| prevention-news-admin@cdcnpin.org 2004-08-03, 6:50 pm |
| CDC HIV/STD/TB Prevention News Update
Wednesday, February 11, 2004
The CDC National Center for HIV, STD and TB Prevention provides
the following information as a public service only. Providing
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HIV/AIDS, other sexually transmitted diseases and tuberculosis
does not constitute CDC endorsement. The following summaries were
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HEADLINES
NATIONAL NEWS
NORTH CAROLINA: "HIV Outbreak Is Identified Early"
CALIFORNIA: "No HIV Spike to Mirror Syphilis Rise"
NEW YORK: "Official Warns of Surge in HIV Cases"
UNITED STATES: "Doctors Call for Abbott Boycott on AIDS Price
Hike"
INTERNATIONAL NEWS
UNITED KINGDOM: "Explicit Ads Target Sex Diseases Among Young"
MEDICAL NEWS
UNITED STATES: "Black Tar Heroin May Save Users from HIV: Report"
LOCAL AND COMMUNITY NEWS
NORTH CAROLINA: "AIDS Agency Closes Doors"
LOUISIANA: "AIDS Program Geared to African-Americans"
NEWS BRIEFS
VIRGINIA: "Morning-After Pill Bill Resurrected"
SOUTH AFRICA: "South Africa Catholic Church to Provide AIDS
Drugs"
INDIA: "Geneva Agency to Help India Fight AIDS"
MOZAMBIQUE: "AIDS Threatens Mozambique education System"
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NATIONAL NEWS
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NORTH CAROLINA:
"HIV Outbreak Is Identified Early"
Washington Post (02.11.04)::David Brown
Yesterday at the 11th Conference on Retroviruses and
Opportunistic Infections in San Francisco, scientists reported
that a new type of HIV testing led North Carolina public
officials to identify a mini-epidemic of HIV last year among
black college students. As a result, health workers began
delivering prevention messages and offering free HIV testing
while the outbreak was still growing.
The investigation uncovered a network of sexual liaisons
among 61 male students, at 21 colleges, who contracted HIV within
the past four years. Nearly all were infected through homosexual
activity. The researchers said no person, place or mode of
contact appeared to be driving the outbreak.
In late 2002, the state Health Department began polymerase
chain reaction (PCR) HIV testing to identify new cases by blood
samples containing HIV but no antibodies, common in people
infected for only about two weeks. Health officials found two
cases of newly infected men and routinely interviewed them.
Following the chain of infection led to 69 linked HIV cases,
61 college men and 8 men outside college. The investigators found
a network of sexual liaisons among a small population of shared
race, age, interests and geography. A small pool of partners, and
people having sex soon after they were infected - when viral load
is often 10 times higher than it would be years later - increased
rates of infection.
The researchers believe the epidemic had a distinct
beginning, not simply resulting from a steady state of HIV
transmission. The number of new HIV infections in N.C. college
men has risen from six in 2000 to 19 in 2001, 29 in 2002, and 30
in 2003. Of that total of 84, 73 were black and 11 white. They
attended 33 colleges in North Carolina, two in South Carolina,
one in Georgia and one in Florida. The colleges used knowledge of
the outbreak to include safer-sex messages in orientation
sessions last fall.
Adding the PCR method to HIV testing adds $2.00 to the
roughly $3.50 cost of a standard test.
CALIFORNIA:
"No HIV Spike to Mirror Syphilis Rise"
San Francisco Chronicle (02.11.04)::Sabin Russell
A sharp rise in syphilis cases among gay men in San
Francisco has not produced a corresponding increase in HIV
infections, researchers reported yesterday at the 11th Conference
on Retroviruses and Opportunistic Infections in San Francisco.
The findings, combined with other data pointing to decreases in
unsafe sexual practices, could mean that an increase in the
city's rate of HIV infections, which began in 1998, might be
waning.
Four years ago, Dr. Willi McFarland, chief AIDS
epidemiologist for the San Francisco Department of Public Health,
said the city's declining HIV infection rate had reversed and
that the estimated number of newly infected was growing to 900
per year from 500 throughout much of the 1990s. Of the many
factors driving the increase in HIV infections, syphilis was of
particular concern because the genital ulcers it causes become
portals for HIV to enter the bloodstream. From 1998 to 2003,
reported syphilis cases in the city rose from 40 to more than 600
annually.
CDC's Kate Buchacz presented the study showing that HIV
infection rates at two clinics where gay men are treated for
syphilis were holding steady or even declining. A team of CDC and
San Francisco Department of Public Health researchers conducted
the study.
However, Dr. Jeffrey Klausner, director of STD Prevention
and Control Services for the Health Department, remains cautious.
Klausner said the lesson of the surprising syphilis report may be
that it takes a greater number of syphilis cases - not just an
increase in the trend - to affect HIV rates. San Francisco sexual
practices favoring oral sex may also be a factor, since syphilis
is readily spread by oral sex while HIV is not.
Also playing a role is "sero-sorting," the trend toward men
picking partners of their same HIV serostatus. In a separate
presentation yesterday, McFarland said the percentage of gay men
surveyed who reported unprotected anal sex with an HIV-positive
partner had declined from 11 percent in 2000 to 8 percent in
2002. The percentage of HIV-positive men surveyed who had
unprotected sex with partners of an unknown serostatus had
declined from 31 percent in 2001 to 21 percent in 2003.
NEW YORK:
"Official Warns of Surge in HIV Cases"
Newsday (02.11.04)::Laurie Garrett
Although two-thirds of new HIV infections in New York City
are among heterosexuals - chiefly African Americans - gay men's
sexual habits may foreshadow a resurgence of cases, according to
data presented in San Francisco yesterday at the 11th Conference
on Retroviruses and Opportunistic Infections. In late 2000, New
York City began requiring that laboratories and physicians report
positive HIV tests, and since then, city officials have tracked,
confirmed, and analyzed the cases for trends.
In 2001, 6,400 new HIV diagnoses were reported, said Dr.
Lucia Torian, director of the city Health Department's HIV
Epidemiology Program. Further testing found that 21 percent of
the cases were infections less than six months old. The tests
also reveal that "our new cases of HIV are more likely to be
women, more likely to be black and more likely to be in the
category of heterosexual or 'no discernible risk,'" Torian said.
Nearly 65 percent of new infections in New York in 2001 were
heterosexual, the studies found.
Of new HIV diagnoses in 2002, 29 percent involved residents
from Manhattan; 28 percent from Brooklyn; and 24 percent from the
Bronx. Of the 1,784 women diagnosed with HIV in 2002, 1,203 were
black. But while the HIV caseload increases in the outer boroughs
and among heterosexuals, few New York City doctors recommend HIV
tests to their heterosexual patients, said Torian. Everybody
should take an HIV test, and doctors should offer it as routinely
as cholesterol screening, she said.
Torian said her department believes new HIV infections among
gay men have held steady, at about 1,100 cases annually, based on
a comparison of new infections with spot surveys taken in
previous years. But she said recent health department surveys
show that more than half of the HIV-infected men in the city
routinely have anal intercourse without using a condom. "This is
a prescription for a resurgent, explosive HIV epidemic," Torian
warned. "Have we seen it yet? No. Could we? Definitely."
UNITED STATES:
"Doctors Call for Abbott Boycott on AIDS Price Hike"
Reuters (02.10.04)::Lisa Richwine; Kim Dixon
On Tuesday, a group of about 200 AIDS doctors called for a
boycott of drugs made by Abbott Laboratories Inc. to protest the
company's recent 401 percent price increase in its HIV medication
Norvir. The increase has generated "a never-before-seen level of
outrage" among physicians, said HIV specialist Dr. Benjamin Young
of Rose Medical Center in Denver.
Norvir (ritonavir) is a key component in AIDS drug
cocktails. Unique in its drug class, Norvir can boost the
effectiveness of other drugs. It has no equivalent; however,
doctors can find substitutes for other Abbott products, Young
said. In addition, the doctors have banned Abbott salespersons
from their offices and will refuse to take part in any new
clinical trails supervised by the manufacturer. Critics have
charged the increase is meant to point patients to Kaletra, an
Abbott product containing Norvir.
Abbott spokesperson Laureen Cassidy said the price increase
was long overdue and noted that public assistance programs can
buy Norvir at the old price. Anyone without public aid or private
insurance can get it for free, said Cassidy, who noted that the
boycotting doctors are only a minority of the 6,000 US physicians
treating AIDS patients. Abbott denied the price rise is related
to Kaletra.
The AIDS Healthcare Foundation, which operates HIV clinics
in the United States, Africa and Central America, announced
Tuesday it is filing an antitrust lawsuit against Abbott. AIDS
activists, too, are asking federal antitrust authorities to
investigate the hike. Abbott confirmed it has been sent subpoenas
by the attorneys general of Illinois and New York.
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INTERNATIONAL NEWS
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UNITED KINGDOM:
"Explicit Ads Target Sex Diseases Among Young"
The Guardian (02.07.04)::James Meikle
Britain's Department of Health is launching an explicit
government advertisement campaign as part of a drive to reduce
STD rates. Radio advertisements warn of the risk of developing
genital warts, and spoof Valentine cards will be distributed in
clubs, student unions and other young people's social venues.
Advertisements will also appear in tabloid newspapers, and
radio advertisements, run after 9 p.m. on independent stations,
will test the boundaries of taste, despite being passed by the
radio advertising clearance center. The campaign is also
supported by a sexual health hotline and a Web site.
The latest stage of the £4 million (US $7 million) "sex
lottery" campaign aimed at sexually active 18- to 30-year-olds is
the brainchild of Melanie Johnson, the public health minister.
She said the campaign was "targeting those most at risk by using
thought-provoking language and direct language."
In the last 10 years, new sexually transmitted infections
have more than doubled to nearly 1.5 million a year. And
chlamydia incidence in England increased by 139 percent in six
years, to more than 78,000 new cases, Johnson said.
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MEDICAL NEWS
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UNITED STATES:
"Black Tar Heroin May Save Users from HIV: Report"
Reuters Health (02.02.04)::Merritt McKinney
New research suggests that regional differences in varieties
of heroin may explain why injection drug users (IDUs) in the West
are much less likely to contract HIV than IDUs in the East.
Unlike the powdered heroin that predominates in eastern cities,
the black tar heroin common west of the Mississippi clogs them,
meaning users are more likely to thoroughly clean syringes,
flushing out possibly infected blood. They are also likely to
dispose of syringes more frequently. Such behavior may reduce the
risk of transmitting HIV through needle sharing.
"This paper shows a possible solution for a public health
paradox that has been unsolved for 20 years, i.e., why did
western US heroin injectors not get the full brunt of [the] HIV
epidemic?" noted study co-author Dr. Daniel H. Ciccarone of the
University of California-San Francisco.
Ciccarone and co-author Dr. Philippe Bourgois said Mexican
black tar heroin was dominant among western IDUs in the early- to
mid-1990s, while powdered heroin from South Asia and South
America was more common in the East. New York City and Los
Angeles, both with considerable IDU populations, differed greatly
in HIV infection rates in the early 1990s: about 41 percent of
New York City IDUs were HIV-positive, versus only 4 percent of
Los Angeles IDUs.
Aside from being gummy, black tar heroin is heated before
use, which researchers think might kill HIV. Injecting black tar
heroin leads quickly to venous sclerosis, which makes injecting
into veins difficult. This causes IDUs to start injecting into
muscle or skin - injection methods that may be less likely to
transmit HIV.
HIV infections among IDUs have begun dropping in many parts
of the United States, but Ciccarone warned a possible influx of
powdered heroin from Afghanistan and Pakistan may spark an
increase in HIV. The study, "Explaining the Geographical
Variation of HIV Among Injection Drug Users in the United
States," appeared in the journal Substance Use & Misuse
(12.31.03;38(14)2049-2063;DOI:10.1081/JA-120025125).
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LOCAL AND COMMUNITY NEWS
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NORTH CAROLINA:
"AIDS Agency Closes Doors"
Winston-Salem Journal (02.07.04)::Lisa Hoppenjans
More than 100 HIV/AIDS patients lost support services when
HIV Outreach Programs and education (HOPE) made the decision to
close after months of financial struggle. Bernard Davis, chairman
of HOPE's board, said the agency is filing for bankruptcy and
that clients were notified as soon as the decision was made.
Davis said the agency had cut back on staff, programs and the
number of clients to try to make ends meet, but the
organization's debt overshadowed its income. HOPE's 2001 tax
return shows it took in $291,000 and spent $261,000 in fiscal
2001-2002.
HOPE received grants, donations and federal reimbursements
for its case-management work. Federal funding came through
Medicaid and the Northwest Care Consortium, which administers
money for local residents with HIV/AIDS. Richard Wooldredge, the
consortium's executive director, noted the consortium had a
contract with HOPE for $110,000 this fiscal year, but said only
$30,700 had been paid to HOPE more than halfway through the year
because the agency had cut back on services.
Wooldredge noted that many case-management activities -
driving patients to appointments, driving to see a client - are
not reimbursable under state law. The reimbursement rate covers
only about two-thirds the cost of a case manager's salary.
Besides case management, HOPE offered play-therapy programs
for HIV-positive children, organized support groups, and a food
pantry for hundreds of families. HOPE was one of two agencies in
Forsyth County focusing on services for HIV/AIDS patients, and
its closing leaves a gap. Positive Wellness Alliance, based in
Davidson County, has discussed opening an HIV/AIDS case-
management office in Winston-Salem, according to Executive
Director Julie Meyer. She hopes to establish an office within the
next few months.
LOUISIANA:
"AIDS Program Geared to African-Americans"
Times-Picayune (02.08.04)::Barbara Kaplinsky
The Southeast Louisiana Chapter of the American Red Cross, a
United Way member agency, recently received a $3,700 grant from
the National American Red Cross to pay for AIDS Education
programs specifically targeted to the African-American community.
The grant will fund Red Cross HIV/AIDS educational materials for
African Americans and training for HIV/AIDS instructors. The
chapter was chosen for the grant because it has been successful
in tailoring HIV/AIDS education for African Americans in New
Orleans.
According to the most recent Office of Public Health and CDC
reports, Orleans Parish has the highest number of people with
AIDS in Louisiana. Sixty-six out of every 100,000 people in the
parish have HIV/AIDS, and 78 percent of all newly diagnosed cases
are African Americans.
African-American youth are also at risk. Of every 100,000
teenagers and young adults in Orleans Parish ages 15-24, 100 have
HIV/AIDS. The Red Cross has directed some efforts toward peer-
educator programs in high schools. CDC recommends peer educators
as the best way to reach the youth community.
"As we celebrate Black History Month, the timing of the
grant is a reminder of the need to identify and respond to the
AIDS epidemic and other issues which hinder progress in the black
community," said United Way President Gary Ostroske.
During 2002-03, United Way contributed more than $517,000 to
Red Cross health- and safety-education programs. For information
on the Red Cross's African-American HIV/AIDS education program,
telephone 504-620-3105.
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NEWS BRIEFS
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VIRGINIA:
"Morning-After Pill Bill Resurrected"
Washington Times (02.11.04)::Christina Bellantoni
Virginia lawmakers voted 56-44 Tuesday to reconsider for a
final time a bill that would allow public schools to instruct
students that emergency contraceptives can be used to prevent
pregnancy after a rape. Del. James Dillard II (R-Fairfax County)
said he hopes to persuade his colleagues to rethink their votes.
Dillard is the education Committee chair. His bill was defeated
Monday by a 49-48 vote. It would have added the pill to the
state's Family Life education curriculum guidelines, which
already cover abstinence and adoption as a way to handle unwanted
pregnancies. The bill is up for consideration today.
SOUTH AFRICA:
"South Africa Catholic Church to Provide AIDS Drugs"
Reuters Health (02.04.04)
South Africa's Catholic Church will begin providing HIV/AIDS
drugs, its bishops said in a Feb. 4. announcement that criticized
the government's slow response to the epidemic. The Southern
African Catholic Bishops Conference - comprising clergy from
South Africa, Swaziland and Botswana - said it will provide free
drugs at five church-run centers, with hopes to open 19 more when
funding permits. The conference ended its annual meeting with a
plea for the government to remove all bureaucratic obstacles to
ARV access. Although the nation's Health Ministry said as many as
50,000 people could begin receiving drugs in 2004, officials
responded to criticism about a slow rollout of the medicine by
citing capacity constraints. The bishops said the Catholic Church
is the largest provider of home care for patients and AIDS
orphans in the country, and that the church is ready to work with
the government. The bishops also called for a basic monthly
income grant for South Africa's poor, a step the Treasury is
reluctant to take.
INDIA:
"Geneva Agency to Help India Fight AIDS"
Associated Press (02.10.04)
The Global Fund to Fight AIDS, Tuberculosis and Malaria said
Tuesday it is ready to give $26.1 million of the pledged $100
million to help India fight HIV/AIDS. The Geneva-based fund
pledged the money about a year ago, but procedural hurdles
delayed disbursal of the funds. "This grant is intended to
support India in its crucial phase of tackling the epidemic,"
Executive Director Richard Feachem said in a statement. The
money, to be spent over two years, will be used primarily to
support the country's plan to offer free drugs to HIV-infected
people, the statement said. The plan is expected to begin in
April, starting with 100,000 patients in six states with a high
prevalence of HIV/AIDS: Karnataka, Andhra Pradesh, Kerala and
Tamil Nadu in southern India, western Maharshtra and Uttar
Pradesh state in northern India.
MOZAMBIQUE:
"AIDS Threatens Mozambique education System"
Associated Press (02.10.04)::Emmanuel Camillo
HIV/AIDS is threatening Mozambique's education system, Prime
Minister Pascoal Mocumbi announced Tuesday at a regional seminar
on education and AIDS in the capital of Maputo. About 17 percent
of the country's teachers are HIV-positive - 4 percent higher
than the national prevalence rate among 15- to 49-year-olds,
Mocumbi said. "Many children in Mozambique have already begun to
act as heads of households. They begin to work at a tender age,
to attend to the needs of their relatives, or to spend all their
time supporting them. And so they are obliged to leave school,"
he said. Last year, Mozambique's agriculture ministry reported
that 1 million children had already left school. Calling for new
information and prevention strategies targeted at youth, Mocumbi
said, "If we are not capable through education to ensure that
young people know how to avoid the disease, then all other
efforts we make will be meaningless."
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