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Sunday, May 08, 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: "Despite Objections, FDA Set to Implement New
Rules Rejecting Gay Men as Anonymous Sperm Donors"
Associated Press (05.05.05):: David Crary
Any man who has had homosexual sex in the previous five years
would be barred from serving as an anonymous sperm donor under new Food
and Drug Administration rules. The provision is part of a package of
regulations, set to take effect on May 25, governing tissue and cell
donations.
Critics of the policy say FDA is stigmatizing all gay men rather
than adopting a behavior-focused policy to screen out any donors, gay or
straight, who engage in high-risk sex. But FDA has rejected calls to
scrap the provision; it insists that gay men collectively have a
higher-than-average risk of being HIV-positive.
Most doctors and clinics are expected to abide by the policy,
though there is disagreement over whether it will have the force of law.
The provision is likely to affect some lesbian couples who want a baby
and prefer to use an anonymous gay donor's sperm for artificial
insemination.
Lambda Legal, in a letter to FDA, suggested a policy under
which, any donor, gay or straight, would be rejected if he had engaged
in unprotected sex in the previous 12 months with an HIV-positive
person, an illegal drug user or "an individual of unknown HIV status
outside of a monogamous relationship." An FDA spokesperson, however,
cited agency documents suggesting that the broad exclusion is prudent
even if it affects gay men who practice safe sex.
Already, many doctors and fertility clinics reject gay sperm
donors, citing the pending rules or existing regulations of the American
Society for Reproductive Medicine.
The new rules do not prohibit gay men from serving as directed
donors. If a woman wants to become pregnant by artificial insemination
with the sperm of a man she knows, a clinic could provide that service
even if the man reported sex with other men in the previous five years.
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UNITED STATES: "AIDS Activists Walk, but the Shoes Talk"
Washington Post (05.06.05):: Petula Dvorak
In the Campaign to End AIDS (CEA) awareness rally and lobbying
event held Thursday in Washington, about 3,500 people marched down
Pennsylvania Avenue and, in front of the White House, placed 8,000 pairs
of shoes to represent the daily, worldwide death toll of AIDS-related
illnesses. CEA is a new organization aiming to reflect a shift in AIDS
activism.
"Way back when, the activists were usually gay, white men,
privileged and educated," said Eric Sawyer, who helped found ACT UP in
the late 1980s. "Today we've got African-American churchwomen from the
South walking with someone straight out of prison, walking with an Asian
Harvard graduate."
"There's a general public perception that AIDS is not a problem
right now," said Tim Murphy, an organizer of the campaign, which he said
aimed for a diverse coalition. "This is not 1989. We have the tools to
treat this now. They're just not accessible for a huge percentage of the
population."
"People of faith are concerned about this epidemic, but there is
silence," said Fatima Prioleau, who got about 30 people from New York
churches to take a bus to the Washington event. "Our goal is to break
that silence in the church," said Prioleau, 42, a mother of five who has
had HIV for 13 years.
"We know AIDS affects people from Yale and people in jail," said
Ron Crowder, executive director of Street Works, an STD prevention
agency in the District. "It's now a disease of people from park benches
to Park Avenue. And we hope to get our message through to Congress and
the Bush administration today."
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UNITED STATES: "The Inexplicable Survivors of a Widespread
Epidemic"
New York Times (05.03.05):: Carol Pogash
Why it is that some treatment-naïve HIV-positive people do not
progress to AIDS? Some 5 percent of people with HIV who are not taking
medicine remain healthy after 10 years, said Dr. Jay Levy, director of
the Laboratory of Tumor and AIDS Virus Research at the university of
California-San Francisco. Dr. Anthony S. Fauci, director of the National
Institute of Allergy and Infectious Diseases (NIAID), however, estimated
that only 0.2-0.4 percent of HIV-positive people are long-term
non-progressors.
Some of Levy's patients have had HIV since 1978, confirmed by
preserved blood samples drawn in a San Francisco hepatitis B study of
6,704 gay men. Over time, some of Levy's long-term survivors became
slow-progressors and died of AIDS. But a dozen have stayed healthy
without treatment.
In 1986, Levy found that survivors' CD8 cells secreted tiny
amounts of an antiviral factor that blocked HIV replication but did not
destroy the virus. It remains an elusive factor. When Dr. David Ho,
founder of the Aaron Diamond AIDS Research Center, and others reported
discovering the factor, Levy told them they were wrong. "After a while
they say 'Levy is spending all this time telling us what it isn't. What
is it?'" Levy said.
While searching for it, researchers discovered instead three
chemokines in the blood of long-term non-progressors. The chemicals
inhibit a subset of the virus, "like bouncers at a disco," said Dr.
Robert Gallo, co-discoverer of HIV and director of the Institute of
Human Virology and Division of Basic Science at the university of
Maryland Biotechnology Institute, who conducted the research with Dr.
Paolo Lusso.
Of 19 non-progressors in his study, NIAID's Dr. Mark Connors
said 95 percent share a gene that encodes molecules allowing the immune
system to recognize infected cells, compared to just 10 percent of
progressors. In non-progressors, CD4 cells continue to order CD8 cells
to kill HIV-infected cells, explained Dr. Eric Rosenberg, an
infectious-disease doctor and Harvard assistant professor. In most
infected people the CD4 cells stop giving such orders.
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International News
CANADA: "More Than 10 Percent of 14- and 15-Year Olds Have
Sex: Statistics Canada"
Canadian Press (05.03.05):: Lorrayne Anthony
Canadian youths are initiating sex at early ages and many are
not using condoms, according to two reports released Tuesday by the
federal agency Statistics Canada.
Among 3,212 youths ages 14-15 surveyed in the 1998-2001 National
Longitudinal Survey of Children and Youth, 12 percent of boys and 13
percent of girls reported already having had sex. And in a 2003 Canadian
Community Health Survey of 18,000 people ages 15-24, nearly four in 10
sexually active respondents reported not using condoms the last time of
intercourse. The average age for losing one's virginity was 16.5 for
both sexes.
Among those ages 15-24, 4 percent reported having been diagnosed
with an STD; females were twice as likely to report an STD diagnosis.
The proportion of youths having sex by ages 14-15 was higher in
Quebec (18 percent) than among teens in eastern provinces (15 percent)
and those in Ontario and the western provinces (10 percent). The earlier
sexual debut, the more likely youths were to have had more than one
partner, and males were more likely to have multiple partners than
females.
Among girls, the onset of puberty, poor self-esteem, having
tried smoking or drinking and not being overweight were significantly
associated with early sexual activity. For boys, older age (15 rather
than 14), a poor relationship with parents, low household income, and
having tried smoking were associated with early sexual debut.
Females were likelier to have intercourse without condoms than
males. Sixty percent of girls who reported debut by age 13 did not use a
condom at last intercourse, compared with 46 percent of females starting
to have sex by ages 14-17 and 37 percent of females who started sex at
ages 20-24.
By ages 15-17, 28 percent of Canadians surveyed reported having
sex, compared with 65 percent of those ages 18-19 and 80 percent of
those ages 20-24.
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Medical News
UNITED STATES: "N.C. Researchers Say HIV Test Can Detect
Earlier, Save Lives"
Associated Press (05.05.05)
Nucleic acid amplification testing can detect HIV infections
weeks earlier than standard tests, helping to eliminate the gap between
infection and diagnosis and reduce the time when patients may
unwittingly spread the virus to sex partners, according to researchers
at the university of North Carolina and the state Division of Public
Health. HIV-infected persons are most contagious immediately after
infection - a period when the virus is multiplying rapidly and before
the immune system produces the antibodies detected by standard tests.
Dr. Leah Devlin, state health director, said, "This tool will
provide an opportunity for us to fight the epidemic in real time. We can
go from a point of testing to follow-up care to treatment within 48
hours."
Between November 2002 and October 2003, 109,250 people presented
for HIV testing at state-funded testing sites in North Carolina. The
standard test for HIV antibodies revealed 583 HIV cases. But when
technicians subjected the HIV-negative samples to nucleic acid
amplification testing, they detected 23 more cases. Through interviews
with these newly infected persons, health professionals found 18 more
people who tested positive. A pregnant woman was found to be newly
infected, allowing doctors to prescribe antiretrovirals to prevent
transmission to her baby, said Dr. Peter Leone, a principal author of
the new report. Since then, two more pregnant women have been diagnosed,
he said.
Following the trial period, North Carolina has continued to
provide the advanced test to people who present for HIV testing. It is
the only state to do so. The testing has cost about $450,000, or $3.63
per patient. Officials estimate that 7,000 North Carolinians are
HIV-infected but do not know it.
The report, "Detection of Acute Infections During HIV Testing in
North Carolina," was published in the New England Journal of Medicine
(2005;352(18):1873-1883).
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Local and Community News
MARYLAND: "Montgomery's Sex education Plan Halted"
Washington Post (05.06.05):: Lori Aratani
On Thursday, Montgomery County School Superintendent Jerry D.
Weast suspended a new sex-education curriculum after a US District judge
issued a 10-day restraining order against its implementation. Citizens
for a Responsible Curriculum (CRC) and Parents and Friends of Ex-Gays
and Gays (PFEG) filed suit to stop the curriculum's launch, alleging
one-sidedness and religious bias and that the school board failed to
follow required procedures.
Revisions incorporated into the new curriculum included allowing
eighth-grade teachers to initiate discussions regarding homosexuality,
and a video instructing 10th-graders how to put on a condom.
"Defendants open up the classroom to the subject of
homosexuality and specifically, the moral rightness of the homosexual
lifestyle," Judge Alexander Williams Jr. wrote in a 22-page opinion.
"However, the Revised Curriculum presents only one view on the subject -
that homosexuality is a natural and morally correct lifestyle - to the
exclusion of other perspectives."
"The Revised Curriculum notes that 'Fundamentalists are more
likely to have negative attitudes about gay people than those with other
religious views,'" Williams wrote. It "also paints certain Christian
sects, notably Baptists, which are opposed to homosexuality, as
unenlightened and Biblically misguided." "The Court does not understand
why it is necessary, in attempting to achieve the goals of advocating
tolerance and providing health related information, Defendants must
offer up their opinion on such controversial topics as whether AIDS is
God's judgment on homosexuals, and whether churches that condemn
homosexuality are on theologically sound ground."
In a statement, Weast said he has ordered a review of the
sex-education curriculum, which was to be piloted in six schools next
week, before deciding its future. PFEG and CRC hope to be involved in
the review, said their attorney, John Garza. The curriculum was
originally passed by the Board of education following a review from a
27-member citizens advisory committee, which included PFEG and CRC
representatives, said board President Patricia O'Neill.
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CALIFORNIA: "Latino Groups Decry Cuts in HIV Aid"
San Francisco Chronicle (05.05.05):: Tyce Hendricks
Four groups in San Francisco's Mission District that work to
fight HIV among Latinos are facing cuts of almost $1 million in city
funding. Concepcin Saucedo, executive director of the Instituto Familiar
de la Raza (IFR), said the group is facing a 12 percent reduction in its
$4 million budget - a "devastating" cut that "creates a scenario for
more death."
IFR coordinates its work with Mission Neighborhood Center,
Aguilas, and Proyecto Contra SIDA Por Vida. Saucedo and the leaders of
other Mission groups said the 2005-06 selection process favored
organizations that could afford to hire professional grant writers. The
process, they said, did not give them credit for their successful work
in the Latino community.
James Loyce, deputy director of the San Francisco Department of
Public Health, runs the city's AIDS office. He said better grant writing
would help any group, and he acknowledged that the funding review
process does not take an agency's history of providing services into
account. But he said some small, as well as large, groups were funded,
while some large agencies got nothing.
The health department panel that distributes HIV prevention
funds cut the city's support for the four Mission groups from about $1.2
million to about $240,000. After the 2005-06 grants were announced,
Loyce met with the four agencies and said a second round of HIV
prevention funding will specifically target the Latino community. There
may still be a shortfall, however: Agency officials said the second
funding round will only distribute $600,000.
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MAINE: "Officials Sound Warning on STD"
Portland Press Herald (04.28.05):: Josie Huang
A recent spate of cases of the rare STD lymphogranuloma venereum
(LGV) in several major US cities, including four suspected cases in
Boston, has Portland public health officials worried. "Four cases in
Boston makes me think we're right around the corner," said Dr. Ann
Lemire.
Last fall, after several European nations - including the
Netherlands, Belgium, Germany, France, and Sweden - reported outbreaks
of LGV, CDC asked US clinicians to report suspected infections. Since
then, six men have been diagnosed with the disease: three in San
Francisco, two in New York City, and one in Atlanta. Most of the men
were also HIV-positive. Confirmation of the four Boston cases is pending
tests by CDC, said Lemire.
In response, Portland's Department of Health and Human Services
recently held one of Maine's first discussions on LGV. In April's state
Bureau of Health newsletter, Maine Epi-gram, public health experts ran
an article titled "LGV Resurgence Among Gay and Bisexual Men."
Clinicians are asked to notify the state if they suspect an LGV case; it
is recommended that sex partners of suspected cases be included in
treatment even in the absence of symptoms.
"It's on our radar screen and our first step is to say, 'Be on
the lookout for this and know the symptoms for this,'" said Bob Woods,
director of the state's HIV/STD and viral hepatitis program. Maine
officials have also met with STD prevention educators from the state's
three publicly funded clinics in Portland, Auburn, and Bangor.
At the university of Southern Maine's student health center in
Portland, nurse practitioner Ann Conley said clinicians have been on the
lookout for LGV since last year.
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News Briefs
SOUTH AFRICA: "Minister Defends Garlic in AIDS Care"
New York Times (05.06.05):: Michael Wines
Speaking in Pretoria, South African Health Minister Manto
Tshabalala-Msimang claimed that her promotion of raw garlic as an AIDS
treatment was vindicated by a World Health Organization report about the
need for nutrition in preventing immunosuppression by HIV. She also
repeated her warning that antiretroviral drugs (ARVs) had possible
adverse side effects. The Health Ministry will conduct a study to
determine how many South Africans who received ARVs had dropped out of
such programs or had died from side effects, she said. "Raw garlic and a
skin of the lemon - not only do they give you a beautiful face and skin,
but they also protect you from disease."
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GLOBAL: "Snapshots: Volunteers Fighting AIDS Globally"
USA Today (05.06.05):: Shannon Reilly; Sam Ward
According to the Peace Corps, an estimated 3,100 corps
volunteers - or 40 percent of total participants - helped HIV/AIDS
programs around the world in 2004, some two-thirds of them in Africa.
Peace Corps volunteers assisted 35,116 service providers and 814,908
individuals.
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