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National News
International News
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News Briefs
Thursday, May 05, 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 relying 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.
National News
UNITED STATES: "Feds Tested AIDS Drugs on Foster Kids"
Associated Press (05.05.05):: John Solomon
Researchers funded by the National Institutes of Health did not
provide an independent advocate to safeguard the well-being of hundreds
of HIV-positive foster children involved in AIDS drug trials, despite
written promises to do so, the Associated Press (AP) has learned.
The research was most prevalent in the 1990s, when foster
agencies sought to access HIV treatments not yet on the market. The
child subjects were mostly poor or minority and ranged from infants to
teenagers. While the effort provided state-of-the-art AIDS care at
government expense and helped extend children's lives, the drugs were
known to have serious side effects in adults, and their safety for
children was unknown.
More than four-dozen studies took place in at least seven
states: Colorado, Illinois, Louisiana, Maryland, New York, North
Carolina, and Texas. Some states - including Tennessee, California, and
Wisconsin - declined to participate. Several studies documented a
variety of side effects; one reported a significantly higher death rate
among children given increased doses of the drug dapsone, tested as a
preventative for AIDS-related pneumonia.
From 1983, the government has required researchers and oversight
boards to appoint independent advocates for foster children enrolled in
studies that involved more than minimal risk and lacked the promise of
direct benefit. Some foster agencies, including those in New York and
Illinois, required researchers to agree, in writing, to provide this
protection regardless of risks and benefits. Yet such advocates were
often not provided, researchers and foster agencies told AP.
Federal law states that if they do not appoint advocates,
researchers and oversight boards must conclude that the investigative
treatment provides the same or better risk-benefit possibilities than
treatments already on the market, and they must abide by any other
safeguards required by state and local authorities.
The researchers in these studies often exempted themselves from
providing advocates by certifying that the risks of the research were
minimal and the children would benefit directly, as the drugs had
already been tested on adult patients. Some children died during the
studies, but foster agencies said they could find no records that any
deaths were directly caused by the experimental treatments.
NIH did not track whether researchers appointed advocates;
rather, this decision was left to volunteer medical review boards. Such
institutional review boards are often overwhelmed, dominated by
scientists, and not focused on patient protection, according to a recent
Institute of Medicine study.
Those who decided to enroll the children say they carefully
explained the risks and benefits to state guardians, foster parents, and
the children themselves.
The US Office for Human Research is examining the use of foster
children in AIDS research, but declined to discuss its investigation.
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MASSACHUSETTS: "Romney Disagrees with DPH Position on
Hypodermic Needles"
Associated Press (05.05.05)
Massachusetts Gov. Mitt Romney does not support the state
Department of Public Health's proposed legislation to legalize
over-the-counter sales of hypodermic needles as a way of preventing
blood-borne diseases like HIV and hepatitis C among IV drug users, his
spokesperson said Wednesday. "The position of the governor and the
lieutenant governor is we don't want to do anything to that facilitates
illegal drug use," said Eric Fehrnstrom. "If you allow addicts easy
access to the tools of the trade, you are facilitating illegal drug
use."
Massachusetts is one of just three states that ban the sale of
hypodermic needles without a prescription. Almost 39 percent of the
state's HIV cases are linked to needle sharing. Public health advocates,
physicians and substance-abuse experts support the health department's
proposed bill.
While many prosecutors and top police officials have long
opposed the measure, resulting in its numerous defeats over the past
decade, some appear to be changing their position. At hearings on
Wednesday, Middlesex District Attorney Martha Coakley, Suffolk District
Attorney Daniel Conley and a Boston police representative said their
views have evolved from seeing needle access as unhelpful to the war on
drugs to viewing it now as a way to fight HIV/AIDS.
Sen. Robert O'Leary (D-Barnstable), a sponsor of the measure,
said such law enforcement support can only help the bill.
Also at the hearings, public health experts testified that
research conclusively shows that needle sharing and the number of HIV
cases related to IV drug use have dropped significantly in states that
permit over-the-counter sales.
Fehrnstrom said it is too soon to say whether Romney would veto
the bill if it crossed his desk.
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International News
AFRICA: "Global Health Experts Devise Plan to Fight African TB
Surge"
Voice of America (05.04.05):: David McAlary
This week in Addis Ababa, Ethiopia, the coordinating committee
of the global Stop TB partnership met to formulate a response to what
the World Health Organization (WHO) calls an alarming surge of the
disease in Africa.
In 21 African nations, TB rates have tripled since 1990, WHO
says. Dr. Mario Ravigilone, Stop TB's chief, said, "That's why we're now
putting emphasis on Africa, because without Africa strengthening their
health system, being able to do TB control properly, we will not achieve
the Millennium Development Goal." Those targets, set in 2000 by the UN,
call for reversing the impact of major diseases by 2015. "We know that
with the present status quo, we will not reach the targets in Africa
unless some special interventions are actually put in place."
The assembly of public-health experts agreed to increase TB's
visibility among regional health and development programs in Africa,
launch an African Stop TB partnership, and organize a TB funding summit
to seek financial support.
In addition, the meeting called on African governments to make
TB control a central part of their development agendas. Some African
governments, Ravigilone charged, "put the money in weapons, for
instance, or in their army and they don't allocate what they should
allocate, which has been calculated as a small percentage of their GDP
and so on. [It] should actually be allocated to health and they simply
don't do it."
Governments, the experts said, should strengthen their
commitment to following WHO guidelines, which call for six months of
directly observed drug therapy for patients. Stop TB also plans to send
high-level delegations to hard-hit countries to meet with national
leaders.
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THAILAND: "Trade Deal Won't Hit Thai Generic AIDS Drugs:
United States"
Reuters (05.04.05)
Wednesday in Bangkok, US Deputy Secretary of State Robert
Zoellick assured Thailand that its domestic manufacture of generic
antiretroviral drugs would not be prevented by a bilateral free trade
deal under negotiation.
"In all our free trade agreements, we made very clear that the
agreement to which the United States joined - and in fact I helped put
together - dealing with access to medicines, dealing with HIV/AIDS,
would not be affected at all by any aspect of this agreement," Zoellick
told reporters after his meeting with Thai Foreign Minister Kantathi
Souphamongkorn. "I understand the anxieties, but I think there is a
very, very good answer," the secretary said on his first stop in a
six-country tour of southeast Asia to garner support for US trade deals
in the region.
US and Thai negotiators have undergone three rounds of trade
talks, but no details of the meetings have been released. Last month,
AIDS advocates and academics demonstrated outside the US embassy in
Bangkok and sent a letter to Thailand's chief negotiator, Nitya
Pibulsonggram, requesting that anything related to generic
antiretrovirals be excluded from a deal.
In developing countries with established pharmaceutical
industries, such as Thailand, generic copies of patented drugs can be
manufactured in medical emergencies, such as the HIV/AIDS epidemic.
Thus, the cost of treating thousands of HIV patients in Thailand, where
an estimated 700,000 people are infected, has dropped from 10,000 baht
(US$250) a month to just 1,200 baht (US$30).
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GLOBAL: "ActionAid Launches Campaign to Revitalize War on
AIDS"
Agence France Presse (05.03.05)
The international development charity ActionAid on Tuesday
embarked on a campaign to reinvigorate the global fight against HIV/AIDS
by guaranteeing that money for AIDS programs actually helps those with
the disease. "An essential part of this campaign is to make the money
work: ensuring that the increasing global resources for HIV/AIDS
actually result in tangible benefits for those [in] whose name the money
is raised," Ramesh Singh, chief executive of ActionAid International,
said at the launch ceremony in Nairobi.
Of the almost 40 million people worldwide living with HIV/AIDS,
nearly two-thirds of them - 25.4 million - live in sub-Saharan Africa.
"We must learn the lessons built from the painful experience Africa has
gone through; that silence, denial, and delayed response are the real
killers, it's not HIV/AIDS," said Singh.
The campaign is part of an effort to collect HIV/AIDS
surveillance figures for Africa and deliver them to July's G-8 meeting
in Scotland, which will include addressing the continent's image as an
AIDS-ravaged disaster.
According to Kenyan President Mwai Kibaki, the drive will help
highlight problems posed by the disease. "I am sure this provides an
opportunity for Kenya and Africa as a whole to influence the world in
making HIV/AIDS a global agenda, not just an African agenda," said
Kibaki. "We must win this fight at whatever cost."
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ZIMBABWE: "In Zimbabwe, AIDS Care Done on the Cheap"
Boston Globe (05.02.05):: John Donnelly
In the region with the world's highest HIV infection rate,
Zimbabwe remains isolated from the ever-increasing donor money now
pouring into other countries. According to the World Bank, last year
Zimbabwe received just $4 in donor support per HIV-infected person,
compared to $187 for each person in neighboring Zambia. The reason:
Donors fear President Robert Mugabe would divert AIDS money for personal
or political gain.
But despite a lack of funding, AIDS programs manage to carry on.
One program designed to prevent mother-to-child HIV transmission has
expanded nationwide, thanks to initiatives started by the country's
health administrators and workers. Its government coordinator, Agnes
Mahomva, said it has expanded to 800 of Zimbabwe's 1,183 hospitals and
clinics.
Mahomva conceded, however, that Zimbabwe's economic and
political problems are eroding many gains. In 2002, government figures
showed 35 percent of HIV-positive mothers and their infants received a
single dose of nevirapine during labor, which dramatically lowers
transmission. By 2003, that figure jumped to 56 percent, but it fell
last year to an estimated 46 percent. Mahomva said her investigation
into the decline showed many health workers left Zimbabwe in the past
year.
This year, the US government, by far Zimbabwe's largest donor,
allocated $25 million for HIV/AIDS programs, including $1.6 million for
the mother-to-child prevention program. US officials said they had not
found any instances of misspending, including money that is given
directly to the Ministry of Health.
Last month, the Global Fund to Fight AIDS, TB and Malaria
released $10 million in funding that had been on hold since 2002. Global
Fund spokesperson Jon Liden said he believes "the proper safeguards are
in place" to ensure the money goes to the people who need it.
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Medical News
SOUTHEAST ASIA: "Antimicrobial Resistance of Neisseria
gonorrhoeae in Selected World Health Organization Southeast Asia Region
Countries: An Overview"
Sexually Transmitted Diseases Vol. 32, No. 2: P. 178-184
(03..05):: Krishna Ray, MD; Manju Bala, MD; Sudarshan Kumari, MD; Jai P.
Narain, MD, MPH
The World Health Organization (WHO) Regional Reference
Laboratory (RRL), Vardhman Mahavir Medical College, and New Delhi's
Safdarjung Hospital are coordinating the Gonococcal Antimicrobial
Susceptibility Program (GASP) under WHO's South East Asia Region (SEAR).
The current communication details the present status and trends of
antimicrobial resistance patterns of Neisseria gonorrhea in India and
neighboring countries.
At the WHO SEAR intercountry consultative meeting held in
December 2001, seven laboratories from India and one each from
Bangladesh, Nepal, and Sri Lanka presented their 2000-2001 data. RRL
Delhi, Bangladesh, and Sri Lanka also presented data from years 1995 to
2001, 1997 to 2001, and 1996 to 2000, respectively. Using either
National Committee for Clinical Laboratory Standards or calibrated
dichotomous sensitivity technique, the various laboratories determined
antimicrobial susceptibility.
Penicillin resistance in the Indian laboratories varied from
20-79 percent, tetracycline resistance from 0.0-45.6 percent, and
ciprofloxacin from 10.6-100 percent. Plasmid-mediated and chromosomal
resistance were observed. In five out of seven laboratories, the strains
were reported to be less sensitive to ceftriaxone; none reported
spectinomycin resistance. Geographical strain difference in different
areas of India could account for the wide variation in the results, the
authors noted.
Sri Lanka reported N. gonorrhea with penicillin (96.8 percent)
and ciprofloxacin (8.2 percent) resistance. Bangladesh reported
gonococci showing resistance toward ciprofloxacin (76 percent),
penicillin (33 percent), and tetracycline (50 percent), with decreased
susceptibility to ceftriaxone (1.5 percent). Neither lab reported
resistance to spectinomycin. Resistance trends in Sri Lanka and
Bangladesh and RRL, New Delhi, exhibited different patterns.
"The report indicates the necessity for continuous surveillance
of antimicrobial resistance pattern in this region of WHO for
establishing antimicrobial policy guidelines for management of this
common but important sexually transmitted infection (STI) pathogen,
known to facilitate human immunodeficiency virus (HIV) infection,"
concluded the authors. "It also highlights the importance of ensuring
quality assurance in the techniques in order to generate uniform data."
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News Briefs
KENYA: "Kenyan President Urges Western Nations to Cancel
Africa's Debt"
Xinhua News Agency (05.04.05)
On Tuesday at the launch of an ActionAid AIDS campaign in
Nairobi, Kenya's President Mwai Kibaki exhorted donor nations to forgive
Africa's debt and help finance the continent's fight against poverty and
its HIV/AIDS pandemic, the Kenya Times reported Wednesday. "These
nation's must know that debt repayment and a skewed global trading
system are taking away opportunities for economic growth and entrenching
poverty on the African continent," Kibaki was quoted as saying. Kenya's
external debt is almost 30 percent of its gross domestic product, or
over $9.5 billion, constraining government funding of areas such as
health and education.
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INDIA: "Global Fund Director Says India Risks AIDS
Catastrophe"
Associated Press (05.03.05)
AIDS prevention, testing, and treatment efforts in India have
been ineffective so far and must be ratcheted up, Richard Feachem,
executive director of the Global Fund to Fight AIDS, TB and Malaria,
said recently at the Center for Strategic and International Studies, a
Washington think tank. Without a "huge-scale response" to its AIDS
epidemic, India "faces a great catastrophe." India "is or is becoming
the global epicenter for the pandemic," he said. Feachem has earlier
stated that India has surpassed South Africa in the number of its HIV
cases, a claim India denies. "India is in the grip of a very large,
rapidly growing mainstream heterosexual epidemic," a problem that "is
going to be much, much bigger before it can get smaller," said Feachem.
Officially, India has 5 million HIV cases, but some believe the figure
is much higher.
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CONNECTICUT: "HIV Testing Day"
Hartford Courant (05.04.05)
On Saturday, the Hispanic Health Council (HHC) will hold an HIV
testing event targeting women in Hartford. Testing and counseling will
be free, conducted by agencies working with the state's Division of AIDS
and Chronic Diseases. The event will have food, games, prizes, child
care, and a kids' corner. "Hartford's rate of AIDS among women is
currently among the highest in the nation," said Ann Levie, director of
HHC's Center of Risk Reduction. The event, titled "Ay Mami Hazte La
Prueba/Yo Ma, Get Tested," will be held from 10 a.m. to 4 p.m. at the
council, 175 Main St., Hartford. For more information, telephone Eddie
Salinas at 860-527-0856, ext. 297.
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