Subject: CDC AIDS Daily Summary for Date: Tue Oct 16 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 "Study: HIV Patients with Case Managers Have Fewer Unmet Needs" "Experts Fear a Risky Recipe: Viagra, Drugs and HIV" "Many Lack Gynecological Care" INTERNATIONAL NEWS "AIDS: #1 Killer Inside City Prisons" "AIDS Orphans Forced into Life on the Streets" MEDICAL NEWS "Extra-relational Sex Among Mexican Men and Their Partners' Risk of HIV and Other Sexually Transmitted Diseases" LOCAL AND COMMUNITY NEWS "Garden City Man Travels Southwest Kansas Fighting HIV" NEWS BRIEFS "A Look at Bills Signed and Vetoed by Gov. Gray Davis" "Tuberculosis Case Leads to Testing of Some SLU Students" "Unprotected Sex More Common in Taiwan than in Other Asian Nations" ************************************************************ NATIONAL NEWS ************************************************************ "Study: HIV Patients with Case Managers Have Fewer Unmet Needs" Associated Press (10.16.01)::Joann Loviglio HIV-infected adults with case managers who help coordinate their health care had fewer unmet needs and higher use of HIV medications, according to a study in today's issue of Annals of Internal Medicine (October 16, 2001; 135 (8): 557-565). The study reported on 2,437 HIV-infected adults who visited inpatient and outpatient medical facilities in 52 urban and rural areas in 1996 and 1997. After looking at the patients at the start of the study and again six months later, researchers found that nearly 66 percent of those without case managers had needs that were not met -nearly 10 percentage points higher than the level of unmet needs for patients who had case managers. Patients with case managers were more likely to get income assistance, health insurance, emotional counseling, substance abuse treatment and other care. They also were more likely to get medicines like drug combination therapy and protease inhibitors, a factor that the study's lead author Dr. Mitchell H. Katz said he found "startling." The study noted that an increasing number of people with HIV are living in poverty and need both support services and medical care, making the role of case managers particularly important for doctors and patients. Still, the study noted that just 56 percent of HIV patients had case managers and that more funding is needed to get assistance -and medications -to where they're needed. "Unless funds increase, we'll have to put new clients on a waiting list or discharge existing clients," said Kevin R. Conare, executive director of Action AIDS, Philadelphia's largest provider of HIV case management services. In a related editorial, also in today's Annals, Conare and Dr. William C. Holmes of the University of Pennsylvania School of Medicine said that case management services for HIV-infected people are at risk if federal funding is not increased. Most money now comes from the federal Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. The Bush administration's fiscal 2002 budget froze the program's funding at $1.8 billion -the same amount as 2001. Holmes said the program needs $300 million more. "Experts Fear a Risky Recipe: Viagra, Drugs and HIV" New York Times (10.16.01)::David Tuller Like many straight men, many gay men are using Viagra as a remedy for erectile dysfunction. But surveys disclose that many gay Viagra users are taking it along with Ecstasy and other illegal drugs, leading some HIV educators to fear a rise in unprotected anal intercourse. And, when combined with the nitrite-based "poppers" some gay men inhale to heighten sensations during sex, Viagra can cause dizziness, strokes or heart attacks. In a recent survey of men visiting a San Francisco STD clinic, 32 percent of gay respondents had used Viagra in the past year, compared to just 7 percent of straight men. The gay men who used Viagra reported having had more recent sexual partners than the gay men who did not use it, and they were more likely to have an STD currently. Thirty percent of gay HIV-negative Viagra users reported having had unprotected anal sex with HIV-positive men or with men of unknown HIV status, compared to just 15 percent of gay HIV-negative men not using Viagra. More than half the gay men had obtained Viagra from a friend instead of a doctor. Dr. Jeffrey Klausner, director of STD prevention at the San Francisco Health Department, said that some gay men use Viagra to counteract the effects of speed, which can cause erection difficulties. "Viagra can turn people with chemically induced erectile dysfunction into more effective transmitters of HIV and other STDs," he said. Still, it is unclear whether Viagra use leads to risky behavior or whether those who engage in risky sex are more likely to use Viagra. And some Viagra advocates suggest that it may actually reduce HIV transmission by making it easier to maintain an erection while wearing a condom. Klausner said he hoped the San Francisco survey's results would help persuade Viagra-maker Pfizer to create educational campaigns about the drug's use and abuse. A Pfizer spokesperson said he did not know whether the company would pursue a gay- oriented ad campaign. "Our position to not use Viagra for recreational purposes is well-known, but any pharmaceutical product can be abused," he said. "Many Lack Gynecological Care" Los Angeles Times (10.15.01)::Linda Marsa More than half of American women avoid going to the gynecologist, a national survey has found, largely due to lack of insurance, lack of money, or language or cultural differences with their physician. According to the American Social Health Association, which conducted the poll, these results have alarming implications. STDs, such as chlamydia and gonorrhea, often cause no symptoms but can be easily detected by routine tests. Up to 40 percent of women with untreated chlamydia or gonorrhea develop pelvic inflammatory disease (PID), a serious infection that can scar Fallopian tubes and result in infertility. Similarly, HIV doesn't have obvious symptoms initially; and a seemingly innocuous infection such as vaginitis can be an early sign of diabetes. In a telephone poll of 1,948 African-American, Latina and white women across the country, one out of four admitted they had not received a routine gynecological exam in the last year, and an additional 28 percent said they don't get annual examinations. The biggest barrier was cost and lack of insurance (24 percent). Other obstacles cited included language and cultural differences (20 percent), discomfort with their physician (20 percent), fear of diagnosis (14 percent) and embarrassment (10 percent). "Cultural fears and taboos play a role, too," says Dr. Luis N. Pacheco, medical director of the California Hospital Medical Center in Los Angeles. "In the Hispanic community, some women believe that they'll lose their virginity if they get a gynecological exam. And certain Middle Eastern cultures frown upon male physicians performing gynecological exams." ************************************************************ INTERNATIONAL NEWS ************************************************************ "AIDS: #1 Killer Inside City Prisons" NewsMexico.com (10.08.01) AIDS has become the biggest killer of prison inmates in Mexico City, the Mexican daily paper Milenio reported. Enoe Uranga, president of the city's Human Rights Commission, visited the Santa Martha penitentiary in April and found deplorable medical conditions and inadequate facilities. "There were HIV- positive inmates that had gone without medical treatment for over a month, in addition to unsanitary conditions ... the HIV victims were in very bad shape," she said. Last year 20 inmates died of AIDS-related illnesses, superceding the number of deaths due to violence. The number of prisoners infected with the virus is unknown and could very well reach into the hundreds. A prison official estimated the number to be around 440; the overwhelming majority of prisoners with HIV are not registered as HIV-positive with prison medical personnel. "There is an epidemic of under-registration, which is why the number of known cases does not reflect the actual number of infected. There are many who get sick and are taken to hospitals where they die without ever receiving treatment in the prison clinics," said Herbierto Zaragoza Garcia, coordinator of the HIV/AIDS program in the city's prisons. Official prison statistics show 46 registered cases of HIV/AIDS in the city's prisons; all but four patients are male. "AIDS Orphans Forced into Life on the Streets" Agence France Presse (10.09.01) The Save the Children fund announced last week that more than 13 million children under age 15 have lost one or both parents to AIDS in the 20 years of the epidemic. Speaking in Australia before the 6th International Congress on AIDS in Asia and the Pacific, the charity told conferees that many orphans end up in prostitution or living a squalid existence on the streets. According to Save the Children adviser Douglas Webb, the number of Asian children orphaned by AIDS could rise sharply as larger numbers of children survive thanks to new medical care that prevents transmission of the virus from mother to their infants. "We are likely to see a disproportionate rise in the number of orphans in this region compared to sub-Saharan Africa," Webb said. The fund's report said that of the estimated 36.1 million people living with HIV/AIDS worldwide, 1.4 million were children under the age of 15, and about 210,000 were children in South and Southeast Asia. The report also gave a chilling picture of child neglect. In India, it reported that 4 million children live on the street. One study indicated that of 1,000 children found, 250 had acquired an STD within nine months of living on the street. In Cambodia, children as young as four have been trafficked to Thailand and forced to live for years working for a pittance, or discovered to have been raped or forced to have sex. In Indonesia, a study of 250 male street children from East Jakarta age 10 and over found that 22 percent had sex experience. Over 85 percent had never used condoms. One third of the children used illicit drugs, 20 percent sniffed glue and 49 percent drank alcohol. ************************************************************ MEDICAL NEWS ************************************************************ "Extra-relational Sex Among Mexican Men and Their Partners' Risk of HIV and Other Sexually Transmitted Diseases" American Journal of Public Health (10.01) Vol 91; No 10: P 1650- 1652::Julie Pulerwitz, ScD; Jose-Antonio Izazola-Licea, MD, ScD; Steven L Gortmaker, PhD Predominant global AIDS prevention strategies encourage monogamous sexual relationships. However, this strategy has been inadequate for many women. Women's main risk for HIV and other STDs is often their male partners' sexual behavior, and negotiation of safer sex is frequently controlled by men. The current investigation explored the risk of HIV and other STDs among married and cohabiting women in Mexico by estimating the prevalence of men's sexual behavior outside of their primary relationships. A multistage, stratified probability household survey was conducted in the Mexico City, Mexico, metropolitan area from June 1992 to March 1993 by the National Council for Prevention and Control of AIDS (CONASIDA), at the Mexican Ministry of Health, and the Population Council. Face-to-face interviews were carried out with a 25-minute structured survey. Of 13,713 eligible men, 8,600 men were contacted in person, and only 532 (6 percent) refused to participate, for an overall response rate of 59 percent (n=8,068). Analyses indicated no evidence for bias because of non-response or underreporting. The analysis was restricted to men ages 17 to 60 years who had been married or cohabiting for at least one year and who were sexually active with their wife or cohabiting partner during the year before the survey (n=4,099). Thirty-seven men had been eliminated from the analysis because they reported sex with a secondary partner only. Men who did not supply an answer for the outcome variable extra- relational sex (n=7) or other variables used in the multiple regression analysis (n=102) were removed from the analysis. The final sample size of 3,990 constitutes 97 percent of the originally specified sample. Extra-relational sex was defined as intercourse with more than one female partner during the year before the interview. Respondents ranged in age from 17 to 60 years (mean=37 years). Eighty-eight percent were married, 31 percent had a primary-school education or less, and 42 percent had at least some university education. Almost half (41 percent) of the respondents were blue-collar workers, and the other half (52 percent) were white-collar workers. Fifteen percent of the married and cohabiting Mexican men reported extra-relational sex. The number of extra-relational partners ranged from 1 to 30. Only three men reported any same-sex sexual behavior during the past year (prevalence=0.1 percent). Of the men who reported extra- relational sex, 28 percent stated that their last sexual partner had been other than their wife or cohabiting partner. Nine percent of the men who reported extra-relational sex indicated that they used a condom during their last intercourse -22 percent if their last sexual partner was a secondary partner and 4 percent if she was the primary partner (P<.001). Condom use rates varied among categories of secondary partners (P<.05). Although few men reported engaging in anal sex during their last sexual activity (n=17), none of these respondents reported using condoms. Condom use was uniformly low across all sociodemographic strata, but a higher education level was associated with condom use with a primary partner, and a white-collar occupation was associated with condom use with a secondary partner. This investigation explored the degree to which married and cohabiting women in Mexico may be exposed to HIV and other STD risk via the sexual behavior of their male partners. Fifteen percent of the total sample of married and cohabiting men in the Mexico City metropolitan area reported extra-relational sex, so almost 250,000 married and cohabiting men are estimated to have sex with secondary partners over 1 year. If only 5 percent of these men are exposed to an STD, including HIV, and transmit it to their primary partners, more than 10,000 wives and cohabiting partners could be infected each year. It would be possible to protect primary partners, with whom almost no condom use was reported in this study, if condoms were always used with secondary partners. However, findings indicated that condom use rates with secondary partners also were low: less than 25 percent. The combination of substantial amounts of extra- relational sex, minimal condom use, and lack of perceived HIV risk indicates that HIV and other STD prevention efforts that take into account the social context of these risky behaviors are required. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Garden City Man Travels Southwest Kansas Fighting HIV" Associated Press (10.09.01) Determined to help prevent the spread of HIV/AIDS among Latinos in southwest Kansas, Arturo Ponce travels to cantinas in Dodge City, Garden City, Ulysses, Hugoton, Satanta, and Liberal - places he says he'd never otherwise go. "There are too many male Latinos who share old fashioned beliefs that they are macho men. It won't happen to them. AIDS only affects white male homosexuals," Ponce said. "But AIDS is growing in the Latino community because the people aren't being educated." His weapons are condoms, bleach kits, clean syringes and pamphlets explaining the dangers of unprotected sex. Ponce distributes safe sex kits that include a card with his name and the address and phone number of United Methodist Western-American Ministries, where he works as the Latino AIDS Program Coordinator and Health Educator. Ponce's organization works with the Kansas Department of Health and Environment (KDHE) and the Western Kansas AIDS Response Effort to reach the public about STDs. According to KDHE, in 1999, there were 59 cases of AIDS reported in the 24 counties of southwest Kansas. Ponce says there currently are 34 cases of HIV in Finney County alone. "I believe the most important point is prevention. But people are still having unsafe sex and reusing syringes," he said. "So we have to present tools to prevent the spread of disease." Often, when he's not handing out the safe sex kits, Ponce leaves them on bar counters in bowls, like peanuts. Ponce said he gets calls and drop-in visits from people who have picked up the packets. They arrive at his office wanting a confidential HIV antibody test or answers to questions. The tests and counseling are kept confidential. The anonymity has helped Ponce carry out his work with many in the community who could be at risk for HIV and other STDs. "I have counseled several of them who were worried that they might be carriers of AIDS. I know it's hard for them to come here to have the blood test done, they want confidentiality. We provide that." ************************************************************ NEWS BRIEFS ************************************************************ "A Look at Bills Signed and Vetoed by Gov. Gray Davis" Associated Press (10.16.01) Bills signed included -Domestic Partners: Provides many of the same rights enjoyed by married couples to 16,000 registered gay, lesbian and senior domestic partners. Bills vetoed included -AIDS: Budgets $3.1 million to expand AIDS prevention instruction to include prevention of sexually transmitted infections. "Tuberculosis Case Leads to Testing of Some SLU Students" St. Louis Post-Dispatch (10.16.01)::Jennifer LeFleur A student at St. Louis University contracted TB in the first week of October and was hospitalized. The student, who did not live in a campus residence hall, has since gone home. Students who may have come into contact with the patient have been notified that they need to undergo a tuberculin skin test. Last week, St. Louis Health Commissioner Melba Moore ordered that a city marshal be posted outside the man's hospital room to make sure he did not leave against medical advice. "The measures that were taken were routine," Moore said. "Unprotected Sex More Common in Taiwan than in Other Asian Nations" Deutsche Presse-Agentur (10.14.01) More people in Taiwan have unprotected sex than anywhere else in Asia, local media reported on Sunday. About 14 percent of sexually active Taiwanese use no contraceptive methods, resulting in the highest pregnancy rate in Asia. An average of two people on the island contract HIV each day, and between 320,000 and 400,000 abortions are performed each year. The data were quoted from the 2001 Durex Global Sex Survey conducted annually by the condom maker.