| prevention-news@cdcnpin.org 2005-03-23, 5:36 pm |
| CDC HIV/STD/TB Prevention News Update
Wednesday, March 23, 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
MASSACHUSETTS: "State Reports Increase in Tuberculosis Cases Last Year"
HAWAII: "Hawaii's TB Rate Among Highest"
DISTRICT Of COLUMBIA: "TB Cases Rise 3 Percent in District of Columbia"
INTERNATIONAL NEWS
GLOBAL: "Global TB Campaign Making Headway, but Africa, AIDS Are Big Problems"
INDIA: "Aid Groups Slam Indian Decision to Adopt Patent Law to End Manufacture of Cheap Copies of Western Medicine"
MEDICAL NEWS
UNITED STATES: "Exploring the Role of Needle Selling in a Drug-Using Community in Baltimore, Maryland"
LOCAL AND COMMUNITY NEWS
ILLINOIS: "Better Drug Treatment for Gays Urged"
NEWS BRIEFS
GLOBAL: "Economic Disparity Threatening Survival of Poor East Asian Children: UNICEF"
MONTANA: "Syphilis Rise Concerns Officials"
CANADA: "Blood Supply Almost Fully Safe from HIV, Hepatitis C"
FLORIDA: "Six HIV/AIDS Groups Receive Grant Funds"
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NATIONAL NEWS
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MASSACHUSETTS:
"State Reports Increase in Tuberculosis Cases Last Year"
Associated Press (03.22.05)::Theo Emery
Active TB cases in Massachusetts last year rose by 9 percent, from 261 cases in 2003 to 284 cases, according to the state Department of Public Health. Officials attributed the increase, which follows years of declining or stable caseloads, to a large
number of latent TB cases that had recently developed into active cases among foreign-born persons from countries with high TB prevalence.
"We're always concerned if the numbers are going in the wrong direction," though the recent uptick is no cause for alarm, said Dr. Alfred DeMaria, DPH's chief medical officer. DeMaria said officials need to increase testing and prevention efforts. "I
f we're really going to get cases down, we have to do more than just find active TB and treat it," he said.
There is no simple answer for why TB case numbers jumped in the state, said Susan Etkind, director of DPH's Division of TB Prevention and Control. "We have looked at the data every way you can possibly analyze it," she said. "There's not one single t
hing that stands out as being the potential factor that caused the increase for this past year."
There are now 4.4 TB cases per 100,000 Massachusetts residents, according to DPH. The state is one of 18, including neighboring New Hampshire and Rhode Island, in which TB cases increased in 2004.
HAWAII:
"Hawaii's TB Rate Among Highest"
Honolulu Advertiser (03.18.05)::Jan TenBruggencate
According to CDC data, Hawaii continues to have a high rate of TB, with 116 cases in 2004 or 9.2 cases per 100,000 population - the nation's second-highest rate - largely due to a significant immigrant population from countries with heavy TB burdens.
"Rural, economically depressed Asian areas still have a lot of TB, but that's really no different than the situation in the United States as little as 60 years ago," said Dr. Steve Berman, an infectious-disease specialist in Honolulu. Health official
s said both the Hawaii and US TB rates are declining. Yet worldwide, TB remains a huge problem.
"The World Health Organization says that one-third of the people in the world are infected with TB," said Dr. Jessie Wing, a CDC medical officer who runs Hawaii's TB control program. "This disease is going to outlast all of us until we have a vaccine
," she said.
"TB is one of those orphan diseases without enough funding," said Wing. "A third of the people infected and no vaccine? We need a vaccine for this." TB is a "smart" disease, Wing said, developing antibiotic-resistant strains just six months after the
drugs were developed 60 years ago.
The state Department of Health carefully monitors latent TB treatment to ensure that patients, most of whom are treated as outpatients, adhere to therapy. Patients who are treated through the DOH receive free therapy. "The Department of Health TB bra
nch is and has been a success," said Berman, who is not involved in the program.
Wing noted that QuantiFERON, a new blood test for TB approved by the Food and Drug Administration in December, appears to be much more accurate than the skin test and should eliminate most false positives. Berman expects the new blood test to replace
the skin test within five years.
DISTRICT Of COLUMBIA:
"TB Cases Rise 3 Percent in District of Columbia"
Washington Times (03.23.05)::Melissa Brosk; Gary Emerling
The number of TB cases in the District of Columbia, which had the nation's highest TB incidence in 2003, increased by 3 percent last year, health officials said Tuesday. In 2004, active TB cases totaled 81, up from 79 in 2003. The District averaged 1
4.2 cases per 100,000 people last year, compared to 14 cases per 100,000 in 2003. Nine percent of the District's cases in 2004 were homeless, more than 22 percent were co-infected with HIV, and 33 percent were foreign-born.
Officials from the American Lung Association said 414 active TB cases were recorded in the metropolitan area last year, including 93 in Montgomery County and 72 in Prince George's County.
Area health advocates reacted to the announcement by calling for increased funding for TB prevention and control. "We are strongly encouraging our legislators at the federal level to reverse their plan to cut funding to fight tuberculosis," said Dr.
James L. McDaniel, chairperson of the ALA of Virginia's board of directors.
In Virginia, the number of TB cases decreased for the first time in four years. The state recorded 329 cases in 2004, down from 332 in 2003. More than half of last year's cases, or 168, were in Northern Virginia. About 92 percent of those cases were
among foreign-born persons who have lived in the United States for less than five years.
"I think we can cautiously say that the TB epidemic is under control in Virginia, but we can't let our guard down. There is more work to be done," said McDaniel.
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INTERNATIONAL NEWS
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GLOBAL:
"Global TB Campaign Making Headway, but Africa, AIDS Are Big Problems"
Agence France Presse (03.23.05)
In its annual update marking World TB Day on Thursday, the World Health Organization said global efforts to combat TB are making gradual progress but problems remain in fighting the disease in Africa and among people co-infected with HIV. "In 2003, t
he TB incidence rate was falling or stable in five out of six WHO regions, but growing at 1.0 percent globally," the UN agency said. "The exception is Africa, where incidence has been rising more quickly in countries with higher HIV prevalence rates. But
for the strongly adverse trends in Africa, prevalence and death rates would be falling more quickly worldwide," said WHO.
WHO estimated there were about 8.8 million new TB cases in 2003. But just 3.9 million - or less than 45 percent - of new cases were formally diagnosed by laboratory testing, meaning the majority of TB-infected people went without treatment and could
likely spread it to others. Of the diagnosed cases, 674,000 also had HIV. TB killed about 1.7 million people in 2003, the report said.
WHO credited much of the progress to the DOTS (Directly Observed Treatment, Short Course) strategy. DOTS guidelines require health care workers to closely monitor patients to ensure they complete a short course of TB drugs, so as to minimize the poss
ibility for drug resistance. The report said that DOTS has been adopted, either regionally or nationally, in 182 countries.
WHO was encouraged by the rise of TB funding for developing countries. Approximately $2.2 billion is needed globally to fight TB in 2005. Developing and transitional countries account for $1.3 billion of this need; $1.2 billion has already been raise
d, thanks to additional government funding and grants from the Global Fund to Fight AIDS, TB and Malaria.
INDIA:
"Aid Groups Slam Indian Decision to Adopt Patent Law to End Manufacture of Cheap Copies of Western Medicine"
Associated Press (03.23.05)::Rajesh Mahapatra
On Wednesday, international charities criticized India's lower house of Parliament for approving strict patent regulations that the groups said would deprive hundreds of thousands of AIDS and cancer patients of low-cost generic drugs made in India. T
he new patent rules approved Tuesday are required by India's World Trade Organization membership, which will enhance the nation's global trade participation. Parliament's upper house is widely expected to approve the bill later this week.
For decades, India has permitted its pharmaceutical industry to produce cheap generic copies of Western name-brand drugs. About 50 percent of 700,000 HIV patients in Africa, Asia, and Latin America rely on generic drugs produced by Indian firms. The
se copies cost just 5 percent of similar US and European name-brand drugs.
Because India is home to the world's largest generic-drug producers, many developing countries that need the cheaper copies will be affected, said Samar Verma, regional policy adviser of Oxfam International.
Aid groups are concerned that the bill requires a three-year wait before India could override a drug patent based on the large number of people who need, but cannot afford, a medicine. There is an exclusion for national emergencies; however, since HI
V is not considered a national emergency in India, companies would not be allowed to copy new AIDS treatments, said Ellen 't Hoen, a Doctors Without Borders representative who led a delegation from more than two-dozen aid groups.
Lower house amendments to the bill include a restriction to the definition of "new inventions" that prevents new patent filings based on minor changes to existing drugs. In addition, patents could be challenged before they are granted - a provision o
pposed by multinationals but long demanded by Indian firms. But the bill also grants multinational drug firms with advantageous leverage, since there is no cap to the royalties they could charge generic producers, said Fatima Hassan of the South Africa-ba
sed Treatment Action Campaign.
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MEDICAL NEWS
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UNITED STATES:
"Exploring the Role of Needle Selling in a Drug-Using Community in Baltimore, Maryland"
Journal of Acquired Immune Deficiency Syndromes Vol. 38; No. 1: P. 57-60 (01.01.05)::Carl A. Latkin; Wei Hua; Melissa A. Davey
By providing sterile needles and removing contaminated syringes, needle-exchange programs (NEPs) play a major role in fighting HIV transmission among injection drug users (IDUs). However, many IDUs rely on needle sellers, not NEPs, for their syringes
. The current study examined differences between needle sellers and others in a drug-using community and assessed the sources and quantity of needles sold by needle sellers, as well as factors associated with needle selling.
The researchers used data from the Self-help in Eliminating Life-Threatening Disease Study (SHIELD). The data were collected from April 2000 through June 2002 from participants recruited in areas of Baltimore with high levels of drug activity. Inform
ation from 991 individuals was included in the present study. Approximately 8 percent reported needle selling in the past six months. Of the 76 needle sellers, 62 were injectors.
Compared with non-needle sellers, needle sellers were more likely to be homeless, HIV-positive, and unemployed. The NEP was the most frequent supplier of needles for needle sellers. Compared with non-needle sellers, needle sellers were more likely to
share needles with sex partners and with strangers. In the whole sample, needle selling was associated with injecting drugs and the number of roles the person held in the drug economy. For injectors, needle selling was associated with obtaining needles f
rom the NEP and having more than one role in the drug economy.
"This study found that most needle sellers do obtain their needles from the NEP. Therefore, needle sellers, as well as other secondary exchangers, could be identified by NEPs and trained in HIV prevention activities, such as promoting safe injection
practices. In addition, needle sellers could be provided with risk reduction materials like alcohol pads and sharps containers that could be distributed to injectors. Research has shown that the use of peer educators is an effective strategy for HIV preve
ntion," the authors wrote.
"Although almost all of the needle sellers reported that none of the needles they distributed were used, it is important to note that a few individuals did disseminate used needles that may not have been cleaned," the researchers noted. "This finding
demonstrates the need for safety seals on needles to ensure that they are sterile. In addition, both needle sellers and nonsellers need to be trained in the proper techniques of needle disposal."
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LOCAL AND COMMUNITY NEWS
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ILLINOIS:
"Better Drug Treatment for Gays Urged"
Chicago Tribune (03.18.05)::Johnathon E. Briggs
On March 17, the Chicago Health Department released a report that found substance-abuse services do not address the needs of the city's lesbian, gay, bisexual, and transgender (LGBT) community and should be more sensitive to issues related to clients
' sexual orientation. The report was issued as public health officials worry about the link between recreational drug use and transmission of HIV and other STDs in the LGBT community. In response, community advocates also are urging more emphasis on subst
ance abuse issues.
While substance abuse is a "significant problem" in Chicago's gay community, the full extent of the problem is unknown because of limited research, the report said. Stigma, homophobia, and anxiety about AIDS further compound the problem, as is the fa
ct that many enter the gay community through the club and party scene, the report said.
"Substance use and abuse is an issue within our community, and we haven't addressed it in the way we should," said Jim Pickett, director of public policy for the AIDS Foundation of Chicago and the report's lead author. The report stemmed from communi
ty forums hosted in 2002 by the city Health Department's Office of LGBT Health and was written by members of the Chicago Task Force on LGBT Substance Use and Abuse. The report is available online at http://egov.cityofchicago.org/health/.
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NEWS BRIEFS
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GLOBAL:
"Economic Disparity Threatening Survival of Poor East Asian Children: UNICEF"
Associated Press (03.23.05)::Ker Munthit
Today in Cambodia, UNICEF Director Carol Bellamy asked governments in the East Asian and Pacific regions to do more to address the growing inequality that threatens many young people in the region. Speaking to some 200 officials, development experts,
and members of private aid groups at the outset of three days of talks on the plight of children, Bellamy said "strong, concerted, unified action" is needed "to ensure that disparities do not become a scourge that robs us of hard-won gains." This growing
disparity could also feed conflicts, she said. In the keynote speech, former Thai Prime Minister Anand Panyarachun noted that the recent tsunami had orphaned many children, leaving them vulnerable to abuse and sexual exploitation. In addition, he said w
orld leaders must also address "other very grave problems" in the region. "In the long term, AIDS will kill far more people than any natural disaster, however big. We must not forget that," said Anand, who is now a UNICEF goo
dwill ambassador.
MONTANA:
"Syphilis Rise Concerns Officials"
Associated Press (03.22.05)
Montana reported no syphilis cases from 1999 through 2003 but had four cases in 2004 and has logged five so far this year, said Laurie Kops, manager of the STD program for the state Department of Public Health and Human Services. The cases this year
have been scattered across the state, she said; all five patients have been treated, and efforts are underway to identify and treat their partners. "Unfortunately, syphilis has been making a comeback. This is true across the nation as well as in Montana,"
Kops said in a statement.
CANADA:
"Blood Supply Almost Fully Safe from HIV, Hepatitis C"
Edmonton Journal (02.17.05)::CanWest News Service
A new study calculates the estimated risk of contracting a serious infection, such as HIV or hepatitis C, from a blood transfusion in Canada at one in 3 million to one in 4 million. "The risks in Canada of transmitting infectious agents by blood and
especially by plasma-manufactured products, are extremely low," according to the report co-authored by blood experts from Nova Scotia and the federal Public Health Agency. "To put it in context, a one-in-three-million risk is similar to that of being hit
by lightning." The full report, "Transfusion and Risk of Infection in Canada: Update 2005," was published in Paediatrics & Child Health (2005;10(3):149-153).
FLORIDA:
"Six HIV/AIDS Groups Receive Grant Funds"
Miami Herald (03.20.05)
The Florida Department of Health is awarding grants totaling about $1.08 million to six nonprofit HIV/AIDS organizations in Miami/Dade County. The grantees are Union Positiva Inc.; South Florida AIDS Network; South Beach AIDS Project; Village South I
nc.; Hep-C Alert Inc.; and Care Resource Inc. Ranging in amount from $42,000 to $250,000, the grants were provided in part by CDC's Advancing HIV Prevention initiative, which seeks to increase early diagnosis and access to medical care and treatment.
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