Subject: CDC AIDS Daily Summary for Date: Fri Jun 23 07:01:00 PDT 2000 (228 lines) From: National AIDS Info Clearinghouse Copyright 2000, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Friday, June 23, 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 "23-Valent Pneumococcal Polysaccharide Vaccine in HIV-1-Infected Ugandan Adults: Double-Blind, Randomised and Placebo Controlled Trial" GENERAL MEDIA "AIDS Is Moving into Rural Areas, U.N. Study Says" "Bankrolling Colombia's War on Drugs: House and Senate Will Now Reconcile Bills" "Half of New AIDS Cases Worldwide Occur in Women" "Experiment Offers New Route to AIDS Vaccine" "Campaign Aims to End Growing Complacency About AIDS" "AIDS May Kill 500 on East Side, Study Says: If Residents Don't Get Better Treatment, Their Average Life Expectancy Will Fall Dramatically" INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION "National HIV Testing Day at CDC-Funded HIV Counseling, Testing, and Referral Sites--United States, 1994--1998" "Gonorrhea--United States, 1998" *************************************************************** PEER-REVIEWED JOURNALS *************************************************************** "23-Valent Pneumococcal Polysaccharide Vaccine in HIV-1-Infected Ugandan Adults: Double-Blind, Randomised and Placebo Controlled Trial" Lancet (www.thelancet.com) (06/17/00) Vol. 355, No. 9221, P. 2106; French, N.; Nakiyingi, J.; Carpenter, L. M.; et al. A study of HIV-infected adults in Uganda by British and African researchers attempted to determine if vaccination with 23-valent pneumococcal polysaccharide vaccine is effective in preventing complications like pneumonia or death among such patients. A total of 1,392 HIV-1-infected adults enrolled in the study, 937 of them female. Of these adults, 697 received the vaccine and 695 received a placebo. Results show the vaccine was well tolerated. There were 34 instances of invasive pneumococcal disease in 25 different subjects, with 29 of the cases among patients who had received the vaccine; the other cases were in individuals who had received a placebo. Five subjects had recurrent invasive events. The pneumococcal vaccine offered no protection to the adults studied, the researchers report. Surprisingly, the rates of all-cause pneumonia were higher in the group that received the vaccine. A total of 140 people died in the first six months of the study, with 73 deaths due to wasting syndrome and 61 due to cryptococcal disease. According to the authors, immunization with the pneumococcal polysaccharide vaccine for HIV patients was ineffective in this case and could be detrimental to the health of such persons. The researchers suggest that "the direct harmful effect of pneumococcal polysaccharides is by destruction of polysaccharide-responsive B-cell clones," and they conclude that overall, the vaccine appears to have little public health value in sub-Saharan Africa. **************************************************************** GENERAL MEDIA **************************************************************** "AIDS Is Moving into Rural Areas, U.N. Study Says" New York Times (www.nytimes.com) (06/23/00) P. A11; McNeil Jr., Donald G. A report from UNAIDS and the Food and Agricultural Organization indicates that HIV is moving into rural areas of developing countries. The shift may have disastrous effects, because while sick city residents can sometimes obtain help from social services or beg on the streets, the fatal illness of one adult in a poor farm family can lead to the farm's collapse. "HIV hits particularly the young adults, and they are the core of the labor force, the keystone of the farm household," said Jacques du Guerny, an AIDS expert at the Rome-based Food and Agricultural Association. The report noted that, in turn, food production for city residents may decline, and any crops that are planted may be less labor-intensive and less nutritious. Areas particularly hard hit are Africa, India, and some Caribbean nations. HIV is spreading into rural regions as people migrate to cities or mines for work, become infected, and return home for visits. The virus is also being spread along trucking routes, where prostitution is rampant. Cities are usually the focus of prevention efforts like sex education and condom distribution, while customs that can further HIV's spread, such as "cleansing" a widow via sex with a relative of her dead husband, are more prevalent in rural areas. The study offered no global estimate of urban-rural prevalence, noting that rural HIV infections tend to be underreported or misdiagnosed. "Bankrolling Colombia's War on Drugs: House and Senate Will Now Reconcile Bills" New York Times (www.nytimes.com) (06/23/00) P. A11; Marquis, Christopher The Senate has approved a package of $1.3 billion in aid for Columbia to fight narcotics trafficking. The money is a show of American commitment in Colombia, which is the source of 90 percent of cocaine in the United States. Officials in Congress said they now plan to reconcile the Senate's aid package for Colombia with one approved by the House earlier this year. The Senate also increased spending on international anti-AIDS efforts by $30 million to $255 million and added $10 million more to the global fight against tuberculosis, for a total of $66 million. "Half of New AIDS Cases Worldwide Occur in Women" Reuters Health Information Services (www.reutershealth.com) (06/22/00); Bussey, Eliza At a press conference in Washington on Thursday, Dr. Mohammad Akhter, executive director of the American Public Health Association, said that half of the new AIDS cases worldwide are among women. Akhter noted that women are four times more likely to contract HIV from sexual intercourse compared to men. Marsha Martin, special assistant to the Secretary of the Department of Health and Human Services, also noted that while access to care is greater in the United States, there are still health disparity issues, with HIV now the No. 1 cause of death among African-American women between the ages of 25 and 44. Both Martin and Akhter believe that education and condom use are the best ways to fight HIV, and they also noted the need for a barrier product that women can readily access and control themselves. "Experiment Offers New Route to AIDS Vaccine" Reuters (www.reuters.com) (06/22/00); Fox, Maggie Researchers from the University of California at Los Angeles have found a way to kill HIV and expose it to the body's immune system, creating an immune response and a possible vaccine. Kathie Grovit-Ferbas, the study's lead researcher, noted that for a vaccine to be effective, it must spur the body to produce antibodies and then generate a cellular response for immunity. The researchers, who reported their findings in the Journal of Virology, tested the dead virus on three long-term HIV survivors and found that the vaccine appeared to help the patients produce gamma interferon to fight HIV. "Campaign Aims to End Growing Complacency About AIDS" Orlando Sentinel Online (www.orlandosentinel.com) (06/23/00); Perez, Robert Health educators at Seminole County Health Department in Florida are finding that today's youth is growing complacent regarding AIDS. Many officials believe that better drug therapies and fewer AIDS cases have created false hope and apathy among young adults. However, the odds of contracting HIV remain as high as ever before. As part of National HIV Testing Day, public health agencies nationwide--including each of Florida's 67 counties--are participating in an effort to encourage people to be tested. Seminole is offering free food and music to attract people to the tests Saturday. Seminole County officials hope to test 300 people, either using a blood test or oral test, while also promoting healthy lifestyles. "AIDS May Kill 500 on East Side, Study Says: If Residents Don't Get Better Treatment, Their Average Life Expectancy Will Fall Dramatically" Vancouver Sun (www.southam.com/vancouversun) (06/23/00) P. B3; Skelton, Chad A study from the British Columbia Center for Excellence in HIV/AIDS predicts that Vancouver's Downtown Eastside will see life expectancy drop eight to nine years unless HIV residents get better access to drugs in the next six years. An estimated 500 people will die in the six years, mostly injection drug users, if AIDS is not treated. Men would lose 8.1 years off their lifespan and women 9.1 years. Using computer models, the researchers estimated that the HIV infection rate will stay at 7 percent, but more will die of AIDS as infections progress. The researchers found that if 80 percent of Eastside patients received drug cocktails, only 172 would die between 1999 and 2006, compared to 503 if only 20 percent are treated. **************************************************************** INFORMATION FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION **************************************************************** "National HIV Testing Day at CDC-Funded HIV Counseling, Testing, and Referral Sites--United States, 1994--1998" Morbidity and Mortality Weekly Report (www2.cdc.gov/mmwr) (06/23/00) Vol. 49, No. 24, P. 529 June 27 is National HIV Testing Day, an annual campaign to encourage Americans who are at risk for HIV infection to learn whether or not they are infected. To evaluate the success of previous testing day efforts, the Centers for Disease Control and Prevention analyzed the level of HIV testing for the week of testing day, compared to the week prior. Data collected by CDC-funded HIV counseling, testing, and referral sites show an increase in the number of tests performed during the week of testing day. This increase was seen for each year data was available, beginning in the first year of the campaign (1995) through 1998. In 1998, there were 5,523 additional tests, including 70 additional HIV-positive results. "Gonorrhea--United States, 1998" Morbidity and Mortality Weekly Report (www2.cdc.gov/mmwr) (06/23/00) Vol. 49, No. 24, P. 538 From 1997 to 1998, overall gonorrhea rates increased by more than 8 percent. This was the first rise in the gonorrhea rate in 13 years. Prior to this upswing, gonorrhea rates declined by 64 percent from 1985 to 1997. The Midwest reported the highest increase with more than a 16 percent jump, followed by the South with almost 9 percent and the West by 6.5 percent. The northeast was the only region to report a decline in rates, although it was less than 1 percent. Women showed a more than 10 percent upturn, compared to nearly 7.5 percent in men. The gonorrhea rates in African Americans also increased from 1997 to 1998 by more than 13 percent, Hispanics by almost 16 percent, Asian/Pacific Islanders by nearly 20 percent, and American Indians and Alaska Natives by 17 percent. In two states that were surveyed, increased gonorrhea rates in men who have sex with men also were reported and may be related to an increase in unsafe sex practices.