Subject: CDC AIDS Daily Summary
Date: Thu Feb 18 08:31:02 PST 1999 (231 lines)
From: National AIDS Info Clearinghouse
Copyright 1999, Information, Inc., Bethesda, MD


CDC HIV/STD/TB Prevention News Update
Thursday, February 18, 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
"Sex Differences in HIV-1 Viral Load and Progression to 
AIDS"
"Sexual Behaviour in Travelers"

GENERAL MEDIA
"Prison System Is Faulted on Prevention of H.I.V."
"Selling of Tainted Blood Spreads Disease in China"
"Medicine's Dirty Little Secret" 
"Nationline: AIDS Injection"
"Urine Test Could Replace Pelvic Exam for Sexually 
Transmitted Diseases"
"No Major Gender Differences in AIDS Outcome Seen in 
New York Drug Users"
"'Ideal' Microbicide May Be Best Form of Protection" 


*************************************************************** 
                        PEER-REVIEWED JOURNALS 
***************************************************************

"Sex Differences in HIV-1 Viral Load and Progression to 
AIDS"
Lancet (www.thelancet.com) (02/13/99) Vol. 353, No. 9152, 
P. 589; Junghans, Cornelia; Ledergerber, Bruno; Chan, 
Phil; et al.
     In a letter to the editor of the Lancet, Swiss 
researchers and others comment on a recent study conducted 
by Homayoon Farzadegan and colleagues indicating that HIV-
positive women who acquired their infection through 
intravenous drug use progress to AIDS with a lower viral 
load compared to HIV-positive male IDUs. Junghans et al. 
conducted studies which found that there were no sex 
differences in disease progression for HIV-infected IDUs 
and people who acquired the virus through heterosexual 
transmission. They did find, though, that the women in 
their study had slightly lower viral loads than the men. 
Mauro Moroni, of the ICONA study of HIV-1 infected 
individuals in Italy, notes that the ICONA study also 
provides some evidence that women have a slightly lower 
viral load than men at a specific stage of immunosuppression. 
Both authors suggest that further studies are needed before 
any change in treatment initiation guidelines for women are 
considered. In a third letter, Mary A. Foulkes and Lawrence 
Deyton of the Department of Veterans Affairs assert that 
heavy selection bias could have affected Farzadegan's results. 
In reply, Farzadegan, of the Johns Hopkins School of Hygiene 
and Public Health, and colleagues, assert that Foulkes and 
Deyton misinterpret the design of their study. 

"Sexual Behaviour in Travelers"
Lancet (www.thelancet.com) (02/13/99) Vol. 353, No. 9152, 
P. 595;Abdullah, Abu Saleh M.; Hedley, A.J.; Fielding, R.; et al.
     Abu Saleh M. Abdullah and associates from the University 
of Hong Kong report the findings of a survey they conducted 
on sexual behavior of over 1375 people who had been overseas 
during the previous year. A recent study by Michael Bloor 
and colleagues found that men and women take sexual risks 
while traveling. Abdullah and others surveyed airport 
travelers, business sector workers, service sector workers, 
university staff, and social hygiene clinic patients in Hong 
Kong, observing that those who attended the clinics or were 
interviewed in airport lounges were more likely to have had 
sex with strangers while traveling. In a letter to the editor 
of the Lancet, the authors report that men were much more 
likely to have had sex while traveling compared to women, 
except among business sector and airport departure lounge 
respondents. Consistent condom usage during sexual contact 
measured lower than 10 percent for business and service 
sector respondents, airport travelers, and university 
staff. The authors also noted that younger respondents 
were more likely to have had sex with strangers while 
traveling, but that middle-aged participants were more 
likely to be at high risk due to inconsistent condom usage. 
In a separate letter, Brian P. Mulhall notes that health 
prevention methods need to be promoted among travelers. 
Mulhall, of the University of Sydney, suggests that future 
campaigns should "confront the individual traveler with the 
notion that he or she might behave differently [while away 
from home] whether they intend to or not." 


**************************************************************** 
                         GENERAL MEDIA
**************************************************************** 

"Prison System Is Faulted on Prevention of H.I.V."
New York Times (www.nyt.com) (02/18/99) P. A23
     According to the New York State AIDS Advisory Council, 
state prison health systems have failed to provide adequate 
HIV prevention and treatment. The council has recommended 
that inmate health care be transferred to the State Department 
of Health. On Wednesday, an AIDS advocacy group also announced 
that there are high levels of unsafe sex in prisons. Some 8,000 
of the state's 70,000 prisoners are believed to be infected with 
HIV. In response to the criticism, a spokesman for the State 
Department of Correctional Services, James Flateau, noted that 
there has been a sharp drop in the number of AIDS-associated 
deaths in the prison system since 1995. He claims the reduced 
number of AIDS-deaths attests to the quality of care in the 
prison system. 

"Selling of Tainted Blood Spreads Disease in China"
Washington Post (www.washingtonpost.com) (02/18/99) P. A15; 
Laris, Michael
     The practice of selling blood in China may have 
contributed to the spread of infectious diseases, including 
hepatitis C virus (HCV) and HIV. A low blood supply and 
increased poverty have added to the problem, with many poorer 
people jumping at the chance to sell their blood. However, 
uneven safeguard monitoring can lead to the donation of 
tainted blood. The Chinese government banned the sale of 
blood in October and now imposes strict penalties for doctors
who are lax in screening. To prevent a serious blood shortage 
resulting from the decrease in donors, the Health Ministry 
has ordered hospitals to reduce their blood use and follow 
standards for how much blood should be used in particular 
operations. Additionally, college students and soldiers have 
been enlisted in blood drives. During the last quarter of 1998, 
blood has dropped by up to 30 percent in major cities in China 
compared with the same period a year earlier. Approximately 2 
percent of the Chinese population carry HCV and 10 percent carry 
hepatitis B virus. Hundreds of thousands of Chinese are estimated 
to be HIV-positive. 

"Medicine's Dirty Little Secret"
USA Today (www.usatoday.com) (02/18/99) P. 1D; Davis, Robert
     Microbiologists warn that many endoscopes are not being 
properly cleaned in hospitals, a problem that could lead to 
the transmission of infectious diseases. Lloyd Shue, an 
endoscope technician at FiberTech Medical in Baltimore, 
estimates that as many as 30 percent of the 1,500 endoscopes 
his company fixes a month have not been properly cleaned. 
Between 1988 and 1992, there were 28 reported cases of 
infection from endoscopes. While that means there is about 
one case per 1.8 million procedures, some scientists feel 
the risks are greater because many endoscope-transmitted 
infections are not reported. However, the devices are very 
hard to clean and check after cleaning, and doctors have been 
reluctant to address the issue for fear that potential 
patients will delay important diagnostic tests amid concerns 
of infection. Endoscopes are commonly used to find fatal and 
curable diseases, especially colon cancer. Some physicians 
and officials note that patients must be informed of the risk. 
Walt Bond, who was the Centers for Disease Control and 
Prevention's leading expert on the issue before he retired 
last year, notes that the majority of the infections cause 
simple diarrhea or a mild fever, and that most procedures 
are worth that risk. In two separate cases, two men have 
alleged that they contracted human papillomavirus during 
colon exams, but neither case appears to have been reported 
to regional health authorities. 

"Nationline: AIDS Injection"
USA Today (www.usatoday.com) (02/18/99) P. 3A; Bacon, John
     A doctor who was accused of injecting his lover with 
HIV-infected blood received 50-years hard labor for attempted 
second-degree murder. Richard Schmidt received the maximum 
sentence possible from Judge Durwood Conque in Lafayette, La. 

"Urine Test Could Replace Pelvic Exam for Sexually Transmitted 
Diseases"
Nando Times Online (www.nando.com) (02/17/99)
     Researchers from the University of California at San 
Francisco, report that a urine test could be as effective 
as a pelvic exam in detecting chlamydia and gonorrhea in 
teenage girls. The researchers compared the two tests, 
finding that the urine test worked nearly as well as the 
pelvic examination. Shafer said that as many as one-third 
of adolescent girls and women avoid STD screening for fear 
of embarrassment and pain associated with pelvic examinations. 
Pelvic screening is still necessary for older women in order 
to detect cervical cancer, which is very rare in teens. 

"No Major Gender Differences in AIDS Outcome Seen in New 
York Drug Users"
Reuters Health Information Services (02/17/99)
     A report in the Feb. 4 issue of AIDS indicates that 
the clinical outcome of HIV infection and related mortality 
are comparable for men and women in a cohort of drug users 
in New York. Dr. Mayris P. Webber of the Montefiore Medical 
Center in the Bronx and colleagues analyzed 222 HIV-positive 
women and 302 HIV-positive men in a methadone maintenance 
clinic. They found that men and women had similar CD4+ cell 
rate decline, time to first CD4+ cell count below 200 cells 
per microliter and clinical AIDS diagnosis, incidence and 
distribution of initial AIDS-defining illnesses, and mortality 
rates. Crack cocaine use was independently associated with AIDS 
progression. 

"'Ideal' Microbicide May Be Best Form of Protection"
AIDS Alert--International (02/99) Vol. 14, No. 2, P. 3
     With the possibility of an effective HIV vaccine 
becoming available in the near future relatively remote, 
microbicides present an alluring option for the control 
of HIV in developing nations. Many infected individuals 
have poor access to anti-HIV medications, while condoms--
both male and female--have presented some problems. 
Microbicides offer a discreet method for women to reduce 
the risk of HIV transmission. Few studies have been 
conducted, however, and the two major studies that have 
been done(one in Kenya, the other in Cameroon) were 
complicated by a variety of issues. Nonoxynol-9 was used 
in the two studies, which have failed to conclusively 
prove whether the substance can help reduce the transmission 
of HIV. Further research on the chemical and other potential 
microbicides is currently underway. Scientists are looking 
into the use of lactobacilli, acid-buffering gels, and other 
substances as potential microbicides. However, trials run 
into difficulties because condom use must ethically be 
endorsed in the trials, making it difficult to measure 
the efficacy of the microbicides. Researchers are now 
devising ethical methods to accurately test the microbicides