Subject: CDC Summary 3/4/93 Date: Thu 04 Mar 1993 16:09:57 GMT (240 lines) Archive-Number: 323 From: igc.apc.org!bigoldberg (Billi Goldberg) Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary March 4, 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 ====================================================================== "In the News: AIDS in Ethiopian Community Is Focus of Health Seminar" Washington Post (03/04/93), P. D.C. 1 A free seminar will be held this Saturday at the University of the District of Columbia that will address AIDS in Ethiopia and in the Washington Ethiopian Community. The issues discussed will include approaches for fighting AIDS, treatment of HIV infection, and the psychological effects of the disease on those who have it and their families. ====================================================================== "We Shouldn't Exclude Immigrants With H.I.V." New York Times (03/04/93), P. A24 (Gostin, Lawrence O.) Instead of concentrating our efforts on preventing HIV-positive people from entering the United States, we should dedicate ourselves to the principles of justice, scientific cooperation, and a global response to the AIDS epidemic, writes Lawrence O. Gostin, executive director of the American Society of Law, Medicine, & Ethics. The New York Times editorial on Feb. 20, "Immigrants Infected With AIDS," supports the Senate decision to exclude HIV-positive immigrants. The editorial is based on public health and financial cost grounds. However, it neglects to acknowledge human rights that could be violated as a result of such exclusion. This policy is based not on risk the HIV-positive people pose to others, but rather on their serologic status. This type of discrimination punishes a great majority of those who will behave safely, as well as the few who will not. The ban against HIV-positive people affects only those who otherwise have a right to reside in the United States because of family or other close ties. Therefore, the policy interferes with family unity. The Haitian refugees who are detained at Guantanamo Bay, Cuba, fear danger in their home country, but may be denied entry into the U.S. simply because of their HIV-positive status. This policy will not reduce the abundance of infection in the world, nor will it provide more resources for education and counseling. If cost were the actual reason for this policy, the United States would have included all those with chronic costly diseases like heart disease, cancer, and kidney disease. It is ironic that the United States, which has probably exported more cases of HIV infection than any other nation, should establish such an exclusionary policy, concludes Gostin. ====================================================================== "Miss America Crusades Against AIDS" USA Today (03/04/93), P. 1D (Painter, Kim) The 1992 Miss America, Leanza Cornett, promised to discuss AIDS wherever she went, and she has followed through on her promise--much to the delight of many AIDS organizations and even the Miss America Organization. Leonard Horn, the group's chief executive, said, "We feel very strongly that the young lady who is Miss America should be a true role model, interested in some of the troublesome issues that face our world." Before she was crowned, Cornett had worked as a volunteer at AIDS service organizations in Orlando, Fla. She said, "I had friends who were infected and affected, and I was frustrated because so little was being done." She eventually gave safer sex seminars and worked at a home for HIV-positive children. During the televised Miss America Pageant, Cornett wore the symbolic red ribbon and discussed AIDS awareness. "I was really proud," she said. Cornett continues to wear the red ribbon every day. She was asked to talk on Christian talk show The 700 Club a few weeks ago. She said, "They weren't necessarily interested in my platform, but I managed to turn around the interview and talk about it. And I said, 'As Christians, we can't ignore this any longer. People are dying.'" When she does discuss AIDS at the various places she is asked to speak, she says, "Fight AIDS, not people with AIDS." She also emphasizes the importance of abstinence, but acknowledges that many people do engage in sexual activity. Consequently, she tells them, "If you're going to do it, do it as safely as you can and that means condoms." ====================================================================== "AIDS Fails to Change French Sex Habits--Survey" Reuters (03/03/93) Paris--Only about one-sixth of French adults have used more caution while engaging in sexual relations since the AIDS epidemic began, and 56 percent dislike condoms, according to a survey released Wednesday. A government agency dedicated to fighting AIDS conducted the survey, which showed 84 percent of the French population had made no changes in their sexual behavior, even though sex is one of the primary ways the virus is transmitted. About 56 percent of respondents said condoms "killed off romance." The survey involved 20,000 people, and is likely to heighten concern in a country with one of the highest rates of AIDS cases in Europe. Approximately 250,000 French people are infected with HIV, and more than 13,000 people have died. Among those who have slept with more than one person in the last year, the survey showed that 30 percent of men and 50 percent of women had never used a condom during sex. However, more than 90 percent acknowledged that penetrative sex was potentially risky. The underlying problem was that most French people do not believe they are at risk for HIV infection. ====================================================================== "AIDS Campaign Groups Accuse French Rail of Secret Testing" Reuters (03/02/93) Paris--Two AIDS activist groups accused the French state rail company SNCF of testing some of its employees without obtaining their consent. ACT-UP said in a statement that one case involved an employee who was tested for HIV two years ago, but was never told. He tested positive, and now he is in danger of losing his job, said ACT-UP. The group added that some of its members went to the office of SNCF director Jacques Fornier on Tuesday and demanded an explanation. SNCF officials were not available for immediate comment on the matter. "The risk of violation of privacy is very real. When these practices are accompanied by sanctions in the workplace, they become unacceptable discrimination," ACT-UP said. Another activist group, AIDES, also said that SNCF was involved in what it claimed was a recent increase in cases of secret HIV testing. The group did not elaborate further. ====================================================================== "Hong Kong to Lower Taxes, Increase Spending" United Press International (03/03/93) Hong Kong--The colony of Hong Kong revealed plans Wednesday to transform its enormous budget surplus for 1992-1993 into a deficit to lower or eliminate income taxes for 90 percent of taxpayers and increase spending on roads and AIDS prevention efforts. Financial Secretary Hamish Macleod said in his budget speech in the Legislative Council that the estimated 1992-93 surplus of $2.6 billion will result in a deficit of $436 million in the next fiscal year beginning April 1. Expenditures are predicted to be $19.4 billion and revenues $18.9 billion. ====================================================================== "The Emergence of Drug-Resistant Tuberculosis in New York City" New England Journal of Medicine (02/25/93) Vol. 328, No. 8, P. 521 (Frieden, Thomas R. et al.) AIDS patients are more likely to be infected with drug-resistant tuberculosis and are more likely to die if infected with these organisms, write Thomas R. Frieden et al. of the Centers for Disease Control in Atlanta, Ga. The researchers gathered information on every patient in New York City with a positive culture for Mycobacterium tuberculosis during April 1991. Among the 518 patients with positive cultures, 466 (90 percent) had isolates available for testing. A total of 33 percent of these patients had isolates resistant to one or more antituberculosis drugs, 26 percent had isolates resistant to at least isoniazid, and 19 percent had isolates resistant to both isoniazid and rifampin. Among the 239 patients who had received antituberculosis therapy, 44 percent had isolates resistant to one or more drugs and 30 percent had isolates resistant to both isoniazid and rifampin. Of the patients who had never been treated, the proportion with resistance to one or more drugs increased from 10 percent in 1982-1984 to 23 percent in 1991. Patients who had never been treated and who were HIV-positive or reported IV-drug use were more inclined to have resistant isolates. Among AIDS patients, those with resistant isolates were more likely to die during follow-up through January 1992. A history of antituberculosis treatment was the strongest indicator for the presence of resistant organisms. Improvements in TB-control programs and in social and economic conditions are greatly needed and can promote the control of both TB and the emergence of drug-resistant organisms, conclude the researchers. ====================================================================== "More Disclosure of AIDS in Celebrities" New England Journal of Medicine (02/25/93) Vol. 328, No. 8, P. 583 (Carrino, Amy Fairchild and Bayer, Ronald) Even though there was a rise in HIV testing among the public after celebrities such as Magic Johnson and Arthur Ashe disclosed their HIV/AIDS-related conditions, the increase was not among high-risk individuals, write Amy Fairchild Carrino and Ronald Bayer of the Columbia University School of Public Health in New York, N.Y. In the Nov. 5 issue of the New England Journal of Medicine, Gellert and colleagues wrote about the benefits of the disclosures of HIV-infection by celebrities, claiming that "such disclosures have an impressive effect on the public health." They demonstrated graphically that anonymous HIV testing increased significantly after the disclosure, voluntary or involuntary of the HIV status of celebrities. Nevertheless, their graph exhibits not only the increase in testing after such disclosures, but also the number of tests that were positive. The line for the number of positive tests stays constant throughout the period of observation--1985 through 1992--regardless of the fluctuations in testing. This finding suggests that such disclosures increase testing among those at low-risk for HIV infection, but not among those at high risk. Despite the number of people tested, the number of positive tests remains the same. What is more alarming, is rather than suggesting an increased public awareness of the risk of HIV, their data indicate that public health campaigns have not effectively educated about HIV and that the population is still vulnerable to hysteria. Public awareness in the form of hysteria cannot be interpreted as a positive outcome of disclosure by celebrities, conclude Carrino and Bayer. ====================================================================== "Dental HIV Transmission?" Nature (02/25/93) Vol. 361, No. 6414, P. 691 (DeBry, Ronald W. et al.) The case of the Florida dentist who allegedly infected five of his patients needs to be examined more closely with another dataset from some other region of the HIV genome, write Ronald W. DeBry et al. of the Florida State University in Tallahassee, Fla. Ou et al. recently reported that the dentist did indeed transmit the virus to his five patients. Population genetics indicate that a rapidly evolving marker can develop strong geographical substructure. Therefore, an appropriate null hypothesis is that the patients independently acquired similar variants within the local community. The dental transmission hypothesis entails that a branch on the viral phylogenetic tree lead to the dental group alone and not include any controls. But in phylogenetic terms, the dental group must be monophyletic. The null hypothesis would be rejected if a tree with a monophyletic dental group is significantly better supported than any tree with controls intermixed within the dental group. The researchers tested the hypotheses using new sequences from the dental patients and a new set of regional controls. This selection is justified: the dental group should be monophyletic compared to any controls. In addition, the test is biased in favor of accepting the dental transmission hypothesis because the controls in both studies were obtained at clinics about 90 miles from the dentist's practice area. The researchers conclude that the available data are consistent with both the dental transmission hypothesis and the null hypothesis and do not yet distinguish between the two. ====================================================================== "The AIDS Crisis: Learning From Mistakes" Financial World (03/02/93) Vol. 162, No. 5, P. 46 San Francisco is viewed as the nation's model for humane and cost- effective AIDS treatment because of its aggressive response to the epidemic in the early 1980s. The city assembled a continuum of services that could keep people out of hospitals, except when necessary. Also, the City and County of San Francisco Department of Public Health ensured that those dealing with the epidemic knew one another and talked regularly. Consequently, a study published in 1986 in the Journal of the American Medical Association estimated lifetime hospital costs of an AIDS patient in San Francisco to be about $41,500, versus $60,000 to $75,000 nationwide. But as the numbers of AIDS patients grew, so did the number of community organizations eager to help. Every minority group wanted its own AIDS organization, which began to quickly use up city funds. Nevertheless, other cities were able to learn from San Francisco's mistakes. When Seattle sought to improve its AIDS efforts, it emulated much of what San Francisco pioneered, but avoided allowing too many AIDS service groups. Only two agencies in Seattle have the specific role of providing case managers. The city prevented a proliferation of small agencies by creating a coalition consisting of a limited number of major players, including an umbrella group for minorities. The Seattle-King County Department of Public Health made sure all the groups worked together to predict where the city was heading, much like San Francisco. Hospital charges per AIDS patient dropped from $13,000 in 1984 to under $10,000 at the end of 1989. Also, the mean lengths of hospital stays dropped from 18.4 days to 9.5 days, whereas the national average in 1989 was 16.3 days.