Subject: CDC AIDS Daily Summary for Date: Thu Oct 18 12:31:02 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 "US, Mexico Team up on Health Care" INTERNATIONAL NEWS "South Africa; Denial Won't Make Child Sex Tourism Go Away, Conference Told" "'Don't Forget to Fight AIDS, Poverty': UN Envoy Stephen Lewis Says Terrorist Attacks Should Not Blind People to Other Issues" "Cambodia Takes Measures Against HIV/AIDS" "Action Is Needed to Stop Heroin Epidemic" MEDICAL NEWS "Retaining Hard-to-Reach Women in HIV Prevention and Vaccine Trials: Project ACHIEVE" LOCAL AND COMMUNITY NEWS "Face of AIDS is Growing Older in Tarrant" NEWS BRIEFS "Augusta Rally to Focus on AIDS Program Funds" "More Cancer Drugs Found to Be Diluted" "Fans Welcome Guillen Back After TB Scare" ************************************************************ NATIONAL NEWS ************************************************************ "US, Mexico Team up on Health Care" Los Angeles Times (10.17.01)::James F Smith The United States and Mexico this week took some imaginative steps to combat health problems -including TB, diabetes and AIDS -that plague border communities and migrant workers. Meeting in El Paso, Texas, and neighboring Ciudad Juarez, Mexico, health experts from the two nations agreed on a 10-year agenda for improving care for the 11.5 million people who live along the nearly 2,000-mile border. As part of the program, Mexico unveiled its "Go Healthy, Return Healthy" initiative, and California and Mexico kicked off their first joint "health week." A commission study issued Monday found that rates of communicable diseases such as TB, HIV/AIDS and hepatitis A are higher in the border region than they are nationally for both countries. Cancer, asthma and diabetes rates are also higher along the border. A workshop of about 100 TB experts met to map out cross-border approaches to tracking and caring for patients. The interruption of TB treatment -which can lead to resistance to medication -occurs frequently when ailing migrants cross illegally into the United States. The workshop focused on the development of a binational TB card that would allow patients to continue confidential treatment on either side of the border. US Health and Human Services Secretary Tommy Thompson and Mexican Health Secretary Julio Frenk visited several sites that symbolize their nations' emerging cooperation. These included the La Fe health clinic in South El Paso, which treats many AIDS patients, and a US Food and Drug Administration inspection operation. Both countries agreed in September to expand cross- border food safety operations. Frenk said that in the past, Mexico did not clearly understand the differences between treating stable and migrant populations. The new program acknowledges that migrants carry health problems with them as they leave home, and they bring ailments like AIDS with them when they return from the United States. Thompson told the US delegates he would try to come up with an additional $25 million for border health projects if they would come up with specific, effective ways to spend the money. ************************************************************ INTERNATIONAL NEWS ************************************************************ "South Africa; Denial Won't Make Child Sex Tourism Go Away, Conference Told" Africa News Service (10.17.01) "Every now and then an issue comes up that polarizes people and gets labeled controversial," Western Cape social services Director Sharon Florentine said Tuesday at the conference "Sex Tourism, Myth or Reality" in Cape Town, South Africa. "I'm reminded of our reaction to HIV/AIDS. The delay in dealing with it is costing us dearly as it decimates the population, changes family structure and reverses any developmental gains made." Despite calls to acknowledge the problem, the conference has been marred by the decision of high-level government members not to attend. On Tuesday, Deputy Defense Minister Nozizwe Mdlala- Routledge cancelled her appearance as keynote speaker. Five years after the government committed itself to the Stockholm Congress against the commercial sexual exploitation of children, it has still not translated the agenda into action. Evidence of child prostitution is on any main road in any big city in South Africa. "Child sexual exploitation is an open secret," said Virginia Petersen, superintendent general of social services in the Western Cape. Factors contributing to the increase are growing tourism, fear of HIV, availability of children, the impunity of sex offenders and poverty. "Men who fear diseases, especially HIV, are turning to children in the belief they are less likely to be infected," said researcher Karin Koen. Joan van Niekerk, chairwoman of Childline South Africa, who also sits on the Law Commission, said it would take more than changes in the law to eliminate child prostitution. "Some significant role-players are absent and NGOs [nongovernmental organizations] carry the burden -we struggle to get politicians and government departments involved," she said. "Children orphaned by HIV, from 12 to 16, are supporting their younger siblings and friends through prostitution. There is nothing else for them," van Niekerk said. "'Don't Forget to Fight AIDS, Poverty': UN Envoy Stephen Lewis Says Terrorist Attacks Should Not Blind People to Other Issues" Vancouver Sun (10.16.01)::Glenn Bohn Canada's former ambassador to the UN, Stephen Lewis, urged Canadians on Monday not to forget global issues like AIDS and poverty after responding to the victims of terrorist attacks in the United States. Lewis, now a UN special envoy for HIV/AIDS in Africa, was speaking before an international conference on charitable foundations and was not critical of the public's response to the attacks. "People were overwhelmed and wanted to respond," Lewis said of the $850 million raised for the families of the victims, about 10 times the money raised in the 1980s for hundred of thousands of Africans then suffering from famine. "It spoke to the most elemental and decent human instincts," he added. "What we have to do is ensure it doesn't get totally distorted, and that we remember the human needs and imperatives that exist out there in the world," Lewis said. His address earned a standing ovation. Later in an interview with UPI, Lewis suggested that government should be spending more money on the problems the public neglects in the aftermath of Sept. 11. He said that he had "begged" the United States administration for its $200 million contribution to a global trust fund on health and AIDS. "But within 24 hours, $40 billion had been requisitioned to respond to the tragedy," in New York and Washington, D.C. "It isn't that money isn't available for the imperatives of this world. It's just that we have to remind people there are other things going on." "Cambodia Takes Measures Against HIV/AIDS" BERNAMA (Malaysian National News Agency) (10.15.01) Specialists of the UN Development Programme (UNDP) Southeast Asia HIV and Development Project have warned that Cambodia still remains one of the world's most HIV/AIDS-affected countries. This is true despite the fact that the estimated prevalence among adults ages 15 to 49 has shown a steady decline from 3.9 percent in 1997 to 2.8 percent in 2001. It is estimated that of the 11 million people in the country, there are about 200,000 people with HIV/AIDS, and this number is expected to grow quickly in the next five years. The epidemic is largely due to heterosexual intercourse, with men bringing infection from prostitutes to their wives, according to reports from the National AIDS Authority (NAA) and non- governmental (NGO) organizations in the country. Two percent of Cambodian women who had blood tests and pregnancy checkups were infected with HIV/AIDS, and 4,000 babies had the virus. As many as 30,000 children have HIV, and about 200 children die of the disease annually, reports indicated. The NAA, joined by the UNDP Southeast Asia HIV and Development Project have studied the heavily affected areas along major highways, National Routes One and Five that link neighboring countries in the Greater Mekong Sub-region. In response to the epidemic, the NAA was set up in 1999 to strengthen policy, consolidate structures and functions for response and to mobilize resources nationally and internationally. It plans to actively work on raising public awareness of HIV transmission, to educate local people, and to launch, with provincial authorities, the 100 percent condom use programs, which will be expanded to the public nationwide. Cambodia has drafted a National Strategic Framework for a Comprehensive and Multi-sectoral Response to HIV/AIDS 2001-2005. The government has asked related departments to pay attention to increasing respect for the rights and status of women and girls, as well as encouraging men and boys to engage in safer sexual behavior. "Action Is Needed to Stop Heroin Epidemic" Belfast News Letter (10.18.01)::Ross McKee The author of a new report on the experiences of heroin users in Northern Ireland has warned that her recommendations need to be acted upon to stop "an epidemic of heroin and HIV" emerging there. Dr. Karen McElrath of Queens University, whose report follows a two-year study based on interviews with 43 current or former heroin users, wants to see an increase in access to clean needles, expansion of treatment and support services, and effective outreaches to deal with the heroin problem. "It is still very difficult to get clean needles here, and we don't have a lot of treatment on hand," McElrath said. "These treatments need to be in place to stop it becoming a heroin and HIV epidemic. ... We have seen HIV spread everywhere." The vast majority of the 43 users surveyed had injected their heroin at one time, and many did so regularly. The report said that the limited supply of needles and the cost of purchasing them contributed to a number of risk behaviors and other health consequences. Some respondents were unwilling to approach general practitioners or were unwilling to be tested for HIV and other infectious diseases for fear they would be identified as drug users. Other believed the doctors lack knowledge about heroin, addiction and hepatitis C. David Warwick, who counsels addicts at the Together project in Ballymena, said it was of great concern that the injectors in McElrath's study had engaged in various activities that posed considerable risk for HIV and other infectious diseases. "It's a big risk with dirty needles and sharing needles. We have done some strong pressing for needle exchanges. There is also sexual relationships where HIV can be picked up." ************************************************************ MEDICAL NEWS ************************************************************ "Retaining Hard-to-Reach Women in HIV Prevention and Vaccine Trials: Project ACHIEVE" American Journal of Public Health (09.01) Vol 91; No 9: P 1377- 1379::Pamela Brown-Peterside, PhD; Evelyn Rivera; Debbie Lucy, MS; Izzie Slaughter, MPH; Leigh Ren, MS; Mary Ann Chiasson, DrPH; Beryl A Koblin, PhD Finding a preventive vaccine for HIV will mean asking people at high risk for HIV infection to participate in vaccine efficacy trials. Although vaccine preparedness studies indicate that high- risk cohorts are willing to participate in trials, many women at risk for HIV infection in the United States are poor and disenfranchised and are confronted with life issues that can interfere with their ability to adhere to scheduled study visits. To ensure broad participation in clinical trials and other cohort studies by those at high risk for HIV infection, successful retention strategies are needed. From April to September 1998, Project ACHIEVE's South Bronx site enrolled 164 HIV-negative women, ages 18 to 60, in a vaccine preparedness study as part of a larger multisite study. To qualify as being at high risk of HIV infection, each participant had to meet 1 or more of the following criteria: have a current male sex partner who is HIV-infected or an injection drug user; or in the past year have smoked crack, exchanged sex for money or drugs, had 5 or more male sex partners, or had an STD. Recruitment strategies included street outreach, newspaper ads, flyers, posters and tabling in clinics and at health fairs. At enrollment, most of the women were poor; half of them reported 5 or more partners or exchanging sex for money or drugs, and two- thirds had smoked crack in the preceding year. At the initial visit, informed consent and locator information were obtained, eligibility was confirmed, vaccine trial information was provided, willingness to participate in vaccine trials was assessed and sexual and drug history interviews were conducted. Women were counseled and tested for HIV. Participants returned two weeks later. Those who tested positive were referred to primary care. Those who tested negative were enrolled in the study and returned to the clinic for further counseling and testing every 6 months for 1 year. Referrals for social services were provided when needed. Three months after enrollment, researchers were able to contact 98 percent of the participants. Six months into the study, 96 percent of enrollees completed study visits. At the 9-month contact point, researchers reached 96 percent of the participants. At the 12-month visit, 92 percent of enrollees completed their study visits; 88 percent completed both the 6- and 12-month visits. At each visit, women were reimbursed for their time ($20), given a $3 Metrocard to cover roundtrip public transportation, and offered male and female condoms and small gifts. The counseling that women received was part of the researchers' approach. It offered the participants support to cope with difficulties in their lives and may have helped them keep their appointments. Retention support for this population requires at least 1 full-time staff member who focuses on retention; financial support for home visits, and a computerized tracking system. The efforts reported are purely descriptive; in the absence of a comparison group, the researchers have no way of knowing which specific strategies contributed to retention. Furthermore, the research is based on a vaccine preparedness study, not on participation in an actual vaccine trial. The researchers' findings suggest that high-risk women who are living in poverty can be successfully retained in HIV vaccine trials. Preconceived ideas about retention should not lead to the exclusion of hard- to-reach populations from HIV vaccine or other prevention trials, according to the study. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Face of AIDS is Growing Older in Tarrant" Fort Worth Star-Telegram (10.17.01)::Mitch Mitchell Joseph Manuel assumed that he would never get AIDS. He was older than 40, white, middle class and heterosexual. He didn't belong to any demographic groups targeted for safer sex messages. He might have worn a condom had he been 10 years younger, Manuel said. Like others his age, Manuel believed that he was safe as long as he had sex within his peer group. So when Manuel learned in April 1998 that he had AIDS, he was surprised -as was his girlfriend. "She went ballistic," said Manuel, 44, of Fort Worth, Texas. "Now we don't even speak anymore." When Manuel found out that he had AIDS, he was sure that he would die. He spent more than six hours a day hooked to an IV next to cancer patients having chemotherapy at John Peter Smith Hospital in Fort Worth. Increasingly, new AIDS patients in Tarrant County, Texas, are older than 40 and middle class, public health experts say. They are older and sicker at diagnosis than in the past, said Elvin Adams, an AIDS outreach center physician with Tarrant County Health Department. Department figures indicate that in 1993 about 26 percent of the new AIDS diagnoses were among patients 40 and older. By 2000, that number increased to 45 percent. During the same period, the number of newly diagnosed AIDS patients age 50 and older increased to 10 percent from 7 percent. "There certainly are not enough educational programs directed at older people to make them aware that they are at risk of getting this disease," Jane P. Fowler said, national coordinator of the National Association on HIV over Fifty. "That younger doctor is sitting across the desk from someone who looks like his grandmother, and they don't point out the risks." ************************************************************ NEWS BRIEFS ************************************************************ "Augusta Rally to Focus on AIDS Program Funds" Bangor Daily News (10.17.01) The Eastern Maine AIDS Network (EMAN), in conjunction with other AIDS service organizations throughout Maine, will hold an informational rally from noon to 4 p.m. Oct. 24 on the steps of the Capitol in Augusta. "State funding for HIV prevention and programs serving those living with HIV has remained level without even inflationary cost increases for nearly a decade," said Denis Cranson, executive director of EMAN. "This funding level -added to the recent slowdown on instituting the Medicaid Waiver program as well as caseload increases of up to 350 percent -has had a negative impact on HIV-related programs and services in Maine." For information, telephone 207-990-3626. "More Cancer Drugs Found to Be Diluted" Associated Press (10.18.01) Two more cancer drugs were found to be diluted at a Kansas City, Mo., pharmacy where a drug-tampering investigation is being conducted, the FBI said Wednesday. Pharmacist Robert Courtney, 48, has pleaded innocent to 20 counts of tampering, adulterating and misbranding the chemotherapy drugs Gemzar and Taxol. Tests conducted by the FDA on the drugs Nupogen and Interferon found the drugs to be diluted as well, the FBI said Wednesday. Both drugs also are used to treat leukemia, while Nupogen has also been used to treat AIDS. Courtney is being held without bond. His trial is scheduled for Feb. 4. "Fans Welcome Guillen Back After TB Scare" Atlanta Constitution (10.18.01) Seattle Mariners Carlos Guillen was greeted by the song "Welcome Back" and a standing ovation as he stepped to the plate for the first time in three weeks. Diagnosed with pulmonary TB 19 days earlier, Guillen started as shortstop Wednesday and batted second in the opener of the American League Championship Series against the Yankees. "I feel like a new guy. I feel better than I felt for three, four months. I feel 90 to 100 percent," said Guillen, 26. Mariners Manager Lou Piniella said, "He's a tough kid. He played with TB for probably a good while and never complained." The Yankees won the game, 4-2.