Subject: CDC AIDS Daily Summary Date: Wed Feb 17 07:31:02 PST 1999 (204 lines) From: National AIDS Info Clearinghouse Copyright 1999, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Wednesday, February 17, 1999 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. 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, press releases, 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. HEADLINES PEER-REVIEWED JOURNALS "Control of Sexually Transmitted Diseases for AIDS Prevention in Uganda: A Randomized Community Trial" "Implementation of Condom Social Marketing in Louisiana, 1993 to 1996" GENERAL MEDIA "Single Women Would Use Protective Vaginal Cream" "HIV-Positive Boy Can Be Barred by Karate Class" "White House Fact Sheet: U.S. Mexico Cooperation on Tuberculosis Control" "HIV, Syphilis Cases in Mississippi Fell Last Year" "Windham Says No to Needle Exchange" "As the Aral Sea Retreats, Dust and Disease Flourish" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Control of Sexually Transmitted Diseases for AIDS Prevention in Uganda: A Randomized Community Trial" Lancet (02/13/99) Vol. 353 , No. 9152, P. 525; Wawer, Maria J.; Sewankambo, Nelson K.; Serwadda, David; et al. A multinational team of researchers determined that large-scale sexually transmitted disease control interventions had no effect on HIV-1 infection in over 10,000 participants in the Rakai district of Uganda. The scientists conducted intensive STD control for all consenting residents aged 15- to 59-years, visiting their home every 10 months, interviewing them, taking biological samples for assessment of HIV-1 and STD infection, and providing treatment. Syphilis and trichomoniasis rates were lowered significantly over 20 months of follow-up in treatment groups compared to control groups, but HIV-1 incidence was not. The authors estimate that if trichomoniasis, syphilis, gonorrhea, chlamydial infection, and chancroid could be completely controlled in the setting, HIV-1 acquisition rates might be reduced by about 17 percent. However, they add that, "even the intensive mass treatment could not eradicate these endemic disorders." A recent study in Mwanza, Tanzania, also investigated the connection between large-scale STD control and HIV-1 infection, finding that there was a corresponding decrease in HIV-1 infection associated with STD control. The authors believe that the differences in the studies are not likely to be due to random error, pointing out that there are differences in HIV-1 exposure in the two regions. Rakai has a 15.9 percent HIV-1 incidence at baseline, while Mwanza has a 4.1 percent incidence. The researchers state that the high background rates of HIV-1 infection in Rakai seems to occur independently of STD cofactors. The two research teams are collaborating on joint analyses on the data to fully explore the correlation between HIV-1 exposure and STD infection. "Implementation of Condom Social Marketing in Louisiana, 1993 to 1996" American Journal of Public Health (02/99) Vol. 89, No. 2, P. 204; Cohen, Deborah A.; Farley, Thomas A.; Bedimo-Etame, Jean Roger; et al. Louisiana researchers evaluated the implementation and impact of the first statewide condom social marketing intervention conducted in the United States. Louisiana made condoms available at 93 public health clinics, 39 community mental health centers, 29 substance abuse treatment sites, and over 1,000 businesses in neighborhoods with high rates of sexually transmitted diseases and HIV. More than 33 million condoms were distributed between 1994 and 1996, during which time self-reported condom use at last encounter increased substantially among African-American women, particularly those with two or more partners, and African-American men. There was little opposition to the program, and the number of reported sex partners did not increase. According to the authors, "interventions to increase condom use are feasible in the United States and hold a significant promise in prevention of HIV infection and other STDs." **************************************************************** GENERAL MEDIA **************************************************************** "Single Women Would Use Protective Vaginal Cream" Washington Times (02/17/99) P. A8; Wetzstein, Cheryl A study published by the Alan Guttmacher Institute this month in Family Planning Perspectives indicates that about 40 percent of women, particularly single women, would be interested in vaginal microbicides designed to reduce the spread of sexually transmitted diseases. The study measured the interest in the microbicides of 1,000 women aged 18 to 40. It also found that 30 percent of women were worried about STDs, but only 10 percent of the women used condoms. Women noted that condom use was often "male-controlled" and said that they had the most interest in products that would be available in drugstores, could be applied several hours before sexual activity, and would be inexpensive. However, microbicides--which are still in development--are unlikely to be available before 2001. There are an estimated 15.3 million new STD infections in the United States annually. "HIV-Positive Boy Can Be Barred by Karate Class" Washington Post (02/17/99) P. B2; Masters, Brooke A. A federal appeals court has ruled that a Richmond, Va., karate school has the right to prohibit an HIV-infected boy from participating in classes. The 4th U.S. Circuit Court of Appeals decided that the boy posed a "significant risk" in the combat-style classes that occasionally draw blood. While the three-judge panel noted that the risk of transmission was low, the judges explained in their decision that the consequences of infection were severe enough to warrant the child's exclusion. In response to the decision, AIDS Action's Daniel Zingale said, "Communities ... are right to be concerned about HIV, but cases like this distract from giving young people the information they need and give a false sense of how it is transmitted." "White House Fact Sheet: U.S. Mexico Cooperation on Tuberculosis Control" U.S. Newswire (02/16/99) A new agreement designed to increase Mexican and American cooperation in the fight against drug-resistant tuberculosis was announced by U.S. President Clinton and Mexican President Zedillo. There are concerns that increased commerce, tourism, and labor migration will result in the increased spread of the disease in both countries. Under the agreement, the U.S. Agency for International Development and the Mexican Ministry of Health would identify regions that need TB prevention. The groups would then collaborate on education, surveillance, and diagnosis of the TB. There are an estimated 11,000 new cases of tuberculosis in Mexico annually. "HIV, Syphilis Cases in Mississippi Fell Last Year" Sun Herald Online (02/16/99) The number of reported HIV cases and syphilis cases in Mississippi declined in 1998, according to a report by the American Social Health Association of Research Triangle Park, N.C. Meanwhile, the number of reported sexually transmitted disease cases appears to be rising in the state due to better screening and surveillance. There were an estimated 187,300 new STD cases in Mississippi last year. State Health Officer Ed Thompson said that Mississippi has seen an increase in the number of observed gonorrhea cases due to greater screening, but there is not an increasing trend in disease level. Laurie Flatt, a spokeswoman for the Centers for Disease Control and Prevention, explained that "what the new estimates reflect are better reporting and better surveillance and the fact that we are recommending that chlamydia has been reportable only for a couple of years." "Windham Says No to Needle Exchange" Willimantic Chronicle (02/17/99); Shayer, Harold C. An increase in the use and reuse of needles recently led Connecticut officials to ask whether the town of Windham would be interested in renewing a needle-exchange program that was discontinued two years ago. However, according to First Selectman John Lescoe, there is no interest in re-introducing the program. The program was suspended following a lack of public support, state health commissioner Stephen A. Harriman noted. Beth Weinstein, director of AIDS programs for the state Department of Health, made the inquiry following a report by University of Connecticut researcher Robert Broadhead indicating the increased reuse of unsafe needles in Willimantic, Conn. "As the Aral Sea Retreats, Dust and Disease Flourish" Baltimore Sun (02/14/99) P. 1A; Lally, Kathy A substantial increase in tuberculosis cases has been noted in a region of Uzbekistan called Karakalpakstan that used to lie on the Aral Sea before the sea began to dry out. One city in the region, Muynak, used to be a thriving port, but now lies 70 from the Aral Sea, which began receding following widespread irrigation projects in the 1950s. The city now has a tuberculosis rate similar to that of Russian prisons, with 200 cases per 100,000 people. Other areas around the sea also have seen a rise in TB; Uzbekistan has 54.8 TB cases per 100,000 people, and Russia has 82.3 cases per 100,000 people. Pesticide buildup may be related to the rise in cases, but research has not shown any conclusive evidence that the chemicals are tied to immune dysfunction. Meanwhile, doctors are trying to combat the disease, which may be spreading because of a decaying health care infrastructure. Drug-resistant TB has been a problem, so doctors have instituted World Health Organization-recommended directly observed treatment short-course. They also are using sputum smear for diagnosis instead of x-ray and are hospitalizing people for a shorter period of time. Karakalpakstan's minister of health, Damir R. Babanazarov, notes that the region "has been a paradise for infectious diseases."