do the home test.
"There's reasons, though, for wanting to test alone in your home. While the stigma is not like it was 30 years ago," Adler said, "it's still there and can be heavy. It's a disease around sex, or around needle use. Who wants to talk about those things? It's not like we're talking about cholesterol, or something you got because you ate certain foods or got too much sun."
OraSure emphasizes that its HIV home test is simply an additional option to the testing already available -- which often comes free -- at public health clinics, community service organizations and doctors' offices.
"We know that there's a lot of individuals who should be getting tested but aren't, and this is another opportunity for them to do so," OraSure's Ticho said. "Is it the right option for everyone? Probably not."
Nevertheless, with an HIV diagnosis no longer sounding a death knell, it could be a test whose time has come.
"The tide has really turned on HIV testing," said Dr. Rochelle Walensky, co-director of the Medical Practice Evaluation Center and an AIDS researcher at Massachusetts General Hospital in Boston.
"It's a lot more streamlined, and there's not a lot of counseling required now. Treatment is available, and there's a lot of literature that says that life expectancy is up to near normal if people engage in care early and take care of themselves.
"There are cancers, and many, many other diseases that have far worse outcomes than HIV that people deal with on their own without a lot of counseling."
Of the 1.2 million Americans living with HIV in the United States, the Centers for Disease Control and Prevention estimates that 20 percent don't even know that they're infected and account for more than half of the 50,000 new infections a year in the United States.
Whether people most at risk -- African-American gay-bisexual men, especially those between the ages of 13 and 24, according to the CDC -- will have the money and motivation to go to the drug store and pay $40 for the home test is another question, Walensky said.
Even if they have the $40 to spend on an HIV home test, many won't be able to buy it anyway, because the OraQuick home test cannot be sold to anyone younger than 17, and requires ID.
"Any availability of any test anywhere is a good thing," Walensky said. "Whether this is going to be an epidemic game-changer is where I have to opt out.

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Germany passes law to protect circumcision after outcry

BERLIN (Reuters) - German politicians passed a law on Wednesday to protect the right to circumcise infant boys in a show of support for Muslims and Jews angered by a local court ban on the practice in May.
The ban - imposed on the grounds that circumcision amounted to "bodily harm" - triggered an emotional debate over the treatment of Jews and other religious minorities, a sensitive subject in a country still haunted by its Nazi past.
The outcry prompted Germany's centre-right government and opposition parties to draw up legislation confirming the practice was legal - overruling the decision by a court in the western city of Cologne.
The new law passed by an overwhelming majority in Bundestag lower house said the operation could be carried out, as long as parents were informed about the risks.
Jewish groups welcomed the move.
"This vote and the strong commitment shown ... to protect this most integral practice of the Jewish religion is a strong message to our community for the continuation and flourishing of Jewish life in Germany," said Moshe Kantor, President of the European Jewish Congress.
Germany's Catholic Bishops Conference said it hoped the bill would help safeguard religious freedoms. No comment was immediately available from the country's Central Council of Muslims.
PAIN MINIMISED
The May ruling centered on the case of a Muslim boy who bled after the procedure and the ban only applied to the area around Cologne.
But some doctors in other parts of Germany started refusing to carry out circumcisions, saying it was unclear whether they would face prosecution.
Under the new law, a doctor or trained expert must conduct the operation and children must endure as little pain as possible, which means an anesthetic should be used. The procedure cannot take place if there is any doubt about the child's health.
Justice Minister Sabine Leutheusser-Schnarrenberger said no other country in the world country had made the religious circumcision of boys an offence.
"In our modern and secular state, it is not the job of the state to interfere in children's' upbringing," she said.
Child welfare group Deutsche Kinderhilfe disagreed, saying the government had "(pushed) through the legalization of the ritual of genital circumcision ... against the advice of child right campaigners and the medical profession."

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Nation’s First Sex-Ed Standardized Testing Shows Students’ Gaps

The District of Columbia has released results for the nation’s first-ever standardized test that includes sex-education, showing that fifth- and eighth-graders have a lot to learn about their bodies.
The test, known as the 2012 District of Columbia Comprehensive Assessment System (DC CAS), was administered to fifth-graders, eighth-graders and high school students throughout the city. Results were posted today, and show that even though students answered an average of 62 percent of questions correctly, they have work to do.
“The results that we received will be very helpful in determining the improvements needed to be made for teacher professional development training and create challenging material that can further student’s  interest and knowledge in personal health,” Ayan Islam, communications specialist for the Office of the State Superintendent of Education, told ABC News.
Islam says the test is part of landmark state legislation passed in 2010, requiring agencies to provide more in-depth reporting and engagement of various community stakeholders with different interests.
More than 11,000 students from fifth-grade through high school were enrolled in health courses and then selected to take the 50-question exam in April. The exam measured students’ knowledge in health-related categories, including wellness, disease prevention, physical education and healthy decision-making.
“Fifth-graders seem to know a lot more when it comes to recognizing their own personal health,” Islam said. “When it comes to general knowledge and physical education on alcohol, tobacco and drugs, they have a slight idea, but may not be exposed enough to give them an awareness to be prepared when they are exposed to those things.”
Sample questions included a discussion on a healthy pregnancy to steps students should take to maintain a healthy diet.
In this sample question, administrators asked fifth-graders about disease prevention.
Fifth-Grade
Health Strand 1: Students comprehend concepts related to health promotion and disease prevention.
Health Standard 5.1.7: Define STIs [sexually transmitted infections] and HIV/AIDS; describe behaviors that place one at risk for HIV/AIDS, STIs, or unintended pregnancy; and explain why abstinence is the most effective way to prevent disease or pregnancy.
Example Item:
People can get HIV/AIDS by –
Touching a person who has HIV/AIDS
Sitting beside a person on the Metro who has HIV/AIDS
Having sexual intercourse with a person who has HIV/AIDS
Sharing drinks or utensils with a person who has HIV/AIDS
Fifth-graders scored 66 percent overall in the disease-prevention portion.
“Engaging students in health-based learning is an area our agency is committed to addressing every single day,” State Superintendent Hosanna Mahaley Jones said in a news release.
Jones added that the city has ranked first nationally in childhood summer nutrition for eight consecutive years.
Overall, in human body and personal health, fifth-graders scored 44 percent while eighth-graders scored 58 percent.
“Given the importance of wellness and physical education, the 2012 DC CAS findings allow us to establish the baseline indicators, subject and skill-specific instruction needed to align student’s knowledge at all ages to the standards required of them to live safe and healthy lifestyles,” Jones said.
Results were presented at the D.C. Council’s Committee of the Whole and the Committee on the Environment, Public Works and Transportation hearing for “The Implementation of the Healthy Schools Act of 2010″ and “The District’s Environmental Literacy Plan” today and are being further analyzed.

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A lesson in pop culture via Guantanamo

SAN JUAN, Puerto Rico (AP) — An Afghan man who is being held with the most significant terrorism suspects in U.S. custody has apparently gained extensive knowledge of western pop culture in an unlikely place: the top secret prison-within-a-prison in Guantanamo Bay.
Nearly five years ago, Mohammed Rahim al-Afghani became the last prisoner sent to Guantanamo. He was accused of helping Osama bin Laden elude capture, and the CIA had interrogated him for months at an undisclosed location before he was locked away in Guantanamo's Camp 7, a prison unit shrouded in secrecy that holds about 15 men who have been designated "high value" detainees by the U.S. government.
With no court appearances, or even charges filed, nothing was heard from Rahim and he has remained largely a mystery. So, it was a surprise when his lawyer, Carlos Warner, released letters from the detainee described by the head of the CIA as a "tough, seasoned jihadist." More surprising still was the content: quirky notes peppered with references to Howard Stern, Fox News and the global video hit of South Korean singer PSY.
"Dear Mr. Warner," he wrote. "I like this new song Gangnam Style. I want to do the dance for you but cannot because of my shackles."
In another letter, the multilingual Rahim shows some familiarity with American slang. He tells his lawyer, most likely in jest, that he has adopted a banana rat, a rodent commonly spotted around the U.S. base in Cuba. "Tell the guards to leave my friend alone. They need to chillax."
It's hardly what one would expect from a middle-age Afghan who has never been to the U.S. While there is still little public information about Rahim, the letters provide some insight into the man — and suggest that the prisoners in Camp 7, a group that includes five charged with aiding and orchestrating the Sept. 11 terror attack, are not completely isolated from the outside world.
To Warner, a federal public defender for the Northern District of Ohio, the letters humanize a man who he contends has been demonized by U.S. authorities, who allege he worked as a translator and assistant to bin Laden and other al-Qaida leaders. The lawyer says the letters demonstrate a surprising amount of resilience.
"It shows he's different and he's intelligent," Warner said. "Just think that he's doing this under all the restrictions that's he's under down there. He has an incredibly good sense of humor."
There have been letters released to the media in the past from other detainees at Guantanamo, often providing valuable information about a prison that will have been open for 11 years on Jan. 11. Sami al-Haj, an Al-Jazeera journalist when he was captured and sent to Guantanamo, provided detailed accounts of a hunger strike before he was eventually released. Shaker Aamer, the last resident of Britain still held at the prison, has given an insider's view on confinement conditions.
Rahim's are different because he is in Camp 7, and the content departs so sharply from what one might expect from a jihadist. "I want you to contact Amanda Palmer," he wrote Nov. 6, referring to the American singer. "... Ask her to write a song about me and my family."
Warner and U.S. officials are prohibited from publicly discussing Rahim's life and the allegations against him, but the broad outlines are in a public document filed in federal court by the government in response to Warner's filing of a civil writ of habeas corpus seeking the prisoner's release.
The document says Rahim is about 47 and was born in eastern Afghanistan. He fled with his family over the border to Pakistan when the Soviet Union invaded in 1979. Rahim has told authorities that he returned temporarily to fight the invaders, a war that killed two of his brothers, and moved back permanently once they retreated from the country.
A younger brother, Abdul Basit, told The Associated Press in London, where he is seeking asylum, that Rahim eventually got a job working for an Afghan government committee responsible for eradicating opium poppies, but that he was forced from the job by members of the Taliban, the Islamic fundamentalist movement that emerged in the 1990s.
Basit, who was detained by the U.S. military for five years in Afghanistan, says his brother is a well-educated man who was not particularly interested in global politics. He suggests his brother is being held more for who he might know rather than what he has done. "There is no reason to put him in Guantanamo for this long time," Basit said in broken English.
The Justice Department document says Rahim began helping the Taliban in the 1990s and that job morphed into working for al-Qaida. It cites two other prisoners and an undisclosed source identifying Rahim as a close associate of bin Laden. Rahim was captured in Pakistan in 2007 and turned over to the CIA, in whose custody he was subjected to prolonged sleep deprivation. He was transferred to Guantanamo in March 2008.
In photos taken by the Red Cross at Camp 7, and obtained by the AP from the prisoner's family in Afghanistan, Rahim has a long flowing beard. In one, he smiles broadly at the camera.
The first letters from Rahim released by Warner were in June, including one in which he disclosed that Majid Khan, a former Maryland resident who pleaded guilty to aiding al-Qaida, had acquired a cat at Camp 7, which AP reported at the time. The Pentagon and prison officials declined comment and said they could not discuss conditions of confinement for high-value detainees, although they added that prisoners are not permitted to have pets.
The rest of the letters came during or after subsequent visits by Warner, who had them cleared by the military before releasing them to the AP. None are more than a few sentences, and contain many typographical errors, which have been corrected for this story for the sake of clarity.
In one, Rahim returns to the theme of his fellow prisoner's alleged cat. "I want a dog," he writes. "I will train my dog to chase Majid Khan's cat."
In separate notes, he asks Warner to appeal for help from radio personality Howard Stern. "If he is the 'King of All Media' he can help me."
In another, he criticizes Fox News' "Fair and Balanced" slogan, writing that if that were true the channel "would not have to say it every five minutes."
How he came by this information is not clear. A prison spokesman, Navy Capt. Robert Durand, won't discuss life in Camp 7 but he says that "where satellite television and radio is available for detainees," they have access to a wide variety of channels in Arabic, Farsi, English, Russian, Spanish and other languages. The line-up, however, apparently does not include Howard Stern or Fox.
With no Internet access, he could have picked up such information from other shows or through Warner, who has spent hours with him and delivered magazines such as Rolling Stone, Sports Illustrated and The Economist.
The U.S. military will not say when or if Rahim will be charged. His name does not appear on the list of detainees who have been cleared for release from Guantanamo and his name was not among those mentioned as possible candidates for an exchange with the Taliban as part of a peace deal.

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Chavez suffers new complications in cancer fight

CARACAS, Venezuela (AP) — President Hugo Chavez's new complications after cancer surgery prompted his closest allies to call for Venezuelans to pray for him on Monday, presenting an increasingly bleak outlook and prompting growing speculation about whether the ailing leader has much longer to live.
Vice President Nicolas Maduro looked weary and spoke with a solemn expression as he announced in a televised address from Havana on Sunday that Chavez now confronts "new complications" due to a respiratory infection nearly three weeks after his operation. He described Chavez's condition as delicate.
The streets of Caracas were abuzz on Monday with talk of Chavez's increasingly tough fight, while the news topped the front pages of the country's newspapers.
"He's history now," said Cesar Amaro, a street vendor selling newspapers and snacks at a kiosk in downtown Caracas. He motioned to a daily on the rack showing side-by-side photos of Maduro and National Assembly President Diosdado Cabello, and said politics will now turn to them.
Amaro said he expects a new election soon to replace Chavez. "For an illness like the one the president has, his days are numbered now," he said matter-of-factly.
In Bolivar Plaza in downtown Caracas, Chavez's supporters strummed guitars and read poetry in his honor on New Year's Eve. They sang along with a recording of the president belting out the national anthem.
About 300 people filled a Caracas church for a Mass to pray for Chavez.
"This country would be terrible without Chavez. He's the president of the poor," said Josefa Carvajal, a 75-year-old former maid who sat in the pews. "They say the president is very sick. I believe he's going to get better."
The president's aides held a Mass at the presidential palace, while government officials urged Venezuelans to keep their president in their prayers.
Political analyst Ricardo Sucre said the outlook for Chavez appears grim, saying Maduro's body language during his televised appearance spoke volumes.
"Everything suggests Chavez's health situation hasn't evolved as hoped," Sucre said. He said Maduro likely remained in Havana to keep close watch on how Chavez's condition develops.
"These hours should be key to having a more definitive prognosis of Chavez's health, and as a consequence make the corresponding political decisions according to the constitution," Sucre said.
Sucre and other Venezuelans said it seems increasingly unlikely that Chavez would be able to be sworn in as scheduled on Jan. 10.
The Venezuelan leader has not been seen or heard from since undergoing his fourth cancer-related surgery Dec. 11, and government officials have said he might not return in time for his inauguration for a new six-year term.
If Chavez dies or is unable to continue in office, the Venezuelan Constitution says that a new election should be held within 30 days.
Before his operation, Chavez acknowledged he faced risks and designated Maduro as his successor, telling supporters they should vote for the vice president if a new presidential election were necessary.
Chavez said at the time that his cancer had come back despite previous surgeries, chemotherapy and radiation treatment. He has been fighting an undisclosed type of pelvic cancer since June 2011.
Maduro said on Sunday that he had met with Chavez. "We greeted each other and he himself referred to these complications," Maduro said, reading from a prepared statement.
"The president gave us precise instructions so that, after finishing the visit, we would tell the (Venezuelan) people about his current health condition," Maduro said. "President Chavez's state of health continues to be delicate, with complications that are being attended to, in a process not without risks."
Maduro was seated alongside Chavez's eldest daughter, Rosa, and son-in-law Jorge Arreaza, as well as Attorney General Cilia Flores. He held up a copy of a newspaper confirming that his message was recorded on Sunday.
"Thanks to his physical and spiritual strength, Comandante Chavez is facing this difficult situation," Maduro said.
Maduro said he had met various times with Chavez's medical team and relatives. He said he would remain in Havana "for the coming hours" but didn't specify how long.
Maduro, who arrived in Havana on Saturday for the sudden and unexpected trip, is the highest-ranking Venezuelan official to see Chavez since the surgery in Cuba, where the president's mentor Fidel Castro has reportedly made regular visits to check on him.
Before flying to Cuba, Maduro said that Energy Minister Hector Navarro would be in charge of government affairs in the meantime.
"The situation does not look good. The fact that Maduro himself would go to Cuba, leaving Hector Navarro in charge only seems understandable if Chavez's health is precarious," said David Smilde, a University of Georgia sociologist and analyst for the Washington Office on Latin America think tank.
Smilde said that Maduro probably made the trip "to be able to talk to Chavez himself and perhaps to talk to the Castros and other Cuban advisers about how to navigate the possibility of Chavez not being able to be sworn in on Jan. 10."
"Mentioning twice in his nationally televised speech that Chavez has suffered new complications only reinforces the appearance that the situation is serious," Smilde said.
Medical experts say that it's common for patients who have undergone major surgeries to suffer respiratory infections and that how a patient fares can vary widely from a quick recovery in a couple of days to a fight for life on a respirator.
Maduro's latest update differed markedly from a week ago, when he had said he received a phone call from the president and that Chavez was up and walking.
The vice president spoke on Sunday below a picture of 19th century independence hero Simon Bolivar, the inspiration of Chavez's leftist Bolivarian Revolution movement.
Maduro said that Chavez had sent year-end greetings to his homeland and a "warm hug to the boys and girls of Venezuela."
The vice president expressed faith that Chavez would "successfully fight this new battle." He concluded his message saying: "Long live Chavez."
On the streets of Caracas, images of Chavez smiling and saluting are emblazoned on campaign signs and murals. One newly painted mural reads: "Be strong, Chavez."
State television played video of Chavez campaigning for re-election, including a speech when he shouted: "I am a nation!"
A new government sign atop a high-rise apartment complex reads: "YOU ALSO ARE CHAVEZ."
Chavez has been in office since 1999 and was re-elected in October, three months after he had announced that his latest tests showed he was cancer-free.
Opposition politicians have criticized a lack of detailed information about Chavez's condition, and last week repeated their demands for a full medical report.
Information Minister Ernesto Villegas defended the government's handling of the situation, saying during a televised panel discussion on Sunday night that Chavez "has told the truth in his worst moments" throughout his presidency.
He also referred to a new surge of rumors about Chavez's condition and called for respect for the president and his family.
Chavez's daughter Maria, who has been with the president since his surgery, said in a message on her Twitter account: "Thank you people of Venezuela. Thank you people of the world. You and your love have always been our greatest strength! God is with us! We love you!"
Chavez's son-in-law Jorge Arreaza, who is the government's science minister and has been with the president in Cuba, urged Venezuelans in a Twitter message Monday night not to believe "bad-intentioned rumors" circulating online. "President Chavez has spent the day calm and stable, accompanied by his children," Arreaza said in the message.
Some who stood in the Caracas plaza on Monday night held pictures of the president. Speaking to the crowd, lawmaker Earle Herrera said that Chavez "is continuing to fight the battle he has to fight."
"He's an undefeated president, and he'll continue to be undefeated," he said.

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Venezuelans offer prayers, songs for Hugo Chavez

CARACAS, Venezuela (AP) — Venezuelans gathered on plazas and in churches to pray for President Hugo Chavez amid what seems an increasingly gloomy outlook for the ailing leader in his fight against cancer.
Following an announcement that Chavez had suffered "new complications" from a respiratory infection after undergoing cancer surgery in Cuba, people were out in the streets of Caracas on Monday talking about the leftist president's chances of surviving.
"He's history now," said Cesar Amaro, a street vendor selling newspapers and snacks at a kiosk downtown. He motioned to a daily on the rack showing side-by-side photos of Vice President Nicolas Maduro and National Assembly President Diosdado Cabello, and said politics will now turn to them.
The vendor said he expected a new election soon to replace Chavez, who won re-election in October. "For an illness like the one the president has, his days are numbered now," Amaro said.
In Bolivar Plaza in downtown Caracas, Chavez's supporters strummed guitars and read poetry in his honor on New Year's Eve. They sang along with a recording of the president belting out the national anthem.
About 300 people filled a Caracas church for a Mass to pray for Chavez.
"This country would be terrible without Chavez. He's the president of the poor," said Josefa Carvajal, a 75-year-old former maid who sat in the pews. "They say the president is very sick. I believe he's going to get better."
Chavez's aides held a Mass at the presidential palace, while government officials urged Venezuelans to keep their leader in their prayers.
Some who stood in Bolivar Plaza held pictures of Chavez. Speaking to the crowd, lawmaker Earle Herrera said that Chavez "is continuing to fight the battle he has to fight."
"He's an undefeated president, and he'll continue to be undefeated," Herrera said.
Political analyst Ricardo Sucre said the outlook for Chavez appeared grim. Noting that Maduro appeared weary during a solemn televised appearance Sunday night to announce the latest setback for Chavez, Sucre said that spoke volumes about the situation.
"Everything suggests Chavez's health situation hasn't evolved as hoped," Sucre said. He said Maduro likely remained in Havana to keep close watch on how Chavez's condition develops.
"These hours should be key to having a more definitive prognosis of Chavez's health, and as a consequence to making the corresponding political decisions according to the constitution," Sucre said.
Sucre and other Venezuelans said it seems increasingly unlikely that Chavez would be able to be sworn in as scheduled Jan. 10 for his new term.
The Venezuelan leader has not been seen or heard from since undergoing his fourth cancer-related surgery on Dec. 11, and government officials have said he might not return in time for his inauguration for a new six-year term.
If Chavez dies or is unable to continue in office, the Venezuelan Constitution says that a new election should be held within 30 days.
Before his operation, Chavez acknowledged he faced risks and designated Maduro as his successor, telling supporters they should vote for the vice president if a new presidential election were necessary.
Chavez said at the time that his cancer had come back despite previous surgeries, chemotherapy and radiation treatment. He has been fighting an undisclosed type of pelvic cancer since June 2011.
"The situation does not look good," said David Smilde, a University of Georgia sociologist and analyst for the Washington Office on Latin America think tank.
"Mentioning twice in his nationally televised speech that Chavez has suffered new complications only reinforces the appearance that the situation is serious," he added.
Smilde said Maduro probably made the trip "to be able to talk to Chavez himself and perhaps to talk to the Castros and other Cuban advisers about how to navigate the possibility of Chavez not being able to be sworn in on Jan. 10."
Medical experts say that it's common for patients who have undergone major surgeries to suffer respiratory infections and that how a patient fares can vary widely from a quick recovery in a couple of days to a fight for life on a respirator.
On the streets of Caracas, images of Chavez smiling and saluting are emblazoned on campaign signs and murals. One newly painted mural reads: "Be strong, Chavez."
Venezuelans rang in the New Year as usual with fireworks raining down all over the capital of Caracas. But one government-organized outdoor party that had been scheduled in Bolivar Plaza with a lineup of Venezuela bands was canceled due to Chavez's precarious condition.
State television played video of Chavez campaigning for re-election, including a speech when he shouted: "I am a nation!"
A new government sign atop a high-rise apartment complex reads: "YOU ALSO ARE CHAVEZ."
Norelys Araque, who was selling holiday cakes on a sidewalk Monday, said she has been praying for Chavez. But, she added, "I don't think he will last long."
Araque said that her family has benefited from state-run subsidized food markets and education programs started by Chavez, and that she hopes the government carries on with the president's programs if he doesn't survive.
Chavez has been in office since 1999 and was re-elected in October, three months after he had announced that his latest tests showed he was cancer-free.
Opposition politicians have criticized a lack of detailed information about Chavez's condition, and last week repeated their demands for a full medical report.
Chavez's son-in-law Jorge Arreaza, who is the government's science minister and has been with the president in Cuba, urged Venezuelans in a Twitter message Monday night not to believe "bad-intentioned rumors" circulating online. "President Chavez has spent the day calm and stable, accompanied by his children," Arreaza said in the message.

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Venezuelans take in shifting news on Chavez health

CARACAS, Venezuela (AP) — Venezuelans began 2013 with a respite from shifting news about the health of President Hugo Chavez, who hasn't been seen in public since his fourth cancer-related surgery three weeks ago.
The country was largely peaceful Tuesday after a New Year's Eve that saw a main government-organized celebration canceled due to Chavez's illness.
Jorge Rodriguez, a Chavez ally and mayor of a Caracas district, reiterated that the president is going through a "complex post-operative process."
He told reporters Tuesday that Venezuelans have shown an outpouring of compassion and support for a leader who has "been planted in the hearts of millions." Rodriguez urged Venezuelans to keep Chavez in their prayers and expressed hope the president would recover.
Chavez's son-in-law Jorge Arreaza, who is the government's science minister and has been with the president in Cuba, urged Venezuelans in a Twitter message Monday night not to believe "bad-intentioned rumors" circulating online. "President Chavez has spent the day calm and stable, accompanied by his children," Arreaza said in the message.
That followed a grim announcement from Vice President Nicolas Maduro on Sunday that the president had suffered new complications due to a respiratory infection that appeared after the surgery.
Bolivian President Evo Morales issued a New Year Eve greeting to Chavez lamenting the health problems plaguing his "anti-imperialist comrade."
Morales said he was sending wishes for "strength, energy, and for him to be able to recover soon." Morales made a visit to Havana last week to visit Chavez, but didn't refer to that trip.
In Bolivar Plaza in downtown Caracas, Chavez's supporters strummed guitars and read poetry in his honor on Monday night, singing along with a recording of the president belting out the national anthem.
About 300 people also filled a Caracas church for a Mass to pray for Chavez.
"This country would be terrible without Chavez. He's the president of the poor," said Josefa Carvajal, a 75-year-old former maid who sat in the pews. "They say the president is very sick. I believe he's going to get better."
Chavez's aides held a Mass as well, at the presidential palace, while government officials urged Venezuelans to keep their leader in their prayers.
Venezuelans rang in the New Year as usual with fireworks raining down all over the capital of Caracas. But some of Chavez's supporters had long faces as they gathered in Bolivar Plaza on Monday night holding pictures of the president. A government-sponsored celebration there had been called off.
Speaking to the crowd, lawmaker Earle Herrera said Chavez "is continuing to fight the battle he has to fight."
"He's an undefeated president, and he'll continue to be undefeated," Herrera said.
Political analyst Ricardo Sucre said the outlook for Chavez appeared dark. Sucre noted that Maduro appeared weary during a solemn televised appearance Sunday to announce the latest setback for Chavez.
"Everything suggests Chavez's health situation hasn't evolved as hoped," Sucre said. He said Maduro likely remained in Havana to keep close watch on how Chavez's condition develops.
"These hours should be key to having a more definitive prognosis of Chavez's health, and as a consequence to making the corresponding political decisions according to the constitution," Sucre said.
Sucre and other Venezuelans said it seems increasingly unlikely that Chavez would be able to be sworn in as scheduled Jan. 10 for his new term. The Venezuelan leader has not been seen or heard from since undergoing the Dec. 11 operation.
If Chavez dies or is unable to continue in office, the Venezuelan Constitution says a new election should be held within 30 days.
Before his operation, Chavez acknowledged he faced risks and designated Maduro as his successor, telling supporters they should vote for the vice president if a new presidential election was necessary.
Chavez said at the time that his cancer had come back despite previous surgeries, chemotherapy and radiation treatment. He has been fighting an undisclosed type of pelvic cancer since June 2011.
Medical experts say it's common for patients who have undergone major surgeries to suffer respiratory infections and that how a patient fares can vary widely from a quick recovery in a couple of days to a fight for life on a respirator.
On the streets of Caracas, images of Chavez smiling and saluting were emblazoned on campaign signs and murals. One newly painted mural read: "Be strong, Chavez."
State television played video of Chavez campaigning for re-election, including one of the president shouting: "I am a nation!"
A new government sign atop a high-rise apartment complex reads: "YOU ALSO ARE CHAVEZ."
Norelys Araque, who was selling holiday cakes on a sidewalk Monday, said she has been praying for Chavez. But, she added, "I don't think he will last long."
Araque said her family has benefited from state-run subsidized food markets and education programs started by Chavez, and that she hopes the government carries on with the president's programs if he doesn't survive.
Chavez has been in office since 1999 and was re-elected in October, three months after he had announced that his latest tests showed he was cancer-free.
Opposition politicians have criticized the government for not providing information about Chavez's condition, and last week repeated their demands for a full medical report.

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Venezuelan VP says he has visited Chavez twice

CARACAS, Venezuela (AP) — Venezuela's vice president says he has visited ailing President Hugo Chavez twice in Cuba and plans to return home to Caracas.
Vice President Nicolas Maduro says he spoke with Chavez during their visits. Maduro says the president has "the same strength as always," despite a health situation that he described as complex three weeks after his cancer surgery.
Maduro says he will return to Venezuela on Wednesday.
He made the comments in an interview broadcast Tuesday night by the Caracas-based television network Telesur.

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Rate on 30-year mortgage ticks up to 4 pct.

WASHINGTON (AP) — The average rate on the 30-year mortgage stayed hovered above the record low for a third straight week. But cheap mortgage rates have done little to boost home sales or refinancing.
Freddie Mac said Thursday that the rate on the 30-year loan ticked up to 4 percent from 3.99 percent. Six weeks ago, it dropped to a record low of 3.94 percent, according to the National Bureau of Economic Research.
The average rate on the 15-year fixed mortgage rose to 3.31 percent from 3.30 percent. Six weeks ago, it hit a record low of 3.26 percent.
Rates have been below 5 percent for all but two weeks this year. Yet this year could be the worst for home sales in 14 years.
Mortgage applications fell 10 percent this week from the previous week, according to the Mortgage Bankers Association.
High unemployment and scant wage gains have made it harder for many people to qualify for loans. Many Americans don't want to sink money into a home that could lose value over the next three to four years. And most homeowners who can afford to refinance already have.
The low rates have caused a modest boom in refinancing, but that benefit might be wearing off. Most people who can afford to refinance have already locked in rates below 5 percent. Refinancing fell 12.2 percent last week, according to the mortgage bankers group.
The average rates don't include extra fees, known as points, which most borrowers must pay to get the lowest rates. One point equals 1 percent of the loan amount.
The average fees for the 30-year and 15-year fixed mortgages were unchanged at 0.7.
The average rate on the five-year adjustable loan fell to 2.97 percent from 2.98 percent. The average rate on the one-year adjustable loan increased to 2.98 percent from 2.95 percent.
The average fees on the five-year and one-year adjustable loans were both unchanged at 0.6.
To calculate average mortgage rates, Freddie Mac surveys lenders across the country Monday through Wednesday of each week.

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Rate on 30-year mortgage ticks up to 4 percent

WASHINGTON (AP) — The average rate on the 30-year mortgage hovered above the record low for a third straight week. But cheap mortgage rates have done little to boost home sales or refinancing.
Freddie Mac said Thursday that the rate on the 30-year loan ticked up to 4 percent from 3.99 percent. Six weeks ago, it dropped to a record low of 3.94 percent, according to the National Bureau of Economic Research.
The average rate on the 15-year fixed mortgage rose to 3.31 percent from 3.30 percent. Six weeks ago, it hit a record low of 3.26 percent.
Rates have been below 5 percent for all but two weeks this year. Yet this year could be the worst for home sales in 14 years.
Mortgage applications fell 10 percent this week from the previous week, according to the Mortgage Bankers Association.
High unemployment and scant wage gains have made it harder for many people to qualify for loans. Many Americans don't want to sink money into a home that could lose value over the next three to four years. And most homeowners who can afford to refinance already have.
The low rates have caused a modest boom in refinancing, but that benefit might be wearing off. Most people who can afford to refinance have already locked in rates below 5 percent. Refinancing fell 12.2 percent last week, according to the mortgage bankers group.
The average rates don't include extra fees, known as points, which most borrowers must pay to get the lowest rates. One point equals 1 percent of the loan amount.
The average fees for the 30-year and 15-year fixed mortgages were unchanged at 0.7.
The average rate on the five-year adjustable loan fell to 2.97 percent from 2.98 percent. The average rate on the one-year adjustable loan increased to 2.98 percent from 2.95 percent.
The average fees on the five-year and one-year adjustable loans were both unchanged at 0.6.
To calculate average mortgage rates, Freddie Mac surveys lenders across the country Monday through Wednesday of each week.

Read More..