Subject: CDC Summary 3/10/93 Date: Wed, 10 Mar 1993 09:06:37 PST (244 lines) Archive-Number: 370 From: Billi Goldberg Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed. sold. Copyright 1992, Information, Inc., Bethesda, MD AIDS Daily Summary March 10, 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 ====================================================================== "Surgeons Risk Suits by Hiding AIDS" Baltimore Sun (03/10/93), P. A1 (West, Norris P.) HIV-positive surgeons in Maryland must reveal their status to patients before performing operations if they wish to avoid lawsuits, according to a ruling by the state's highest court yesterday. The decision stated that health professionals infected with HIV may be held liable if they neglect to reveal their conditions. Yesterday's decision reversed a lower court ruling on lawsuits filed against the estate of Dr. Rudolph Almaraz, a Johns Hopkins Hospital surgeon who died of AIDS in 1990. Hopkins sent letters to approximately 1,800 former patients of Dr. Almaraz's after his death to inform them that the surgeon had AIDS, and to ensure them that their risk for contracting the virus was minimal. The lawsuits were filed by two women who had been operated on by Dr. Almaraz and feared that they may have contracted HIV during breast surgery. The two women tested negative but still filed suit. The unanimous ruling by the Court of Appeals was based on a policy statement implemented in July 1991 by the American Medical Association. According to the statement, physicians should be tested for HIV and disclose their status to a public health official if the result is positive. Dr. Hamilton Moses III, Hopkins' vice president for medical affairs, said the institution urges all its health-care professionals to be tested for HIV and to reveal their status to the hospital. But he said current state prohibits hospitals from mandating such testing. Paul F. Strain, a lawyer for the hospital, said surgeons have always been required to disclose any risks in medical procedures. He said the court's ruling permits juries to determine whether a doctor's HIV status should be part of that disclosure. ====================================================================== "Hard-Hit Minorities to Get AIDS Grants" New York Times (03/10/93), P. B3 New York state health officials announced yesterday that they would allot $3.9 million in grants for prevention programs in black and Hispanic neighborhoods. The move is a result of criticism for the state's delays in the anti-AIDS programs among minorities. The funding will be given to 24 organizations that work to curb the spread of HIV among black and Hispanic people. Dr. Mark Chassin, the state health commissioner, said during an Albany news conference, "To halt this devastation, we must help minority communities marshal the resources, both human and financial, needed to bring the HIV epidemic under control." Black and Hispanic people currently account for about 64 percent of New York state's AIDS cases, but they only comprise 25 percent of the population, according to the State Health Department. Dr. Chassin mentioned that $3 million of the AIDS grants will be provided to 14 minority-operated social service groups, which will make a range of AIDS prevention and support services available. ====================================================================== "New York City to Detain Patients Who Fail to Finish TB Treatment" New York Times (03/10/93), P. A1 (Navarro, Mireya) The New York City Health Department yesterday implemented rigid rules for detaining tuberculosis patients who are reluctant to complete their treatment on their own. The move indicates the possible confinement of patients for more than a year. The rules are designed to thwart the spread of TB and the deadly drug-resistant strains of the disease that manifest in patients who repeatedly start and stop treatment. It can take between six months and two years to cure most strains of the disease. The city's most recent policy has been to confine recalcitrant TB patients to hospitals for the few weeks of treatment necessary to eliminate contagion. However, the new regulations are designed to ensure that patients who have demonstrated a pattern of ending treatment when they are released continue their medication until they are completely cured. City officials indicated that long-term detentions could start as early as next month, when the Health and Hospitals Corporation plans to open a 25-bed unit at Goldwater Memorial Hospital on Roosevelt Island for this purpose. The Board of Health officials also adopted due process protections for detained patients, including the right to an attorney paid by the city and to a court hearing. The new regulations also mandate that the health commissioner obtain a court order within two months of the detention--or within five days of a request for release from the patient--and come to court every three months to prove continued need for the order with "clear and convincing evidence." ====================================================================== "Singapore Requires AIDS Test for Foreigners" Reuters (03/08/93) Singapore--HIV tests must be conducted on all foreigners seeking permanent resident status in Singapore, according to an immigration department spokeswoman. The spokeswoman said Monday that the test is part of a medical examination which all applicants for permanent residence must take. Singapore introduced the mandatory HIV tests for foreign work permit-holders on Jan. 1. Foreigners who earn $910 a month or less must hold a work permit, while other employees need an employment pass. Before the January ruling, HIV testing was limited to foreign maids in Singapore. Since January, at least six work permit- holders have tested HIV-positive and have been repatriated, say local newspapers. Health ministry figures issued early this year reported that 37 people had died of AIDS as of Jan. 1, while 158 others were infected with HIV. The number of foreigners who tested HIV-positive increased to 61 last year from 28 in 1991. ====================================================================== "AIDS Safeguards Failed, Court Told" Toronto Globe and Mail (03/09/93), P. A14 (Downey, Donn) The Canadian Red Cross had failed to protect a man who died of AIDS after contracting HIV through a tainted blood transfusion, according to an attorney who spoke to the Ontario Court's General Division on behalf of the man's widow Monday. Kenneth Pittman died of AIDS-related causes in March of 1990, after he received HIV-positive blood from a donor who, the court was told, later conceded that he had had homosexual contact without knowing that he was putting himself at risk. Pittman's wife Rochelle learned this September that she contracted the virus from her husband and is now suing the Canadian Red Cross, the Toronto Hospital, and family doctor Stanley Bain. Her attorney, Kenneth Arenson, tried to convince Madam Justice Susan Lang to hear evidence of two other donors who were gay and also donated HIV- positive blood that subsequently infected the recipients. Arenson requested that the court hear the testimony, which is recorded on videotape. He said the tape shows one man testifying that he had "many, many homosexual encounters" over a span of eight years up to 1982, but had abstained from sex for about two years by the time he donated blood in December of 1984. Arenson said at that time, the Red Cross had published a brochure warning of the potential risk of homosexual sex. However, the man claims he never saw the brochure and continued to donate blood, unaware of any possible consequences. The second man donated blood in September 1983 after the Red Cross had distributed two press releases about the association between HIV and gay sex, but the man never knew about the connection. Judge Lang was scheduled to decide on the relevance of the evidence of the two donors yesterday. ====================================================================== "Spain--Hemophiliacs" Associated Press (03/09/93) Madrid, Spain--Hundreds of HIV-positive hemophiliacs who contracted the virus through tainted blood products provided by the government demanded yesterday that Prime Minister Felipe Gonzalez meet with them and make more than $174 million available for compensation. The Spanish Hemophilia Federation indicated it would sue the government if Gonzalez did not meet with its representatives by Wednesday. Although there was no immediate reaction from the prime minister's office, a health official said the government was willing to contemplate compensating the HIV-positive hemophiliacs. According to the federation, 1,147 Spanish hemophiliacs--42 percent of the hemophiliac population--had contracted HIV through contaminated blood products. It also said 416 have died of AIDS. The federation says government health officials continued to provide HIV-infected blood products between 1983 and 1985, even though there is evidence that heat treatment would have prevented infection. Spain did not begin testing blood products for HIV until after that time. Marcos Pena, the secretary-general for health, said the government was willing to discuss compensation but declined to elaborate. "I don't want to monetarize the discussion of hemophiliacs in public. But economic compensation for individuals is undoubtedly the most adequate solution within the realistic possibilities," said Pena. ====================================================================== "Japan Insurers Ponder Compulsory AIDS Tests" Reuters (03/09/93) Tokyo--Japanese life insurance companies announced Tuesday that they are considering mandating HIV tests for policy applicants. A spokesman for the Life Insurers Association, an industry group, said, "We have started a broad study because it has become an issue that cannot be ignored." An industry committee would consider whether all those applying for policies should undergo an HIV test, said the spokesman. He added that the panel would not make a hasty decision and its guidelines would not be binding. A total of 543 Japanese were reported with AIDS by the end of 1992, and 2,551 were infected with HIV, according to government statistics. The total number of those who have died of AIDS was 298. ====================================================================== "Agency Given Fine on Worker Safety" New York Times (03/09/93), P. B2 The Connecticut State Division of Occupational Safety and Health has fined the State Department of Mental Retardation $24,000 for violating workplace safety regulations concerning AIDS, hepatitis B, and other blood-born pathogens. After inspecting the Hartford Center in Newington, state OSHA officials found that the department did not provide proper masks, gloves, or gowns for employees exposed to infected patients and that workers did not receive vaccines or safety training. The department has since begun following the regulations, which became effective last July. ====================================================================== "Teen AIDS" Associated Press (03/06/93) (Siegel, Lee) Los Angeles--The majority of young people who are sexually active or who use drugs do not believe they are at risk for HIV infection, and health officials need to find new ways of educating them about the disease, according to a new report. The report was released Friday and was conducted by the Los Angeles County Adolescent HIV Consortium, which interviewed 81 providers of AIDS-related services and 36 youths during 12 intense discussion groups. The consortium is operated by county health officials and Childrens Hospital. The report said condoms should be provided for teens and young adults in schools, jails, and prisons. It recommended aggressive anti-AIDS education efforts that focus on homosexual and bisexual youths, runaways, and minority adolescents with diverse cultures and languages. Dr. Marvin E. Belzer of Childrens Hospital Los Angeles and chairman of the consortium, said, "The major finding of the report is a little bit scary: youths don't seem to see themselves at risk. All youth seem to consider HIV someone else's problem regardless if they're gay or straight." American teenagers and those in their early 20s comprise less than 5 percent of AIDS cases nationally--about 10,000 cases as of September. However, the report cautioned that AIDS cases grew 62 percent in that age group from 1989 to 1991, and only 15 percent to 31 percent of them routinely use condoms during sex. It also said that about 70 percent of 18-year- olds are sexually active. ====================================================================== "HIV Cases Rising Among Vietnamese, Officials Say" Reuters (03/05/93) Hanoi, Vietnam--The number of HIV-positive individuals in Vietnam is growing, according to health officials. They said 43 Vietnamese residents, mostly prostitutes or drug addicts, were among the 118 HIV- positive cases confirmed by early March, an increase from 79 at the end of 1992. A total of 35 of the Vietnamese lived in the commercial center of Ho Chi Minh City, and 67 of the 75 infected foreigners were Thai fishermen. The actual number of HIV-infected Vietnamese is likely to be higher than the most recent confirmed figure, based on blood tests of 150,000 people since 1987, said officials from the National Committee for AIDS Protection. The first case of HIV infection was reported in Vietnam in December 1990; but by the end of 1992 eight Vietnamese and 71 foreigners were reported as testing HIV-positive. ====================================================================== "Didanosine and ACTG 116A" Lancet (02/27/93) Vol. 341, No. 8844, P. 570 (Higgins, S. et al.) Because there was no survival advantage from switching from AZT to DDI to treat HIV infection, it cannot be considered effective, write S. Higgins et al. of the University Hospital of South Manchester in Manchester, U.K. In the Jan. 9 issue of the Lancet, the editors discuss the AIDS Clinical Trials Group (ACTG) 116A test of continued AZT versus switching to DDI in HIV infection. The editors state that 500 mg daily of DDI is more effective than 600 mg of AZT in those who have received AZT for 8-10 weeks. But this statement contradicts Lipsky's report (Jan. 2 issue) and the original article. While there were substantially fewer AIDS-related conditions in the DDI 500 mg daily arm than the continued AZT 600 mg daily ram, mortality did not noticeably differ between the three treatment groups. Moreover, two patients had fatal pancreatitis in the higher dose DDI arm--a well-recognized side effect. In the original study, the baseline characteristics demonstrate that those randomized to continue with AZT actually started the study with 13-18 CD4 cells/uL fewer than the DDI groups, and this difference may have worked in favor of DDI. The original study researchers report, "The benefit from didanosine [DDI] may simply demonstrate the advantage of changing from one effective nucleoside to another." Therefore, a survival benefit is essential for a drug to be considered effective at treating HIV infection, Higgins et al. conclude.