Subject: CDC AIDS Daily Summary for Date: Fri Jun 16 07:01:00 PDT 2000 (237 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Friday, June 16, 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 "IOM Report a Blueprint for Elimination of TB" GENERAL MEDIA "Big Benefit Predicted in AIDS Medicine for Pregnant South Africans" "Surprise Failure Dashes Hopes for HIV Product" "Free Condoms in Motels Could Help Prevent AIDS--Study" "State Reports Decrease in Syphilis, Increase in Herpes" "Insurance Program for State's Children Has Healthy Results" "C$3 Million Effort Targets Cervical Cancer [in Ontario]" "Uganda: Health to Import 60 Million Condoms" INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION "Adoption of Protective Behaviors Among Persons With Recent HIV Infection and Diagnosis--Alabama, New Jersey, and Tennessee, 1997-1998" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "IOM Report a Blueprint for Elimination of TB" Journal of the American Medical Association (www.jama.com) (06/07/00) Vol. 283, No. 21, P. 2776; Stephenson, Joan A new report for the Institute of Medicine (IOM) recommends strong measures to end traces of diseases like tuberculosis (TB) in hard-to-reach populations. The blueprint for TB eradication includes screening immigrants for infection before entering the United States. The report called for these measures in order to avoid a TB resurgence as seen in the 1980s. The IOM panel of experts stated that while cases are decreasing, TB can stay dormant and resist detection, later causing an outbreak. In 1999, 43 percent of new cases of active TB in the United States were in immigrants from nations with high TB rates, up from 27 percent in 1992. The new proposal allows immigrants with positive skin test results to enter the nation, but no permanent resident status would be given until they obtained additional evaluation and treatment of latent infection. While the proposal would mean administering skin tests to about 250,000 people annually and treating individuals with latent infection, for a cost of about $23 million, Dr. Morton N. Swartz, the chair of the report panel, asserts that "in the long run, this would be cheaper than the cost of treating the individuals and others they infect." The report recommended helping other nations fight the disease and increasing research funding for TB, and it also called on the U.S. government to develop better tools to combat TB. The National Institutes of Health and the Centers for Disease Control and Prevention spend between $60 million and $80 million on TB research each year, and the IOM report recommended increasing such funding at NIH, the CDC, and other federal agencies to $280 million annually. **************************************************************** GENERAL MEDIA **************************************************************** "Big Benefit Predicted in AIDS Medicine for Pregnant South Africans" Washington Post (www.washingtonpost.com) (06/16/00) P. A9; Brown, David A study published in The Lancet (2000;355:2095) by Dr. Evan Wood and colleagues from St. Paul's Hospital in Vancouver, shows that a short course of antiviral drugs for pregnant women during labor could prevent 110,000 new cases of HIV infection in South Africa over the next five years. Wood stated the cost would be minimal, about 13 percent of South Africa's total health spending. The estimate was based on the assumption that the therapy would cost $8 a day for three drugs. Treating all pregnant women would cost $19 per year of life gained, and anything under $50 is generally considered cost-effective for health care efforts in developing nations. The authors estimated that life expectancy in South Africa will be 46.6 years in five years if most pregnant women do not use antiviral therapies. They noted, however, that life expectancy would be 46.8 years if one-quarter of the pregnant women received the drugs, 47.2 years if 75 percent of the women took them, and 47.5 if all pregnant women were treated. "Surprise Failure Dashes Hopes for HIV Product" Wall Street Journal (www.wsj.com) (06/16/00) P. B1; Brannigan, Martha; Carrns, Ann Earlier this week, researchers reported that among women involved in a trial of a vaginal cream designed to protect against HIV, women taking the product actually had higher rates of infection than those in the placebo group. Columbia Laboratories, the Miami-based company that makes the Advantage S vaginal spermicide, had reported in March that preliminary data from the trial indicated that the product had promise. However, now the company's shareholders are suing, alleging that Columbia misled them and that company insiders sold over $1 million in stock prior to releasing the disappointing results. Ethical questions are also being raised regarding the researchers' use of prostitutes and the fact that some received a placebo while others were given a possible solution. Columbia Chairman and CEO William Bologna explains that the early results were announced in March because "we felt obliged to say something." The executive also notes, "This is the first time in my knowledge where a study with an interim analysis showed a statistical difference between two groups and when the code was broken, the placebo was more effective." The study involved 700 prostitutes from South Africa, Thailand, Ivory Coast, and Benin who were asked to keep diaries about their activities and to encourage their sex partners to use condoms. But UNAIDS' Joseph Perriens points out that many of the women said they backdated their diaries when they went to the clinics. Meanwhile, the Population Council of New York is starting safety trials in South Africa and Thailand of a microbicide gel made from seaweed, called PC-515. "Free Condoms in Motels Could Help Prevent AIDS--Study" Reuters (www.reuters.com) (06/15/00) A study by British and Nicaraguan scientists shows that placing free condoms in hotel rooms could reduce the number of AIDS cases in Latin America. Dr. Matthias Egger of Bristol University in England said free condoms should be made a policy in motel rooms, especially those used by sex workers. In their report in The Lancet (2000;355:2101), the researchers report that over a period of 24 days, when 6,500 couples visited the motels, at least one condom was used in nearly 50 percent of the encounters. Egger said discreet condom provision could be effective HIV prevention in urban Latin American cities. "State Reports Decrease in Syphilis, Increase in Herpes" Minneapolis Star Tribune Online (www.startribune.com) (06/15/00); Wyatt, Sarah Wisconsin health officials have seen a reduction in syphilis rates, but herpes cases have increased from 1990 to 1999. Reported syphilis cases decreased from 615 to 183 in nine years, in part because of the cyclical nature of the disease, which often ebbs and flows in decade-long cycles. Dr. Geoffrey Swain of the Milwaukee Health Department also noted that public-interest advertisements targeting those at high-risk for the disease helped play a role in the decline. Meanwhile, the number of reported cases of herpes increased from 1,304 in 1990 to 2,113 in 1999. However, Swain noted that while state law requires doctors to report cases the first time the virus is detected, it can be difficult to determine whether the virus is new and many physicians do not report it. Health officials also reported 14,495 cases of chlamydia last year, compared to 14,582 in 1990 and 8,558 in 1992. Reported cases of gonorrhea have declined from 8,387 in 1990 to 6,692 in 1999. "Insurance Program for State's Children Has Healthy Results" Birmingham News Online (www.al.com/bhamnews/bham.html) (06/15/00); Sznajderman, Michael The Children's Health Insurance Program (CHIP), started in 1998, has reduced the number of uninsured children in Alabama by 41 percent in two years. A total of 69,000 children have received health coverage through the program, according to the annual report of the state health department. The report also showed that tuberculosis (TB) cases in the state have reached a record low, and syphilis and gonorrhea rates have also fallen. State Health Officer Don Williamson said the reduction in sexually transmitted diseases is hopeful, although the number of chlamydia cases reported increased. Health officials attributed the decline in TB cases to directly observed therapy, but they noted that cases among children ages 14 and younger have not decreased as adult cases have. "C$3 Million Effort Targets Cervical Cancer [in Ontario]" London Free Press (www.canoe.ca/londonfreepress) (06/16/00) P. A2; Nelson, Marissa A C$3 million project hopes to reduce the cervical cancer rate in Ontario, Canada, by 50 percent in five years. The Cervical Screening Project will create a registry of women's Pap smear results, reminding them of the yearly exam and creating guidelines for the frequency of testing. Dr. Beth Henning, Huron County medical officer of health, said fear prevents many women from getting Pap smears. Cervical cancer has been linked to the human papillomavirus, which causes genital warts. Dr. Graham Pollett, the Middlesex-London medical officer of health, noted the importance of having older women tested, since cervical cancer can develop years after the virus is contracted. "Uganda: Health to Import 60 Million Condoms" Africa News Service (www.africanews.org) (06/15/00); Nalumansi, Lillian Uganda's Ministry of Health plans to import 60 million condoms next year, according to Dr. Peter Nsubuga of the World Bank-funded Sexually Transmitted Infections (STI) project. Nsubuga said the additional condoms are needed due to increased demand and changes in sexual behavior. Nsubuga said the STI project imports 60 million condoms into the country each year, with 1 million being used for demonstration purposes. The five-year STI World Bank project ends in 2001. **************************************************************** INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION **************************************************************** "Adoption of Protective Behaviors Among Persons With Recent HIV Infection and Diagnosis--Alabama, New Jersey, and Tennessee, 1997-1998" Morbidity and Mortality Weekly Report (www2.cdc.gov/mmwr) (06/16/00) Vol. 49, No. 23, P. 512 A Centers for Disease Control and Prevention study conducted in three states analyzed self-reported behavior change following HIV diagnosis among young people recently diagnosed with HIV infection. Study participants reported a higher prevalence of protective sexual behaviors soon after diagnosis. Ninety percent of the 180 individuals interviewed had changed their sexual risk behavior after learning of their infection, including 60 percent increasing condom use, 49 percent reducing frequency of sex, and 36 percent reporting not having sex. Among a subset of sexually active men and women, the percentage of individuals reporting "always" using condoms increased from 6 percent prior to diagnosis to 47 percent after learning of their infection. Additionally, most participants (84 percent) report receiving some medical care following their HIV diagnosis--highlighting the potential role health care providers could play in providing sustained HIV prevention counseling, as well as treatment. Treatment advances mean that many of these young people will live longer, healthier lives making comprehensive, sustained prevention services critical for reducing risk and sustaining safer behaviors over a lifetime.