| prevention-news@cdcnpin.org 2004-09-21, 3:22 am |
| CDC HIV/STD/TB Prevention News Update
Wednesday, September 15, 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
CALIFORNIA: =93Two Measures Ease Needle Exchanges=94
INTERNATIONAL NEWS
INDIA: =93India Sitting on AIDS =91Timebomb,=92 Says International Fundin=
g Agency Chief=94
SOUTH AFRICA: =93Indian President Offers Help to Combat AIDS in South Afr=
ica=94
SOUTH AFRICA: =93Government =91Turning Away AIDS Patients=92=94
SOUTH AFRICA: =93Traditional Healers Swamp South Africa with Drug Applica=
tions=94
MEDICAL NEWS
UNITED STATES: =93HIV Transmission Risk Behavior Among Men and Women Livi=
ng with HIV in 4 Cities in the United States=94
UNITED STATES: =93Medication Compliance: Rural Drinkers More Likely to Mi=
ss Doses of HIV Meds=94
LOCAL AND COMMUNITY NEWS
NEW JERSEY: =93Trial Avoided Over $4 Million AIDS Grant=94
NEWS BRIEFS
CHINA: =93China Strives to Curb TB Surge=94
ASIA: =93WHO Urges Greater Access to Essential Medicines for Asia=92s Poo=
r=94
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NATIONAL NEWS=09
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CALIFORNIA:
=93Two Measures Ease Needle Exchanges=94
Fresno Bee (09.12.04)::Jennifer M. Fitzenberger
In 1999, Gov. Gray Davis signed a law allowing municipalities in Cal=
ifornia to establish legal needle-exchange programs by declaring an emerg=
ency =97 but the declaration must be reconsidered every two to three week=
s. Now, Gov. Arnold Schwarzenegger is being lobbied by drug policy advoca=
tes to sign two bills that would make it easier to distribute clean needl=
es.=20
Assembly Bill 2871, approved by the Legislature in August, would let=
local governments establish exchanges with a one-time authorization. The=
current requirement, said Assembly Member Patty Berg (D-Eureka), the bil=
l=92s sponsor, is a =93bureaucratic nightmare=94 that keeps some local go=
vernments from setting up programs. Now, 14 counties and cities have need=
le exchanges; officials in several others have said they would create exc=
hanges if the bill becomes law, Berg said.=20
Senate Bill 1159, by Sen. John Vasconcellos (D-Santa Clara) would le=
t local governments authorize pharmacies to sell up to 10 new syringes to=
an adult without a prescription. Presently, needles can only be sold wit=
hout a prescription in specific circumstances, such as to administer insu=
lin.
A study in the September edition of the Journal of Urban Health =97 =
=93Estimating Numbers of Injecting Drug Users in Metropolitan Areas for S=
tructural Analyses of Community Vulnerability and for Assessing Relative =
Degrees of Service Provision for Injecting Drug Users=94 (2004;81(3):377-=
400) =97 finds that Fresno has the highest per capita number of injection=
drug users of 96 US metro areas: 173 per 100,000 population.=20
Glenn Backes, health policy director for the Drug Policy Alliance Ne=
twork, supports the bills: =93Perhaps the knowledge that the [San Joaquin=
] Valley is in the midst of a crisis=85 will have the needed effect to es=
tablish good disease prevention policy.=94=20
But John Lovell, a Sacramento lobbyist who represents narcotics offi=
cers and police chiefs, said DPAN =93shouldn=92t be permitted to dress up=
their agenda in the cloak of public health. What they=92re proposing is =
not good public health policy.=94
Schwarzenegger has until Sept. 30 to sign or veto the measures; he h=
as not taken a position on either bill.
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INTERNATIONAL NEWS=09
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INDIA:=20
=93India Sitting on AIDS =91Timebomb,=92 Says International Funding Agenc=
y Chief=94
Agence France Presse (09.15.04)
Today in New Delhi, the executive director of the Global Fund to Fig=
ht AIDS, TB and Malaria told reporters that India=92s HIV/AIDS epidemic =93=
is extremely grave,=94 and that official surveillance estimates are conse=
rvative. =93It is a grave, ticking timebomb,=94 Richard Feachem said of t=
he epidemic.=20
According to India=92s National AIDS Control Organization, India had=
5.1 million infections by 2003, the second-highest figure in the world a=
fter South Africa. NACO=92s July report said the nation recorded 520,000 =
new HIV cases in 2003, and attributed the decrease from 610,000 cases in =
2002 to the organization=92s successful AIDS approach. But Feachem said t=
hose figures were =93conservative estimates based on limited data.=94
=93There are large gaps in AIDS surveillance in India. So how can yo=
u say there are only 5.1 million infections?=94 Feachem asked. =93The Ind=
ia epidemic is on the African trajectory=85 it is only 10 or 15 years beh=
ind.=94=20
Since 2002, the Global Fund has approved $265 million dollars to fig=
ht AIDS in India, but the country still lacks effective detection and sur=
veillance mechanisms, Feachem said. =93The Indian epidemic will be huge i=
f the response is not accelerated,=94 he said. =93The full recognition of=
the challenge is not there,=94 said Feachem, adding that he would discus=
s the issue with Prime Minister Manmohan Singh, Health Minister Anbumani =
Ramadoss and others during his three-day visit. Feachem also urged Indian=
business and civic groups to step in and supplement government efforts t=
o stop HIV/AIDS.=20
SOUTH AFRICA:
=93Indian President Offers Help to Combat AIDS in South Africa=94
Agence France Presse (09.15.04)
Today in Cape Town, Indian President Abdul Kalam said his country wo=
uld like to work with South Africa on pressing issues like HIV/AIDS and e=
ducation. =93We are concerned about your health problems,=94 Kalam said a=
t a news conference following a one-hour meeting with President Thabo Mbe=
ki. The state visit, the first by an Indian president to South Africa, co=
mes on the 10-year anniversary of the end of apartheid and the centenary =
of a communal farm established by Indian independence hero Mahatma Gandhi=
..=20
=93We have developed a drug in India that can arrest the development=
of HIV/AIDS and it is being produced,=94 said Kalam, without providing d=
etails. Indian drug giant Cipla is a major producer of antiretrovirals th=
at the South African government needs for its program to provide free ARV=
s to tens of thousands of AIDS patients. According to UNAIDS, South Afric=
a has the world=92s highest HIV/AIDS caseload with an estimated 5.3 milli=
on people infected.=20
In a joint statement, Mbeki and Kalam said they were examining =93ne=
w ways of enhancing the strategic partnership between the two countries=94=
and highlighted a =93close convergence of viewpoints=94 on international=
issues. Kalam was scheduled to address a joint session of India=92s Parl=
iament later today. On Thursday, Kalam is due to meet with Nelson Mandela=
in Johannesburg before traveling to Durban, home to most of South Africa=
=92s 1.2 million citizens of Indian origin.=20
SOUTH AFRICA:=20
=93Government =91Turning Away AIDS Patients=92=94
Business Day (09.14.04)::Tamar Kahn
Weak political leadership is the reason so few South African AIDS pa=
tients are receiving free drugs, according to the Joint Civil Society Mon=
itoring and Evaluation Forum, a new umbrella group that plans to act as a=
n =93early warning system=94 for difficulties affecting the government=92=
s comprehensive AIDS treatment plan. On Tuesday in Cape Town, the forum p=
rovided a report of progress, province-level assessments and a list of ob=
stacles to treatment.
At one KwaZulu-Natal site, waiting lists were so long that patients =
were being told to return in a year, said Fatima Hassan of the AIDS Law P=
roject. =93We don=92t have figures, but we are seeing an increasing numbe=
r of calls from people who are trying to access treatment [and failing],=94=
she said.
In November, the government estimated 400,000-500,000 South Africans=
were at advanced stages of HIV infection and would benefit from AIDS dru=
gs.=20
The forum agreed with the Health Department=92s figure that 8,000 pe=
ople were receiving free AIDS drugs in the public sector. About 60 percen=
t of patients receiving free public treatment live in Gauteng (2,800 pati=
ents) and Western Cape (3,830 patients). In KwaZulu-Natal, which has the =
nation=92s highest HIV prevalence, only 535 patients are receiving treatm=
ent. There are 20 patients receiving treatment in Limpopo and 124 such pa=
tients in the Eastern Cape. An estimated 20,000 are receiving treatment i=
n the private sector.
Additional obstacles to the rollout plan listed by the forum include=
severe staff shortages; underutilization of capacity; reluctance to use =
public-private partnerships; and concerns regarding provinces=92 ability =
to spend their HIV/AIDS budgets.=20
Members of the forum include Anglo American, Treatment Action Campai=
gn, Institute for Democracy SA, Health Systems Trust, Open Democracy Advi=
ce Center, Center for Health Policy, Doctors Without Borders, Public Serv=
ice Accountability Monitor and the university of Cape Town=92s School of =
Public Policy. =20
SOUTH AFRICA:=20
=93Traditional Healers Swamp South Africa with Drug Applications=94
Agence France Presse (09.10.04)
In advance of a new law to manage the alternative medicine field in =
South Africa, about 13,000 traditional medicine applications =97 includin=
g some claiming AIDS cures =97 have been filed for official approval with=
the Medicines Control Council, the Registrar of Medicines said Friday. =93=
The problem is that we do not have documented evidence of their safety pr=
ofile and we do not have evidence of their efficacy profile,=94 said Prec=
ious Matsoso. =93For that reason a reference center has been established =
where the Medicines Research Council will conduct clinical trials to esta=
blish the safety profiles and their efficacy.=94
On Sept. 9, the South African parliament adopted a bill to recognize=
traditional healers as health care professionals and to regulate the ind=
ustry. The bill creates a council to oversee the licensing of traditional=
healers. The Health Ministry is also creating a law to regulate the use =
of traditional medicines. It is in accordance with this law that MCC rece=
ived applications to register the drugs. The regulations have been publis=
hed for comment and are likely to become effective before the end of the =
year, said Matsoso.
There are about 200,000 traditional healers in South Africa who use =
rituals and herbal concoctions to treat patients.=20
=93What we have seen increasingly in South Africa is there have been=
claims for cures that have not been substantiated,=94 said Matsoso. =93T=
hey have been making claims, which I consider as misleading, that they ca=
n cure AIDS but there=92s no evidence that they work.=94 If the drugs mee=
t strict safety and efficacy requirements, MCC could consider registering=
the drugs, she said. =20
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MEDICAL NEWS=09
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UNITED STATES:
=93HIV Transmission Risk Behavior Among Men and Women Living with HIV in =
4 Cities in the United States=94
Journal of Acquired Immune Deficiency Syndromes (08.15.04) Vol. 36; No. 5=
: 1057-1066::Lance S. Weinhardt, PhD; Jeffrey A. Kelly, PhD; Michael J. B=
rondino, PhD; Mary Jane Rotheram-Borus, PhD; Sheri B. Kirshenbaum, PhD; M=
argaret A. Chesney, PhD; Robert H. Remien, PhD; Stephen F. Morin, PhD; Ma=
rguerita Lightfoot, PhD; Anke A. Ehrhardt, PhD; Mallory O. Johnson, PhD; =
Sheryl L. Catz, PhD; Steven D. Pinkerton, PhD; Eric G. Benotsch, PhD;, Da=
niel Hong, MA; Cheryl Gore-Felton, PhD; National Institute of Mental Heal=
th Healthy Living Project Team
The authors interviewed 3,723 HIV-positive people in clinics and com=
munity-based agencies in Los Angeles, Milwaukee, New York City and San Fr=
ancisco from June 2000-January 2002 about sexual and drug-use behaviors t=
hat confer risk for transmitting HIV. Of the participants, 1,918 were men=
who have sex with men (MSM), 978 were women and 827 were heterosexual me=
n. The study sample was ethnically and geographically diverse, and most p=
articipants were sexually active.
The researchers found less than one quarter of women and heterosexua=
l men had 2 or more sexual partners, while 59 percent of MSM reported mul=
tiple partners. More than half of MSM and approximately two-thirds of wom=
en and heterosexual men did not report unprotected vaginal or anal interc=
ourse with any recent sexual partners. =93Among those who did engage in u=
nprotected behavior, more than two thirds of unprotected acts occurred wi=
th HIV-positive partners,=94 the study said. =93These findings are hearte=
ning because they indicate that most persons aware of their own HIV infec=
tion refrain from sexual activities likely to transmit the virus to other=
s who are not infected.=94
The investigators found that most HIV-positive participants revealed=
their status to all partners of any HIV serostatus. However, the authors=
noted =93approximately 19 percent of women, 15.6 percent of MSM and 13.1=
percent of heterosexual men engaged in unprotected vaginal or anal inter=
course with partners who were HIV-negative or whose serostatus was unknow=
n.=94
Eighteen percent of 304 participants who injected drugs during the p=
revious three months reported lending used injection equipment to others.
=93An estimated 30.4 new infections (79.7 percent as a result of sex=
ual interactions with MSM) would be expected among the sex partners of st=
udy participants during the 3-month reporting period,=94 the researchers =
wrote. =93The findings of this study underscore the need to integrate ong=
oing effective HIV risk reduction counseling better within medical and ot=
her care programs serving persons living with HIV infection,=94 the autho=
rs noted.
=93By integrating prevention with medical and social care services, =
it will be possible for persons with HIV infection to live longer and hea=
lthier lives and to avoid behaviors that could result in virus transmissi=
on to others and their own exposure to additional sexually transmitted in=
fections and treatment-resistant strains of HIV,=94 the scientists conclu=
ded.
UNITED STATES:
=93Medication Compliance: Rural Drinkers More Likely to Miss Doses of HIV=
Meds=94
AIDS Weekly (09.06.04)
HIV patients in rural areas are less likely to adhere to treatment r=
egimens if they are problem drinkers, according to a report by Tulane Uni=
versity researchers. About one in three HIV patients surveyed reported mi=
ssing at least one dose of medicine in the prior week.
The complicated dosing schedule of highly active antiretroviral ther=
apy, together with its significant side effects, can make it difficult fo=
r people to adhere to treatment regimens, said lead author Hamish Mohamme=
d, a graduate student at Tulane=92s School of Public Health and Tropical =
Medicine. The researchers analyzed data from 273 patient interviews at ei=
ght rural Louisiana clinics. Mohammed said rural HIV patients =93may face=
different barriers to taking proper care of themselves=94 than patients =
in cities: =93Our analysis suggests that they could benefit from programs=
to address chronic alcohol drinking.=94
Using the CAGE index, the researchers defined =93problem drinkers=94=
as people who answered =93yes=94 to two or more of the following questio=
ns: =93In the past month did you ever feel (1) that you should cut down o=
n your drinking? (2) people annoyed you by criticizing your drinking? (3)=
bad or guilty about your drinking? (4) have a drink first thing in the m=
orning to steady your nerves or rid yourself of a hangover?=94
The researchers identified 12.8 percent of respondents as problem dr=
inkers; 12.8 percent as binge drinkers; and 16.8 percent as illicit drug =
users. Almost half of respondents (49.8 percent) reported signs of depres=
sion. Problem drinking was the strongest predictor of at least one missed=
dose of medication.
The full report, =93Adherence to HAART Among HIV-Infected Persons in=
Rural Louisiana,=94 was published in AIDS Patient Care and STDs (2004;18=
(5):289-296).
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LOCAL AND COMMUNITY NEWS=09
************************************************************
NEW JERSEY:
=93Trial Avoided Over $4 Million AIDS Grant=94
The Record (Bergen County, N.J.) (09.14.04)::Eman Varoqua
On Monday, the Patterson-based Ryan White Planning Council, which se=
rves Bergen and Passaic counties, dropped its lawsuit against the Patters=
on City Council after the two sides reached a settlement out of court. RW=
PC sought a judge=92s help after the City Council failed to approve all t=
he resolutions the group needs to secure a $4 million federal grant. The =
group needs the council=92s signature by Wednesday to get the money.
When RWPC filed a motion to dismiss, it said the two parties were sa=
tisfied after the City Council took back one of its actions, and the two =
bodies would work out a compromise. =93We=92re satisfied the city will mo=
ve forward with the grant,=94 said Frank Covello, RWPC=92s attorney.=20
Last week, the matter came before Superior Court Judge Robert J. Pas=
sero in Patterson. After hearing allegations of =93political cronies=94 a=
nd =93bias,=94 he urged both parties to reach a settlement or face an in-=
depth trial.=20
Formed in 1993, RWPC receives a large federal grant for division amo=
ng local HIV/AIDS service providers. RWPC proposed to grant 23 service co=
ntracts; the City Council accepted 16 but rejected seven. The City Counci=
l=92s attorney said it declined to approve the seven contracts as present=
ed due to allegations of improper review and bias. RWPC said the City Cou=
ncil lacked the authority to change the contracts=92 budgetary figures, d=
epleting some services while providing others with excessive funding. Cou=
rt documents do not list the groups=92 names.=20
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NEWS BRIEFS =09
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CHINA:
=93China Strives to Curb TB Surge=94
Xinhua News Agency (09.15.04)
On Tuesday at a news briefing in Beijing, Vice Health Minister Wang =
Longde said China would have 20 million to 30 million more TB patients in=
the next 10 years unless proper measures are taken. Incomplete adherence=
to drug regimens is contributing to drug-resistant TB, he said. A specia=
l fund rewards Chinese doctors for diagnosing TB patients. China=92s curr=
ent TB caseload, 4.5 million patients, includes 1.5 million with active T=
B. Some 1.45 million new TB cases are diagnosed annually, and TB kills 13=
0,000 Chinese per year. Wang called for greater anti-TB efforts in the ru=
ral areas, where 80 percent of Chinese TB patients live.
ASIA:
=93WHO Urges Greater Access to Essential Medicines for Asia=92s Poor=94
Agence France Presse (09.15.04)
Today in Shanghai, the World Health Organization said too many sick =
Asians are dying needlessly due to the lack of essential medicines. =93Ab=
out 1,000 people in the region die of tuberculosis every day, despite the=
existence of an effective cure,=94 said Shigeru Omi, WHO=92s regional di=
rector for the Western Pacific. In addition to ensuring better access to =
the drugs to fight TB, malaria and various childhood diseases, Omi called=
for an increased effort to fight the proliferation of fake medicines in =
the region: =93Effective medicines regulation and enforcement, legislatio=
n, confiscation and destruction of counterfeit medicines and strong polit=
ical will are all needed if dealers in counterfeit medicines are to be de=
terred.=94
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