| prevention-news@cdcnpin.org 2004-11-04, 7:15 pm |
| CDC HIV/STD/TB Prevention News Update
Thursday, November 04, 2004
The CDC National Center for HIV, STD and TB Prevention provides the follo=
wing information as a public service only. Providing synopses of key scie=
ntific articles and lay media reports on HIV/AIDS, other sexually transmi=
tted diseases and tuberculosis does not constitute CDC endorsement. The f=
ollowing summaries were prepared without conducting any additional resear=
ch or investigation into the facts and statements made in the articles be=
ing summarized, and therefore readers are expressly cautioned against rel=
ying on the validity or invalidity of any statements made in these summar=
ies. This daily update also includes information from CDC and other gover=
nment agencies, such as background on Morbidity and Mortality Weekly Repo=
rt (MMWR) articles, fact sheets and announcements. Reproduction of this t=
ext is encouraged; however, copies may not be sold, and the CDC HIV/STD/T=
B Prevention News Update should be cited as the source of the=20
information. Contact the sources of the articles abstracted below for ful=
l texts of the articles.
HEADLINES
NATIONAL NEWS
MICHIGAN: =93Hepatitis C Diagnoses Rise; Health Cost Concerns Spread=94
INTERNATIONAL NEWS
GLOBAL: =93In Some Nations, the Rise of 'Shortgevity'=94
SOUTH AFRICA: =93South African AIDS Lobby Group Takes Government to Court=
=94
ZIMBABWE: =93In Zimbabwe, Hair Salons Promote Female Condom Use to Protec=
t Against HIV=94
MEDICAL NEWS
UNITED KINGDOM: =93New TB Vaccine Promising in Early Clinical Trials=94
UNITED STATES: =93The Impact of Inaccurate Reporting of Condom Use and Im=
perfect Diagnosis of Sexually Transmitted Disease Infection in Studies of=
Condom Effectiveness: A Simulation-Based Assessment=94
LOCAL AND COMMUNITY NEWS
CALIFORNIA: =93Campaigns Focus on Dark Side of Speed Use=94
NEW JERSEY: =93The Center Helps People with AIDS=94
NEWS BRIEFS
CHINA: =93SW China Province Sets Out to Curb Spread of HIV/AIDS from High=
-Risk Groups=94
INDIA: =93India to Reassess HIV/AIDS Program=94
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NATIONAL NEWS=09
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MICHIGAN:
=93Hepatitis C Diagnoses Rise; Health Cost Concerns Spread=94
Detroit News (10.31.04)::Sheri Hall
Health care costs are likely to rise over the next decade as more pa=
tients infected with hepatitis C virus require treatment for liver damage=
.. State officials estimate 180,000 Michigan residents are unknowingly inf=
ected with hepatitis C, which is the leading cause of liver failure in th=
e United States. At one Ann Arbor clinic, the number of new patients need=
ing treatment for HCV more than doubled from 1997 to 2002, according to a=
recent study.=20
=93These are doctors, lawyers, teachers =97 real people in the commu=
nity who have lived with a potentially serious virus for more than a deca=
de,=94 said Dr. Thomas Shehab of Huron Gastroenterology Associates of Ann=
Arbor. =93And when you start looking for it, there is a lot of really se=
vere liver damage in these people. They're going to end up on the public =
rolls.=94
HCV was discovered in 1989 but a test to identify it was not availab=
le until 1991. The American Red Cross did not eliminate HCV from the nati=
on's blood supply until 1992. HCV is most commonly found in IV drug users=
, health care workers who were accidentally exposed, and people who recei=
ved blood transfusions before 1992.
Because symptoms, such as dark urine and fatigue, may not show up fo=
r 15 years, patients often do not get tested for HCV. During routine exam=
s, doctors sometimes inquire whether a patient could have been exposed to=
the blood-borne disease. Some people may find out they have HCV after do=
nating blood.
=93All we're seeing right now is the tip of the iceberg,=94 said Dr.=
Stuart Gordon, head of hepatology at Royal Oak's Beaumont Hospital. =93T=
here's really no question they're going to continue to show up for treatm=
ent.=94
About 20 percent of HCV-infected patients will suffer severe liver d=
amage, and most will eventually need liver transplants. Nationwide, more =
than 17,000 people are awaiting liver transplants.
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INTERNATIONAL NEWS=09
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GLOBAL:=20
=93In Some Nations, the Rise of 'Shortgevity'=94
Christian Science Monitor (11.04.04)::Gregory M. Lamb
In the last 30 years, the world's average at-birth human life span i=
ncreased from about 60 years to 67 years. But in 24 nations, human life s=
pans have plummeted in what one expert calls a =93shortgevity=94 crisis. =
While adult illicit drug use and alcoholism sapped longevity rates in the=
former Soviet bloc shortly after its dissolution, the biggest longevity =
setback occurred in sub-Saharan Africa, much of it due to HIV/AIDS.=20
In 10 African nations, average life expectancy has dropped below 40 =
years. From 1970-75 to today, the latest UN Development Report figures sh=
ow average life expectancy dropped from 56 years to 33.1 years in Zimbabw=
e; from 49.7 years to 32.4 years in Zambia; from 49.5 years to 35.1 years=
in Lesotho; and from 56.1 years to 39.7 years in Botswana.=20
=93With the onset of HIV/AIDS we have seen a lot of the work we have=
done, and the gains we have achieved, being eroded,=94 said Wilfred Mlay=
, director of African operations for World Vision, the Christian relief a=
nd development organization. World Vision is helping African governments =
provide AIDS education, teaching both abstinence outside of marriage and =
the use of condoms, Mlay said. The group also provides AIDS patients nutr=
ition and medication, he said.=20
In 2001, some 99 percent of HIV infections in Africa were caused by =
unsafe sex, according to a 2002 World Health Organization study.=20
=93If you were to take AIDS away, I think you would see gains [in lo=
ngevity] everywhere,=94 said Dr. John Bongaarts of the Population Council=
.. =93Overall, the developing world is a success story.=94 In these countr=
ies, HIV/AIDS will mean there will be 14 percent fewer people in 2025 tha=
n they would have otherwise, UN projections show. India and China are als=
o projected to face heavy burdens of HIV/AIDS fatalities.=20
However, as HIV/AIDS' course depends on the responses to it, the epi=
demic is by no means predetermined, noted the report: =93The eventual cou=
rse of the disease depends on how individuals, communities, nations, and =
the world respond to the HIV/AIDS threat today and tomorrow.=94
SOUTH AFRICA:
=93South African AIDS Lobby Group Takes Government to Court=94
Agence France Presse (11.04.04)
Today in Johannesburg, the AIDS activist group Treatment Action Coal=
ition asked the Pretoria High Court to force the government to pay the co=
st of TAC's latest legal effort to speed the rollout of free antiretrovir=
als.=20
In November 2003, President Thabo Mbeki's cabinet announced it would=
begin providing the drugs to AIDS patients. The rollout was apparently t=
o proceed according to timelines set out in a document. TAC demanded that=
this document be made public. After its several requests to the health m=
inistry were rebuked, TAC turned in June to the courts, invoking the Publ=
ic Access to Information Act.=20
But in September, the government said the document, called =93Annexu=
re A,=94 was only a draft that the cabinet had never officially adopted =97=
meaning TAC's case could not proceed.
=93This was very surprising to the TAC because since February 2004 w=
e were led to believe that the implementation plan was Annexure A,=94 TAC=
said in a statement. =93We will ask the Pretoria High Court to award us =
all the legal costs for taking this case so far because it took governmen=
t so long to inform us that Annexure A was a draft.=94 Mark Heywood, TAC =
spokesperson, said, =93We are making the political point that the governm=
ent could have told us. Every delay by government results in people dying=
before they get access to treatment.=94
The government had promised to have more than 50,000 HIV patients on=
treatment by March 2004. Yet by October, only about 15,000 people were r=
eceiving the free drugs. Health ministry spokesperson Sibani Mngadi said =
the ministry now hopes to treat 50,000 patients by March 2005.
ZIMBABWE:
=93In Zimbabwe, Hair Salons Promote Female Condom Use to Protect Against =
HIV=94
AIDS Weekly & Law (11.04.04)
Condom maker PSI-Zimbabwe has struggled for six years to sell its fe=
male condom to Zimbabwean women, in part because doing so required intera=
cting with women on how to use the product. The company set out to solve =
this problem by engaging hairdressers throughout Zimbabwe to popularize t=
he condom using their interpersonal skills, the UN Integrated Regional In=
formation Networks reported.
The female condom, like its male counterpart, was originally distrib=
uted through conventional outlets: clinics, pharmacies and supermarkets. =
But PSI-Zimbabwe altered its strategy after recognizing critical difficul=
ties involved in its promotion. =93We asked ourselves some questions, lik=
e 'where do women spend a lot of their time?' and 'who would they be most=
comfortable talking to [someone] about such an intimate topic?'=85 The a=
nswers were that women spent most of their time at home and at hair salon=
s, and so was born the hair-salon and the home-meeting initiatives,=94 a =
company statement said.=20
Over several months, PSI-Zimbabwe has trained around 800 hairdresser=
s at 230 salons across the country on how to discuss the condom and demon=
strate its advantages. The company polled 400 women who visited salons in=
volved in the initiative and found that 59 percent of them felt they were=
at risk of contracting HIV; about 65 percent identified the condom as a =
basic prevention method against STDs including HIV; and 84 percent said t=
hey would feel comfortable purchasing the condom at a salon.
=93Many clients say they could not buy the condom from shops and pha=
rmacies for fear of being ridiculed by other shoppers as prostitutes or i=
mmoral,=94 said hairdresser Memory Mabhena. =93But now that it is being s=
old at salons, where the sellers are women, they are much more comfortabl=
e in buying it.=94
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MEDICAL NEWS=09
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UNITED KINGDOM:
=93New TB Vaccine Promising in Early Clinical Trials=94
Reuters Health (10.25.04)::Megan Rauscher
An initial testing of a new type of tuberculosis vaccine, MVA85A, sh=
ows it is =93safe and stimulates a strong cellular immune response=94 in =
adults with or without a previous bacilli Calmette-Guerin (BCG) vaccinati=
on, reported Dr. Helen McShane, of the Center for Clinical Vaccinology an=
d Tropical Medicine at the university of Oxford, and colleagues.
MVA85A is a genetically engineered vaccinia virus that expresses a p=
rominent TB protein. When given to healthy adults who have never received=
a BCG vaccination, the new vaccine induced =93high levels=94 of TB-speci=
fic immune cells. =93When we give MVA85A to people who have previously re=
ceived BCG, the immune responses are stronger and last for at least six m=
onths after vaccination,=94 said McShane.=20
=93The next step is to see whether this improved immune response act=
ually protects against disease,=94 McShane said, adding that clinical tri=
als of the vaccine are currently underway in Gambia and will begin in Sou=
th Africa next year.=20
Areas of the world where TB is endemic may benefit from a booster MV=
A85A vaccination to enhance and prolong anti-TB immunity, the researchers=
noted.
The full report, =93Recombinant Modified Vaccinia Virus Ankara Expre=
ssing Antigen 85A Boosts BCG-Primed and Naturally Acquired Antimyobacteri=
al Immunity in Humans,=94 was published in Nature Medicine (2004;10(11):1=
240-1244).=20
UNITED STATES:
=93The Impact of Inaccurate Reporting of Condom Use and Imperfect Diagnos=
is of Sexually Transmitted Disease Infection in Studies of Condom Effecti=
veness: A Simulation-Based Assessment=94
Sexually Transmitted Diseases (10.04) Vol. 31; No. 10: P. 588-595::Owen J=
.. Devine, PhD; Sevgi O. Aral, PhD
Condoms' effectiveness in reducing the risk of STDs has been debated=
in the face of equivocal epidemiologic evidence. In the current study, t=
he researchers assessed the potential magnitude of bias in studies of con=
doms' effectiveness resulting from inaccurate reporting of condom use and=
STD diagnostic miscalculation.=20
The researchers used probabilistic simulations to mimic plausible ou=
tcomes for hypothetical prospective and retrospective studies of condoms'=
effectiveness subject to inaccurate reporting of the participants' true =
condom use and to diagnostic error. To conduct the simulations, the autho=
rs generated a series of binomial (yes/no) random variables that correspo=
nded with STD infection status and with accurate diagnosis of STD infecti=
on.
Failure to address reporting and diagnostic errors can result in a su=
bstantial bias in condom effectiveness studies, the simulation shows. Thi=
s bias caused a roughly 25-30 percent reduction in the probability of det=
ecting a true two-fold reduction of infection risk resulting from condom =
use.=20
=93Inaccurate reporting of condom use and reliance on imperfect diag=
nostic tests can substantially bias observable measures of condom effecti=
veness,=94 the authors concluded. =93The potential for these biases shoul=
d be addressed in the design and analysis of effectiveness studies.=94
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LOCAL AND COMMUNITY NEWS=09
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CALIFORNIA:=20
=93Campaigns Focus on Dark Side of Speed Use=94
Bay Area Reporter (10.21.04)::Matthew S. Bajko
San Francisco Department of Public Health officials have initiated a=
new campaign to change how gay men view crystal methamphetamine and info=
rm them of its dangers. One in three gay and bisexual men recently testin=
g HIV-positive had used crystal in the last six months, according to city=
STD clinic data. =20
=93Crystal Mess=94 ads depict speed's negative effects, including be=
ing impotent, engaging in unsafe sex, and acquiring an STD. The campaign,=
created pro-bono by Templin Brink Design, includes billboards in the Cas=
tro and its transit station, with taglines reading, =93Addiction is no pa=
rty=94 and =93Crystal plays more tricks than you can.=94 A Web site, www.=
crystalmess.net, points crystal users toward helpful resources.=20
=93What we know in various surveys is 12 percent of folks report usi=
ng crystal,=94 said Steven Tierney, SFDPH's director of HIV prevention. =93=
We want people to talk about it, and if they need help, to know where to =
go to get it.=94 Tierney said his section is spending $70,000 to place ad=
s and run the Web site.
The city also launched PROP (Positive Reinforcement Opportunity Prog=
ram), a collaborative community organization effort to help recovering sp=
eed addicts avoid relapse. Participants are referred to service agencies =
and given incentives the longer they remain clear of crystal.
A separate Stop AIDS campaign asks men to =93do the math: if 1 in 5 =
gay and bi men use speed and as many as 3 in 10 men who test HIV-positive=
have used speed recently=85 the odds are pretty high.=94 =93Crystal has =
been branded as a party drug. We want to brand it as a drug highly associ=
ated with HIV transmission,=94 said Jason Riggs, spokesperson for Stop AI=
DS. City and Stop AIDS officials said many crystal users were disengaging=
from whatever was their community and turning instead to the Internet. S=
top AIDS plans to expand its outreach in early January. =20
NEW JERSEY:
=93The Center Helps People with AIDS=94
Asbury Park Press (10.28.04)::Amy Kuperinsky
Among numerous HIV/AIDS services offered by The Center, which assist=
s clients living in Monmouth and Ocean counties, some of the most importa=
nt are moral support and a sense of community, said the Rev. Bob Kaeding,=
director. =93Sometimes it's almost like their living room,=94 said Kaedi=
ng. =93They come, hang out, have a cup of coffee and talk to other people=
.. It becomes a social setting in that sense.=94
Founded in 1992, The Center provides people living with HIV/AIDS mea=
ls, transportation assistance, medical services and financial assistance.=
Each day, center volunteers serve hot meals to 30-40 clients through its=
daily lunch program, which is supported by donations from local business=
es. And once a month, the group holds a Sunday afternoon candlelight dinn=
er hosted by area houses of worship.
Each month, volunteers assemble pantry and hygiene bags, help client=
s with laundry, and contribute to fundraising efforts that support The Ce=
nter, said Kaeding. Clients are referred by their caseworkers, health car=
e providers and facilities like Monmouth Medical Center, Long Branch, and=
Jersey Shore university Medical Center, Neptune.
The Center helps HIV patients who may lack stable housing, said volu=
nteer David Duschai, who was originally a client. Rent assistance, subsid=
ized utilities and financial support for medical care are provided. =93We=
try to deal with all that, being part of the problem with AIDS,=94 said =
Duschai.=20
The Center will expand its services dramatically when it opens Cente=
r House, a facility that will have 25 efficiency apartments available for=
people with AIDS, said Kaeding. That facility, set to break ground on Fe=
b. 15, will be equipped with on-site case management and will host variou=
s activities for residents.=20
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NEWS BRIEFS =09
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CHINA:=20
=93SW China Province Sets Out to Curb Spread of HIV/AIDS from High-Risk G=
roups=94
Xinhua News Agency (11.04.04)
So far, about 100 of 1,343 HIV/AIDS prevention task force members fr=
om disease control centers across Yunnan Province have trained to help ch=
eck the virus's spread from high-risk groups to the general public. Train=
ing for the tasks began at county levels on Nov. 1. The task forces will =
disseminate HIV/AIDS information and prevention campaigns aimed at the ge=
neral population and high-risk groups, said Lu Lin, head of the Yunnan Pr=
ovincial Disease Control Center. Messages will include the use of condoms=
, promotion of needle exchanges, and measures to prevent mother-to-child =
HIV transmission. The task forces will also encourage the public to be to=
lerant and treat people with HIV/AIDS appropriately, Lu said. The top age=
nda item is to work with high-risk groups; Prevention work with these gro=
ups will be based on surveys conducted among them, Lu said.
INDIA:=20
=93India to Reassess HIV/AIDS Program=94
Xinhua News Agency (11.04.04)
India's Health Ministry is planning to invite global bids for an ind=
ependent evaluation of its National AIDS Control Organization's programs =
and their impact. =93We are going in for a reassessment of HIV in our cou=
ntry,=94 Health Minister Anbumani Ramadoss said today at a Social Editor'=
s Conference in New Delhi. =93We expect the report by mid next year. It w=
ould help us to restrategize our program,=94 the minister said. The minis=
try plans to expand access to free antiretroviral treatment from the curr=
ent eight hospitals to 25 hospitals in all the states by the end of the y=
ear, said Ramadoss. India has received a five-year $100 million award fro=
m the Global Fund to Fight HIV, TB and Malaria in its second funding roun=
d. =20
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