| prevention-news@cdcnpin.org 2004-11-09, 7:12 pm |
| CDC HIV/STD/TB Prevention News Update
Tuesday, November 09, 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 re
lying on the validity or invalidity of any statements made in these summaries. This daily update also includes information from CDC and other government agencies, such as background on Morbidity and Mortality Weekly Report (MMWR) articles, fact sheets and
announcements. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC HIV/STD/TB Prevention News Update should be cited as the source of the
information. Contact the sources of the articles abstracted below for full texts of the articles.
HEADLINES
NATIONAL NEWS
FLORIDA: “Lessons Focus on Abstinence”
INTERNATIONAL NEWS
NIGERIA: “New Fulbright Scholar to Focus on AIDS in Her Homeland”
SURINAME: “Bridging the Gaps; AIDS Worker from Suriname Completes Northern Stint”
LESOTHO: “Sesotho-Speaking Doctor, Partner Off to Lesotho to Set Up AIDS Clinic”
MEDICAL NEWS
UNITED STATES: “Decline in Perinatal HIV Transmission in New York State (1997-2000)”
LOCAL AND COMMUNITY NEWS
PENNSYLVANIA: “Nurse Asks Judge to Order Patient to Take HIV Test”
NEW YORK: “City AIDS Head Resigns”
NEWS BRIEFS
TAIWAN: “Taiwan to Ask Hotels, Saunas to Provide Condoms to Prevent AIDS”
CANADA: “Toronto Public Health Begins Testing 4,000 Homeless for Tuberculosis”
CONNECTICUT: “TB Suspected in Foxwoods Worker's Death”
OKLAHOMA: “Two Oklahoma Students Test Positive for TB”
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NATIONAL NEWS
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FLORIDA:
“Lessons Focus on Abstinence”
Orlando Sentinel (11.07.04)::Tania Deluzuriaga
In Central Florida, Lake, Osceola, Polk, Seminole and Volusia counties rely on abstinence-only sex education for middle- and high-school students. Classes, presentations and plays discuss the negative physical, social and emotional consequences of pr
emarital sex and encourage students to save sex for marriage. However, the percentage of high-schoolers who said they have had sex increased from 46 percent in 2001 to 47 percent in 2003, according to a National Center to Prevent Teen Pregnancy report rel
eased earlier this year. At least 60 percent of high-school seniors are sexually active by the time they finish school.
Some experts worry that at a time when many teens are making choices about sex, schools are focusing instead on standardized tests. Florida law mandates that sex education is incorporated into a life management class — a half-credit class taken durin
g freshman or sophomore year. Mary Lane, a curriculum specialist in Seminole County, said graduation requirements essentially dictate courses. “It [sex education] doesn't mesh with the curriculum,” she said.
The RESPECT campaign, Osceola's largest abstinence program, reaches most county middle-schoolers. But the program's high school efforts are mostly limited to occasional speakers. “There is no constant message in high school,” said Patti Nivens, RESPE
CT's community coordinator.
Orange County is the only Central Florida county to offer comprehensive sex education, which stresses abstinence but also teaches about birth control. With primary funding by CDC, the program pairs the school district with community-based groups to g
ive students information about sex, abstinence and birth control.
Under Florida law, sexual abstinence outside of marriage and the benefits of monogamous heterosexual marriage must be taught as the expectation for all school-age children. Parents can opt their children out of any sex education program and review in
struction materials. Florida programs teaching abstinence-only until marriage received almost $7 million in federal funding last year.
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INTERNATIONAL NEWS
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NIGERIA:
“New Fulbright Scholar to Focus on AIDS in Her Homeland”
Pittsburgh Post-Gazette (11.08.04)::Ervin Dyer
Moji Adeyeye excelled in science in her homeland, earning a pharmacy degree from the university of Nigeria. In the United States, she earned her master's degree and doctorate in pharmaceutics at the university of Georgia. In January, Adeyeye, who has
taught for 15 years at Pittsburgh's Duquesne University, will join five DU professors as part of a program to help Nigeria fight HIV/AIDS. She will return as a Fulbright scholar — the exchange program sponsored by the US Department of State.
“I met people crying out for help. My heart went out to them. Since my area of expertise is in drug formulation and manufacturing, I knew I had to do something,” said Adeyeye, who will spend nine months in Nigeria.
Adeyeye will work with up to 24 HIV-negative volunteers in Nigeria to compare the efficacy of lamivudine and zidovudine. The study aims to help treat people with AIDS with less expensive, but effective, AIDS drugs. The study, a collaboration of the U
niversity of Lagos and National Institute for Pharmaceutical Research in Nigeria, will test the stability of the drugs in Nigeria's climate and examine their side effects and chemical similarities. Nigerian AIDS patients obtain medicines from the governme
nt, from pharmacies and from underground markets.
Adeyeye also helps Nigerian AIDS patients access treatment through Drugs for AIDS and HIV Patients, a nonprofit faith-based group she established. It collaborates with Nigerian hospitals linked with the Baptist AIDS Awareness and Prevention Program a
nd Catholic hospitals. The group channels drug donations made by manufacturers; monitors drug storage; provides nutritional supplements for patients; and trains health care workers how to spread HIV/AIDS prevention and awareness messages.
SURINAME:
“Bridging the Gaps; AIDS Worker from Suriname Completes Northern Stint”
Daily Herald-Tribune (Grande Prairie, Alberta) (11.04.04)::Debi Ruhl
Erna Aviankoi, a member of an AIDS service organization in the small South American coastal nation Suriname, came to Canada in September to work with HIV Edmonton and HIV North. Her trip is part of a worldwide exchange program that aims to empower AI
DS workers and teach strategies they can use in their homelands.
Aviankoi, who is a journalist, joined her organization seven years ago. In order to make progress against AIDS, women must have the power to make their own decisions, she believes. “It's very difficult for them to say they don't want children or to h
ave sex. The way of thinking is it's the man who takes care of you and you have to accept what he says.”
While there are thought to be about 3,000 HIV-infected people in Suriname, Aviankoi said the true number is probably three times higher. Suriname has a population of less than 500,000 people.
Just before Christmas, Aviankoi will return to Suriname, taking with her what she has learned in Canada. But until attitudes change, AIDS education in her home country will be challenging. “I've learned a lot and I've seen a lot but the biggest chall
enge is the culture is very different here.… Suriname is smaller and is a Third World country. Because we're not as developed [as] Canada, things are very slow and we are in transition. We need a lot of things. That will take some time so we don't want to
be hyper-optimistic.”
LESOTHO:
“Sesotho-Speaking Doctor, Partner Off to Lesotho to Set Up AIDS Clinic”
Ottawa Citizen (11.05.04)::Carrie Kristal-Schroder
The Ontario Hospital Association is setting up an HIV/AIDS clinic in Lesotho, one of the ten poorest countries in the world. The initiative is in response to a challenge by UN Special Envoy for HIV/AIDS in Africa Stephen Lewis for help with the pande
mic in sub-Saharan Africa. The effort will initially rely on the expertise of its four-member team, which includes Ottawa physician Robert Birnbaum and his partner Russell Armstrong, vice president at the Ottawa Hospital and former director of the Canadia
n AIDS Society.
“It's estimated that 30 percent of the population has the disease, and in some groups it's thought to be as high as 50 percent,” said Armstrong. “As part of the advance team, our job is to provide a complete assessment of how the clinic will become s
ustainable, and to build relationships with elders, government officials and local medical personnel — and it's particularly exciting since we will be one of the first projects to set up since the availability of lower-cost drugs.”
For Birnbaum, who spent two years in Lesotho in the early 1980s, understanding patients' customs and beliefs is as critical as his fluency in the local language, Sesotho. “Part of the belief system is that pills aren't effective — when I practiced th
ere before, people would want either an injection or a vile-tasting liquid, which seemed more powerful to them,” Birnbaum said of the potential challenges in getting patients on drug therapy. “It will also be a challenge to make people understand that the
medication is not a cure for HIV/AIDS, and that they will have to continue on the medication and come in for monitoring.”
Birnbaum and Armstrong, who will begin work in Lesotho on Dec. 1 and return to Canada at the end of January, both said their social conscience was the primary motivator in deciding to sign up for the ambitious project. Armstrong said a Web log of the
ir experiences will be posted at www.OHA.com.
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MEDICAL NEWS
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UNITED STATES:
“Decline in Perinatal HIV Transmission in New York State (1997-2000)”
Journal of Acquired Immune Deficiency Syndromes (08.15.04) Vol. 36; No. 5: P.1075-1082::Nancy A. Wade, MD, MPH; Mary A. Zielinski, MA, MSW; Maia Butsashvili, MD, MS; Louise-Anne McNutt, PhD; Barbara L. Warren, BSN, MPH; Roberta Glaros, MA; Babu Cheku, MD;
Wendy Pulver, MS; Kenneth Pass, PhD; Kathleen Fox, RN, MSA; Antonia C. Novello, MD, MPH, DrPH; Guthrie S. Birkhead, MD, MPH
Perinatal transmission of HIV has declined significantly in New York State (NYS) since the state implemented a 3-part regimen of zidovudine prophylaxis in the antenatal, intrapartum, and newborn periods. The current study describe the factors associa
ted with perinatal transmission in the state from 1997-2000, the first 4 years of NYS's comprehensive program through which all HIV-exposed newborns were identified through universal HIV testing of infants.
The authors performed a population-based observational study including all HIV-exposed newborns whose infection status was known and their mothers identified in NYS through the universal Newborn HIV Screening Program (NSP) from February 1997 to Decem
ber 2000. The researchers reviewed antepartum, intrapartum, newborn and pediatric medical records of HIV-positive mothers/infants for history of prenatal care, antiretroviral therapy (ART), and infant infection status; they also examined risks associated
with perinatal HIV transmission.
The investigators found that the proportion of HIV-infected pregnant women who received 3 or more prenatal-care visits increased during the study period from 76.4 percent in 1997 to 85.4 percent in 2000. An increasing proportion of women received ART
at during pregnancy, delivery, or during the newborn period, rising from 63.8 percent in 1997 to 96 percent in 2000. Intrapartum and newborn ART regimens increased from 48.5 percent in 1997 to 74.2 percent in 2000. Combination ART in the prenatal period
increased from 16.2 percent in 1997 to 67.2 percent in 2000. Elective cesarean deliveries increased from 6.5 percent in 1997 to 35.2 percent in 2000. Perinatal HIV transmission decreased each year, from 11 percent in 1997 to 8.6 percent in 1998 to 7.1 per
cent in 1999 to 3.7 percent in 2000.
The authors performed bivariate analysis of HIV-positive women delivering and found that white women had a higher risk of transmission (10.4 percent) than black women (7 percent). Women over age 40 were 2.2 times more likely to transmit HIV than wome
n 20-29 years old (13.9 percent and 6.3 percent, respectively). Residents of New York City had a higher risk of transmission than HIV-positive women living outside the city.
Women with no prenatal care, with infants of low birth weight, or who had vaginal delivery instead of elective cesarean delivery were more likely to transmit HIV.
A 3-part ART regimen administered in the prenatal, intrapartum, and newborn periods was associated with the lowest rate of transmission, compared with other drug regimens. Abbreviated ART regimens were also associated with reductions in transmission
compared with no prenatal ART.
“Public health policies to improve access to care for pregnant women and advances in clinical care, including receipt of appropriate preventive therapies, have contributed to declines in perinatal transmission in NYS,” the authors concluded.
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LOCAL AND COMMUNITY NEWS
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PENNSYLVANIA:
“Nurse Asks Judge to Order Patient to Take HIV Test”
Associated Press (11.06.04)
On Friday, a registered nurse asked a Pittsburgh court to order a male Mercy Hospital patient to undergo an HIV test after she accidentally stuck herself with a needle she used to administer his insulin. The petition states that the unnamed male pati
ent is infected with hepatitis C and used drugs, placing him at high risk of being HIV-infected.
Though the patient was told that by taking the HIV test he “would be helping out the nurse,” the petition states he refused to take it. “This is an unusual circumstance,” said Linda Ross, a spokesperson for Mercy Hospital, which supports the nurse's
efforts to have the patient tested. “It's the first time in our recollection where a patient refused the test,” said Ross, as quoted in a Pittsburgh Tribune-Review interview.
Pennsylvania law allows patients to refuse an HIV test, but hospitals can test blood they already have from patients if there has been “significant exposure.” According to the nurse's petition, the exposure was significant, said Dr. Bruce MacLeod, ch
airperson of Mercy's department of emergency medicine. It is unclear whether Mercy had a patient blood sample.
While most patients agree to take the tests, “it's tough all the way around because it pits the privacy of the patient versus the health of the practitioner,” said Patricia Hogan, president of Seattle/Puget Sound Chapter of the Association of Nurses
in AIDS Care.
The nurse said she wanted to avoid a four-week prophylactic antiretroviral cocktail CDC recommends for occupational HIV exposure, due to the anemia and liver damage the drugs can cause.
NEW YORK:
“City AIDS Head Resigns”
New York Blade (11.05.04)::Mike Lavers
Dr. Marjorie Hill, New York City's assistant commissioner for HIV/AIDS services at the Department of Health and Mental Hygiene (DOH-MH) resigned on Oct. 29. She will take a new position later this month as director for women and family outreach at Ga
y Men's Health Crisis. “This has been an incredible opportunity,” Hill said of her tenure. “I am really excited about this opportunity to specifically focus on women and families. Unfortunately, they are an underserved and often invisible population livin
g with HIV and AIDS.”
Appointed in 2001, Hill helped implement the city's first needle-exchange program in nine years and helped secure for the city a $122 million Ryan White grant in March. “Marjorie Hill has been a distinguished leader in the fight against HIV/AIDS for
more than two decades,” said DOH-MH Commissioner Thomas Frieden. “We have been extremely fortunate to have had her at the DOH-MH for over three years.”
Hill swiftly denied speculation that her resignation was due to tension with Mayor Michael Bloomberg and his administration. She also praised Bloomberg's plan to close the Mayor's Office of HIV/AIDS Policy Coordination and bring it under DOH-MH's jur
isdiction. Though she was not directly involved in the decision, she said it is “good management and logical to have all HIV services within one entity. It does not make sense to have different services in different offices across the city.”
Deputy Director Jan Carl Park will be DOH-MH's acting assistant commissioner for HIV/AIDS services until a permanent replacement is found.
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NEWS BRIEFS
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TAIWAN:
“Taiwan to Ask Hotels, Saunas to Provide Condoms to Prevent AIDS”
Deutsche Presse-Agentur (11.09.04)
In an effort to curb the spread of HIV/AIDS, Taiwan is asking that hotels and saunas provide guests with condoms, a health official said today. “Under the revised AIDS Prevention Bill, hotels and saunas must provide condoms to guests, but they can de
cide whether to charge the guests for the condoms or not,” said Tsai Shu-fen of Taiwan's Centers for Disease Control. Those businesses that refuse to provide condoms face a maximum 30,000 Taiwan dollars (US$900) fine. Under the bill, prostitutes and their
clients arrested must attend a lecture on AIDS prevention. The new measure also stipulates that citizens from China, Hong Kong and Macau must submit certificates proving they are HIV-negative when they apply for long-term residence in Taiwan.
CANADA:
“Toronto Public Health Begins Testing 4,000 Homeless for Tuberculosis”
Canadian Press (11.08.04)
Up to 4,000 homeless people will undergo testing following the discovery of a TB cluster at a Toronto men's shelter. Two active TB cases were identified among the shelter's staff, and four other staff members have tested positive for the disease, sai
d Dr. David McKeown, the city's medical officer of health. “Finding cases among shelter staff is a signal that transmission of the disease has occurred and there is a risk of infection circulating among the population,” said McKeown. Dr. Barbara Yaffe, th
e city's associate medical officer of health, said testing 4,000 people who are transient by nature will be a daunting task that may take up to six weeks. Those found to have TB will be transferred to a health-care facility and receive the required medica
tion for up to six months.
CONNECTICUT:
“TB Suspected in Foxwoods Worker's Death”
Associated Press (11.09.04)
An employee at Foxwoods Resort Casino has apparently died of tuberculosis, prompting the testing of several of his coworkers, said tribal officials. Results from those tests came back negative. “They did not find any signs of the active disease” in t
he coworkers, said Dr. Amarillys Rodriguez. The man was a Haitian immigrant who resided in Norwich and did not have any direct contact with casino customers. TB cases in Connecticut have declined from year to year, and the majority of cases are found in f
oreign-born people who were exposed abroad, said George Raiselis, TB program administrator for the state Department of Public Health.
OKLAHOMA:
“Two Oklahoma Students Test Positive for TB”
Associated Press (11.09.04)
An elementary school student is the second Tulsa-area pupil to test positive for tuberculosis in the past week, said officials. Letters and testing consent forms were distributed to 91 students and 11 staff at Cherokee Elementary School. The student
with active TB will be out of school until cleared by three sputum smear tests, said Janice Sheehan, manager of the Communicable Disease Control Division at the local health department. Last week, parents of students at Shawnee High School received a simi
lar letter after a student there tested positive for TB exposure.
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