Subject: CDC AIDS Daily Summary for Date: Tue Jun 13 07:01:01 PDT 2000 (219 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Tuesday, June 13, 2000 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. Contact the sources of the articles abstracted below for full texts of the articles. HEADLINES PEER-REVIEWED JOURNALS "False-Positive Tuberculin Skin Test Results Among Health Care Workers" GENERAL MEDIA "Antibiotic Misuse Turns Treatable to Incurable" "Spermicide Made by Columbia Labs Fails to Stop HIV" "U.N. Agency Sees AIDS Depleting the African Work Force" "Jackson Calls for Mayoral HIV Tests; He Says it Will Spur More to Follow Suit" "Attitudes About HIV But Not Sexual Risk Behaviors Have Changed in Sweden" "Exchange of Faith; Baltimore Needle Van Hands out Clean Syringes, Safety Advice, Encouragement and Occasional Shot at Redemption" "Mayor Attacks Needle Exchange Program" "Many Southeastern States Lack Adequate ADAP Funds to Meet Medicaid Needs" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "False-Positive Tuberculin Skin Test Results Among Health Care Workers" Journal of the American Medical Association (www.jama.com) (06/07/00) Vol. 283, No. 21, P. 2793; Blumberg, Henry M.; White, Nancy; Parrott, Patricia; et al. A letter to the editor from several physicians and nurses at Emory University School of Medicine in Atlanta discusses the two commercial tuberculin reagents. A study of false-positive tuberculin skin test results among health workers found that 11 in a span of one month had tuberculin skin test (TST) conversions, out of 914 tested. The 11 who tested positive used Aplisol purified protein derivative reagent, and tested negative using Tubersol PPD. The authors note, "Our experience demonstrates the need for a better and more reliable test for detection of tuberculosis infection and suggests that when a TST is used among a low-risk population ... the majority of positive results actually may be false-positives." **************************************************************** GENERAL MEDIA **************************************************************** "Antibiotic Misuse Turns Treatable to Incurable" New York Times (www.nytimes.com) (06/13/00) P. D2; Olson, Elizabeth The World Health Organization (WHO) said Monday that some diseases that were once treatable with antibiotics are now incurable due to misuse of the drugs and overprescribing. The WHO said that one of the "major health care disasters of the 20th century" is the abuse of antibiotics such that gonorrhea has shifted from "a once-curable nuisance, into a potentially life-threatening contagion." In many parts of Southeast Asia, penicillin has become virtually useless in treating gonorrhea strains, and untreated the disease can help spread HIV. Dr. David Heymann, head of the WHO's program on communicable diseases, said, "If we hadn't eradicated smallpox in 1980, we probably couldn't today." He pointed out that the HIV epidemic and the lowered immunity it generates would also challenge the efficacy of the vaccine against smallpox. The WHO called for a global effort to increase vaccinations against preventable diseases and to educate both healthcare workers and the public about how to use medicine. The agency recommended a reduction in the use of drugs for animal growth. The report said that drug resistance was a problem for several diseases, including tuberculosis, pneumonia, malaria, diarrheal diseases, typhoid, and hepatitis. "Spermicide Made by Columbia Labs Fails to Stop HIV" Wall Street Journal (www.wsj.com) (06/13/00) P. B10; Brannigan, Martha New results of a clinical trial sponsored by UNAIDS indicate that 100 of the 700 prostitutes involved in the study of Columbia Laboratories' Advantage-S spermicide contracted HIV. The researchers had believed the gel would prevent HIV, but women receiving a placebo, the vaginal cream Replens, seemed to have slightly lower rates of infection than those using the gel. Columbia Chairman and CEO William Bologna noted that the findings were "unexpected and unanticipated." Advantage-S uses a lower-than-usual concentration of Nonoxynol-9; higher concentrations of Nonoxynol-9 have been associated with vaginal lesions, which could increase the risk for HIV. According to Bologna, all of the study participants were given condoms and told to track their use of the gel and condoms. The study was conducted between 1996 and May 2000 in South Africa, Thailand, Ivory Coast, and another African country. "U.N. Agency Sees AIDS Depleting the African Work Force" New York Times (www.nytimes.com) (06/13/00) P. C4; Olson, Elizabeth The International Labor Organization's (ILO's) first report on AIDS in the workplace states that AIDS will reduce the work force, increase child labor, and lead to rising job absenteeism costs. The report noted that sub-Saharan Africa will be most affected by the disease. According to the report, the depleted work force could result in more working children, particularly those who have been orphaned by AIDS. In Africa, some employers already hire two or three people for one job since "it is feared that employees in key positions may be lost due to AIDS." The ILO report, titled "HIV/AIDS: A Threat to Decent Work, Productivity, and Development," also forecast that over the next two decades, the effects of AIDS on workers between the ages of 20 and 49 will likely reduce the average age of the work force by two years. "Jackson Calls for Mayoral HIV Tests; He Says it Will Spur More to Follow Suit" San Francisco Examiner (www.sfgate.com) (06/12/00) P. A1; Lelchuk, Ilene The Rev. Jesse Jackson has asked mayors gathered in Seattle to take public HIV tests to encourage more Americans to get tested for the virus. Speaking at the U.S. Conference of Mayors, Jackson called for quick action to fight the disease, noting that the mayors taking HIV tests "will attract media attention and public education." Jackson's request drew mixed reactions, but Roosevelt Dorn, mayor of Inglewood, California, said he was excited by Jackson's call to action. On Sunday, Jackson told the mayors that two-thirds of the people with HIV are unaware of their infection. "Attitudes About HIV But Not Sexual Risk Behaviors Have Changed in Sweden" Reuters Health Information Services (www.reutershealth.com) (06/09/00) Drs Claes Andreas Herlitz and Jennifer Lynne Steele of the Dalarna Research Institute in Sweden have found that attitudes regarding HIV have changed greatly in Sweden in 10 years, but high-risk sexual behaviors have changed little. According to a report in the May 5 issue of AIDS (2000;14:881-890), the researchers studied more than 11,000 Swedes between 1987 and 1997 and found by the end of their study, many HIV patients said they were less fearful about their disease than they used to be. The researchers report that people had less hope for a cure for HIV and fewer discussed HIV with family or sexual partners. Condom use remained relatively the same during the study period; however, it increased significantly among single people with no regular partner and among 16- to 17-year-olds. "Exchange of Faith; Baltimore Needle Van Hands out Clean Syringes, Safety Advice, Encouragement and Occasional Shot at Redemption" Baltimore Sun (www.sunspot.net) (06/12/00) P. 1F; Ollove, Michael The Baltimore Needle Exchange van hands out clean syringes, bleach, condoms, and advice. Michele Brown is a career drug counselor who helped create the program almost six years ago. She refers to those at the van as clients, not addicts. For the exchange, clients bring used syringes to the van and receive new ones in about 30 seconds. While there are 390 drug treatment slots set aside for those exchanging needles, there are up to 60,000 addicts in the city. The van also offers free HIV testing. As of May, the van had more than 10,500 registrants, and it collected 43,507 syringes and handed out over 30,000 needles that month. "Mayor Attacks Needle Exchange Program" Australian Broadcasting Corp. News Online (www.abc.net.au) (06/13/00) In Australia, Port Lincoln Mayor Peter Davis has voiced his opposition to a needle exchange program planned for the city hospital. Davis said diabetics should not have to pay for needles while drug addicts would be able to get them free. Jeff Sivich, chairman of the health service board of directors, asserted, however, that the needle exchange will likely help to reduce the transmission of diseases like HIV and hepatitis B. "Many Southeastern States Lack Adequate ADAP Funds to Meet Medicaid Needs" AIDS Alert (www.ahcpub.com/online.html) (06/00) Vol. 15, No. 6, P. 61 AIDS Drug Assistance Program (ADAP) budgets have diminished due to increasing HIV drug costs and funding problems. A report from the ADAP Working Group of Washington, D.C., shows that southeastern states are finding it hard to receive adequate ADAP funding. Bill Arnold, chair of the Working Group, said there have been problems, but no major disasters. Still, the ADAP Working Group has forecast that ADAP will see a $163 million shortfall in fiscal year 2001. The national ADAP budget grew from $207.5 million in fiscal year 1996 to $665.5 million in fiscal year 1999. And the Working Group estimates the average cost of treatment per patient on ADAP next year will be just over $10,000. The problems with funding are found in states that put no state money into the program, including South Dakota. Some southern states like South Carolina have waiting lists for treatment because of medical requirements for ADAP coverage and growing AIDS cases. North Carolina has been struggling with paying for flood damage from Hurricane Floyd but should manage to handle HIV cases for the year. While Georgia and Florida have ended their waiting lists and improved access to the program, Tennessee is the most threatened because it may be forced to end the TennCare program, the state's managed healthcare program for low-income families, due to insufficient funds. If TennCare does close, the state's $5.4 million ADAP budget would be severely strained, although Arnold notes that such problems could be resolved with additional state funding and extra federal ADAP resources.