Subject: CDC Summary 1/28/93 Date: Thu, 28 Jan 1993 09:17:01 PST (271 lines) Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. Archive-Number: 53 AIDS Daily Summary January 28, 1993 The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse makes available the following information as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold. Copyright 1992, Information, Inc., Bethesda, MD ======================================================================= "Dinkins Promises to Maintain AIDS Services Level" New York Times (01/28/93), P. B3 (Belkin, Lisa) New York City Mayor David N. Dinkins' administration announced yesterday that it would continue to provide its various services for AIDS patients, as a new federal definition of the disease qualifies more people for assistance. City officials said they would earmark $38 million over the next two years to make services available, including rental assistance, nutritional assistance, and child placement for people who are defined as having AIDS. Officials added that if that is not enough, the administration will allocate more funds. The Mayor's proposal, which is expected to be issued tomorrow, will be part of New York City's four-year financial plan. On Jan. 1, the Centers for Disease Control implemented the new definition that doubles the number of people classified as having AIDS. This raised the question of whether the city would maintain the same level of services to a much larger group of people. The Mayor's proposal is expected to be the solution. BarbaraJTurk, deputy director of the city's Office of Management and Budget, said the $38-million figure was based on an estimate by her office that the demand for AIDS services would jump 30 percent, to 17,622 from 13,555, as a result of the new definition. Turk said the proposal would add $8.7 million to the 1993 budget of the Human Resources Administration, which would otherwise have $124.3 million. She added that the proposal would provide an additional $28.8 million to the agency's 1994 budget, which would otherwise be $162.1 million. The rest of the money will be given to the Department of Health. ======================================================================= "Small Town Offers Disturbing Look at Future of the AIDS War" Los Angeles Times--Washington Edition (01/28/93), P. A5 (Clary, Mike) A small town in Florida with a predominantly black population has been designated "the AIDS capital of the world" because of the prevalence of HIV infection among heterosexuals. In the last ten years, 381 AIDS deaths have been reported in Belle Glade, Fla.--a rate four to five times the national average. The town is home to migrant workers and is located southeast of Lake Okeechobee. Since AIDS was first identified in the early 1980s, no town has been more researched, no population more examined, questioned and tested than that of Belle Glade, where 52 percent of the 17,000 year-round residents are black and 12 percent are Latino. AIDS is believed to have emerged in Belle Glade early, in the late 1970s, possibly with the migrant stream of farm workers. By the time the disease was detected in the town, it had become an epidemic spread by prostitutes, IV-drug users, and apathetic sexual attitudes. Researchers discovered in 1985 an infection rate of 1.85 per 1,000 people, which is higher than in New York City or San Francisco. But the main population that was infected in Belle Glade was among heterosexuals, not homosexual men or IV-drug users like everywhere else. Tedd V. Ellerbrock, an epidemiologist with the Centers for Disease Control, said there is anecdotal evidence that several towns in Florida and throughout the South may have similar rates of HIV infection. Still, no town has suffered more from the stigma of AIDS than Belle Glade. Some southern Florida high schools even refused to play Belle Glade in football for fear of contracting HIV. ======================================================================= "Israel Will Not Demand Foreigners Pass AIDS Tests" Reuters (01/27/93) Jerusalem--A ruling which would have mandated that foreigners who visit Israel for more than three months undergo HIV testing has been reversed by the country, an interior ministry spokeswoman said Wednesday. The ruling, which was to be enacted this month, spurred controversy in Israel when it was announced in November. The rule would have required foreigners who wanted to stay more than three months and who tested positive for HIV to be forced to return home. The spokeswoman said the interior, health, and immigration ministers had decided not to mandate HIV testing of tourists who want to stay longer. She said, "Foreign visitors can stay on freely--the announcements of changes in regulations are now invalid." Previously, Israeli physicians, parliamentarians, and AIDS activists argued against the rule, claiming it was discriminatory and ineffective. In addition to the reversal, the spokeswoman said, the ministers rejected a proposal that would have forced new immigrants to undergo HIV testing. Israeli law prohibits HIV-positive immigrants from entering the country, but none have been expelled despite reports that Ethiopian newcomers were infected with HIV. Between 1985 and October of 1992, the health ministry reported 195 AIDS cases among an Israeli population of 5 million. Among those AIDS patients, 138 died and 14 left the country. An additional 963 Israelis have tested positive for HIV. ======================================================================= "Philippines--AIDS" Associated Press (01/27/93) Manila, Philippines--The first Protestant Philippine president is challenging the powerful Roman Catholic Church hierarchy by supporting his health secretary's policy of distributing condoms to thwart the spread of HIV infection. In the May 1992 presidential election, the church hierarchy generally opposed Fidel Ramos, and has opposed the condom policy of Health Secretary Juan Flavier. Approximately 85 percent of the 62 million Filipinos are Catholic. On Monday, Ramos said, "This is government policy and it has already been announced in connection with the universal clamor for the control of AIDS as a universal threat. I don't think there is any question about that." The Catholic Bishops Conference of the Philippines argues in a pastoral letter to be read in churches Feb. 7 that government promotion of "safe sex" is "tantamount to condoning promiscuity and sexual permissiveness and to fostering indifference to the moral demand as long as negative social and pathological consequences can be avoided." Still, prostitution is prevalent in virtually every city in the country. The Department of Health states that 362 Filipinos have been found to either have AIDS or HIV infection. However, AIDS testing is not widespread in the Philippines, and the department estimates that only one out of every 100 AIDS patients or HIV-positive patients have been identified. While condoms are openly sold in pharmacies, critics oppose the government funding their distribution. Several congressmen requested Flavier's resignation last month after he distributed condoms to reporters before Ramos' visit to Thailand. ======================================================================= "In Delco, a Lesson in Compassion" Philadelphia Inquirer (01/28/93), P. B1 (McCullough, Marie and Janco, Mary Anne) An interview in McCall's magazine about a boy's fight with AIDS might have provoked ostracism from the Delaware County, Pa., community, but fortunately, residents were supportive. Diane McCullough spoke with the magazine weeks ago and disclosed her son Kyle Cocco's AIDS- related condition. But when the news finally reached the community yesterday, people responded to McCullough's courage with concern and compassion. "I expected more negative feedback from people who don't know me," said McCullough, who is also HIV-positive. On Tuesday, Parkside Elementary School, where Kyle is in third grade, arranged a parent's meeting with McCullough and educators from the Delaware County AIDS Network in Pennsylvania. While Parkside principal Fred Passante learned about Kyle's condition a year ago, he was bound by state law to keep it confidential. At the meeting, questions and concerns were raised, but the reaction was nothing like what has transpired in other schools and other areas. Lisa Cosentino, the AIDS Network educator, said, "There was a lot of warmth for the child we were discussing. Parents were concerned about how to explain AIDS to their own children- -how could they explain the illness and death and loss." Maggie Lyman, president of the Parkside Parent-Teacher League, said Kyle's classmates "want to know what they can do for him." Passante had already educated his staff about AIDS and ensured that they practice universal safety precautions. The school's 228 students will receive additional AIDS education. Also, the district has provided a thick packet of information to help parents discuss the disease with their children. ======================================================================= "School Chief, Now Dead, Is Accused of Stealing" New York Times (01/28/93), P. B1 (Raab, Selwyn) Federal prosecutors yesterday alleged that Alfredo Matthew Jr., a deceased superintendent of a Bronx school district, was the leader of an embezzlement and money-laundering scheme that victimized a pair of anti-poverty agencies designed to assist impoverished elderly people, homeless people infected with HIV, and indigent parents in need of day care. The prosecutors claim Matthew and his associates diverted $185,000 in federal and municipal funds from Hispanic Social Services Inc. and the Puerto Rican Home Attendant Services Program and used the money on such personal items as meals at restaurants, airline flights, home furnishings, clothing, toys, and tickets to New York Yankees baseball games. Matthew apparently killed himself in an Albany, N.Y., hotel earlier this month. Authorities have charged three of his coworkers in the embezzlement scam. ======================================================================= "AIDS Costs--One More Reason for Health Reform" American Medical News (01/11/93) Vol. 36, No. 2, P. 3 (Culhane, Charles) Although the 1992 estimate of the national cost of treating HIV was $10.3 billion, it will increase to more than $15.2 billion by 1995, which is about a 50 percent jump, according to a federal health official. Dr. Fred Hellinger, an official of the Agency for Health Care Policy and Research, said, "Available information indicates that both the average cost of treating a person with AIDS and the average cost of treating an individual with HIV without AIDS are higher than recent studies calculated." Hellinger testified at a hearing before the Senate Finance Committee's subcommittee on health for families and the uninsured. Sen. Don Riegle (D-Mich.) said that approximately 29 percent of AIDS patients in the United States are uninsured, while about 40 percent of AIDS patients are covered through Medicaid, now the primary payer for medical services related to AIDS. In addition, Medicaid provides health care for about 90 percent of the children with AIDS. Dr. Hellinger projected that the average annual cost of treating an AIDS patient is $38,300, and the cost for a person with HIV is $10,000. The average lifetime cost of care for an AIDS patient is $102,000--about twice that of a breast cancer patient, and five times that for a patient with lung cancer. Hellinger said that his predictions only refer to the cost of medical services such as hospitals, physicians, drugs, nursing homes, and home health care. He did not calculate what the expense would be for the use of nonmedical support services like testing, education, counseling, and the indirect costs of lost productivity. ======================================================================= "Projections of the Number of Persons Diagnosed With AIDS and the Number of Immunosuppressed HIV-Infected Persons--United States, 1992-1994" Morbidity and Mortality Weekly Report (01/15/93) Vol. 42, No. 1, P. 17 The Centers for Disease Control recently issued new predictions of the number of Americans who will initially be diagnosed with an AIDS- related condition under the 1987 AIDS surveillance case definition between 1992-94. The report also gives projections of the number of HIV-positive persons with T-cell counts under 200, in addition to estimates on the effect of adding this measure of immunosuppression to the 1993 expanded AIDS surveillance case definition. About 58,000 persons in the United States had AIDS as diagnosed by the 1987 definition during 1991. Between 1992-94, the number of persons who have illnesses meeting these criteria is expected to increase by a few percent annually, with about 85 percent of those people being reported to the CDC with cases of AIDS. The rate of increase in reported AIDS cases in persons who contracted HIV through heterosexual contact is expected to be greater than that in persons who contracted HIV through IV-drug use or male homosexual/bisexual activity. The CDC predicts that an additional 120,000-190,000 Americans had HIV-related severe immunosuppression as of January 1993. If the AIDS definition was not changed, about 50,000-60,000 reported AIDS cases would have been expected in 1993. The expansion of the AIDS surveillance case definition to include HIV-related severe immunosuppression should increase reported cases by about 75 percent. Also, the number of AIDS cases reported in 1994 is still expected to exceed by 10-20 percent the number that would have been reported if the 1987 definition had remained in effect. ======================================================================= "Ill--But Willing to Work" U.S. News + World Report (01/25/93) Vol. 114, No. 3, P. 71 (Saltzman, Amy) Discrimination against ill employees, such as AIDS patients, has decreased as a result of the Americans with Disabilities Act and more corporate AIDS awareness. Nevertheless, ill workers who hope to keep their jobs and even climb the corporate ladder can expect to encounter resistance from employers concerned about productivity. Some well- meaning employers admit that they consider many of the working ill as temporaries. Obtaining the support of co-workers is crucial, since ill employees must be realistic about the workload they can handle but demonstrate that they are effective workers. Fritz Rumpel, director of information services for Mainstream Inc., a training firm in Dallas and Bethesda, Md., that helps employers accommodate sick and disabled workers, recommends that employees who are uncomfortable with addressing their illness directly with co-workers should request that the company bring in a counselor from a local support group or association to discuss the disease. In the United States there are 20,800 people in the workforce with AIDS, and 44,800 with HIV infection. In addition, two thirds of large companies and 1 in 12 small companies have knowingly employed a worker with AIDS or HIV infection. Although it is commendable that many ill employees work harder to prove that they can still do the job, it will likely backfire if the illness progresses and work begins to slide. One way to accommodate an ill employee would be to trade daily responsibilities for special projects with flexible schedules that can prevent conflicts with colleagues. Another option would be to switch to a job where there is less reliance on coworkers. ======================================================================= "RISE-Resistant Tuberculosis Meningitis in AIDS Patient" Lancet (01/16/93) Vol. 341, No. 8838, P. 177 (Horn, David L. et al.) The optimum therapy to treat RISE-resistant tuberculosis meningitis in AIDS patients remains to be found, write David L. Horn et al. of the Lincoln Medical and Mental Health Center in the Bronx, N.Y. TB meningitis is rare, although HIV-positive patients from endemic areas for TB are frequently reported to have meningeal involvement with appreciable mortality. Seldom are drug-resistant strains of Mycobacterium tuberculosis detected in cerebrospinal fluid cultures. RISE-resistant TB, a subset with exceptionally broad resistance, is defined as resistance to at least rifampin, isoniazid, ethambutol, and streptomycin. An HIV-positive man with a gunshot wound to the abdomen was presented in July 1992 with high temperature, night sweats, weight loss, weakness, occipital headache, and confusion. His white cell count was 500. Chest radiography showed left apical pleural thickening and a bullet in the abdomen. Intravenous acyclovir, ampicillin, and cefotazime, and oral isoniazid, rifampin, pyrazinamide, ethambutol, and pyridoxine were administered. On the third day, the patient had shallow respirations, anisocoria, absent corneal reflex, spasticity of the left side with hemiplegia, hyperreflexia, clonus, and bilateral Babinski signs. Although there were aggressive supportive measures, the patient died on day 9. Postmortem cerebrospinal fluid culture grew M. TB that was resistant to isoniazid, rifampin, ethambutol, streptomycin, ethionamide, and kanamycin, and susceptible to capreomycin, cycloserine, and ciprofloxacin. Because RISE-resistance was not detected until after death, it hindered effective therapy, conclude the researchers.