Subject: CDC AIDS Daily Summary for Date: Mon Oct 15 11:31:01 PDT 2001 (375 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 "Men Who Sleep With Men" INTERNATIONAL NEWS "Colombian Rebels Forcing AIDS Tests" "HIV Cases Increase Rapidly in Goa" "US Gives Mozambique $11.5 Million for AIDS Program" MEDICAL NEWS "Bloodborne Pathogens in Rhode Island: Is the Greatest Threat Inside or Out?" "Seaweed Derivative Could Prevent HIV Infection: Researcher" LOCAL AND COMMUNITY NEWS "$300,000 Awarded to AIDS Agency" NEWS BRIEFS "Clinton at Yale: Optimistic on Crisis, But Work is Ahead" "More Adolescents Abstaining from Sex" "AIDS 10K Walk Pulls More Than $1 Million" ************************************************************ NATIONAL NEWS ************************************************************ "Men Who Sleep With Men" Essence (10.01.01)::Tamala Edwards Years ago HIV-infected women usually contracted the disease through drug use. But these days one of the main methods of infection is heterosexual sex. In some instances, women are having sex with men infected through drug use. But researchers say that, more female infection than is generally suspected has come through the "bridge" population of men who also have sex with men. It's hard to quantify this population, but a survey by the CDC found that nearly a quarter of black HIV-positive men who had sex with men consider themselves heterosexual. Because these men don't consider themselves gay, AIDS prevention messages and programs often elude them. It is with this concern that health care workers are now using the phrase "men who have sex with men" (MSM), designed to make men more open to information about safe sex and HIV testing. Shame and stigma lead MSM to carry on elaborate double lives. "These men live in a racist society and a homophobic black community," according to Ron Simmons, Ph.D., executive director of Us Helping Us, People Into Living Inc. an AIDS community outreach group in Washington, D.C. Julie Posey's story is not uncommon. She went to San Francisco to become a fashion merchandiser in the mid-1980s. She soon met and fell in love with Bax; the two married and had three children. Posey discovered Bax was having sex with men; then he tested HIV-positive. Bax died of AIDS in 1999. Though Posey and her children are fortunately HIV-negative, she said, "In the end I felt stupid. There was this truck coming at me the whole time. Why didn't I get out of the way?" Brenda Wade, Ph.D., a San Francisco therapist, said, "You have to take your time and you have to ask questions. ... The issue is can you have a committed, monogamous relationship? Can it deepen and grow?" Though this topic is jarring, there isn't cause for panic. "Tell sisters not to accuse every man in their life of being on the DL [down low]," says Hence J.L. King, author of "Secrets: Life on the Down Low" due out next spring. "And those who are aren't sexual predators either. They're brothers mired in stigma and denial. More hate won't make the situation better, but working to make your community and your heart more open and accepting will," the reporter wrote. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Colombian Rebels Forcing AIDS Tests" Associated Press (10.13.01)::Juan Pablo Toro Elected officials in Vista Hermosa, Colombia, are powerless to stop the nation's largest guerrilla army from forcing all the town's residents to be tested for AIDS. Three people who tested positive have reportedly been expelled from the rebel safe haven. The leftist Revolutionary Armed Forces of Colombia (FARC) says the mandatory exams are nothing more than a public health initiative. Some citizens, however, believe the rebels have an unspoken military objective: to take a disguised census that will help them keep tabs on the population. The mayor and many residents oppose the testing, which began in July, yet they have little authority in the town -one of five that rebels control under a peace concession from President Andres Pastrana. "Here there is a revolutionary government, and its orders must be followed," said Mayor Jose Castano. Colombia's civil war has lasted 37 years. The testing began after a July speech in which a rebel commander claimed large numbers of people were being infected with AIDS. The rebel orders require that all area citizens between ages 12 and 80 take the test and pay for it themselves, even though the $7 cost is more than one day's minimum wage. Some 18,000 of the town's 20,000 residents have been tested so far. Those who have been tested receive a certificate. Some residents believe the rebels will demand the papers as a way to know when outsiders are in town. Concerns over the policy grew when officials reported that FARC had expelled three people who tested HIV-positive, prompting protests from human rights officials in Bogota. "HIV Cases Increase Rapidly in Goa" Times of India (10.10.01) The HIV prevalence rate among commercial sex workers in the red-light area of Bania, South Goa, is as high as 55 percent, according to officials at the Goa State AIDS Control Society. Most HIV carriers are male. Since the first HIV case was detected in Goa in 1987, the number of cases has increased steadily. In 2000, the number of cases recorded was 807, with 13 deaths reported. Between January and August 2001, of the 4,708 HIV tests conducted, there were 507 cases and 36 deaths. These figures relate to blood tests carried out at Goa Medical College Hospital. Officials say many of the HIV cases resulted from tattooing with the same needle and from massages leading to sexual encounters, mainly in the coastal areas of the state. STD patients formed the highest risk group -the chance of acquiring or transmitting HIV was 10 times higher with an STD than without one. Although the Goan government is engaged in prevention and control of HIV through awareness drives and campaigns, including blood safety measures and management of STDs, there is a growing fear that the problem is far from solved. One of the biggest drawbacks to arriving at any credible figure of those with HIV is the fear of stigma and ostracism by society or even family. Dr. Jeremy Joseph Dias is director of Health Services for the STD Control Program in Goa. He said his department was using anonymous surveys conducted by a team of doctors, laboratory technicians and nurses at five HIV Sentinel Surveillance sites to pinpoint at-risk populations in both the high- and low-risk categories. "US Gives Mozambique $11.5 Million for AIDS Program" Agence France Presse (10.09.01) The United States Agency for International Development (USAID) has granted $11.5 million to Mozambique for an HIV/AIDS program, officials said last week. The program, called the Development Corridor of Hope, will involve individuals and communities living along the Maputo Development Corridor -a key road and rail link between South Africa and Mozambique -in the distribution of information designed to combat AIDS and encourage safe sexual practices. The southern provinces of Gaza and Inhambane, where large numbers of people are infected, will also be covered by the program. Mozambique's AIDS program also aims to improve health care for those already infected with the virus and to tackle the discrimination faced by sufferers. An agreement formalizing the grant for the program from the US government agency was signed last Monday by USAID country director Cynthia Rozell and Graca Machel, Mozambique's former first lady and now head of the local non-governmental organization the Community Development Foundation, which will oversee the implementation of the program. Official estimates say that about 16 percent of Mozambique's population of 17 million are HIV-positive, with 700 new infections occurring daily. ************************************************************ MEDICAL NEWS ************************************************************ "Bloodborne Pathogens in Rhode Island: Is the Greatest Threat Inside or Out?" HIV Hepatitis Education Prison Project Newsletter (HEPP) (08-09.01) Vol 4; No 8 & 9: P 5-7::Betsy Stubblefield What is the risk of contracting a bloodborne disease while serving a prison term? At the Adult Correctional Institute (ACI) of Rhode Island, this question may be first in the minds of any of the 15,000 people who pass through ACI intake every year. Two studies conducted by Grace Macalino, Ph.D., and her colleagues in the Brown University Department of Community Health may show that the real threat lies on the "outside" rather than in prison. This makes prisons and jails an essential intervention site for disease prevention in the "free" community. The investigators have been conducting a blind sero-survey of all sentenced inmates entering the ACI during the last three years. Blood is drawn at intake by ACI for mandatory testing for HIV. For the first part of the study, half of the excess sera samples from testing are sent to off-site laboratories to blind- test for Hepatitis B and C (HBC and HCV), as well as Human T- Lymphotropic Virus (HTLV I/II). The other half of the sera samples (linked with demographic data) is reserved for incidence measurement. This part requires new blood samples from inmates who have continuously been at the ACI for a minimum of 11 months. At 11 months, inmates provide consent and are pre-counseled before being tested. Outreach workers return within a month to counsel and disclose results of the tests. In the second study, Macalino and colleagues are measuring prevalence of the same bloodborne pathogens among recidivist men. The design is similar to an earlier study conducted with women inmates at ACI (Rich, JD, Macalino, GE, Dickinson, B, Flanigan, T, "CDC HIV Prevention Conference: Community Incidence and Intake Prevalence in a Population of Incarcerated Women," Atlanta, Ga., 1999). It estimates the "community" incidence of the tested infections by comparing the results of serial samples obtained at intake. Since inmates are often in the correctional system for short periods of time, Macalino attributes this incidence (i.e., negative on an earlier intake and positive on a later intake) to transmission in the community. Preliminary results from 675 participants at intake found prevalence rates of 1.3 percent HIV, 19.8 percent HBV, 24.7 percent HCV and 1.2 percent HTLV I/II. Preliminary analysis found no seroconversion to reveal infection with HIV, HCV or HTLV I/II. Two cases of conversion to HBC infection were found. Data kept on injection drug use (IDU) among study participants found the highest rate of IDU among those patients with HIV (66.7 percent). For those with HBV, IDU was 38 percent; for HTLV I/II, 50 percent; and for HCV, 46 percent. In the previous recidivist study, 2.4 percent of women at the ACI returned from the community infected with HIV. The numbers are much higher for hepatitis: 34 percent had HBV, and 36 percent had HCV. Nine women (2.2 percent) had HTLV I/II. Because of these results, colleagues of Macalino recently received a grant to evaluate the feasibility of hepatitis B vaccines in prison. Macalino anticipates that transmission rates within the prison will be much less than on the outside. Any positive results will indicate to the ACI administration that education and prevention should be an essential component of their staff training and inmate health-education programs. In an interview for the article, Macalino expressed appreciation for the ACI Medical Director Anne Spaulding who has recently stated that it is "better to know than not to know" the transmission rates within prison. Macalino said "My frustration is that you hope that you're going to make changes [but it is not a guarantee]. This is a high risk-population -a hidden population. They are not going to be in most studies or accessing care, and there is a chronic history of feeling overlooked and mutual distrust." Yet, Macalino is optimistic that research is possible with corrections, provided that researchers establish open communication and awareness among all interested and involved staff and inmates. "Seaweed Derivative Could Prevent HIV Infection: Researcher" Australian Associated Press (10.09.01)::Rada Rouse Dr. Peter Kilmarx of the CDC is coordinating early trials of a microbicide called Carraguard that is derived from the seaweed Chrondrus crispus. "This seaweed is used already in foods and cosmetics and has been shown in animal studies to have no significant problems of irritation," Kilmarx said. Studies showing that women are at risk of HIV because of their husband's extramarital sexual activities indicate the urgent need for female-controlled prevention, he said. According to US clinical researcher Professor Ken Mayer, about 50 different chemical cocktails are being studied worldwide for their potential ability to kill sexually transmitted infections, including HIV, but only four are ready for human trials. "The likelihood is that at least in the next few decades, even if we have a vaccine or a safe microbicide, neither is going to be 100 percent effective, so I think you probably want to have both on board, given how serious HIV is," Mayer said. "Women's empowerment is a very important aspect because if you had a product that a woman could use without her partner knowing it, it would be a way to slow down the progress of this epidemic globally," said Mayer, a professor at Brown University in Providence, R.I. Yet despite the urgent need for a topical gel or cream to fight HIV and STDs, the impetus to develop them comes from small biotech companies, private foundations and public research facilities, with little interest from multinational pharmaceutical companies, Mayer said. Megan Gottemoeller of the Global Campaign for Microbicides said that in the United States, microbicide research received only 1 percent of the overall public AIDS research budget. However, a bill recently introduced in Congress provides for the establishment of new microbicide research programs at the CDC and the National Institutes of Health. The microbicide movement was dealt a setback when poor trial outcomes resulted in the abandonment of the compound N-9. But four other compounds appear promising, including a gel that keeps the acidity of the vagina so low it is toxic to HIV, and a family of compounds that work by inhibiting HIV from binding to cells. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "$300,000 Awarded to AIDS Agency" Houston Chronicle (10.04.01)::Patrick Reynolds A local community residence for low-income individuals with HIV/AIDS has gotten a financial boost from the Houston City Council. Stevens House received almost $300,000 in federal funds through a Housing Opportunities for Persons with AIDS grant. Stevens House has operated since 1992, helping HIV-positive patients live independently. Councilman Jew Don Boney, who spearheaded the grant, said the funds continue the support the city of Houston has provided the agency since 1996. Stevens House officials say they offer more than just a place for HIV-positive patients to stay. "Coming here is the first step low-income people with AIDS can take to get back on their feet and into an independent living situation," said Wanda Carrington, executive director for Stevens House. "It gives them a chance to lead independent lives again." Besides offering a bed and three meals a day, the center encourages and assists its patients finding jobs, seeking proper medical attention and returning to normal lives. The center offers referrals to local medical centers, provides transportation for the patients, and sets up medication regimens and diet training for patients. Stevens House also offers vocational training and GED instructors. Stevens House was founded in 1992 by an anonymous Roman Catholic Priest who had a friend named Steven dying of AIDS. "The priest had no place to take Steven and thought it was time the Houston area had such a place," Carrington said. "That's how the center came to be. And since then, we've had a 68 percent success rate, as far as leading our patients into a position to live independently again." The grant will provide $298,000 over a two-year period. ************************************************************ NEWS BRIEFS ************************************************************ "Clinton at Yale: Optimistic on Crisis, But Work is Ahead" New York Times (10.14.01) Former President Bill Clinton wrapped up Yale University's yearlong 300th birthday celebration with an Oct. 6 speech on globalization. Summing up what optimists would say about the 21st century, as well as what a pessimist or a "designated worrier" might say, Clinton included in the latter concerns about a world engulfed by a health crisis. "This year one in four people in the world will die of AIDS, TB malaria or infections related to diarrhea. Thirty-six million people will have AIDS within five years. The fastest- growing rates are in the former Soviet Union on Europe's back door, and in the Caribbean on our front door, and in any of the world's greatest democracies. And China just admitted they have twice as many AIDS cases as they had previously thought. And only 4 percent of the adults know how the disease is contracted and spread. You could say when we have 100 million AIDS cases it will collapse a lot of these democracies, and it is a recipe for total turmoil and violence." "More Adolescents Abstaining from Sex" Washington Times (10.14.01)::Kim Folstad A report from the CDC entitled "The Cautious Generation?" indicates that more high school students are graduating as virgins now than did a decade ago. Half of the teens surveyed for the National Campaign to Prevent Teen Pregnancy's 2000 report said the main reason not to have sex is the fear of pregnancy and STDs. Eighty-seven percent of those who took part in "The Cautious Generation?" surveys said they don't think it is embarrassing for teens to admit they are virgins. According to the latest data from the CDC's National Center for Health Statistics, teen pregnancy rates declined to a record low in 1997. "AIDS 10K Walk Pulls More Than $1 Million" Atlanta Constitution (10.15.01)::Dana Tofig On Sunday, thousands of walkers turned out for the annual AIDS Walk Atlanta. The walk raised more than $1 million, according to organizers, and will benefit AID Atlanta and 14 other metro area AIDS service and education providers. Last year, the event raised $1.4 million. "I don't think we could have picked a more difficult economic environment," said Tony Braswell, executive director of AID Atlanta.