Subject: CDC AIDS Daily Summary for Date: Mon Oct 1 12:31:00 PDT 2001 (435 lines) From: National AIDS Info Clearinghouse Copyright 2001, Information, Inc., Bethesda, MD 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 NATIONAL NEWS "Some Charities Hurting Because of Terror Relief Effort" "Mariners Will Have Tests for TB" INTERNATIONAL NEWS "Brazilian Women Ravaged By AIDS; Infection Rate Rises In Culture of Denial" "Political Resistance in South Africa Blocks Wide Use of HIV Drugs; Leaders Ambivalent About Distribution of Antiretrovirals" "Princess Royal Berates Drug Firms Over Prices" MEDICAL NEWS "HIV Infection in Children -Clinical Review" LOCAL AND COMMUNITY NEWS "'Still Here' -Transit Shelter/Billboard Project About HIV/AIDS -Set to Debut in Berkeley, San Francisco" NEWS BRIEFS "Tuberculosis Rates Rising in State's Foreign-Born Population" "Somali TB Patients Left Without Drugs After Aid Agency Pull Out" "New Nevada Laws Take Effect Oct. 1" ************************************************************ NATIONAL NEWS ************************************************************ "Some Charities Hurting Because of Terror Relief Effort" Associated Press (09.28.01)::Leon Drouin Keith Some charities not playing a direct role in the half- billion-dollar-plus Sept. 11 relief efforts have delayed fundraising, stopped direct-mail programs and told their fundraisers to keep a low profile. They have done so out of respect for the victims of the terror attack and out of fear of angering would-be donors. "At this point, we consider our needs to be incidental to theirs," said Marshall McNott, president of the Los Angeles Mission, an agency that helps the homeless. Almost simultaneously, a plunging stock market has reduced the reserves of many charities, threatening the viability of their operations. The Los Angeles Society for the Prevention of Cruelty to Animals has had to lay off eight of its 55 employees and close two adoption centers. "The donations have essentially dried up. Since the attack, there's almost no mail coming into the organization," President Madeline Bernstein said. Many organizations have been hard hit. One regular donor to the San Francisco chapter of the Salvation Army asked that his $1.7 million donation be diverted to New York. And chapter officials might not have enough money to buy toys for 33,000 families in December or fill 2,000 food bags. The Elizabeth Glazer Pediatric AIDS Foundation has postponed several events, including a Malibu triathlon, pushed back two weeks from its original Sept. 15 date, and a Washington gala set for November that now will be held sometime next year. Fund raising for even something as urgent as pediatric AIDS is hard right now, "when there's so much tragedy going on," said Janis Spire, the foundation's executive director. Across the board, many organizations are increasingly fearful that in the next few months when they do go to corporate funders, they will encounter difficulties in meeting charitable budgets. Some organizations, however, including the American Diabetes Association, have scheduled their events as usual and found the response equal or higher than last year's results. "Mariners Will Have Tests for TB" USA Today (10.01.01)::Mike Dodd The entire Seattle Mariners team and coaching staff will be tested for pulmonary TB following word that shortstop Carlos Guillen was diagnosed with the contagious disease during the weekend. "We don't believe anybody else is at risk to become ill with tuberculosis ... but we're going to test them and take the precaution because they have been exposed," said team physician Mitch Storey. The team will be tested when it returns from a two-game road trip to Anaheim, Calif., and the results should be known by the weekend, said Lou Piniella, manager. "Most of the guys are concerned about their kids," said outfielder Mike Cameron. "I don't want to tell my wife about it because she'll go ballistic. We all fly together, and Carlos has been sick for a while." Guillen, who took over at shortstop for the departed Alex Rodriguez and has played well this year, was admitted to a Seattle hospital Saturday to begin antibiotic treatment and a weeklong quarantine. Hospitalization was not required, but Guillen lives alone and felt it would be better to begin treatment there for two or three days. The Mariners -who have clinched their division and enjoy the home-field advantage through the American League playoffs - have not ruled out Guillen's participation in the playoffs, which open a week from Tuesday. Piniella, however, has said there is no more than an "outside possibility" that Guillen will be available for the American League Division Series. Guillen, who turned 26 on Sunday, had not been feeling well for several weeks. He went to the hospital on Thursday, and his condition was diagnosed on Friday. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Brazilian Women Ravaged By AIDS; Infection Rate Rises In Culture of Denial" Washington Post (10.30.01)::Anthony Faiola Although Brazil, Latin America's largest country, has one of the most progressive anti-AIDS programs in the world, women -and housewives in particular -are becoming infected at an alarming rate. A recent government survey showed that new AIDS cases reported among women shot up 75.3 percent from 1994 to 1998, compared with a 10.2 percent increase among men. Experts say the culture of machismo makes it difficult for women to insist on condom use. "One of our biggest enemies in AIDS prevention is machismo," said Paulo Roberto Teixeira, secretary of Brazil's AIDS program. "We need to empower women, especially those living in poverty who have even less ability to negotiate sex with their partners. But we also need to educate women of all classes, who often don't see themselves with any risk factor." The vast majority of women with HIV are heterosexuals who do not use intravenous drugs. While some are prostitutes, many are married or are in long-term relationships. The government is trying to address cultural pressures by sponsoring AIDS education classes in corporate offices and community centers taught by women living with AIDS. During one class offered to phone company managers in Porto Alegre, a city of 2 million in Brazil's deep south, women listened closely while men tended to take it more lightly. As the instructor Maria Beatriz Pacheco, who contracted AIDS from her ex-husband, spoke seriously about the need for safe sex even among married couples, one manager joked, "Come on, they haven't invented a condom big enough for a Brazilian man." "We have so far to go," Pacheco said. "Even if a wife knows her husband is cheating, it is more likely he will accuse her of infidelity for just suggesting he use a condom. We are trying to change that, but it will take a long time." "Political Resistance in South Africa Blocks Wide Use of HIV Drugs; Leaders Ambivalent About Distribution of Antiretrovirals" Washington Post (10.01.01)::Jon Jeter The Greater Nelspruit Rape Intervention Project (GRIP) moved into unoccupied offices of the two public hospitals in Nelspruit 18 months ago, dispensing counseling and AIDS medicines to abuse victims in this rural province on South Africa's eastern border. Volunteers helped women and children file police reports, provided them with morning-after pills to prevent pregnancy, antibiotics to treat STDs and antiretroviral drugs that some doctors believe may reduce the transmission of HIV if prescribed immediately after sexual intercourse. But when word of the efforts reached provincial government officials, they evicted the project. "It is not the policy of the government to supply [antiretrovirals] and it causes problems for the department to try and explain to ordinary people ... the reason why it is not supplied while [the two hospitals that house the project] do supply those medicines," the provincial health minister wrote in eviction papers filed with the court. South Africa continues to approach antiretroviral therapies with an ambivalence that first surfaced publicly nearly two years ago when President Thabo Mbeki began questioning the drugs' efficacy and the link between HIV and AIDS. Mbeki has repeatedly emphasized the role of poverty in the spread of HIV, and last year assembled a panel of experts including dissident scientists who contend that AIDS is not caused by a virus, but a host of other factors including immune systems weakened by substandard living conditions that are prevalent in sub-Saharan Africa. GRIP leader Barbara Kenyon said that when the provincial health minister summoned her to a meeting to inform her she was being evicted, the official accused the agency of "poisoning" blacks. In addition, a petition that followed the agency's ensuing legal challenge to its eviction sided with the ruling African National Congress and accused GRIP of intending to "drug our people to death." But Kenyon defended the project: "There are 70,000 children born with HIV each year in this country and half of them could be spared this horrible disease with a stroke of the government's pen. AIDS is the enemy, not us." "Princess Royal Berates Drug Firms Over Prices" Scotsman (United Kingdom) (09.26.01)::Alastair Dalton Britain's Princess Anne last Tuesday attacked drug companies for "simplistic philanthropy" that was failing to tackle disease in developing countries. In a hard-hitting speech to the British Pharmaceutical Conference in Glasgow, Princess Anne said firms should focus on effective long-term measures, such as cutting drug prices, rather than on short-term publicity stunts. The conference was organized by the Royal Pharmaceutical Society, of which the princess is an honorary fellow. Princess Anne warned that basic disease prevention measures, such as immunization programs, were in decline in many countries. She said donations of medicines often failed to cover their distribution costs, which sapped other scarce health spending. The princess, who is also president of the Save the Children Fund, said cheap medicines are urgently needed to treat conditions such as HIV/AIDS, and urged the drug companies to re- examine their pricing policies. Her comments echoed concerns expressed at the conference by Oxfam Great Britain Director Barbara Stocking, who said drug patents were preventing the production of cheap, generic medicines that poorer countries could afford. "Fair pricing based on the ability to pay would be an important step forward," said the princess. She warned, "If quick results are what companies want, then they run the risk of being accused of simplistic philanthropy rather than rising to the greater challenge of social responsibility." Princess Anne said that more than 150 children are born each day in South Africa with HIV, but that even the cheapest remedies to ease their suffering, such as drugs for breathing problems and fungal infections, are beyond reach. In Africa, she said, the wonder drugs used to prolong the lives of Western AIDS patients are but a "cruel mirage." ************************************************************ MEDICAL NEWS ************************************************************ "HIV Infection in Children -Clinical Review" British Medical Journal (09.22.01) Vol 323: P 670-674 ::Haroon Saloojee; Amy Violari HIV has transformed pediatric practice in developing countries. A specialty that once dealt mainly with acute illnesses is now consumed, in many settings, with managing chronically ill and dying children. Last year, 600,000 children were newly infected with HIV, with 90 percent of occurrences in sub-Saharan Africa. Almost all acquired the virus by vertical transmission, from mother to child. According to the authors, "The statistics do not adequately portray the suffering and disrupted lives of the most vulnerable of the world's population." UNAIDS recently reported that by 2010, a doubling of child mortality is expected. Globally, the number of orphans from AIDS will increase from 13.2 million to 44 million by 2010. "Finding appropriate responses to this crisis must rank as the single most important global challenge to child health in the next decade," the authors wrote. The authors' article is based upon a Medline search of papers and reviews, unpublished material, presentation, abstracts and personal communications with scientists and clinicians. HIV disease progresses more rapidly in children. Children have higher HIV viral loads than adults, and they have recurrent invasive bacterial infections more often. Opportunistic infections often present as primary diseases with a more aggressive course. The cellular responses to HIV in children are similar to adults, and children respond almost as well as adults to antiretroviral regimens. Reducing vertical transmission from mother to child is paramount, particularly in resource poor countries, where up to 40 percent of pregnant women are infected with HIV and 25-48 percent of their children inherit the disease. In populations where breast-feeding is uncommon, most transmission occurs in the intrapartum period. In communities where breast-feeding is common, postpartum transmission contributes from a third to a half of all infections. Antiretroviral treatment reduces vertical transmission by decreasing maternal viral load and by offering prophylaxis to infants before and after exposure. Longer antenatal treatment (28 weeks forward) with zidovudine is better than a shorter course, and this regimen combined with three days of zidovudine for the infant may be as effective as a six-week course postnatal. Currently, 95 percent of vertical transmission occurs in developing countries. Nevirapine, a non-nucleoside reverse transcriptase inhibitor, is the most effective and practical treatment regimen. Administration to the mother at time of delivery and a dose given to the infant within 72 hours of birth shows a 47 percent reduction in transmission. The drug costs only about $4 for the course and the manufacturer has agreed to provide it at no cost to developing countries. Despite this and recommendations from WHO and UNAIDS that the prevention of vertical transmission of HIV be included in a minimum standard of care, most governments have been slow in responding. Many have difficulties providing the prerequisite antenatal HIV screening, counseling and distribution, and many fear toxicity and resistance. According to the authors, there is no evidence that exposure to zidovudine has serious side effects. There are concerns about the toxicity of antiretroviral treatment in pregnancy but current data indicate that the benefits of treatment far outweigh any potential harm. Elective cesarean delivery reduces HIV transmission by more than half over other modes of delivery, with administration of zidovudine offering additional benefit (85 percent reduction). In resource poor countries cesarean delivery is not appropriate due to cost constraints and the risk of postoperative complications. Simpler and cheaper interventions like vagina cleansing with chlorhexidine during labor and supplements like Vitamin A are ineffective. The controversy over breast-feeding versus formula feeding in resource poor countries continues. Research on three key issues may change policy. One critical issue is the effect of breast-feeding on mother and child. A Kenyan study showed that breast-fed children are more likely acquire HIV than non-breast- fed (36.7 percent versus 20.5 percent). Mortality in the breast- fed group is greater. For mothers the effect of breast-feeding was a 3.2 times higher mortality. Patterns of breast-feeding are also at issue. Exclusive breast-feeding for the first three months may be as safe as formula feeding and much safer than mixed formula and breast-feeding. But this finding needs to be confirmed. Thirdly, the evidence of the advisability of antiretroviral treatment in communities where breast-feeding is the norm are conflicting. One study showed no reduction in overall HIV transmission at 18 months. Two other studies showed 42 percent and 28 percent reduction at ages 12 and 24 months respectively, despite continued breast-feeding. Vaccine research has progressed but, according to the authors, the "challenges in developing safe and effective vaccines are daunting...."Intriguing examples of multiply exposed adults who remain seronegative long-term suggest that partial natural protection can occur. Routine childhood vaccinations play an important role in preventing common illnesses that affect HIV- infected children. HIV-infected children show few adverse reactions to routine vaccinations. To date, the FDA has approved 11 different antiretroviral treatments for children. Antiretroviral drugs have dramatically reduced morbidity and mortality in both adults and children. From long-standing viral suppression to ever more promising new drugs with novel targets, future treatments will almost certainly emerge and be especially effective at immune modulation. But antiretroviral treatment has several limitations, not the least of which is that it fails to rid the body of infected cells (resting memory CD4 cells) and fails to completely suppress viral replication. Treatment failures often occur and viral resistance to drugs is increasing. Most importantly, according to the authors, "It remains unaffordable for 95 percent of infected adults and children worldwide. Even if the cost issue was resolved, the complexity of the various regimens and the many side effects make adherence difficult and the infrastructure needed to support anti-retroviral treatment limits its widespread availability." Rather than rejecting these treatments, the authors recommend alternative and innovative treatment options like optimal timing of treatment, with prescriptions for children based upon easily observed clinical signs and symptoms, as is currently practiced with Haitian adults. "The key to preventing HIV infection in children clearly lies in preventing their parents from acquiring the disease. Unfortunately, except for isolated successes such as in Uganda and Thailand (associated with enlightened sex education and condom use), there is little hope that the expansion of the pandemic will be halted soon," the authors said. More effort needs to be directed at socio-cultural and economic aspects of prevention and in linking individuals to biomedical approaches, they concluded. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "'Still Here' -Transit Shelter/Billboard Project About HIV/AIDS -Set to Debut in Berkeley, San Francisco" Associated Press (09.26.01) With a little over one month to go, Bay Area artists Sharon Siskin, Nancer Le Moins and Robert Corti are pulling together the elements of "Still Here." The "postcards" will debut on Nov. 4, and run through Dec. 15, 2001 in Berkeley in the Addison Street Windows, and from Nov. 14, 2001 through Feb. 15, 2002 in transit kiosks along Market Street in San Francisco. Each billboard-sized postcard bears the phrase: "Greetings from San Francisco," along with a photographic portrait of a resident or art program participant of the Derek Silva Community, a housing and support community for low-income people who are HIV-positive. Each postcard also features a note, written by the participant, describing his or her experience of living with HIV. While the design of the postcard will evoke an old-timey feel and the sense that writer is "on vacation," the background will be an enlarged image of red blood cells as seen through a microscope. Both exhibits are timed to coincide with World AIDS Day, Dec. 1, 2001. Participants in the project were photographed in their homes doing everyday activities. Notes by volunteers were written when they attended a summer writing workshop taught by Alison Luterman, a poet, writer and HIV counselor. The workshop helped volunteers articulate their experiences of living with AIDS. ************************************************************ NEWS BRIEFS ************************************************************ "Tuberculosis Rates Rising in State's Foreign-Born Population" Associated Press (09.28.01) In Benton County, Ark., TB rates among the foreign-born population are rising, according to Scott Jones of the CDC. While infection rates among the county's Hispanic population are consistent with Caucasians, rates among Asian and Pacific Island ethnic groups are up. TB rates across the rest of Arkansas have been falling for nine years. All inmates held for more than two weeks at the Benton County Jail are tested for TB, and those who test positive are given medicine to prevent full-blown TB. However, jail officials say about 60 percent of inmates do not finish their course of medicine before leaving jail -raising the risk for the creation of drug-resistant TB strains. TB was Arkansas' leading cause of death about 100 years ago. "Somali TB Patients Left Without Drugs After Aid Agency Pull Out" Agence France Press (09.26.01) TB patients in the southern Somali town of Jowhar complained last Wednesday that they had been left without medicines after the withdrawal of an Italian aid agency. The relief agency left Jowhar following a dispute with the regional administration headed by Mohamed Omar Habeb, a former member of Somalia's transitional parliament. "Inter-SOS gave us medicine to fight TB for free. The drugs are now either not available or unaffordable," said Mohamed Abdi, who spoke on behalf of about 200 TB patients in the town. "Generators and other properties belonging to Inter-SOS were looted, and the action prompted the agency to withdraw," a local elder, who asked not to be identified, told AFP. "New Nevada Laws Take Effect Oct. 1" Associated Press (09.30.01) More than 125 new laws take effect in Nevada today. Among these is AB453, which legalizes medical marijuana. The new medical marijuana program will be run by the state Agriculture Department; it enables people with chronic and debilitating conditions, such as AIDS and glaucoma, to use pot for pain relief. The law also makes first offense possession of an ounce of marijuana or less a misdemeanor punishable by a maximum fine of $600; the previous felony statue mandated up to four years in prison.