Subject: CDC AIDS Daily Summary for Date: Thu Oct 4 11:31:05 PDT 2001 (381 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 "Donors Wanted to Help, but Some Blood Rejected As Infected" "Questions Surround Guillen's Illness" "FDA Panel Recommends Approval of New HIV Drug" INTERNATIONAL NEWS "'Explosive' AIDS Epidemics Hit Asian Sex Workers" "Irianese Women Targeted in HIV/AIDS Campaign" MEDICAL NEWS "An Intervention for Parents with AIDS and Their Adolescent Children" LOCAL AND COMMUNITY NEWS "Security Concerns Shift AIDS Walk" NEWS BRIEFS "Southern Kazakh Region Prepares TB Vaccines, Housing for Afghan Refugees" "Hepatitis Outbreak Infects About 200 People in Ukrainian Town" "Teens Unaware of STD Prevalence" "250,000 Ethiopian Children Under Five Have HIV: Health Ministry" ************************************************************ NATIONAL NEWS ************************************************************ "Donors Wanted to Help, but Some Blood Rejected As Infected" Associated Press (10.03.01) Hundreds of people in Michigan and in other parts of the country who donated blood for the victims of the Sept. 11 attacks may soon find out their contribution was rejected because of infection. Most tainted blood comes from first-time donors, and nearly 65 percent of people who gave blood in the days after the attacks were new donors, according to the National Institutes of Health. Each unit of donated blood is put through a series of 12 tests screening for HIV, hepatitis B and C, syphilis and other antigens. HIV shows up in one of every 50,000 to 200,000 donations. Hepatitis is slightly more common, showing up in one of every 10,000 to 50,000 donations, depending on the virus, said Brooke Doherty, spokesperson for America's Blood Centers, an association of the independent blood banks that collect half of the nation's blood supply. No one is sure yet how many recent donors are infected. Blood banks have been overwhelmed for the past three weeks with donations. "With such an outpouring of community response to the disaster, there's bound to be at least twice as many folks who turn up with negative results," said Rick Rolls, infectious disease counselor with the American Red Cross Great Lakes Region. "It's hard to tell them that. They were just trying to do good." Most people he has had to tell have been shocked, but generally have expressed displeasure because their donations could not be used, Rolls said. Contacting infected donors is standard practice for blood banks, and their status is kept confidential. Donors who are confirmed positive for HIV will meet with Rolls. Letters and calls are sent to donors whose blood showed signs of other infectious diseases. "Questions Surround Guillen's Illness" Seattle Post-Intelligencer (10.04.01) Dr. Charles Nolan, director of TB control for Public Health/Seattle and King County, said it is "extraordinary" that Seattle Mariners shortstop Carlos Guillen developed such a severe case of pulmonary tuberculosis before it was diagnosed last Friday. Some Seattle physicians have said Guillen's symptoms should have prompted the team's medical staff to consider TB much earlier. Guillen has been quarantined in Northwest Hospital since Saturday and is receiving antibiotics. On Tuesday, doctors operated to place a small artificial clot in one of his lungs to stop minor bleeding caused by his persistent cough. Team physician Dr. Mitch Storey said Guillen had requested that details of his condition be withheld. Storey said Guillen will miss the first round of the American League division series next week. But because teams are allowed to change rosters after each round of playoffs, Guillen could be added later. Guillen's teammates and the Mariners' staff will be tested for TB today. Because it can take weeks after exposure to produce a positive skin reaction, those potentially exposed will be monitored for symptoms and likely tested again. A negative skin test, such as that done on Guillen in spring training, does not rule out disease because the test has a relatively high rate of false negatives. Yet questions remain regarding how Guillen's illness escaped detection. Teammates said he had been ill and had suffered nosebleeds, but he had not complained to Manager Lou Piniella or to coaches. Pitcher Jose Paniagua said Guillen had been sick for three months and had said he suspected the blood he was losing was from his lungs, not his nose. General Manager Pat Gillick said Guillen was sent to an ear, nose and throat doctor in response to the nosebleeds, which were thought to be the result of an on-field collision with another player. Seattle and King County record about 125 active cases of TB each year, mostly in people who have immigrated from other parts of the world. It's possible Guillen could have been infected in Venezuela, where he grew up and lives in the off-season. "FDA Panel Recommends Approval of New HIV Drug" Wall Street Journal (10.04.01) An advisory panel to the Food and Drug Administration yesterday supported approval of the new HIV drug Viread, made by Gilead Sciences Inc. The panel was split on whether to recommend the drug for all patients or only for those who have failed other courses of therapy. The drug targets reverse transcriptase, an enzyme essential to the replication of the virus and the spread of the disease in the body. Taken as a pill once a day, Viread has been shown to lower the quantity of HIV particles in the blood of 552 patients who have been "highly treated" with other antiretroviral medication for an average of 5.4 years. Only 3 percent of the patients who received Viread developed resistance to the drug after 24 weeks. The panel's opinion is not binding on the FDA, although the agency frequently follows the advice of its advisory panels. The drug was not approved for "front line" treatment because it has so far only been tested in patients that have received other HIV drugs. ************************************************************ INTERNATIONAL NEWS ************************************************************ "'Explosive' AIDS Epidemics Hit Asian Sex Workers" Reuters (10.04.01)::Wendy Pugh Prostitutes in China, Indonesia and Vietnam are falling victim to "explosive" AIDS epidemics that will spread to their customers' wives and girlfriends, a UN-funded report said today. While large-scale preventive action had kept the disease at bay in parts of Asia, there was "clear potential" for HIV/AIDS to spread, according to "Monitoring the AIDS Pandemic Network." The report found soaring levels of HIV infection among intravenous drug users and sex workers in some regions. HIV testing of sex workers in three provinces in China showed recent rapid increases in infection rates. In Guangxi province, 9.9 percent of sex workers were found to have HIV in the second quarter of 2000. The figure rose to 10.7 percent by the fourth quarter of the same year. In Ho Chi Minh City in Vietnam, HIV infection rates among sex workers and their clients increased to more than 20 percent in 2000 from virtually zero in 1996. Indonesia recorded a jump in HIV among sex workers to 26 percent in three geographic areas from 6 percent previously. There were also outbreaks of the virus among injecting drug users around the country. The report noted the success of prevention programs in hard-hit Thailand and Cambodia in limiting the spread of HIV and said there was great potential for containment in Asia because most of the epidemics in the region remained concentrated. The report said only three Asian countries -Cambodia, Myanmar and Thailand -had registered nationwide AIDS prevalence rates of more than one percent, compared with rates 10 or more times higher in some African countries. The report said Asian national figures hid concentrations in certain groups and were meaningless in countries like China and India, where some regions have populations larger than many countries. "Already today I think about a third or 40 percent of the world's people with HIV are living in Asia," UNAIDS Executive Director Peter Piot said. "Irianese Women Targeted in HIV/AIDS Campaign" Jakarta Post (09.30.01) Irian Jaya has the highest rate of HIV/AIDS in Indonesia. "The curve of HIV spread follows that of Papua New Guinea or the African curve; it has reached an alarming level," said Dr. Paul Crouch-Chivers, who works for the mining company PT Freeport Indonesia. Part of the speed of transmission can be attributed to the Irianese way of life. Doctors, health officials and nongovernmental organization workers say the male members of many local communities practice sexual activities such as exchanging wives, passing on widows to younger brothers and acquiring new partners. Also, sex without foreplay -which can injure the genitals -is a common practice. Heterosexual intercourse is the main means by which HIV is spread in the region. As of June 2001, official figures from Irian Jaya showed 599 people had contracted HIV, 224 of whom developed full-blown AIDS. The number of people infected with HIV/AIDS in Indonesia has reached 1,956 overall, meaning Irian Jaya's figures make up almost 30 percent of cases in Indonesia. Crouch-Chivers said while the HIV epidemic in mining communities in Timika was in the early stages, "the annual incidence rate would continue to increase unless there were significant changes in sexual behavior by using condoms or limiting the number of partners." Officials, doctors and activists said special attention needs to be directed at mothers. "I am sure we will start to see infected new-born babies in the future," Crouch-Chivers said. Surveys by an Irian Jaya health agency show that sexual harassment and ill treatment of wives is rampant among the local population in villages and towns. "Some women still have sexual intercourse with their husbands although they know that their husbands are infected," said Dr. Gunawan Ingkokusumo, a senior member of staff of a health agency in Jayapura. He said the HIV/AIDS problem in Irian Jaya was similar to a fire ignited in a dry forest. "If we are not alert to the fire, it will spread and scorch a big part of the human resources needed to build this province," Ingkokusumo said. ************************************************************ MEDICAL NEWS ************************************************************ "An Intervention for Parents with AIDS and Their Adolescent Children" American Journal of Public Health (08.01) Vol 91; No 8: P 1294- 1302::Mary Jane Rotheram-Borus, PhD; Martha B Lee, PhD; Marya Gwadz, PhD; Barbara Draimin, DSW In the United States, increasing numbers of parents have AIDS, and these individuals will either live with a chronic, life-threatening illness or they will die. Parents with AIDS must cope with physical health symptoms, complex medication regimens, stigma, and fear of AIDS-related death, as well as caring for their family. Parents' ability to care for their family and their illness are likely to influence their children. After living with an ill parent, about 80,000 children in the United States have been orphaned by AIDS (internationally, 13 million). Parental death reduces children's self-esteem and increases depression, anxiety, conduct disturbance, academic difficulty, somatic complaints, and suicidal acts over the long term. To help adolescents and their parents cope with parental AIDS, researchers evaluated the efficacy of an intervention designed to improve behavioral, social and mental health outcomes. On the basis of the social learning theory, a 24-session intervention was designed to be delivered over 12 Saturdays in small groups. The purpose of the intervention was to help parents with AIDS and their adolescents cope with illness-related tasks. Sessions were organized into two modules, with each module aimed at helping parents and youth cope with different-illness-related challenges. Module 1 (eight sessions over four Saturdays) of the intervention addressed parents' issues of disclosure, emotional reactions to AIDS, and coping with stigma. Module 2 addressed making custody plans, expressing love and affection, and maintaining positive family routines with a very ill parent. This report summarizes the efficacy of the intervention in terms of reducing behavioral, social, and mental health symptoms over two years among adolescents and their parents with AIDS. From August 1993 to March 1995, all financially needy persons with AIDS who requested services were logged at the Division of AIDS Services in New York City. From this log, 429 eligible parents with AIDS were identified: those who were alive during the recruitment period, were ages 25 to 70 years, had at least 1 adolescent child age 11 to 18 years, were not institutionalized, and had the assent of their clinical social worker that study participation was appropriate. Of the 429 eligible parents with AIDS, 84 percent (n=307) were successfully recruited. Four hundred twelve adolescents were recruited (mean per family=1.5, SD=0.7, range=1-5). Parents and children were randomly assigned to the intensive intervention or to a standard care control condition. Most of the parents with AIDS were Latino and African- American mothers. The age distribution among parents was large, from 25 to 70 years. About half of the parents had graduated from high school. Household composition varied: 94 percent included children, while in the remaining cases children were temporarily in foster care placements, in group homes, or incarcerated. Twenty-seven percent of households included an adult partner, 11 percent included a grandparent, and 10 percent included other relatives. About half of the adolescents were female. The mean age of the adolescents was 14.8 years (SD=2.1, range=11-18), and 89 percent were enrolled in school. When families were recruited into this study, the parents anticipated dying in about a year. Most (75 percent) had told their children about their HIV status. The children who knew about their parent's health status were exhibiting more behavior problems than those who did not know. These families faced challenges in regard to the illness, disclosure, custody and saying good-bye. While the intervention substantially improved outcomes among parents with AIDS and their adolescent children, the outcomes for families in the control condition also improved over time, in contrast to existing theories regarding the long- term impact of chronic illness and bereavement. There are at least three reasons for this improvement. First, antiretroviral therapies were introduced about two years into the study. Second, adolescents and parents may have learned to adapt to the illness; over time, conversations about the parent's HIV status decreased. Finally, participation in the study itself may have been a positive intervention for the families, even if they took part only in the standard care condition. During two years, 44 percent of the parents with AIDS died. Deaths were distributed throughout the follow-up period, and rates were similar across intervention conditions. After the parent's death, a third intervention module was delivered to the bereaved adolescents and their caregivers. The results of that module are being evaluated. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Security Concerns Shift AIDS Walk" Los Angeles Times (10.04.01) The 17th annual AIDS Walk Los Angeles, which has previously started and ended at Paramount Pictures, has been moved to the Pacific Design Center because of security concerns following the Sept. 11 terrorist attacks, officials announced yesterday. The Oct. 21 event was moved because of the heightened security at southern California movie studios, said Craig E. Thompson, executive director of AIDS Project Los Angeles. Security guards are checking under cars that enter the studio, Thompson said, and examining picture identification of everyone entering the lot. "The pure logistics wouldn't work," Thompson said. "We expect 27,000 people to participate, and how could we do 27,000 security checks?" When the 10K (6.2-mile) walk began in 1985, it attracted 4,500 participants. Over the years, the walk has evolved into an annual event for thousands of people to unite in the fight against HIV or to remember a loved one who died of AIDS. Last year almost 28,000 people participated. ************************************************************ NEWS BRIEFS ************************************************************ "Southern Kazakh Region Prepares TB Vaccines, Housing for Afghan Refugees" BBC (10.03.01) South Kazakhstan has received an additional 50,000 doses of TB vaccine for refugees from Afghanistan and other countries, according to the regional sanitary and epidemiological service. The regional administration met behind closed doors to discuss possible accommodation of Afghan refugees, taking stock of summer camps and rest homes where people can be housed during the winter. However, according to news reports, Kazakhstan's southern regions remain calm, and migration services have not yet registered a single refugee. "Hepatitis Outbreak Infects About 200 People in Ukrainian Town" Associated Press (10.03.01) A hepatitis outbreak in eastern Ukraine has infected about 197 people, including 43 children, emergency officials said Tuesday. The first cases of the hepatitis A outbreak were reported in the town of Torez on Sept. 17. After a week, more than 100 people were infected with the virus, and the number of victims has since doubled, the Emergency Situations Ministry said. Health officials are urging residents of Torez to boil their drinking water. "Teens Unaware of STD Prevalence" USA Today (10.02.01) One in four sexually active teens will contract an STD this year, but only 28 percent of surveyed teens ages 12 to 17 assessed the risk correctly. Twenty-eight percent thought the risk was one in 40; 22 percent thought it was one in 400; and 19 percent thought the risk was one in 4,000. Kaiser Family Foundation conducted the research. "250,000 Ethiopian Children Under Five Have HIV: Health Ministry" Agence France Presse (10.02.01) Some 250,000 Ethiopian children under age five are HIV- positive, the Health Ministry stated Tuesday. On national radio, the ministry called for further AIDS prevention measures as it released the figures. A UNICEF official coordinating AIDS projects in Addis Ababa confirmed the official figures but said they were estimates. The UNICEF estimates that 750,000 children in the east African country have been orphaned by AIDS. The government plans to train health professionals in methods of fighting the spread of AIDS, an official on attachment to the Health Ministry said. The ministry and UNICEF are organizing a seminar for several dozen midwives and gynecologists about caring for pregnant women who have HIV.