| prevention-news@cdcnpin.org 2005-03-23, 5:35 pm |
| CDC HIV/STD/TB Prevention News Update
Tuesday, March 22, 2005
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
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tracted below for full texts of the articles.
HEADLINES
NATIONAL NEWS
UNITED STATES: "TB Declines, but Not in Immigrants"
INTERNATIONAL NEWS
GLOBAL: "India's Lower House Approves Patent Bill"
ASIA: "WHO Warns of Undetected Cases of TB in East Asia and Pacific"
CHINA: "Chinese Province Requires HIV Tests for Hospitality Industry Workers, Threatens Those Who Fail with Sacking"
GLOBAL: "More Countries Get Price Break on AIDS Drug"
TANZANIA: "Tanzania Wants 44,000 HIV Patients on Drugs by December"
MEDICAL NEWS
UNITED KINGDOM: "AIDS Virus Came to Britain Six Times, Study Shows"
LOCAL AND COMMUNITY NEWS
ARIZONA: "Pinal County Program Urges Teens to Practice Abstinence"
NEWS BRIEFS
CALIFORNIA: "AIDS Foundation Finds New Director Nearby"
GLOBAL: "Trafficking in Children on the Increase, European Body Warns"
THAILAND: "38 Thai Construction Workers Found HIV Positive in Bangladesh"
SPAIN: "More than 2,000 New Spanish AIDS Cases in 2004"
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NATIONAL NEWS
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UNITED STATES:
"TB Declines, but Not in Immigrants"
New York Times (03.22.05)::Donald G. McNeil Jr.
The US tuberculosis infection rate reached an all-time low in 2004, according to a recent CDC report. However, 17 states reported increased TB rates, and states with large immigrant populations - including California, Florida, New Jersey, and New Yor
k - accounted for the majority of new cases.
CDC found that TB rates for Asians were 20 times that of whites, and rates for blacks and Hispanics were eight times greater than for whites. Overall, last year's number of cases, 14,511, was the lowest since recording began in 1953.
According to Dr. Kenneth Castro, director of the TB control division at CDC, the high rates for Asians "are a reflection of immigration patterns and TB rates in the countries of origin." At least half the US cases were born abroad and probably infect
ed there as well, said Castro.
The higher rates among blacks and Hispanics reflect their disproportionate rates of incarceration, homelessness, and drug abuse, Castro said, as well as high TB rates in Mexico.
Cases of multi-drug-resistant TB (MDR-TB) continued to decline, which Castro attributed to measures taken after an epidemic of drug-resistant strains broke out in the late 1980s. TB patients are now tested regularly for drug resistance, and doctors c
an change their regimens accordingly. Just 114 cases of MDR-TB were recorded in 2003, the last year for which they have been tallied; 86 of them were in foreign-born persons.
Local clinics have also become more adept at enticing patients to report daily for supervised treatment during the six to nine months it takes to treat TB, Castro noted, thus minimizing the opportunities for drug resistance to develop.
Castro cited two recent MDR-TB outbreaks in high schools in Georgia and California that were from strains circulating abroad. "To me, that shows the importance of the US being involved in controlling TB overseas," he said. "It's enlightened self-inte
rest."
The full report, "Trends in Tuberculosis - United States, 2004," was published in CDC's Morbidity and Mortality Weekly Report (2005;54(10):245-249).
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INTERNATIONAL NEWS
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GLOBAL:
"India's Lower House Approves Patent Bill"
Reuters (03.22.05)::Surojit Gupta
Today in New Delhi, the lower house of India's Parliament passed a bill making it illegal to copy patented drugs. The passage, by a voice vote, is seen as key to fulfilling India's World Trade Organization commitments. The bill, which also covers oth
er products, will become law if approved by the upper house.
The Congress Party-led government bowed to its communist allies by including amendments allowing the export of pharmaceutical products to the least-developed countries. Earlier, the bill faced opposition from those concerned about its effects on the
availability of affordable drugs in India.
A robust drug manufacturing industry has flourished in India for more than three decades thanks to the existing patent law; it allows drug makers to copy patented drugs so long as they use a different manufacturing process. That India is the world's
fourth-largest drug producer by volume but only the 13th largest by value reflects the very low prices charged in the local market.
Some protested the move. Legislators from the Hindu nationalist Bharatiya Janata Party led an opposition walk-out from Parliament before the legislation was approved. Health activists called on the government to review the bill, warning that it would
make drugs unaffordable for millions of people with AIDS. "Fifty percent of people with AIDS in the developing world depend on generic drugs from India," said Ellen 't Hoen, director of policy advocacy and research at Doctors Without Borders.
Analysts, however, applauded the passage of the bill, which they said would encourage foreign companies to undertake research and development activities in India.
ASIA:
"WHO Warns of Undetected Cases of TB in East Asia and Pacific"
Deutsche Presse-Agentur (03.22.05)
Half of the estimated 2 million people in East Asia and the Pacific who are infected with TB each year go undetected and untreated, the World Health Organization said today. Without treatment, around one-third of these undetected cases will likely in
fect 15 people each, worsening the region's TB epidemic, WHO warned ahead of Thursday's World TB Day.
"It's tragic that so many people suffer silently with TB when there is, in fact, a cure that works," said WHO's Western Pacific Regional Director Shigeru Omi. "The sick waste away slowly, suffer financial ruin, and maybe infect family members. And it
's all so unnecessary."
TB kills four people worldwide every minute, and multi-drug-resistant TB, which is more difficult to treat, is on the rise, said WHO. In Asia, the disease causes more deaths than all other infectious diseases, it added.
WHO said the failure to detect and treat TB can be attributed to poor public awareness about the disease, limited access to and delivery of health care services, and the low quality of laboratory services. WHO is working to enhance case detection and
further promote the DOTS strategy, which calls for early detection and consistent monitoring of a six-month drug regimen.
WHO's 2005 goal for the Western Pacific region is to provide 100 percent access to DOTS, improve detection to 70 percent of all cases, and have a cure rate of at least 85 percent. DOTS coverage in the region reached 90 percent in 2003, while the trea
tment success rate has already exceeded the target, WHO said, though it added that the region's 2003 case detection rate of 52 percent was short of the target.
CHINA:
"Chinese Province Requires HIV Tests for Hospitality Industry Workers, Threatens Those Who Fail with Sacking"
Associated Press (03.22.05)::Christopher Bodeen
On Monday, authorities in China's Yunnan province announced they will require hospitality industry workers to take annual HIV tests, Xinhua News Agency reported. The mandatory free tests are meant to control HIV's spread and help get those infected i
nto timely treatment, said Wang Yinsheng, a Yunnan AIDS Prevention Center official.
The testing rule would apply to employees of hotels, bathhouses, beauty salons, nightclubs, and other entertainment venues that play a role in China's sex industry. Those testing positive for HIV or other STDs would be denied a certificate of good he
alth, without which they could not legally work in the hospitality or service industries. Xinhua said those infected would be fired; however, Wang said health officials would not insist that infected workers be fired - they could instead be transferred to
jobs involving no public contact, Wang said.
Though the UN strongly supports voluntary HIV testing, Yunnan's mandatory testing rule "is a worrisome development," said Joel Rehnstrom, UNAIDS country coordinator in Beijing. Mandatory testing was tried several years ago in Thailand and was found
to be much less effective than condom promotion, he said.
UNAIDS is forwarding its concerns about such testing to government authorities, said Rehnstrom. "We're encouraged by the overall attention of the government to raise attention to AIDS. But we also want to make sure that the best possible policies are
put in place."
Yunnan borders Southeast Asia's drug-producing Golden Triangle and has the second-largest number of registered AIDS cases, after Hennan province. Yunnan has also adopted robust AIDS control measures, including condom and clean-needle promotion, and c
reating AIDS monitoring and treatment centers.
GLOBAL:
"More Countries Get Price Break on AIDS Drug"
San Francisco Chronicle (03.18.05)::Sabin Russell
On March 16, drugmaker Gilead Sciences announced that 27 more countries can buy its AIDS drug Viread (tenofovir) at a "no profit price." In December 2002, Gilead announced it would sell Viread virtually at cost to 68 countries named as "least develop
ed" by the UN. By late August, those countries could theoretically obtain Viread for about $25 a month. With the addition of the newest countries, mostly in Latin America and the Caribbean, Gilead has expanded the program to 95 countries.
However, Doctors Without Borders criticized Gilead's Viread program, and Gilead acknowledged that of the 68 original countries named, only 22 have been supplied the drug. The drug has received approval by authorities from only five countries: Uganda,
Rwanda, Zambia, Kenya, and Gambia. However, Gilead has arranged temporary importation permits pending final approval by governments. The approval process is often slow, but such efforts are ongoing, said Amy Flood, a Gilead spokesperson. So far, 7,000 pa
tients have received Viread through the program, she said.
DWB claims the Gilead program's track record is poor and that adding more countries is an empty gesture. "Like most announcements from pharmaceutical companies, there is something disingenuous about this one," said Rachel Cohen, DWB's US director of
the Campaign for Access to Essential Medicines. Without registration in the low-income nations, "it can't be made available," she said.
DWB has a keen interest in tenofovir, which the group views as a good drug option to use if patients in poor countries start to develop HIV resistant to cheaper drugs. "We would really like the option of being able to use this drug," said Cohen.
TANZANIA:
"Tanzania Wants 44,000 HIV Patients on Drugs by December"
Reuters (03.17.05)::Helen Nyambura
On Thursday, Tanzanian Health Minister Anna Abdallah said her country plans to sharply increase the number of HIV patients receiving antiretroviral drugs by the end of 2005. According to UN figures, about 12-15 percent of Tanzanian adults are HIV-inf
ected and about 200,000 of them in acute need of antiretroviral (ARV) therapy. Abdullah said the government had 4,000 patients in treatment at the end of 2004 and hopes to have expanded that number to 44,000 by the end of 2005. "The total number of patien
ts we wish to reach is 500,000 by 2008," she said, noting that other stakeholders are helping the government ramp-up treatment access.
The Health Ministry has ordered $3.5 million worth of ARVs for 2005, and Canada has provided a similar amount of money to purchase more drugs, said Abdallah.
On March 16, the ministry and US officials signed an agreement for the procurement and distribution of ARV drugs under the US President's Emergency Plan for AIDS Relief. Tanzania received $49 million in PEPFAR funds in 2004. For 2005, US officials sa
id they have requested $80 million.
Health officials say Tanzania's need for low-cost AIDS drugs will likely continue unabated. An increase in the country's TB infection rate is an indicator that HIV infection is escalating, said Abdallah. "Our worry is that the number of [TB patients]
is on the increase. It was 19,000 in 1995; it has reached 65,665 in 2003," she noted. In 2004, 63,687 TB cases were reported in 19 of Tanzania's 26 regions. "Sixty percent of the patients are HIV positive, it is an indicator that prevalence is growing,"
said Abdallah.
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MEDICAL NEWS
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UNITED KINGDOM:
"AIDS Virus Came to Britain Six Times, Study Shows"
Reuters (03.15.05)
The history of the UK's HIV-1 subtype B epidemic began with six separate introductions of the virus in early to mid-1980s, rather than from one transmission, according to genetic research by Dr. Deenan Pillay, of university college London's Center of
Virology, and colleagues. HIV-1 subtype B is Britain's most common form of the virus and is transmitted there mostly among men who have sex with men.
Study authors created a genetic family tree for HIV using samples taken from 1,645 British patients and 1,784 samples of subtype B around the world. In the UK, there was no epicenter for any of the epidemics, suggesting the carriers moved around the
country, said researchers.
Condom use may explain a later deceleration of new HIV transmissions, Pillay said. However, the team found no indication that HIV drug cocktails affected HIV's spread. There are now more than 57,700 people in Britain infected with HIV.
"Our study suggests that the HIV-1 subtype B epidemic currently circulating in the UK is made up of at least six established chains of transmission, introduced in the early and mid 1980s," said Pillay. "This goes against the prevailing belief that on
e initial entry of HIV-1 was responsible for the spread of the epidemic."
The full report, "Genetic Analysis Reveals the Complex Structure of HIV-1 Transmission Within Defined Risk Groups," was published in the advance online edition of Proceedings of the National Academy of Sciences of the USA (2005;doi10.1073/pnas.040753
4102).
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LOCAL AND COMMUNITY NEWS
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ARIZONA:
"Pinal County Program Urges Teens to Practice Abstinence"
Associated Press (03.20.05)::Preston McConkie
Pinal County's abstinence program, Worth the Wait, teaches teens that sex is one of five youth risk behaviors, in addition to drinking, illegal drugs, tobacco, and violence. Teens are listening to that message, said Juli Kelly, the health education o
utreach director and president of the Coolidge Unified School District school board.
But Kelly said the program is suffering due to an $800,000 line item veto by Gov. Janet Napolitano that included a cut in WTW's funding. "We went from a $180,000 program in '03-'04 to an $80,000 program this year," Kelly said.
WTW integrates information and decision-making skills, said Susan Price, principal of the McCray Intermediate School in Coolidge. "With sex education, kids need to be taught goal-setting, decision-making, and other application skills," Price said. Be
fore WTW, two sixth-grade girls left school due to pregnancy, said Price. That has not happened in the seven years since the program started, she said.
WTW makes the most noticeable difference to younger students' attitudes, said David Silvas, a counselor who teaches grades 6-12. The program helps end the teasing about sex that begins around sixth grade, Silvas said. "The single biggest predictor of
whether a child will abstain is simply whether their parents tell them they don't want them to have sex," he said. Hearing that message from an authority figure may increase the effectiveness of parental guidance, he said.
For those schools that lost WTW, there are other programs, including the university of Arizona Extension Program's abstinence-based Safe Dates and a traveling student troupe called the Power of Intelligence Not To team.
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NEWS BRIEFS
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CALIFORNIA:
"AIDS Foundation Finds New Director Nearby"
San Francisco Chronicle (03.22.05)::Sabin Russell
The San Francisco AIDS Foundation has concluded its nationwide search for a new executive director by hiring the chief of another city nonprofit. Mark Cloutier is now executive director of Continuum, a Tenderloin-based treatment center serving adults
with HIV and concurrent challenges such as mental illness and substance abuse. He will take the reins of SFAF on June 1, replacing Pat Christen, who resigned in July after 15 years. Lonnie Payne, a member of SFAF's board, praised Cloutier for having the
"intellect, broad background, and practical experience" needed to steer the AIDS service organization during a time of reduced federal spending and tough economic realities for corporate donors. Cloutier's salary of $170,000 is less than the $190,000 rep
ortedly paid to Christen in 2003. Payne called the salary competitive and "appropriate for an organization of this size."
GLOBAL:
"Trafficking in Children on the Increase, European Body Warns"
Agence France Presse (03.18.05)::Michael Adler
On Friday in Vienna, the Organization for Security and Cooperation in Europe warned that trafficking in children is growing internationally and may have doubled in southeast Europe in just the past three years. An estimated 1.2 million children are s
muggled throughout the world each year and are bought and sold for work in mines, homes, farm fields, and the sex industry, said Helga Konrad, the organization's representative fighting human trafficking. Child-selling is booming for many reasons, she sai
d, including that children are desired in the sex industry because they are perceived to be a less likely to have HIV/AIDS.
THAILAND:
"38 Thai Construction Workers Found HIV Positive in Bangladesh"
Associated Press (03.20.05)
Of 38 Thai construction workers diagnosed as HIV-positive in Bangladesh, 21 have been deported and the remaining 17 have been ordered to leave, the Bangladesh newspaper Daily Star reported Sunday. The workers had been employed on a bridge constructio
n project in Khulna, the report said. A government health official in Khulna, Daud Ali Mir, said he was not aware of the deportations.
SPAIN:
"More than 2,000 New Spanish AIDS Cases in 2004"
Agence France Presse (03.18.05)
On Friday, Spain's health ministry said it registered 2,034 new AIDS cases in 2004, a 10 percent decline in the rate of growth from 2003. Of the new cases, three-quarters are men and the majority acquired the virus through intravenous drug use. The r
eduction in new AIDS cases is due to the effectiveness of antiretroviral treatments, according to Lourdes Chamorro, who is leading a national effort against AIDS. Spain has had a cumulative 69,799 people with AIDS, of whom 42,149 had died as of 2001, said
the ministry.
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