Subject: CDC Summary 2/8/93 Date: Mon, 08 Feb 1993 07:41:11 PST (265 lines) Archive-Number: 138 published today in the Archives of Internal Medicine. The University From: Billi Goldberg Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary February 8, 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 ======================================================================= "Pope, in Uganda, Urges Chastity as AIDS Defense" New York Times (02/08/93), P. A5 (Cowell, Alan) Pope John Paul II visited AIDS patients at the Roman Catholic- operated Nsambya Hospital in Kampala, Uganda, on Sunday, preaching chastity as the only defense against what he considers the scourge of Africa. At the hospital, about 60 percent of the 400 patients are HIV- positive or have full-blown AIDS. The Pope's five-day visit brought him to a country whose population is about 17 million, 44 percent Catholic, and includes 1.5 million believed to be infected with HIV. There are nearly 35,000 Ugandans with full-blown AIDS, according to government statistics. The epidemic has left 1.5 million Ugandan children orphaned since it first emerged in the country a decade ago. The Pope said to a rally of about 30,000 young people in Nakivubo Stadium in Kampala on Saturday, "The sexual restraint of chastity is the only safe and virtuous way to put an end to the tragic plague of AIDS which has claimed so many young victims." Vatican officials said the Pope's comment excluded all other forms of protection against HIV infection, including condoms. The comment also contradicts an American- funded government effort in Kampala that promotes the use of condoms to thwart the spread of HIV. Several church leaders contend that the use of condoms will promote the very heterosexual promiscuity that has spread the disease in African countries. Rev. Steve Collins, a Scottish missionary who runs a self-help program for about 600 HIV- positive Ugandan widows, said, "We don't encourage the use of condoms. But we tell people that condoms lessen the risk of AIDS." ======================================================================= "To Battle AIDS, Scots Offer Oral Drugs to Addicts" New York Times (02/08/93), P. A3 (Schmidt, William E.) A broad-based community effort in Edinburgh, Scotland, has not only decreased the number of addicts injecting drugs, but it has also effectively curbed the spread of HIV through contaminated needles. In 1985, more than 50 percent of blood samples taken from drug addicts in Edinburgh's poorest neighborhoods tested positive for HIV. Eight years later the program has reduced the number of IV-drug users from thousands to only a few hundred. The drastic reductions in infection rates and numbers of addicts are due to a decision to permit local doctors to prescribe, free and on demand, oral versions of nearly any drug craved by addicts, on the condition that they avoid the use of needles and agree to routine drug and medical counseling. The policy has been so effective that even street-front centers for dispensing free syringes to addicts, established in 1987 to reduce needle sharing, report that their business has been virtually depleted as drug users have switched to oral alternatives. The overall reported rate of AIDS cases in Britain is 2 per 100,000 people, which is lower than the rest of Europe. Officials at the World Health Organization say that the lower rate of AIDS cases reflects ambitious and early government programs to intervene, including providing clean needles for IV-drug users. In the mid-1980s, Scottish health officials were finding an average of 120 new HIV infections a year linked to tainted needles. However, the spread of the virus among addicts in the Edinburgh area quickly began to decrease as government programs were established. By 1987, only 47 new cases were reported due to IV-drug use; in 1990, there were 10, and last year only eight. ======================================================================= "Seeking AIDS Vaccine, Using People in Tests" Philadelphia Inquirer (02/08/93), P. A1 (Collins, Huntly) The Johns Hopkins University is currently testing an AIDS vaccine on HIV-negative people. A total of 330 volunteers nationwide, including 60 in Baltimore, Md., are being recruited by the federal government to try out its AIDS vaccine. Some of the participants will receive experimental vaccines, while others will receive a placebo. The volunteers are part of what is expected to become a very large- scale effort. In two to three years, it could involve thousands of people, both in the United States and abroad, who are at high risk of contracting HIV. The government is recruiting IV-drug users at Hopkins because they are among the most likely to become infected with HIV. However, problems accompany this at-risk population, including the fact that some are illiterate, some have no phone, and several rarely see a doctor. What is worse is that they might decide that the trial vaccine has protected them from HIV, and become even more reckless about their drug and sexual behavior. The trial volunteers, many of them low- income minorities, are being paid $20 per visit to cover their expenses. Each receives an initial inoculation, followed by two boosters. They will be tested regularly for 18 months to determine whether the vaccine has increased their antibodies to HIV. The researchers regularly tell the volunteers that the vaccine is still unproven and warn them to avoid risky behavior. ======================================================================= "Public More Accepting of Health Workers With AIDS" United Press International (02/08/93) (Wasowicz, Lidia) San Francisco--More Americans are convinced that they can contract HIV from their health-care providers, even though fewer fear HIV- positive health-care workers in 1991 than in 1988, according to a study published today in the Archives of Internal Medicine. The University of California--San Francisco survey discovered that only 5 percent of the 1,350 adults questioned nationwide thought doctors with HIV should quit their jobs. The report showed that 37 percent would change physicians if they knew theirs was HIV-positive. In a similar poll conducted in 1988, 56 percent said they would change doctors. Although only 19 percent were concerned about HIV transmission in health care settings in 1988, 38 percent said they were worried about it in late 1991. Also, the number of those who thought they could be infected by a doctor rose from 33 percent to 46 percent in the four years. This rise could be attributed to the news of Kimberly Bergalis, a Florida woman, who contracted HIV from her AIDS-infected dentist. In the new poll, a total of 92 percent said health-care workers should be tested for HIV, and 1993 percent thought infected workers should be required to reveal their status to their patients. Most respondents, 89 percent, said health care providers have a right to know their patient's HIV status. The number of those who stated that infected doctors should not be permitted to work dropped from 45 percent in 1988 to 39 percent in 1991. Moreover, those who personally knew an AIDS patient were less concerned about HIV transmission and more supportive of infected workers' rights to their jobs. ======================================================================= "Arthur Ashe, Tennis Star, is Dead at 49" New York Times (02/08/93), P. B9 (Finn, Robin) Arthur Ashe, former tennis champion, died of AIDS-related pneumonia on Saturday at the age of 49. Ashe was the only black man to win Wimbledon and the United States and Australian Opens. He spent most of his tennis career fighting discrimination in the sport, and the last year of his life was spent fighting for AIDS-related causes. He announced his AIDS condition on April 8, 1992, after being forced by USA Today, which threatened to publish an article about his illness as soon as it could confirm it. Ashe, who said he believed he became infected with HIV through a transfusion of contaminated blood during his second round of heart-bypass surgery in 1983, first learned of his infection after he entered New York Hospital for emergency brain surgery in September 1988. The surgery and a biopsy revealed the presence of toxoplasmosis, a parasitic AIDS-related condition. Ashe had been hospitalized in recent weeks with pneumocystis carinii pneumonia, according to an AIDS researcher. Last September, Ashe formed a foundation to benefit AIDS causes at the United States Open, using top tennis pros to start his 15-month, $5- million fund-raising effort. He said, "The foundation was something I always knew I wanted to do, long before I went public on April 8." He referred to the date as the start of his life as an AIDS activist. ======================================================================= "After Years of AIDS, Ashe Stricken Suddenly" New York Times (02/08/93), P. C1 (Altman, Lawrence K.) Arthur Ashe's physician said yesterday that the tennis player's death on Saturday came as a surprise. He added that what was also surprising was how Ashe had remained healthy for more than four years after AIDS was diagnosed. Ashe died from AIDS-related pneumocystis carinii pneumonia (PCP). He had recovered from an earlier occurrence of PCP in January but became ill again last Wednesday and was admitted to New York Hospital on Friday. His doctors believed, even a few hours before his death, that Ashe would make it. Dr. Henry W. Murray, Ashe's doctor, said yesterday, "I don't believe he actually knew it was the end." The doctor maintained that Ashe "knew he was very ill" and that "he knew what the implication of" being on a mechanical respirator was. Ashe's condition improved Friday night and Saturday morning before his medical team was surprised by a sudden turn for the worse, Murray said. "For reasons that are unexplained but that are typical of respiratory failure, something came along and went wrong," he explained. While Ashe was unable to speak in his last hours, he was alert and wrote notes about the results of his tests and President Clinton's possible nominees for Attorney General, said Murray. To most observers, Ashe appeared healthy in recent months. However, Murray said that Ashe had been in declining health over the last seven months, frequently suffering pain from his continuing heart condition. He experienced a mild heart attack last September. Ashe had been taking AZT since last summer, Murray said. He also took ddI, in part because he felt his health was deteriorating. Related Story: Washington Post (02/08) P. A1 ======================================================================= "PRI--AIDS-Grand Moms" Associated Press (02/04/93) (Neergaard, Lauran) Atlanta--A government-funded group designed to help poor black HIV-positive mothers cope with their condition has been operating out of Atlanta, Ga., since last year. The group, MOMS Hands, short for Mothers Offering Mothers Support, was founded by Sandra McDonald with a $400,000 grant for three years from the federal Health Resources and Service Administration. Only recently has the public recognized the AIDS problem among women. McDonald said, "In the black community, folks say people with AIDS deserve to die; they're targets of violence. There is no support for women, mothers." She added that because everyone loves and respects grandmothers, "we pair these young mothers with grandmothers and automatically somebody loves them." The federal government hopes that other programs like MOMS Hands will form to give young, black mothers with HIV/AIDS the support they need. MOMS Hands is an offshoot of Outreach Inc., also founded by McDonald. Outreach was launched in 1986 in Atlanta, and was among the first AIDS groups in the South to provide for the needs of minorities there. Of the 242,146 AIDS cases reported in the country since 1981, women account for 11 percent. About 53 percent of those women are black, according to the Centers for Disease Control. MOMS Hands has already paired about 80 Little Moms with 22 Big Moms. The Big Moms serve as volunteers, but their training and public education is paid for by the program. The Big Moms help the Little Moms disclose their HIV-infected status to children. They also offer comfort and help when the infected women become ill or are tempted by drugs. ======================================================================= "Your Health: Education Plus Testing Boosts AIDS Awareness" United Press International (02/06/93) (Klinger, Karen) Boston--While anti-AIDS efforts have largely concentrated on education, a study of heterosexual college students found that this technique was only effective when coupled with blood tests. Researchers at the University of California--Los Angeles conducted a study over a six-month period, comparing the practices of 136 students who went through a multi-media education program on AIDS in conjunction with blood tests with the practices of 144 students who only went through the education program. Another 90 students who were observed did not receive education or testing. The number of participants who received education and testing and who asked about partners' HIV status went from 31 percent before the testing to 56 percent afterward. But those who only received the education program had a much smaller increase in partner questioning--from 34 percent at the start to 41 percent afterward. The study discovered that partner questioning among students who received neither education nor testing did not change at all. Although education and blood tests made the students more apt to question their partners about HIV, it did not change their behavior in other respects. In all three groups, less than two-thirds of the students reported regularly using condoms. Also, the number of sexual partners was not affected by testing or education, said the researchers. Dr. Neil Wenger, lead author of the study published in the Annals of Internal Medicine, said the findings "in no way support the concept of mandatory testing in any population, but they do suggest that voluntary HIV testing, in association with education, should be central to our public health intervention to stop the spread of HIV infection." ======================================================================= "Clarithromycin has Short-Term Benefits for Treatment of MAC" AIDS Alert (01/93) Vol. 8, No. 1, P. 7 Children with AIDS who have Mycobacterium avium complex (MAC) infection can receive some clinical benefit from taking clarithromycin, which appears to be well-tolerated, according to researchers at the Children's Hospital of Los Angeles. But when clarithromycin is used alone, it becomes resistant in six to 12 weeks, and clinical benefits seem to be somewhat temporary. A total of 24 children with MAC who were receiving antiretroviral therapy with AZT, ddI, or ddC also received 3.75, 7.5, or 16 mg/kg of clarithromycin for 12 weeks. Dr. Clark Inderlied, associate professor of pathology and director of clinical microbiology at Children's Hospital, said that among 18 patients who completed the study, clarithromycin has been well- tolerated in all dose levels. No serious side effects have been reported. In addition, there appears to be no effect of clarithromycin on the pharmacokinetics of the antiretroviral drugs. There was also clinical improvement in the children studied, such as a decrease in the number of fevers and night sweats and an increase in their activity levels. Inderlied said that quantitative mycobacterial cultures indicated that there were consistent decreases in mycobacteremia only in children receiving the highest dose of the drug after six and 12 weeks, and most patients experienced a recurrence of MAC symptoms within six to 12 weeks. He also said that in order for clarithromycin to be effective in the long-term, it should be administered with other antimicrobials, such as ethambutol. ======================================================================= "News in Brief: North Carolina" Advocate (02/09/93) No. 622, P. 26 Anonymous HIV testing must be resumed in North Carolina at least temporarily under terms of a preliminary injunction issued in Raleigh, N.C., Jan. 4 by Wake County superior court judge Orlando F. Hudson. The ruling followed a civil lawsuit filed by ACT-UP against the state health commission, which proposed in 1991 that anonymous testing be discontinued in 83 North Carolina counties. The lawsuit argued that the plan infringed upon the civil rights of people in the 83 counties, since people in other counties would still have access to anonymous testing. Hudson upheld an administrative law judge's decision that the selection of the 83 counties was "arbitrary and capricious." Type