Subject: CDC AIDS Daily Summary for Date: Fri Oct 19 11:31:01 PDT 2001 (340 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 "Volunteers Give the Peace Corps a Chance" INTERNATIONAL NEWS "Bombing Aftermath -Health Specialists Fear TB Outbreak" "Asian Governments Approve Plan Against Child Sexual Exploitation" "Free Distribution of Needles Reduces Spread of AIDS in Brazil" "European Regulators Approve Gilead AIDS Drug" MEDICAL NEWS "HIV Highly Contagious Before Symptoms Show: Study" LOCAL AND COMMUNITY NEWS "A Model Example: Rebekka Armstrong, Former Playboy Playmate Turned HIV Activist" NEWS BRIEFS "Fears over Teen Sex -Tenfold Increase in Young Suffering from Diseases" "Malawi: Doctors Shun HIV Tests" "A Case of Security vs. Liberty in Bremerton" ************************************************************ NATIONAL NEWS ************************************************************ "Volunteers Give the Peace Corps a Chance" Christian Science Monitor (10.17.01)::Nicole Itano As the Peace Corps celebrates its 40th birthday this year, the stereotypical left-leaning, 20-something idealist who defined the corps for many years is giving way to a new type of volunteer: middle-age, mid-career individuals who want a break from life in the fast lane, and retired professionals like Mary Jo Reimer. Three months ago, Reimer abandoned her comfortable life as a hospice nurse in Los Angeles to spend two years as a Peace Corp volunteer at a South Africa home for street children and HIV-positive orphans. Her mission is to turn Peace Haven, founded 10 years ago, into a financially viable nongovernmental organization (NGO). These older volunteers, a few of whom are in their 80s, bring new skill sets and attitudes to the corps, and they are changing the kind of work it does. Their involvement is making possible new programs, like Reimer's, that help build local institutions. Reimer has a background both in AIDS and accounting and was considered a perfect fit for her new job. She is part of a pilot program that is working to help make small AIDS NGOs - many of which were founded by people with little or no experience running such organizations -into sustainable projects. The new corps program is important because it is helping the government provide better, more cost-effective health services through community-based organizations, said Edith Harrington, deputy director of health in Mpumalanga Province, where an AIDS project is operating. "The AIDS epidemic is starting to really strain our capacity," she said. "We cannot cope with the patient load in the hospitals, and, as long as people can be taken care of in the community, that's what we would like to see happen. The Peace Corps is helping to make sustainable the kinds of organizations that can provide these services." Yvonne Hubbard, country director for the Peace Corps in South Africa, said programs like the Mpumalanga AIDS project are made possible largely because of older volunteers with years of professional experience -like Reimer -who bring with them vital skills. Community members, she added, are often more receptive to elders, who are accorded respect in South African society. About 10 percent of volunteers are now over age 50, and another 15 percent are in their 30s or 40s. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Bombing Aftermath -Health Specialists Fear TB Outbreak" Boston Globe (10.19.01)::John Donnelly World health officials are increasingly concerned about possible outbreaks of TB in Afghanistan and Pakistan following the US-led bombing campaign, prompting calls yesterday for a plan to monitor the health of refugees and displaced people in the region. Pakistan and Afghanistan are among the world's top 20 countries in TB cases. A relatively high proportion of the estimated 150,000 cases reported each year in Pakistan are resistant to most commonly used drugs, which complicates treatment regimens. The World Health Organization (WHO) and the World Bank will host a meeting in Washington Monday for the 20 countries with the highest number of TB cases to promote expanding the directly observed treatment (DOT) program -from 23 percent of TB cases worldwide to 70 percent in five years. The DOT program is a six- month daily regimen administered under the observation of health care workers. "We've got to get the world to start taking this threat of TB seriously and putting the resources in to fight it," said Ian Smith of the STOP TB Initiative at the WHO. Past studies on refugee populations show that the majority of deaths are not from hunger, but infectious diseases that flourish among the malnourished. "In fact, most people actually never starve to death," Andrew S. Natsios, administrator of the US Agency for International Development, testified before Congress last week. "They die of communicable disease before they actually starve to death because their bodies, their immune systems, have been weakened from the hunger." Relief agency officials in Pakistan said yesterday that many Afghan families are now moving from the cities to the countryside, where three and four families are now sharing small homes. "It's starting to get very crowded in the countryside now. With the shortage of food, and with cold weather coming, it's an excellent breeding ground for TB and other diseases," one official said. "Asian Governments Approve Plan Against Child Sexual Exploitation" Associated Press (10.19.01) Delegates attending a preparatory regional meeting in Asia for the Second World Congress against Commercial Sexual Exploitation of Children committed their governments to deadlines for legal and social frameworks to protect children and aid survivors. Some 200 government and UN officials, as well representatives of nongovernmental organizations and concerned young people, approved an action plan with specific deadlines to improve the rights and protection of children. Opening this week's meeting, Kim Hak Su, the executive director of the UN Economic and Social Commission for Asia and Pacific (ESCAP), said that 1 million children in Asia were involved in prostitution, pornography and trafficking for sex. He said that the HIV infection rate among children in some areas of Asia was as high as 50 percent. Organizers of the meeting included ESCAP, UNICEF, and ECPAT, an international coalition devoted to ending child prostitution, child pornography and child trafficking for sexual purposes. An official of UNICEF applauded the unprecedented move to set deadlines. "By agreeing to time-bound commitments for the first time, governments have moved one step further toward action on critical initiatives in this region," said Margie de Monchy, UNICEF's regional adviser on child protection for East Asia and the Pacific. The First World Congress on the commercial exploitation of children was held in Stockholm five years ago. At that meeting, representatives of 30 nations drafted a Declaration and Agenda for Action. The Second World Congress will be held in December in Yokohama, Japan. "Free Distribution of Needles Reduces Spread of AIDS in Brazil" EFE News Service (10.17.01) The distribution of syringes to Brazilian drug addicts free of charge has reduced the spread of AIDS among IV drug users, the Brazilian Health Ministry reported. Official figures made public at a seminar in Rio de Janeiro on Wednesday show a reduction of more than 40 percent in the AIDS infection rate among IV drug users in the last four years. "In the city of Salvador, 49 percent of IV drug users were infected with HIV in 1996. In 2000, that percentage fell to 7 percent," health officials said in a statement. In Rio de Janeiro, the rate of the spread of AIDS since the free needle distribution program was launched has fallen from 25 percent to 8 percent. In Baixada Santistas, an area located on the outskirts of Sao Paulo with a high rate of drug use, the percentage of addicts infected with the virus fell from 65 percent in 1996 to 42 percent in 2000, the officials added. The program has also changed the behavior of IV drug users. In 1996, 80 percent of drug users said they had never used condoms during sexual intercourse, a figure that decreased to 63 percent in 2000. Nearly 600,000 people are infected with HIV in Brazil -the largest number of any Latin American country, although it only represents 0.57 percent of the nation's population. Brazil has been praised for providing free health care to its infected citizens, which has helped reduce the country's AIDS mortality rate by up to 50 percent. "European Regulators Approve Gilead AIDS Drug" Financial Times (London) (10.19.01)::David Firn Patients who no longer respond to their AIDS drugs were given new hope on Thursday when European regulators approved Viread, a new antiviral treatment developed by Gilead, the US biotechnology company. Gilead said it expected to launch its AIDS drug in Europe early next year, following faster-than-expected approval by regulators. The European Medicines Evaluation Agency used new regulations for urgently needed treatments to approve the new medicine in 85 days, making it the fastest-ever approval in Europe. Initial approval is restricted to HIV patients who no longer respond to other AIDS treatments because the virus has become resistant. Gilead hopes to widen the approval to include all HIV patients after completing extra clinical trials of the treatment. Patients who started taking treatments before triple therapy became standard are most at risk of resistance. Patients who do not take their drugs regularly are also at increased risk of developing resistance. Doctors usually switch patients to different treatments if resistant strains of the virus appear in their blood, but the number of treatments is limited, making approval of new drugs an urgent issue. The drug was approved by US regulators last month. ************************************************************ MEDICAL NEWS ************************************************************ "HIV Highly Contagious Before Symptoms Show: Study" Reuters Health (10.18.01) HIV may be highly transmissible before an infected person experiences its first, flu-like symptoms, and before HIV tests can detect the virus, researchers reported last week. The findings underscore the importance of consistent safe sex in preventing AIDS. The investigators studied five couples in whom HIV transmission occurred soon after one partner contracted the virus -and as early as one week before the partner developed the flu-like symptoms that characterize early HIV infection. "The main thing that's new is that we've shown for the first time that sexual transmission can happen readily and very soon after exposure," said a statement from Dr. Christopher D. Pilcher of the University of North Carolina-Chapel Hill. Researchers had suspected but not documented this phenomenon, according to Pilcher. He and his colleagues reported their findings in the Oct. 10 issue of the Journal of the American Medical Association (2001; 286: 1713). During the period shortly after transmission, known as primary HIV infection, virus levels soar in the blood, and short- lived symptoms such as fever, fatigue and swollen glands may occur. But because the immune system has not yet produced antibodies to the infection, standard tests for HIV antibodies cannot detect the infection. Researchers have theorized that during this period, large amounts of the virus are "shed" into the genital tract and make the patient highly infectious. The current study suggests that this is, indeed, the case. The team came to its conclusions by taking the couples' sexual histories and genetically analyzing the HIV in their blood samples. All transmission had been suspected of occurring when one partner had a documented primary HIV infection. The researchers concluded that each case of a documented primary infection presents "a unique public health opportunity" to track down that person's recent sexual contacts and prevent the further spread of HIV. "If you engage in unsafe sex, you cannot assume that you are not infected or infectious because you had a negative antibody test for HIV. The most commonly used tests can't show HIV for several weeks," Pilcher said. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "A Model Example: Rebekka Armstrong, Former Playboy Playmate Turned HIV Activist" Guardian (London) (10.16.01) Rebekka Armstrong, 34, a former Playboy Playmate turned HIV activist, is on a speaking tour of the United Kingdom to address sexual boundaries with teenagers. At 18, she escaped to Los Angeles where she became what she euphemistically calls a swimwear and lingerie model. She was soon incredibly successful, becoming Playboy's Miss September in 1986. But by the age of 22, Armstrong had become chronically fatigued. She took an HIV test as part of an overall physical. It was the craze in Los Angeles clubs to carry proof of a negative test result. But hers came back positive. Armstrong now believes that she contracted HIV at 16, either from a lover or a blood transfusion. For five years, Armstrong kept her diagnosis a secret, attempting to maintain her modeling career while her body was being ravaged by the high doses of AZT she was prescribed. When the side effects became unbearable, she began abusing amphetamines and alcohol. The turning point came when a friend took Armstrong to a seminar for HIV-positive women. She came out about her HIV status in the gay and lesbian magazine the Advocate, and has since talked to thousands of young people in schools and colleges across the United States. Armstrong's message goes beyond preaching safer sex. "What I want people to go away with is the ability to set boundaries and make a mental note of their own limitations, so that they don't put themselves at risk," she says. "Every time I tell my story, I get back twice as much as I give," she said. "So I win." ************************************************************ NEWS BRIEFS ************************************************************ "Fears over Teen Sex -Tenfold Increase in Young Suffering from Diseases" Evening Mail (United Kingdom) (10.19.01) In Walsall (West Midlands, Britain), the number of teenagers with an STD soared by ten times during the past five years, health chiefs revealed Wednesday. Teenage cases of gonorrhea shot up by 1,050 percent, and chlamydia was up by 466 percent. Gonorrhea cases among all those under age 30 increased by 138 percent; chlamydia was up by 129 percent. "Safe sex messages are not only relevant for HIV and AIDS but also for the potentially devastating effects of these infections," said Dr. Sam Ramaiah, Walsall public health director. "Malawi: Doctors Shun HIV Tests" Africa News Service (10.17.01) Malawian doctors are turning down specialist training offered in the Republic of China because they are reluctant to submit to the AIDS test required to travel there. As part of its development assistance to Malawi, Taiwan has offered 10 scholarships a year for specialist training since 1999. These are open to all Malawian doctors, but Taiwan insists on an HIV test as a condition of application, and only those who test negative qualify. Four doctors applied in 1999; two applied last year; and only one has applied in 2001. "Many doctors are wary of the rigorous process of testing for HIV, which includes pre-testing counseling for applicants and their spouses followed by the ordeal of waiting for the results," said principal secretary of the Health Ministry, Richard Pendame. "A Case of Security vs. Liberty in Bremerton" Seattle Times (10.19.01)::Florangela Davila In Bremerton, Wash., a new military checkpoint is worrying public health officials who say it is scaring clients away from an area health clinic. The Austin Drive checkpoint sits at the entrance to the Navy's Jackson Park housing complex. Anyone wanting to access the county health facility, housed in a former barracks, must now pass through the checkpoint. The Navy said the new checkpoint is necessary to safeguard military families from the terrorist threat. But Phyllis Mann, director of emergency management for Kitsap County, said people seeking treatment for STDs are not comfortable going through a checkpoint. One hundred to 250 people a day visit the clinic for services ranging from flu shots to anonymous HIV/AIDS testing. A dozen people in the past two weeks have reported being unable to get through the checkpoint or being intimidated by it, said Ricki Johnson, lead case manager for HIV/AIDS.