| prevention-news-admin@cdcnpin.org 2004-08-03, 6:50 pm |
| CDC HIV/STD/TB Prevention News Update
Monday, January 26, 2004
The CDC National Center for HIV, STD and TB Prevention provides
the following information as a public service only. Providing
synopses of key scientific articles and lay media reports on
HIV/AIDS, other sexually transmitted diseases and tuberculosis
does not constitute CDC endorsement. The following summaries were
prepared without conducting any additional research or
investigation into the facts and statements made in the articles
being summarized, and therefore readers are expressly cautioned
against relying on the validity or invalidity of any statements
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abstracted below for full texts of the articles.
HEADLINES
NATIONAL NEWS
OKLAHOMA: "No Appeals Filed During Settlement Protest Period"
NORTH CAROLINA: "AIDS Prevention: New CDC-Funded HIV Program at
UNC Integrates Treatment with Prevention"
INTERNATIONAL NEWS
GLOBAL: "Fight Against AIDS Needs Much More Money - Aid Groups"
INDIA: "Melinda Gates Meets Indian Sex Workers, Discusses AIDS
Prevention Programs"
CANADA: "Canadian Diplomat Says Celebs Like Oprah Winfrey May
Hold Key to AIDS Cure"
CANADA: "Health Unit Uses Light Touch for Serious Topic"
MEDICAL NEWS
UNITED STATES: "Gender and Hospitalization Patterns Among HIV-
Infected Drug Users Before and After the Availability of Highly
Active Antiretroviral Therapy"
NEWS BRIEFS
IDAHO: "Idaho Housing and Finance Association Gets $1.3 Million
for AIDS/HIV"
MICHIGAN: "Three More Sebewaing Students Test Positive for TB"
MEXICO: "Mexican Government Authorizes Use of Morning-After Pill"
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NATIONAL NEWS
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OKLAHOMA:
"No Appeals Filed During Settlement Protest Period"
Associated Press (01.26.04)
A period set aside for participants to oppose a $25 million
settlement of a lawsuit regarding exposure to hepatitis C has
passed without protest in Norman, Okla. As no appeals were filed,
the lawsuit is considered "in judgment, which means it's been
disposed of," said Cleveland County, Okla., District Judge
William Hetherington.
The class-action suit had 1,234 plaintiffs. Most of the $25
million will be paid to 65 former patients of a pain management
clinic who developed hepatitis C after nurse anesthetist James
Hill reused syringes and needles to inject pain medication into
patients' IVs. Those patients will get $332,500 each. A man who
became ill will get $710,000. Those who tested positive for
hepatitis B will receive varying amounts. The 754 patients who
tested negative will each get $625.
The defendants in the lawsuit were Norman Regional Hospital,
which housed the pain management clinic; clinic operator Dr.
Jerry Lewis; Hill; Oklahoma City-based Northwest Surgical Center;
and the Oklahoma Center for Orthopedic and Multi-Specialty
Surgery. Five attorneys appointed by the court as the plaintiffs'
co-counsel will share 3 percent of the $25 million, or $750,000.
NORTH CAROLINA:
"AIDS Prevention: New CDC-Funded HIV Program at UNC Integrates
Treatment with Prevention"
Health & Medicine Week (11.24.03)
The Center for Infectious Diseases (CID) at the University
of North Carolina-Chapel Hill School of Medicine has received a
$1.8 million grant from CDC and the Health Resources and Services
Administration. The center recently established a demonstration
project in UNC Hospitals' Infectious Diseases Outpatient Clinic
(IDOC).
The clinic treats about 1,500 HIV-positive North Carolinians
annually. If successful, the project may shape the national
approach to HIV outpatient therapy. "Despite extensive preventive
efforts targeted at people not infected with HIV, 40,000 new HIV
cases are identified in the US annually, a number that has
remained somewhat consistent," said Dr. Evelyn Byrd Quinlivan,
assistant professor of medicine at UNC and medical director of
IDOC.
In 1999, CDC requested that the Institute of Medicine form a
Committee on HIV Prevention Strategies in the United States. Dr.
Myron S. Cohen, director of the CID, was on the committee. In
2001, Cohen and colleagues published a book, "No Time to Lose:
Getting More from HIV Prevention," with the underlying premise
that, "Each new infection begins with someone who is already
infected." Thus, prevention is enhanced by also targeting
infected people.
The committee's report recommended that prevention services
for HIV patients become a standard of care in all clinical
settings including primary care centers, STD clinics, drug
treatment facilities and mental health centers, and it called for
research proposals to develop effective "secondary prevention"
programs to integrate into HIV treatment. UNC's proposals were
funded.
Caregivers in the UNC clinic will be trained to enhance
their counseling and behavioral intervention skills. For more
complex situations - such as people who do not understand how to
use condoms or who do not feel safe disclosing their HIV status
to partners - a clinic counselor will be available. Such efforts
will be combined with medical therapy to reduce blood HIV levels
and lower the amount of virus that is shed.
Experts predict incorporating drug therapy with counseling
and education will be more effective than either effort alone. To
assess outcome specifics, the program will measure the degree to
which self-reports of HIV risk behaviors, STD infections and HIV
status-disclosure outcomes are improved by integrating prevention
counseling services into primary care.
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INTERNATIONAL NEWS
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GLOBAL:
"Fight Against AIDS Needs Much More Money - Aid Groups"
Reuters (01.24.04)::Lucas van Grinsven
On Saturday at the World Economic Forum in Davos,
Switzerland, representatives of aid organizations said the fight
against AIDS, malaria and TB might be at risk if billions of
dollars are not raised quickly. "We need $1.6 billion in 2004,
and we're close to that," said Richard Feacham of the Global Fund
to Fight AIDS, Tuberculosis and Malaria. "But in 2005 we need
$3.6 billion and by 2007 and 2008 we need to be at a cruising
altitude of $7 [billion] to $8 billion a year. These numbers are
well above current thinking."
The World Health Organization says 6 million AIDS patients
in developing countries need immediate antiretroviral treatment,
but only 300,000 currently get it.
US Health Secretary Tommy Thompson said the United States
has committed to invest $3 billion a year to fight HIV/AIDS, but
corporations could do more to prevent and treat the disease. He
added that health should play a more important role in
international relations.
Bill Gates, who is contributing billions of his personal
wealth to upgrade health care in poor countries, warned of the
potential of HIV/AIDS to spread in populous countries like India.
Richard Burzynski of the International Council of AIDS
service organizations said he was doubtful the promised money
would be delivered. "You bet I have doubts," he said. "All
governments have made promises, but we're not even meeting the
targets set three years ago."
Feacham urged the European Union to open dormant development
funds. Burzynski said the United States and the European Union
should divert billions in annual agriculture subsidies that hurt
farmers in poor countries.
Cape Town's Anglican Archbishop Njongonkulu Ndungane said
churches should play a more active role. "Faith-based
organizations can reach out to every citizen in Africa at least
once a week," he said. "Churches should set up one-stop health
care centers."
INDIA:
"Melinda Gates Meets Indian Sex Workers, Discusses AIDS
Prevention Programs"
Associated Press (01.25.04)::Nupur Banerjee
On Sunday, Melinda Gates visited Sonagachi, a rundown area
with some 6,000 prostitutes in north Calcutta, and discussed
HIV/AIDS control programs with sex workers. In a small hall,
Gates met with nearly 40 sex workers who talked about their lives
as security guards restrained a surging crowd of journalists and
onlookers.
"We live in rat-infested rooms that double as home and work
space. We want a better environment for our children where they
are not harmed by the effects of our trade," Pushpa Sarkar told
Gates. Another woman, Sadhya Roy, spoke of the heartbreak she
endures from her son's mistreatment at school because he is the
son of a sex worker.
Gates watched a play staged by a group of prostitutes and
their children depicting women as the targets of violence and
exploitation. "They are lots like all women around the world.
They have the same concerns, same values and worries for their
children," Gates later told the Associated Press.
The Seattle-based Bill and Melinda Gates Foundation has
given $200 million to fight HIV/AIDS in India, where an estimated
4.6 million people, or 0.9 percent of adults, have the disease.
"India hangs in balance so far as AIDS is concerned," said Gates,
adding that the country's largest hurdle is a lack of awareness
and social stigma. "Social stigma is still an enormous issue, but
pockets of people are speaking out, and it's fundamental to back
them," she said.
CANADA:
"Canadian Diplomat Says Celebs Like Oprah Winfrey May Hold Key to
AIDS Cure"
Canadian Press (01.26.04)
In an interview yesterday, Stephen Lewis, UN special envoy
on HIV/AIDS, said celebrity attention, such as talk-show host
Oprah Winfrey's visit to Zambia, may be the key to fighting the
AIDS pandemic sweeping Africa. "To go to a country as poor as
Zambia, struggling as hard as Zambia, was... quite a jolt and
reinforced her determination to do something," said Lewis.
Winfrey traveled to Zambia last year and later broadcast a show
about her experiences with AIDS orphans.
Lewis, who was in Saskatoon for a weekend symposium on
HIV/AIDS, said that ideally, celebrities should not be the ones
taking up the cause. "It should be major politicians in major
countries who are the voice, supporting what Africa wants to do,"
said Lewis.
According to Lewis, efforts to treat and prevent HIV/AIDS
have not lessened its devastating effects on African society.
"When you're on the ground, the situation remains appalling and
the death remains ubiquitous and the desperation is everywhere,"
he said, adding that help cannot come fast enough. "Every time
you go back, all the people you saw six months or 12 months ago
are dead," Lewis noted.
Lewis, named Canadian of the Year for 2003 by Maclean's
magazine, said there are glimmers of hope, including the Canadian
government's proposal to make cheap, generic drugs readily
available in Africa - a proposal Lewis said Prime Minister Paul
Martin seems willing to turn into reality.
CANADA:
"Health Unit Uses Light Touch for Serious Topic"
Guelph Mercury (01.21.04)::Joanne Shuttleworth
Ontario's Wellington-Dufferin-Guelph Health Unit uses humor
in its latest poster campaign to encourage men to be treated for
sexually transmitted diseases. Headlined, "Guys, urine luck," the
posters explain that new tests mean many STDs can be detected
from a urine sample rather than with a urethral swab.
Elaine Scott, manager of the health unit's adolescent/sexual
health program, said chlamydia continues to have the highest
incidence rate of the many STDs the unit tracks, affecting people
ages 20-24 more than any other age bracket. Since 1991, chlamydia
rates dropped from 222.58 per 100,000 in Guelph to 74 per 100,000
in 2000, the latest figures available. In Wellington County over
the same time period, the rate rose slightly, going from 25.96
per 100,000 in 1991 to 27.6 per 100,000 in 2000.
The health unit operates free clinics in Guelph,
Orangeville, Palmerston and Shelburne and will open one in Fergus
on Feb. 4. It also operates Student Wellness Centers at public
high schools in the area, allowing students to visit doctors and
nurses with any kind of complaint.
"There are two barriers to testing: people either don't want
to admit to their family doctor they may have an STD, or they
don't want to go where their family goes and could find out,"
Scott explained. "That's why the clinics are so important. The
more cases that are detected, the more cases that are treated.
And that's the really important number."
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MEDICAL NEWS
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UNITED STATES:
"Gender and Hospitalization Patterns Among HIV-Infected Drug
Users Before and After the Availability of Highly Active
Antiretroviral Therapy"
Journal of Acquired Immune Deficiency Syndromes
(11.01.03)::Michelle Floris-Moore, MD, MS; Yungtai Lo, PhD;
Robert S. Kelin, MD; Nancy Budner, MPH; Marc N. Gourevitch, MD,
MPH; Galena Moskaleva, MS; Ellie E. Schoenbaum, MD
In the era of highly active antiretroviral therapy (HAART),
according to the current study, drug users represent a large
proportion of persons living with HIV. According to CDC,
injection drug use was associated with the acquisition of HIV in
57 percent of women with AIDS and 23.5 percent of men with AIDS
in 2000. The rate of HIV infection among US women is growing,
with CDC reporting a 138 percent increase in the number of women
living with AIDS in 2000.
Studies have shown an increased risk of disease progression
and a lower rate of HAART use among HIV-positive women compared
to men. Many HIV-positive women who are intravenous drug users
(IDUs) are from underprivileged populations and may be at
particularly high risk of adverse health outcomes from HIV, the
authors noted. Therefore, they surmised, there may be
differential morbidity in men and women with HIV.
To investigate morbidity patterns, the researchers examined
hospital admissions among 604 HIV-positive IDUs enrolled in a
prospective study in Bronx, N.Y., from January 1992-December
2000.
The HIV Epidemiology Research on Outcomes is a prospective
cohort study of HIV disease progression and clinical
manifestations in current and former opiate-dependent drug users
that began in 1985. Participants were recruited from a hospital-
affiliated long-term methadone treatment program (MTP).
At semiannual visits, investigators administered structured
interviews to obtain demographic information, medical history,
and data on use of medications, illicit drugs, and tobacco and
the occurrence of any intercurrent hospitalizations. Reports of
hospitalizations triggered a review of the hospital records for
coded discharge diagnoses. The investigators analyzed data from
two periods, January 1992-December 1996 (pre-HAART) and January
1997-December 2000 (the HAART era).
"Three hundred three study participants (50.2 percent) were
hospitalized," the study noted, "with a total of 961
hospitalizations. Investigation of patterns of HAART use revealed
that 9 persons (4 percent of the eligible population) reported
using HAART in 1996. In 1997, this number increased to 69 (32
percent), in 1998, it increased to 111 (46 percent), and in 2000,
it increased to 135 (58 percent)."
Eighty-eight percent of study participants in the first
period and 100 percent in the second period were undergoing
methadone treatment. During the first period, 27 percent of
participants reported injecting drugs and 24 percent reported
snorting heroin or cocaine. Drug use was similar during the
second period and did not differ by race in either period.
The rate of hospitalizations per 100 patient-years in the
HAART era was 49.3 compared with 44.1 in the pre-HAART era, the
authors found. Among women, the rate was significantly higher in
the HAART era than in the pre-HAART era. In the second period,
HAART users had lower rates of hospitalization than those not on
HAART, for both HIV-related and non-related conditions.
"Among HIV-infected drug users," the scientists wrote,
"those who use HAART have a decreased risk of hospitalization;
those who do not use HAART remain at high risk of continuing
morbidity from both HIV-related and non-HIV-related illness and
have high hospitalization rates."
"Further study is needed," the investigators concluded, "to
understand the factors underlying gender differences in relation
to disease outcomes and utilization of health care services among
HIV-infected drug users."
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NEWS BRIEFS
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IDAHO:
"Idaho Housing and Finance Association Gets $1.3 Million for
AIDS/HIV"
Associated Press (01.25.04)
The US Department of Housing and Urban Development has
awarded more than $1.3 million to help the Idaho Housing and
Finance Association (IHFA) provide housing for people with
HIV/AIDS. Idaho is one of 12 states to get the funds, IHFA
officials said. In the last three years, IHFA has helped house
178 people long-term, said IHFA officials. The money will be
distributed to seven service providers throughout the state,
including North Idaho AIDS Coalition in Coeur d'Alene, North
Central District Health in Lewiston, Boise City/Ada County
Housing Authority in Boise, Family Practice Residence of Idaho in
Boise, south Central District Health Department in Twin Falls,
South Eastern Idaho District Health in Pocatello, and District
Seven Health Department in Idaho Falls.
MICHIGAN:
"Three More Sebewaing Students Test Positive for TB"
Associated Press (01.23.04)
In the final round of testing that followed the discovery of
active TB cases in the district, three more 10th-graders have
tested positive for TB exposure, officials of Unionville-
Sebewaing Area Schools said Friday. Last Monday, TB skin tests
were administered to 546 students and teachers. Tests read
Wednesday showed two 5th-graders, three 9th-graders, two 10th-
graders and one 11th-grader were positive for TB exposure.
Superintendent John "Kip" Walker said the eleven people who had
tested positive in the latest testing round will need a chest X-
ray to determine if they have active TB. The first TB cases hit
the district in October, when one teacher and student were found
to have active cases. Another 36 people had positive skin tests
at that time.
MEXICO:
"Mexican Government Authorizes Use of Morning-After Pill"
Associated Press (01.23.04)::E. Eduardo Castillo
Mexico's Department of Health has approved the use of the
morning-after pill for family planning. The authorization was
part of an amended version of the country's federal family-
planning guidelines that went into effect on Jan. 22. Taken
within 72 hours of intercourse, the morning-after pill cuts the
chances of pregnancy by up to 89 percent. The pills prevent
ovulation or fertilization and possibly interfere with a
fertilized egg's implantation in the uterus. Although
conservatives in the predominantly Catholic country have objected
to any interference with a fertilized egg, the pill is not as
controversial as RU-486, called the abortion pill. Gregorio
Perez, former health department reproductive health director,
cited opposition to the morning-after pill by conservative groups
who "absurdly qualified it as abortive."
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