Subject: CDC AIDS Daily Summary Date: Wed Feb 24 07:31:02 PST 1999 (178 lines) From: National AIDS Info Clearinghouse Copyright 1999, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Wednesday, February 24, 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 "Disability Discrimination in America" GENERAL MEDIA "Rate of New HIV Cases in B.C. on Decline" "NewsBites: Two Drugs Added to HIV, AIDS Program" "Board Seeks Funds to Fight TB" "Health Officials Criticized Over Tuberculosis Outbreak" "Glass Tubes Put Health Workers at Risk" "Doctors Should Coordinate Use of Alternative Therapies" "Demographic Fatigue" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "Disability Discrimination in America" Journal of the American Medical Association (02/24/99) Vol. 281, No. 8, P. 745; Gostin, Lawrence O.; Feldblum, Chai; Webber, David W. Lawrence O. Gostin, of the Georgetown University Law Center, and others review court cases involving the Americans With Disabilities Act. They state that the ADA was perceived to be a broad protective measure when it was first enacted in 1990, but later decisions often interpreted the ADA in a more restricted manner. However, the Supreme Court's decision in its first case involving HIV infection and the ADA--Bragdon v. Abbott--restored broad protective measures to the act. The court's ruling protects asymptomatic HIV-positive people from discrimination by health services. The court did rule that health care workers can refuse to treat a patient, but only if they have an objective, scientific basis for believing that the patient poses a direct threat to safety. The authors also conducted a state-by-state survey of ADA rulings, finding court rulings at the state level to be consistent with the Supreme Court ruling in regards to the ADA and HIV. **************************************************************** GENERAL MEDIA **************************************************************** "Rate of New HIV Cases in B.C. on Decline" Canadian National Post Online (02/23/99); Howard, Cori The British Columbia Centre for Disease Control reports that the HIV incidence is falling in the Canadian province. Officials note, however, that the decline does not indicate the AIDS crisis is becoming less serious; instead, they found that the decline is due to the fact that HIV infection among intravenous drug users has reached its saturation point. According to the report, to be released next week, there were 540 new HIV infections in British Columbia last year, 21 less than in 1997 and 174 less than the peak level in 1996. There were 165 new HIV infections among IDUs last year, compared to 387 new infections in 1996. Dr. Michael O'Shaughnessy, an AIDS researcher in Vancouver, warns that "unless we do something to improve the programs for getting people off drugs, unless we address the big issues, we'll have another outbreak." There are some 10,000 HIV-infected people in the province, 30 percent of whom are IDUs living in Vancouver's downtown eastside. Officials also found only a marginal decline in new infections among heterosexuals and homosexual men. According to B.C. CDC assistant director of AIDS research, Dr. David Patrick, the new statistics indicate the fact that younger gay men are having more unprotected sex. "NewsBites: Two Drugs Added to HIV, AIDS Program" Philadelphia Daily News Online (02/24/99) Pennsylvania has added the anti-HIV drugs Sustiva and Ziagen to its Special Pharmaceutical Benefits Program. People who are not eligible for Medicaid can qualify for the program to obtain the medications. The $20 million program helps more than 4,600 people across the state. "Board Seeks Funds to Fight TB" Toronto Globe and Mail (02/23/99) P. A13; Abbate, Gay The Toronto Board of Health has asked the city council to boost its funding for tuberculosis control, adding an additional C$635,000 this year and C$1.59 million next year and thereafter. The city spent C$2.1 million on TB control in 1998. There are 450 to 500 new TB cases in Toronto annually. According to Dr. Sheela Basrur, the city's medical officer of health, tuberculosis is an increasing problem worldwide and the city needs an effective program against the disease to prevent a resurgence. Basrur added that Toronto is seeing more TB cases compared to a decade ago, partially due to increased immigration and the lack of an effective system to ensure that infected immigrants are identified and treated for the disease. Other factors in the increase include HIV co-infection, crowded drop-in centers and shelters, and poverty. Sixteen percent of TB cases in the city show drug resistance, Basrur said, almost two times the national average. Basrur noted that less than 20 percent of TB patients in Toronto are on directly observed therapy, the treatment method endorsed by the World Health Organization. "Health Officials Criticized Over Tuberculosis Outbreak" Chicago Tribune Online (02/23/99) In Indiana, LaPorte County Health Department administrator Geoff Downie said the county's recent increase in tuberculosis levels is "a community-wide problem" but that efforts would be limited to at-risk areas due to limited resources. TB levels hit an all-time high in the county last year. There were 22 cases reported in 1998, the most in Indiana; however, almost all the cases were in Michigan City, giving the city an infection rate of about 66 cases per 100,000 people. "Glass Tubes Put Health Workers at Risk" Reuters Health Information Services (02/23/99) High breakage rates of capillary glass tubes used for blood collection may increase the risk of HIV and hepatitis C virus infection for healthcare workers, warned four federal health agencies on Monday. The Occupational Safety and Health Administration reported that at least 2,800 healthcare workers are injured by capillary breakages each year, with a 2.6 per 100,000 tubes injury rate at one facility surveyed. The Food and Drug Administration, the National Institute for Occupational Safety and Health, and the Centers for Disease Control and Prevention also warned of the dangers associated with capillary tubes. The agencies suggested using tubes made from alternative materials or wrapping the tubes in puncture-resistant film to prevent injury, "Doctors Should Coordinate Use of Alternative Therapies" AIDS Alert (02/99) Vol. 14, No. 2, P. 20 Throughout the United States, use of alternative therapies has increased from 33.8 percent in 1990 to 42.1 percent in 1997. According to Dr. Donald Abrams, assistant director of the AIDS Program at San Francisco General Hospital, between 40 percent and 70 percent of HIV/AIDS patients have turned to some kind of alternative or complementary medicine. Because of this, physicians should be aware of any alternative treatments their patients are taking in order to assess potential side effects with prescribed drugs and treatment outcomes. Abrams notes that "physicians need to learn how to ask their patients whether or not they're using them." Washington, D.C. physician and author Richard A. Elion notes that it is not surprising many HIV-infected individuals often seek both forms of treatment. According to Elion, alternative medicine sometimes better addresses restoration and maintenance of the immune system, while drug therapy helps suppress the viral load. "Demographic Fatigue" Futurist (02/99) Vol. 33, No. 2, P. 40; Brown, Lester R.; Gardner, Gary; Halweil, Brian Some countries that have high birth rates and low death rates are experiencing so-called demographic fatigue, which results in problems with child education, job creation, and the environment. These countries also may experience a resurgence of traditional diseases, such as tuberculosis, and new diseases, such as AIDS. These problems can force a country into pre-industrial demographic conditions characterized by high birth rates and high death rates. Some African countries are already beginning to slide back to these levels. In Zimbabwe, for example, the adult HIV infection rates is 26 percent, and the nation cannot afford costly anti-HIV medication. Zimbabwe is expected to reach population stability in 2002, with Botswana, Namibia, Zambia, and Swaziland also expected to follow this course.