Subject: CDC AIDS Daily Summary for Date: Wed Oct 10 11:31:01 PDT 2001 (355 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 "HIV Reporting System Working Well" INTERNATIONAL NEWS "How Some Live with AIDS with Little or No Therapy" "Boy Prostitutes an Invisible Group in India with Little Support" "AIDS Discrimination Spreading in Asia" "Latest South Africa AIDS Victim Buried" "WHO Plans Action Against Rising HIV Count from Blood Transfusions" MEDICAL NEWS "Diet, Alcohol Linked to HIV-Related Fat Deposits" NEWS BRIEFS "China to Hold National HIV/AIDS Conference" "Some Local Fund-raisers Say Donations Are Down" "Korean TB Strain Discovered" ************************************************************ NATIONAL NEWS ************************************************************ "HIV Reporting System Working Well" Columbian (Vancouver, Wash.) (10.07.01)::Ken Olsen Two years after Washington state started requiring identification of HIV patients, fears of confidentiality breaches and a drop in the number of people getting tested appear unfounded. When state officials began pressing for a reporting process, critics raised the specter of ugly possibilities -such as intolerant officials or other individuals obtaining and distributing the names of HIV patients -that would result in a fear of testing. But those critics seem to have been wrong, as testing appears to be proceeding at the same pace as before. "We really haven't had any of those things play out that people were concerned about," said Maria Courogen, epidemiologist for the Washington Department of Health. Thomas Bruner, executive director for the regional Cascade AIDS Project, agrees. This is all good news for Oregon residents who began facing the same HIV reporting rules last week. Doctors and other health- care workers have long been required to report dozens of infectious diseases, and early on, many health-care professionals pushed for HIV to join the list. But critics argued that fears of confidentiality breaches and persecution of the infected would keep potential HIV patients, especially those living in small towns, from getting tested. Washington finally agreed to adopt a "name-to-code" reporting system. Under this system, the medical community must notify the state when someone tests positive for HIV. The state has 90 days to convert the name into a unique code and forever erase the true identity of the HIV patient. Oregon becomes the 45th state with mandatory HIV reporting. Only three -Maine, Oregon and Washington -convert the names to codes and drop them from the system. Eleven states use a unique code throughout the reporting process. Thirty-four states simply report HIV cases by patient name. The CDC estimates that between a quarter and a third of people with HIV do not know they are infected. ************************************************************ INTERNATIONAL NEWS ************************************************************ "How Some Live with AIDS with Little or No Therapy" New York Times (10.10.01)::Elisabeth Rosenthal As Asia confronts a new and fast-growing AIDS epidemic, scientists and researchers from all over the world at the 6th International Congress on AIDS in Asia and the Pacific heard from many brave individuals who are pushing their governments to respond to a wealth of needs. They play much the same role that ACT UP did in the United States 20 years ago, but their quest requires more courage. They are admitting to a disease associated with sex and drugs in socially conservative societies. They demand treatments in countries low on resources, and they demand an end to discrimination. Many, like Celina D'Costa, reminded the audience that they have received no treatment after years of infection with HIV, even though their homelands, like India, now produce the medicine that have vastly prolonged the lives of Western AIDS patients. "The therapy is not available to most of us," said D'Costa, a gentle woman in a traditional sari, who is vice president of an organization for Indians infected with HIV. "The medicines are very expensive and the testing that goes along with it costs five or six months of my salary. Most of us have never even seen these pills. We should be receiving treatment and services, of course, but our voice isn't really heard." "We're still at the beginning stage," said Suzanna Murni, who started the Spiritia Foundation in Indonesia four years ago to promote the interests of people with HIV, like herself. "There are more positive people who are open and speaking out in front of officials and doctors. It changes attitudes toward positive people." A recent report by a panel affiliated with UNAIDS said that Asian countries are facing serious health crises from AIDS and are often poorly prepared to respond. Several countries, including China, Indonesia and Vietnam, are experiencing explosive epidemics. Murni has promoted her patient-centered message at conferences, at the UN and at Indonesian meetings. Her themes include training doctors about HIV and stopping discrimination and bias against those with the virus. "Boy Prostitutes an Invisible Group in India with Little Support" Associated Press (10.06.01)::Emma Tinkler In the Indian city of Bangalore, boy prostitutes earn money by selling their bodies to men seeking sex. The 5,000 rupees ($106) they can earn nightly for their services is far more than they could ever hope to make in other jobs because they have little education and are mostly illiterate, said Vinay Chandra, executive director of Jagruthi, a nongovernmental organization that assists these prostitutes. Chandra said Jagruthi has established a medical clinic to educate the boys about HIV/AIDS but is unable to make a dent in child prostitution without community and government support. "Structures that help the boys to get out of the trade must be stronger than those that keep the boys in the trade," he said. Speaking at the 6th International Congress on AIDS in Asia and the Pacific, Chandra said many of the tens of thousands of Indian boys are first introduced to the sex industry between the ages of 10 and 13 -largely by force. Though some boys are conscious of STDs such as HIV/AIDS, few use condoms. Instead, they attempt to avoid infection by sleeping with well-dressed clients they believe to be disease-free. In another presentation on child prostitution in Asia, Mao Land, the director of the Meatho Phum Kumah shelter in Cambodia, said child trafficking is an enormous problem in the country's second largest city, Battambang. Lang said children are sold to traffickers by their parents or sometimes handed over as repayment for debts. They are taken to Thailand where most become prostitutes, often begin taking drugs and are at risk of contracting HIV/AIDS. "Families who sell children are desperate," Lang said. "They often feel they have little option if the rest of the family is to survive." "AIDS Discrimination Spreading in Asia" Times of India (10.09.01)::Reuters Some people with HIV/AIDS in Asia have been sterilized, thrown out of their homes, and disinherited, delegates to the 6th International Congress on AIDS in Asia and the Pacific were told this week in Australia. With about 7 million people across Asia living with HIV/AIDS, advocates say discrimination is a growing problem. "Even my dad doesn't give me a job," said Rajiv Kafle, 28, of Nepal. Kafle found out five years ago he was HIV-positive, having been infected with the virus after sharing syringes. Now he is drug-free, but the stigma of HIV has hampered his search for a job and his attempt to get his life back on track. "I lost my right to stay in my own house," Celina D'Costa told the conference. She was thrown out of her house in Kochi, India, by her in-laws and disinherited when she learned, eight years ago, she was HIV-positive. AIDS advocates said people are being tested for HIV without their knowledge or consent, and that some patients are refused treatment or care. Susan Paxton of the Key Center for Women's Health in Melbourne said that one of her friends in Bangkok was forcibly sterilized after being diagnosed as HIV-positive. The five-day conference, which attracted some 3,000 delegates, concluded today in Melbourne. "Latest South Africa AIDS Victim Buried" Newsday (New York) (10.09.01)::Ravi Nessman, Associated Press As the South African government debated over the past few weeks just how deadly its HIV crisis is, Francina Mteniso lay in a hospital bed dying of the disease. She was buried Tuesday in a funeral full of tears and prayers, but also full of defiance against what many mourners saw as the government's stubborn unwillingness to come to terms with a crisis that is devastating the country. South Africa's government, which has been criticized for its policies on AIDS, has courted new controversy by declining to release new estimates showing AIDS is the leading cause of death in the country. Instead, the government cast doubt on their accuracy. The statistics in the report by the Medical Research Council, a government-sponsored research organization, estimated AIDS caused 40 percent of adult deaths and 25 percent of total deaths in South Africa last year. The disease will have killed 5 million to 7 million South Africans by 2010, said the report. The unreleased report was leaked last month after President Thabo Mbeki ordered a review of health spending on the basis of 1995 statistics showing HIV accounted for just 2.2 percent of South Africa's deaths. Officials of the ruling African National Congress questioned the report's credibility, and several Cabinet ministers issued a statement denying they were suppressing it, saying they did not have the authority to release it. Because of the stigma, a funeral like Mteniso's is rare. Her yard was jammed with AIDS activists singing songs of mourning. Mteniso, 37, discovered she had HIV in 1990 while she was pregnant. Her baby died of AIDS at seven months. Mteniso, a shy woman, later became an activist with the AIDS Care and Counseling Trust. Mteniso died Sept. 28 and was buried in Soweto's Avalon Cemetery amid rows of graves of people in their 30s, 20s and, in some cases, their infancy. Activists speaking at the funeral blended praises for Mteniso's strength with criticisms of the government, which they are suing to provide medicine for HIV- positive pregnant women that could help prevent their babies from becoming infected. "WHO Plans Action Against Rising HIV Count from Blood Transfusions" Agence France Presse (10.08.01) The World Health Organization (WHO) on Monday announced plans for a training center for blood bank officials in the Western Pacific. WHO said the current lack of training was putting people at risk of HIV infection. The details were released in Singapore, where the center will be located, during a WHO-organized meeting on quality management for blood transfusion services. Officials declined to give figures on how many people were being infected with HIV because of poor blood screening, but they said the figure was rising. The center's goal will be training 200 blood bank officers, including directors and quality control personnel, in four years. "HIV infections are increasing in certain countries and certain areas in certain countries," said U.H. Susantha De Silva, the WHO representative for Brunei, Malaysia and Singapore. "The HIV epidemic situation in countries such as Cambodia and Vietnam -and the recently reported cases of HIV infections through blood products collection in China -highlights the importance of the issue," he told the meeting. "In many countries of our region, transfusion therapy - despite being a life-saving procedure -is still associated with significant risks." De Silva cited "inadequate awareness among senior officers of the importance of quality management and insufficiently trained staff" as being among the main reasons for poor quality regional blood supplies. The screening process has broken down in some countries, he told reporters, and officials are skeptical about whether blood donors are being correctly monitored. Patrick Tan, director of Singapore's Center for Transfusion Medicine, said some countries, which he would not name, did not process blood properly and correctly record blood groups. "With all the strict measures and new developments available to avoid transfusion-transmitted infections such as HIV ... it is ironic that the commonest cause of fatal transfusion reactions continues to be transfusion of blood of an incompatible ABO blood group," said Hang Chang Chieh, chair of the Singapore Health Sciences Authority. ************************************************************ MEDICAL NEWS ************************************************************ "Diet, Alcohol Linked to HIV-Related Fat Deposits" Reuters Health (10.02.01) Dietary levels of fiber, alcohol and fat may play important roles in lipodystrophy, the abnormal body-fat distribution seen in some HIV patients, according to a new report. The condition can cause sunken cheeks, increased fat around the waist and the development of a fat pad on the back of the neck. While various metabolic problems have been found in HIV patients with lipodystrophy, and certain HIV drugs are linked to the condition, it remains unclear how the abnormality arises. But the new study's findings suggest that some dietary changes might help HIV patients with the problem. The research, conducted by Dr. Colleen Hadigan of Massachusetts General Hospital in Boston and colleagues, was reported in Clinical Infectious Diseases (2001; 33: 710-717). "Our data indicate that certain modifiable components, such as polyunsaturated fats, fiber and alcohol, are strongly associated with insulin resistance and [high cholesterol] among these patients," Hadigan and colleagues concluded. The researchers examined the associations between dietary habits, metabolism and body composition in 85 men and women with HIV and body-fat redistribution. They questioned the patients on their eating and drinking habits in the previous month, and they examined them after a day of fasting. The researchers found that low fiber and high polyunsaturated fat intakes were linked to insulin resistance among the patients. Insulin resistance, a problem with the body's use of insulin, is one of the metabolic disturbances seen in HIV patients who develop lipodystrophy. In addition, heavier drinking was associated with higher levels of LDL ("bad") cholesterol. These dietary associations with metabolism and lipodystrophy were independent of factors like patients' age and sex, and length of time on protease inhibitors, which are believed to contribute to the condition. The authors called for studies to determine whether changing patients' fat intake, increasing fiber consumption and reducing alcohol would affect the metabolic factors associated with lipodystrophy. ************************************************************ NEWS BRIEFS ************************************************************ "China to Hold National HIV/AIDS Conference" Xinhua News Agency (10.09.01) China will hold a national AIDS conference in mid-November in Beijing. It will be the biggest HIV/AIDS event in China since it reported the first AIDS case in 1985, according to the Chinese Association of STD/AIDS Prevention and Control, one of the organizers. Initiated by the Ministry of Health, the conference will be comprehensive, covering policy-making, project management, and participation of government departments and non- governmental organizations. Along with ranking Chinese officials and specialists in the field of HIV/AIDS and STDs, some volunteers and HIV patients will also attend forums and activities during the conference, according to Dong Yongkun, secretary-general of the association. "The meeting is open to the whole society because the fight against HIV/AIDS needs efforts from all people of the country," he said. Medical research and disease surveillance, health education and behavioral intervention, and treatment and nursing of AIDS patients will also be on the agenda. "Some Local Fund-raisers Say Donations Are Down" Associated Press (10.10.01) Leaders of some Cincinnati charities and non-profit organizations say donations may decline because people have been so generous in fund-raisers for the victims of the Sept. 11 attacks on the United States. "The spirit of the community is to rally around national needs, and that's exactly as it should be. The concern for us is that we don't want to be in conflict and compete with that," said Victoria Brooks, executive director of AIDS Volunteers of Cincinnati, a non-profit AIDS service organization. The group hoped to collect about $150,000 in gross proceeds from a 10-kilometer walk, a 5-kilometer run and a benefit concert in late September. Instead, it collected $110,000 in gross proceeds, netting about $70,000. "Korean TB Strain Discovered" Korea Herald (09.29.01) The Korea Institute of Tuberculosis (KIT) has discovered a variant of tubercle bacillus that is more likely to infect Koreans. The KIT said the new strain was detected in DNA analyses of 231 TB patients in a 1999 study. Of the 231 patients, 18.4 percent were carrying the variant, which the institute believes may have mutated into a new form to which Koreans are more susceptible. The institute said it hoped the finding would lead to the development of a more potent vaccine for TB, which claims the lives of thousands of Koreans each year.