| prevention-news@cdcnpin.org 2005-03-26, 10:14 am |
| CDC HIV/STD/TB Prevention News Update
Friday, March 25, 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
FLORIDA: "State's TB Incidence Rate Jumps; Manatee Ranks 12th"
OKLAHOMA: "Diabetic American Indians at High Risk for Tuberculosis"
LOUISIANA: "Judge Hears Arguments over Louisiana Abstinence Web Site"
INTERNATIONAL NEWS
SOUTH AFRICA: "South Africa on WHO's 'High-Burden' TB List"
SIERRA LEONE: "TB Making Gains in Post-War Sierra Leone"
MEDICAL NEWS
UNITED KINGDOM: "HIV+ Heterosexuals Test Positive at Later Stage than Homosexual or Bisexual Men"
EDITORIALS AND COMMENTARY
GLOBAL: "Tuberculosis: Consuming Concerns"
NEWS BRIEFS
FLORIDA: "Probe of Leaked AIDS Names Widens"
ROMANIA: "Cancer and HIV Patients in Romania Angered by Drug Shortages"
CALIFORNIA: "Winning Design for National AIDS Memorial Picked"
TEXAS: "Striking a Note Against Hepatitis C"
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NATIONAL NEWS
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FLORIDA:
"State's TB Incidence Rate Jumps; Manatee Ranks 12th"
Bradenton Herald (03.25.05)::Stephen Majors
TB incidence in Florida grew by 3 percent in 2004, a reversal of the state's previous yearly declines since 1994, according to a state Department of Health report marking World TB Day. State officials do not yet know what caused the increase in TB in
cidence.
Last year, foreign-born persons - many from countries with high TB prevalence - comprised 49 percent of the state's active TB cases. Of Florida's active TB cases, 20-25 percent were coinfected with HIV, said Dr. Michael Lauzardo, DOH's deputy TB controlle
r. The state needs to target TB control among immigrant populations separately, rather than use a "one-size-fits-all" approach, he said.
Manatee County had 14 cases in 2004, or 4.7 cases per 100,000 people - the 12th highest in TB incidence among Florida's 67 counties - according to Jan Hinz, the county Health Department's community health nurse supervisor. That was up from 10 cases i
n 2003. Hinz said she was surprised that only one county TB patient was HIV-coinfected last year.
Florida has the fourth largest number of TB cases in the nation and the Southeast's highest incidence of the disease. Florida has received a five-year, $7.5 million CDC grant for the Southeastern National Tuberculosis Center, which will be located in Gain
esville, DOH announced.
OKLAHOMA:
"Diabetic American Indians at High Risk for Tuberculosis"
Associated Press (03.24.05)::Ashley Gibson
Oklahoma health officials are working to decrease TB infections by paying particular attention to the state's Native Americans, who comprise 20 percent of all TB cases in Oklahoma. Diseases such as diabetes and HIV/AIDS weaken patients' immune system
s, making them more susceptible to TB. More than 10 percent of Oklahoma's Native American population has diabetes.
"We're not going to eliminate tuberculosis," Dr. Jon Tillinghast, TB control officer for the state health department, said on World TB Day Thursday. "We're going to have to focus on it. We can do that by focusing on our target groups, like Native American
s with diabetes," he said.
According to John Farris, chief medical officer for the Oklahoma City Area Indian Health Services, people with diabetes are two to four times more likely to develop TB. IHS plans to conduct yearly TB skin tests for diabetic patients as a way to detec
t latent cases.
"We still have deaths from TB in Oklahoma," said Tillinghast. "And they are often diagnosed after their death. But virtually all TB cases in Oklahoma are treatable and curable if we don't have a delayed diagnosis," he said. "You may catch TB in 1988
and it may not manifest until 2008. If we can identify newly infected people, with preventative therapy, we can prevent active TB from occurring," Tillinghast added. Increasing TB awareness among Oklahoma doctors is another preventative measure, said stat
e Health Commissioner Dr. Michael Crutcher.
In 2004, Oklahoma had 178 TB cases, a 15-case increase from 2003.
LOUISIANA:
"Judge Hears Arguments over Louisiana Abstinence Web Site"
Associated Press (03.24.05)::Alan Sayre
On Thursday in New Orleans, the American Civil Liberties Union argued before US District Judge Thomas Porteous that the Governor's Program on Abstinence is in contempt of court for failing to abide by an earlier agreement to stop promoting religion.
ACLU attorney Caroline Corbin said several links from GPA's Web site lead to sites advocating prayer and repentance. "If the government teaches abstinence, it must teach it in a secular way," she told the court.
The state maintains that the religious references do not amount to an excessive entanglement between government and religion - the standard by which federal courts determine compliance with the Establishment Clause of the Constitution, which prevents
the government from endorsing religion. Assistant State Attorney General Roy Mongrue argued that the material on the main site was secular, and that religious references on the linked sites do not constitute endorsement of religion. Corbin cited a 5th US
Circuit Court of Appeals decision stating that an Internet site cannot disavow responsibility for what comes through on its direct links.
Porteous said he does not intend to arbitrate what appears on GPA's site. Corbin suggested that the court appoint a third party to monitor the site. The judge did not rule but set a date for a possible second hearing. He gave the state until April 8
to complete a review of ACLU's latest arguments.
In July 2002, Porteous determined that some GPA money was being used to promote religion and ordered the state to stop the practice. Program officials appealed the order, maintaining they had already stopped such spending; they abandoned their appeal and
agreed to the settlement in November 2002.
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INTERNATIONAL NEWS
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SOUTH AFRICA:
"South Africa on WHO's 'High-Burden' TB List"
Business Day (03.24.05)::Tamar Khan
South Africa's HIV epidemic and weakness in its public health care system are thwarting its efforts to fight TB, according to a report by the Massive Effort Campaign and RESULTS International. The World Health Organization's TB report - whose release
coincided with World TB Day - lists the nation among the world's 22 "high-burden countries" for TB.
South Africa has the world's largest number of patients coinfected with TB and HIV. TB is the most common opportunistic infection among persons with HIV: 60,000 South Africans have both diseases. South Africa's cure rate for TB ranges from 35 percent
KwaZulu-Natal to 70 percent in Western Cape, according to Health Minister Manto Tshabalala-Msimang. The resulting average cure rate is 54 percent; WHO's goal is 85 percent.
Tshabalala-Msimang said some patients fail to complete their six-month drug regimen for a variety of reasons that include a shortage of health care staff to monitor their treatment, and poverty, since "it's hard to swallow three pills a day on an empty st
omach." Patients who stop treatment before they are cured risk relapsing and developing drug-resistant TB. Two percent of all new TB cases in South Africa are multi-drug-resistant, she said. Standard treatment costs about 300 Rand (US$48) per patient, whi
le treating resistant TB can take two years and cost 30,000 Rand (US$4,827).
SIERRA LEONE:
"TB Making Gains in Post-War Sierra Leone"
Agence France Presse (03.24.05)
Post-war Sierra Leone - the world's poorest country - has seen a rise in its TB incidence rate, government health officials said Thursday. Due to the ease of travel and to increased medical access and treatment availability in the west African state'
s 13 districts, there has been considerable increase in the TB caseload, said Dr. Foday Dafae, director of the health ministry's TB control program.
Around 5,863 new TB cases were reported last year - compared to 5,421 cases in 2003 - representing approximately 1.5 percent of Sierra Leone's 5 million population. "There were quite a number of TB patients trapped in former rebel-held areas that wer
e no-go zones, but now these people are reaching out to us," said Dafae. "We have created an awareness for people to be diagnosed and this is another reason for the upward national trend."
Sierra Leone has managed to evade a dramatic spike in its HIV infection rate, but health officials are worried about the coexistence of the two deadly diseases in the country, whose health infrastructure has been devastated by war. TB is the number-o
ne killer among HIV-infected Africans.
The government announcement followed new World Health Organization data released ahead of Thursday's World TB Day showing that Africa continues to struggle with TB control.
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MEDICAL NEWS
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UNITED KINGDOM:
"HIV+ Heterosexuals Test Positive at Later Stage than Homosexual or Bisexual Men"
Women's Health Weekly (03.10.05)
HIV-positive heterosexual men and women present for HIV testing at a later stage of infection than homosexual and bisexual testers, according to a prospective observational study by K. Manavi and colleagues, Lothian university Hospital National Healt
h Service Trust. The authors defined late presentation as testing HIV-positive with a baseline CD4+ T-cell count less than 200 cells/mL.
Between December 1999 and January 2003, researchers compared baseline CD4+ T-cell counts in HIV-positive heterosexual men and women, IV drug users, homosexual and bisexual men diagnosed in Genitourinary Medicine and Regional Infectious Disease Unit (GUM/R
IDU) departments, and routinely screened pregnant patients in Edinburgh.
During the study, 189 patients tested in GUM/RIDU and 13 screened pregnant females were diagnosed with HIV. Of them, 34 percent of GUM/RIDU patients and 38 percent of maternal patients had CD4+ T-cells of fewer than 200 cells/mL at diagnosis. Among the he
terosexuals diagnosed at GUM/RIDU sites, 45 percent were late presenters. Significantly fewer homosexual men tested late. There was no difference in proportion of late testing between the antenatal diagnoses and all heterosexual GUM/RIDU diagnoses (5/13 a
nd 35/78, respectively).
"A significant number of HIV-infected heterosexual patients are late presenters in the HIV testing at GUM/RIDU," researchers concluded. "HIV screening programs for heterosexual individuals in any medical encounter may reduce the number of late presenters.
"
The full study, "Heterosexual Men and Women with HIV Test Positive at a Later Stage of Infection Than Homo- or Bisexual Men," was published in International Journal of STDs and AIDS (2004;15(12):811-814).
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EDITORIALS AND COMMENTARY
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GLOBAL:
"Tuberculosis: Consuming Concerns"
The Guardian (London) (03.25.05)
For those lucky enough to live in the world's wealthier nations, tuberculosis is an illness with an old-fashioned ring.. It probably carried off some of our greatest talents, from Emily Bronte to John Keats to D.H. Lawrence - and more recently Vivien
Leigh. Its shadow has faded now, though TB is increasing again even here; 7,000 cases a year in Britain, half of them in London. Even so, thanks to antibiotics and mass immunization, the hundreds of TB sanatoria that once dotted Europe are now historical
curiosities.
However in much of the rest of the world, especially Asia and Africa, TB remains a much deadlier threat. That is why yesterday - March 24 - was designated 'World TB Day': both to commemorate the day in 1882 when German bacteriologist Robert Koch firs
t identified the tuberculosis bacillus and as an unhappy reminder that the infection in still at large - with devastating effect..
The statistics are staggering: some 2 million die from TB each year.. TB has received a grotesque boost from the spread of HIV/AIDS.. Because of the ravages of their immune systems, around a third of all HIV sufferers also develop TB, and an estimate
d 14 million people worldwide are co-infected..
While Southeast Asia and the former Soviet Union suffer greatly from TB, it is the people of Africa who are the worst hit.. .The Africa Commission [launched by British Prime Minister Tony Blair last year to promote and support development in Africa].
warned that many African countries' health care systems are in danger of disintegrating 'beyond repair.' Health spending per head in Africa is just $13-$21 a year, compared with more than $2,000 per head in the developed world. If ever there was a proble
m that could be solved by throwing money at it - enough to raise per person spending to $38 a year - this is one. The additional $50 billion a year, for 10 years, called for by the commission, must be contributed by the world's wealthy, so that one day Ma
rch 24 can be remembered for its historical significance alone.
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NEWS BRIEFS
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FLORIDA:
"Probe of Leaked AIDS Names Widens"
Miami Herald (03.25.05)::Jane Daugherty
On Thursday, Palm Beach County Health Department Director Dr. Jean Malecki confirmed that agents from the Federal Bureau of Investigation and the US Postal Service have joined the criminal investigation into the disclosure of the names and address of
some 6,500 HIV/AIDS patients in the county. "FBI agents are definitely involved in the investigation now as are inspectors from the US Postal Service. My understanding is that Congressman [Mark] Foley got the FBI involved. I think the Postal Service was
called in because the mails were used to harass people who are on our list," Malecki said.
ROMANIA:
"Cancer and HIV Patients in Romania Angered by Drug Shortages"
Associated Press (03.18.05)
A large number of Romanian cancer and HIV patients are unable to fill their prescriptions due to drug shortages prompted by budget shortfalls and disputes between the Health Ministry and suppliers, patients' groups said March 18. Under Romanian law,
HIV/AIDS, cancer, and diabetes patients are entitled to free prescriptions. The National Union of Organizations of People with HIV/AIDS reported shortages of antiretroviral drugs in six counties and said patients elsewhere were encountering difficulties f
illing free prescriptions. Romania's health system has been underfunded for years, and suppliers claim the government owes them hundreds of millions of dollars. Mircea Cinteza, Romania's new health minister, pledged to resolve the crisis when he took offi
ce in December, but many pharmacies refuse to fill government-paid prescriptions.
CALIFORNIA:
"Winning Design for National AIDS Memorial Picked"
Associated Press (03.24.05)::Lisa Leff
On Wednesday, two architects won the international competition to design the centerpiece of the National AIDS Memorial Grove, the seven-acre garden in Golden Gate Park that is the only federally recognized AIDS memorial. Janette Kim and Chloe Town's
entry was chosen among 201 submissions from 24 countries. Centered in the green grove, "Living Memorial" features a blackened field and burned stand of trees made from carbon fiber, a charred wood deck, and a burned walkway - all elements of a fire-scarre
d forest, to evoke a sense of loss. The walkway will in time sprout greenery, representing renewal. "While the design is at first frightening, it is also rich with the eventual triumph of life," said Ken Ruebush, co-chairperson of the contest. The memoria
l's board of directors has not yet committed to fulfilling the vision of the contest winners, which will require raising $2 million. "Living Memorial" will be on display at the San Francisco Museum of Modern Art on April 1.
TEXAS:
"Striking a Note Against Hepatitis C"
Austin American-Statesman (03.20.05)::Mary Ann Roser
On March 19, country music star Willie Nelson lent his voice and face to a public service announcement about hepatitis C (HCV), the most common blood-borne infection in the United States. The PSA, filmed at Nelson's ranch west of Austin, could begin
airing as soon as June, said Jim "Taco" Gerik, president of Dallas-based Tocrok Productions Inc. and the PSA's director. The announcement was conceived and executive-produced by Julia Spears, the HCV-infected wife of Nelson's bass player Bee Spears, as a
way to raise awareness about the infection and urge people to get tested. "Willie is doing this out of the goodness of his heart," Julia Spears said. "He understands what a problem hepatitis C is," she added. About 3.9 million Americans, or 1.8 percent of
the population, are affected by HCV.
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