| prevention-news-admin@cdcnpin.org 2004-08-03, 6:50 pm |
| CDC HIV/STD/TB Prevention News Update
Wednesday, February 04, 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
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of the articles abstracted below for full texts of the articles.
HEADLINES
NATIONAL NEWS
UNITED STATES: "AIDS Drug's Price Soars"
UNITED STATES: "AIDS Groups Petition Congress to Close ADAP Fund Gap"
INTERNATIONAL NEWS
NIGERIA: "Nigerian AIDS Sufferers Complain Expired Drugs, Shortages and
Corruption Threaten Lives"
SOUTH AFRICA: "South African Companies Fail to Focus on HIV"
MEDICAL NEWS
UNITED STATES: "STD Risk Rises After Teens Have a Baby"
SOUTH AFRICA: "HIV/AIDS Transmission: Vaginal Substance Use and
Douching Common Among Sex Workers in South Africa"
LOCAL AND COMMUNITY NEWS
CALIFORNIA: "LA County to Intensify Fight Against HIV, STDs in Gay
Bathhouses"
CALIFORNIA: "Tenants with HIV Gain Link to Resources"
NEWS BRIEFS
TENNESSEE: "Black HIV/AIDS Awareness Day"
CAMBODIA: "Media Campaign to Highlight HIV/AIDS Issues in Cambodia"
UGANDA: "25,000 Babies Born in Uganda Every Year Have HIV: Official"
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NATIONAL NEWS
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UNITED STATES:
"AIDS Drug's Price Soars"
Sacramento Bee (02.02.04)::Dorsey Griffith
Doctors have begun an unprecedented nationwide protest over Abbott
Laboratories' 400 percent price increase of its protease inhibitor (PI)
Norvir. In a Jan. 20 letter to Abbott, more than 150 HIV specialists
said they will resign from Abbott advisory panels and refuse to
participate in Abbott drug trials or attend Abbott-sponsored lectures.
They will ban Abbott representatives from their offices and consider
alternatives to Abbott drugs when possible for their patients.
The price increase has spurred the Washington, D.C.-based Consumer
Project on Technology to complain to the Federal Trade Commission,
invoking a little-known provision in its petition that, if granted,
would allow generic production of Norvir (ritonavir).
Six of the seven PIs on the market need Norvir as a booster to be
effective. Abbott's price increase makes these drug regimens more
expensive. Doctors and AIDS activists argue that by raising Norvir's
price - from $2.14 to $10.71 per 100mg pill - Abbott is pushing doctors
to prescribe Kaletra. Abbott's Kaletra, a PI that contains a Norvir
booster, has not likewise increased in price and so is now the lowest-
priced PI available.
Abbott executives argue the price hike was necessary to recoup
research and development costs. Abbott spokesperson Ann Fahey-Widman
said Norvir's price increase reflected the drug's value in a range of
AIDS treatments. Most patients would not be affected by the increase,
she said, since 55 percent of HIV patients have their drugs covered
through assistance programs. The increase will not immediately affect
AIDS Drug Assistance Programs because Abbott has agreed to a price
freeze for ADAPs through June 2005. In addition, Fahey-Widman said
Abbott has changed its own assistance program and will provide the
medicine free to any uninsured patient.
The HIV Medical Association, representing 2,600 physicians, and
the American Academy of HIV Medicine, with 1,600 members, condemned the
price increase in a letter to Abbott as "contemptible." The association
predicted the price strategy would mean higher insurance premiums and
co-payments for patients and higher future costs for ADAP. The 200-
member Community Consortium of HIV providers in San Francisco voted
last Wednesday to refuse any financial or in-kind support from Abbott,
said group chair Dr. Donald Abrams.
UNITED STATES:
"AIDS Groups Petition Congress to Close ADAP Fund Gap"
AIDS Policy and Law (01.30.04)
Hundreds of AIDS activists, treatment and service organizations
and community outreach workers wrote to Congress in January and urged
legislators to support additional funding for the AIDS Drug Assistance
Program for 2004.
ADAP, funded under Title II of the Ryan White CARE Act, is the
final safety net for Americans who have no other means of accessing HIV
medications and for low-income people with HIV/AIDS who are
underinsured or lack adequate prescription coverage. Every month,
90,000 clients access the program.
However, many state ADAPs are facing financial constraints and are
unable to meet the needs of those who depend on the program. The
National Alliance of State and Territorial AIDS Directors (NASTAD) said
by November 2003, 16 states were restricting access to treatment, and
nearly 700 people were on waiting lists in 13 states. The petitioners
noted that five more states anticipate upcoming new restrictions, while
the number of people who depend on ADAP is growing. The petitioners
acknowledged the $35 million ADAP increase approved for 2004 by a joint
House-Senate committee but said it falls well short of the $215 million
needed to alleviate the current ADAP crisis.
"We urge your leadership in securing an emergency supplemental
appropriation for the remaining 180 million," the petitioners wrote.
"In addition, we urge you to also support the highest funding possible
for the entire Ryan White CARE Act and other vital HIV/AIDS programs in
the next appropriations process."
"The Bush administration has strongly encouraged that all
Americans learn their HIV status, and by implementing policies such as
the approval and dissemination of the rapid HIV test, the numbers of
people being tested are growing," the petition said.
But it cited evidence indicating that "many of these new HIV cases are
people who are disproportionately uninsured and need safety net
programs such as ADAP to access treatment that will keep them healthy
and productive."
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INTERNATIONAL NEWS
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NIGERIA:
"Nigerian AIDS Sufferers Complain Expired Drugs, Shortages and
Corruption Threaten Lives"
Associated Press (02.03.04)::Dulue Mbachu
On Tuesday, AIDS activists faulted Nigeria's government for its
overall handling of a plan to provide cheap AIDS drugs to more than
14,000 HIV-infected Nigerians. AIDS Alliance Nigeria cited repeated
shortages, dispensing of expired drugs, and corruption in what should
have been a laudable program. A Nigerian health official admitted the
AIDS program had run out of medication but said the government had
ordered more.
Estimates show more than 3.5 million people infected with HIV in
Africa's most populous nation. President Olusegun Obasanjo's government
launched the drug program in 2002 in response to criticism that Nigeria
was not doing enough to help those infected. When the program began,
more than 14,000 people signed up to receive drugs from 25 government
treatment centers at 1,000 naira (US$8.30) per month, compared to the
12,000 naira (US$100) cost at pharmacies. According to AIDS Alliance
Nigeria, treatment centers began handing out expired drugs, or turning
patients away, in July 2003. At centers that still had drugs, officials
were taking bribes for them, patients said.
Lt. Commodore Nsikak Ekpe, an HIV patient and president of AIDS
Alliance Nigeria, said, "A total of 14,370 people living with HIV/AIDS
on government-subsidized antiretroviral drugs may lose their lives to
expired drugs and erratic drug administration."
Health Minister Eyitayo Lambo declined to comment, but an
anonymous official said the drug program was "in crisis" and more
supplies had been ordered from India. The official said funds had not
been released in time to replenish the drug supply, and that a few
doctors dispensed expired drugs rather than have HIV patients break
their regimen and develop resistance.
SOUTH AFRICA:
"South African Companies Fail to Focus on HIV"
Financial Times (02.04.04)::John Reed
A study published Tuesday shows that while 43 percent of 1,006
South African companies surveyed expect "a significant adverse impact"
from HIV/AIDS on their operations within five years, only 26 percent
have an HIV/AIDS policy. Fewer still have voluntary counseling and
testing programs or provide care, treatment and support to HIV-infected
workers, according to the Bureau for Economics Research poll.
"The problem is big, but the response is not," said Leighton
McDonald, a board member of the South African Business Coalition on
HIV/AIDS, which commissioned the survey. "Some companies are doing
great stuff [on HIV/AIDS], but others are not," McDonald said.
The survey, conducted in October and November, is the clearest
indication yet of the disease's impact on corporate bottom lines in
South Africa. Companies in KwaZulu Natal and Gauteng - which includes
Johannesburg, South Africa's business capital - said they were hardest-
hit by the disease. The survey did not include the mining sector, which
is considered most affected by HIV/AIDS.
Of the companies surveyed, 39 percent reported lower labor
productivity or increased absenteeism due to HIV/AIDS. About one-third
said their employee costs and turnover rates had risen. The
manufacturing sector is the worst hit, with more than 40 percent of
companies reporting the disease had reduced their profits. Of large
domestic and multinational companies surveyed, 92 percent said they
have an HIV/AIDS policy in place, compared to just 13 percent of small
firms and 64 percent of mid-sized companies. Only 6 percent of
companies reported they were supplying their workers with
antiretroviral drugs, which are not yet available in South Africa's
public health system.
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MEDICAL NEWS
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UNITED STATES:
"STD Risk Rises After Teens Have a Baby"
Reuters Health (01.26.04)
A recent study found that teenage girls appear to be at high risk
of getting a sexually transmitted disease in the year after having a
baby. Researchers said the findings suggest more needs to be done
during routine post-delivery care to promote STD prevention among new
teen moms.
The Yale university team found that among 203 pregnant girls ages
14-19 seen at community health clinics in Connecticut, 7 percent
contracted either chlamydia or gonorrhea roughly three months after
giving birth. The rate rose to 14 percent six months later - nearly
double that of a control group of non-pregnant teens. The pregnant
teens, all of whom were unmarried, were predominantly African-American
or Hispanic.
The researchers found that the risk of the two STDs increased with
the number of lifetime sex partners that study subjects reported. Those
who had new partners after having their babies also faced relatively
higher risk.
The authors noted that the high STD rates in the study are of
serious concern and point to the need for health care professionals to
target new teen mothers for STD prevention. "Routine prenatal and
postpartum care provide unique opportunities to promote condom use and
risk reduction interventions among adolescents," the study stated.
The report noted that many teens are encouraged to use hormonal
forms of contraception after delivery, yet these methods offer no STD
protection. Doctors must stress both pregnancy prevention and STD
prevention, the study said.
The article, "High Postpartum Rates of Sexually Transmitted
Infections Among Teens: Pregnancy as a Window of Opportunity for
Prevention," appeared in the journal Sexually Transmitted Infections
(2003;79(6):469-473).
SOUTH AFRICA:
"HIV/AIDS Transmission: Vaginal Substance Use and Douching Common Among
Sex Workers in South Africa"
Women's Health Weekly (12.18.03)
According to a recent South African study, "A local cultural
practice that may enhance sexually transmitted infections (STIs) and
HIV transmission is vaginal douching and vaginal substance use. These
activities also have potential implications for the acceptability of
HIV-prevention strategies such as the use of condoms and vaginal
microbicides."
N.S. Morar and colleagues at the Medical Research Center- Durban
sought to establish "the prevalence, determinants and reasons for these
practices among sex workers in KwaZulu-Natal, South Africa."
Researchers administered a structured questionnaire to 150 sex workers
being screened for a vaginal microbicide-effectiveness trial in the
province. The questionnaire sought to elicit information on "the
frequency, reasons for and nature of vaginal douching and vaginal
substance use," the study said, "and was drawn up on the basis of
findings from a pilot study."
The scientists found that douching and vaginal substance use were
common, with 97 percent of respondents reporting douching and 94
percent reporting vaginal substance use for "dry sex."
"A combination of traditional remedies, patent medicines, antiseptics
and household detergents was used to clean and make the vagina dry and
tight," the report stated. "The primary reasons for dry sex were to
increase men's sexual pleasure (53 percent) and to attract clients and
generate more money (20 percent). Sixty-five percent of the women
reported the practice of douching mainly for hygienic purposes and 13
percent for the prevention and treatment of sexually transmitted
infections."
Seventy percent of the sex workers were HIV-positive, the
researchers found, and they averaged five sexual partners per day.
"Douching and dry-sex practices may increase women's risk of HIV and
STI infection, and may have implications for the acceptability and
development of HIV-prevention barrier methods such as microbicides and
the use of condoms," the researchers wrote.
The study, "Vaginal Douching and Vaginal Substance Use Among Sex
Workers in KwaZulu-Natal, South Africa," appeared in the South African
Journal of Science (2003;99(7-8):371-374).
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LOCAL AND COMMUNITY NEWS
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CALIFORNIA:
"LA County to Intensify Fight Against HIV, STDs in Gay Bathhouses"
Associated Press (02.04.04)
Yesterday, the Los Angeles County Board of Supervisors ordered
local health officials to review HIV/AIDS and STD prevention efforts in
gay bathhouses and sex clubs. The board unanimously backed a motion
instructing the Department of Health Services and other county workers
to recommend improvements in a report within 90 days. The order also
requires officials to look for ways cities and the county can
coordinate licensing and permitting for the clubs.
The motion, authored by County Supervisor Zev Yaroslavsky, cited a
study showing 11 percent of patrons at two bathhouses in 2002 were HIV-
infected despite counseling and testing efforts. This rate "suggests
that our HIV/AIDS and STD prevention and treatment efforts must be
strengthened to address the environment in which high risk sexual
behaviors occur," the motion stated. It also noted the risky behavior
occurs at such venues as sex clubs frequented by gay men, with the
potential for higher rates of HIV and other STDs at these sites as
well.
According to John Schunhoff, chief of operations for the public
health division of Los Angeles County's health department, an estimated
50,000-60,000 people are infected with HIV in the county. Schunhoff
said the motion was also prompted by a syphilis outbreak in 2000 among
men going to bathhouses. CDC reports syphilis cases throughout the West
soared 64.3 percent between 2001 and 2002.
"We are glad that the county has taken these crucial first steps
toward safeguarding public health and well-being by regulating these
establishments," said AIDS Healthcare Foundation President Michael
Weinstein.
CALIFORNIA:
"Tenants with HIV Gain Link to Resources"
San Francisco Chronicle (01.29.04)::Rona Marech
Brian Basinger, an AIDS patient who experienced housing
discrimination, is launching the AIDS Housing Alliance, an organization
to connect HIV/AIDS patients to friendly landlords and roommates.
"There are landlords willing to take in HIV-positive patients, willing
to take Section 8 [housing vouchers]. The problem is finding them,"
said John Crapo, an adviser to the new organization. "It's the next
generation of evolving services needed for people living with HIV.
Initially, organizations were set up for the crisis and the dying
times. Now, the issues are longevity: How do we live?"
In San Francisco, Marin and San Mateo counties, 21,851 people have
AIDS, said Bill Hirsh, director of the AIDS Legal Referral Panel. The
figure represents the fifth-highest number of total cases in a US
metropolitan area and the highest rate in the country of cases per
100,000 people. The statistic does not include HIV-positive people who
have not developed AIDS.
Hirsh said about one-third of the AIDS Legal Referral Panel's
annual cases involve housing. A significant number of the 750 fair
housing complaints the city's Human Rights Commission gets each year
come from HIV-positive people or people with AIDS, according to Ed
Ilumin, a compliance officer.
Basinger said although the San Francisco housing market has
loosened, the drop in rents has not yet hit low-income people. Although
the city has affordable housing units for AIDS patients, the waiting
lists are long and turnover has slowed as medication extends lives.
Volunteers will initially staff the AIDS Housing Alliance, whose
nonprofit status is pending. The group will link landlords, tenants and
roommates through listings that can be viewed on site and at monthly
functions that Basinger calls "speed dating for roommates." The Housing
Rights Committee of San Francisco has donated office space (427 S. Van
Ness Ave.) and an anonymous donor has given the organization seed
money. For information, telephone 415-703-8634.
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NEWS BRIEFS
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TENNESSEE:
"Black HIV/AIDS Awareness Day"
Chattanooga Times Free Press (01.31.04)
On Saturday in commemoration of Black HIV/AIDS Awareness Day, Dr.
David Foster, former surgeon general nominee, will speak on "The
Challenges of HIV/AIDS: Especially for Our Youth" at the Piney Woods
Family Resource Center in Chattanooga. The event, which seeks to
heighten AIDS awareness in the black community, will offer volunteer
opportunities and free, confidential HIV counseling and testing between
10:30 a.m. and 2 p.m. Sponsors are the Southeast Tennessee Regional
Advisory Committee and the Southeast Tennessee Development District.
Day care will be provided; the facility is at 701 Hooker Rd. Telephone
423-697-7130.
CAMBODIA:
"Media Campaign to Highlight HIV/AIDS Issues in Cambodia"
Agence France Presse (02.03.04)
On Tuesday, Giselle Portenier of the BBC World Service Trust told
reporters that the organization would launch a two-year media campaign
in May to promote awareness of HIV/AIDS and reproductive, maternal and
child health issues in Cambodia. "We are hoping to have a huge impact
on HIV/AIDS and maternal and child health," she said at a two-day
workshop in Phnom Penh. Currently in Cambodia, one in eight children
dies before age five. With 2.8 percent (170,000) of its adult
population infected, Cambodia has the highest HIV infection rate in
Asia. About 80,000 people have died of AIDS since 1993. Secretary of
State for Health Mam Bun Heng welcomed the campaign, which is sponsored
by the British government.
UGANDA:
"25,000 Babies Born in Uganda Every Year Have HIV: Official"
Xinhua News Agency (02.02.04)
At least 25,000 babies born annually in Uganda have HIV, according
to local media reports Monday that quoted Uganda Ministry of Health
official Dr. Alex Opio. The high rate of mother-to-child (MTC) HIV
transmission, which he said stood at 30 percent, is responsible for the
figure, said Opio, the assistant commissioner of health services in
charge of national disease control. Research done in Uganda and other
countries supports the use of antiretroviral drugs (ARVs) in stemming
MTC transmissions, he said. "But ARVs should be aided by [a]
comprehensive antenatal care package, modified delivery practices and
good infant feeding options," Opio said. In Uganda's population of 25
million, about 1 million people have HIV/AIDS.
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