Subject: CDC AIDS Daily Summary for Date: Tue Oct 23 11:31:01 PDT 2001 (377 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 Shows Gay Men in San Francisco Less Afraid of HIV - Attitude May Be Leading to More Infections" "Officials Say Baton Rouge AIDS Cases Growing at Alarming Rate" INTERNATIONAL NEWS "South Africa Hits Out at Firms on AIDS Drugs" "New Vaccine for TB" MEDICAL NEWS "Modeling and Reinforcement to Combat HIV: The MARCH to Behavior Change" LOCAL AND COMMUNITY NEWS "Black Coalition on AIDS to Host Open House" "Students to Seek Expanded Sex Education" NEWS BRIEFS "Vietnam's Ho Chi Minh City to Send All Drug Addicts to Rehabilitation Centers" "China to Strengthen Fight Against Tuberculosis" "Number of HIV Infection Cases Doubles This Year in Latvia" ************************************************************ NATIONAL NEWS ************************************************************ "Study Shows Gay Men in San Francisco Less Afraid of HIV - Attitude May Be Leading to More Infections" San Francisco Chronicle (10.22.01)::Christopher Heredia According to a just-released University of California-San Francisco (UCSF) study, gay men don't find HIV as threatening as they once did; ads for AIDS drugs are seen as glamorizing life with HIV; and there is increased acceptance of unprotected sex. Recent San Francisco Department of Health projections indicate a rising rate of new HIV infections, translating into about 750 new infections this year. Author Stephen Morin, director of the UCSF AIDS Policy Research Center, said the study's aims were to get gay men to explain the increase and to define prevention messages that might reduce risk among gay and bisexual men. "The community norm has changed. Guys in the survey told us a friend may go on a date, or to a bathhouse, but the question, 'Were you safe?' doesn't come up. That 'Friends don't let friends drive drunk' kind of social support that came out loud and clear -there's been a real deterioration in that. And it seems to be a major way people felt supported for staying negative," Morin said. The study was conducted last summer with 55 gay and bisexual San Francisco men, who were divided into six focus groups. The men recommended a new social marketing campaign with ads on television and in bus shelters, magazines, bars and sex clubs to encourage men to dispel HIV myths by talking with their friends. "Friends Can Be Good Medicine -Talk About HIV" was one suggested slogan. Surveyed men also expressed concern that ads for AIDS medications glamorize life after infection, and these need to be balanced with images of men suffering the drugs' side effects. New ads are set to be ready by early next year, but Survive AIDS member Jeff Getty said a better tactic would be to send gay men to sex clubs as safe sex advisers. "Officials Say Baton Rouge AIDS Cases Growing at Alarming Rate" Associated Press (10.22.01) The Baton Rouge, La., metropolitan area is one of seven areas nationwide to have between 1,000 and 2,000 new AIDS cases diagnosed in the last five years. Baton Rouge ranks 16th in the nation with new AIDS cases. The metro area has a higher rate of new AIDS cases than the metro areas of Houston, Atlanta, Dallas, Chicago, Boston and Los Angeles, according to the CDC. Those statistics have Baton Rouge leaders worried and trying to find ways to cope with the epidemic and educate residents. Louisiana Gov. Mike Foster declared this week "Know AIDS Mobilization" week to spread information about the disease. Activities such as forums and informational fairs will take place at Southern University, Louisiana State University and Baton Rouge Community College as part of the spotlight on HIV/AIDS awareness. Last year, the region, which includes East and West Baton Rouge, Ascension and Livingston parishes, had the highest HIV/AIDS detection rate in the state -more than even New Orleans -with 50 cases per 100,000 people. The state average is 26, according to Jennifer Chase, an epidemiologist for the state HIV/AIDS program in the office of Public Health (OPH). Nearly 4,000 Baton Rouge area residents are infected with HIV/AIDS; statewide, about 12,700 people are infected, according to OPH statistics. Madeline McAndrew, OPH assistant secretary, said East Baton Rouge Parish has received federal grant money to determine why the growth rate in the area is worse than in other, much larger, metropolitan areas. ************************************************************ INTERNATIONAL NEWS ************************************************************ "South Africa Hits Out at Firms on AIDS Drugs" San Diego Union-Tribune (10.22.01)::Steven Swindells, Reuters South Africa said on Monday AIDS Drugs were ineffective and produced side effects almost as bad as the disease itself. The African National Congress (ANC) government accused an alliance led by the pharmaceutical industry, and including AIDS activists and churches, of trying to force it into dispensing harmful antiretroviral drugs. "Government is resisting pressure to provide to all and sundry highly toxic drugs that offer no hope of eradicating the virus," ANC spokesperson Smuts Ngonyama said in a letter sent to the country's leading Business Day newspaper. South Africa has balked on cost and safety grounds at the nationwide use of antiretroviral AIDS drugs, which slow down the duplication of the virus that leads to full-blown AIDS. The ANC's latest attack on the drug industry came weeks after London-based GlaxoSmithKline (GSK) granted a license to South African generic producer Aspen Pharmacare to manufacture its AZT, 3TC and Combivir antiretroviral drugs. But the success of the scheme, which could drastically cut the cost of these drugs to around $1.61 per pill, will hinge on whether the government offers a state tender to Aspen for GSK's products under license. Ngonyama, questioning the motives of the industry, said German pharmaceutical giant Boehringer Ingelheim had funded an AIDS activist group that was demanding the use of antiretrovirals. The company has previously denied the allegation. Mirryena Deeb, chief executive of the Pharmaceutical Manufacturers Association of South Africa, said, "All medicines, including antiretrovirals, are registered by drug regulatory bodies around the world as being safe and effective provided they are used as prescribed under medical supervision because it is found that the benefits of those drugs far outweigh any potential side effects." "New Vaccine for TB" BBC News (10.22.01) Scientists are working on a new TB vaccine that would work in combination with the existing BCG medication. The six-year study, funded by the Wellcome Trust, is being conducted by a team of researchers at the John Radcliffe Hospital in Oxford, England, with parallel trials in Africa. Known as MVA85A, the new vaccine, when used with the current BCG vaccine, is expected to reactivate BCG's effect on adults. BCG, first introduced in 1921, is a good TB vaccine for children, but its effect wears off after about 10 years. The new vaccine works by asking immune cells to "remember" the first BCG vaccine and create a bigger barrier to TB. Research leader Dr. Helen McShane said, "Because BCG is often not effective, especially among adults and in some parts of the developing world, we have the chance of giving many more people protection and hopefully saving lots of lives." According to the World Health Organization, TB could kill 35 million people in the next 20 years if new controls are not introduced. The number of recorded cases of TB in England and Wales rose from 5,085 in 1987 to 6,797 in 1999, according to the Public Health Laboratory Service. ************************************************************ MEDICAL NEWS ************************************************************ "Modeling and Reinforcement to Combat HIV: The MARCH to Behavior Change" American Journal of Public Health (10.01) Vol 91; No 10: P 1602- 1607::Christine Galavotti, PhD; Katina A Pappas-DeLuca, MA; Amy Lansky, PhD The CDC has initiated the Global AIDS Program, which seeks to implement projects in primary prevention, improve community- and home-based care and treatment, and develop capacity and infrastructure. In the area of primary prevention, the Global AIDS Program has developed a model strategy for changing behavior that integrates entertainment as a vehicle for education ("entertainment-education") with interpersonal reinforcement. This program strategy is called MARCH: Modeling and Reinforcement to Combat HIV. In Africa, where HIV/AIDS took an estimated 2.2 million lives in 1999, the harsh reality of having an increasingly infected young adult population threatens the whole fabric of society, with teachers, workers and parents dying at an unprecedented rate. In the face of these public health threats, women and men in developing countries have a limited ability to imagine other futures and other choices. They are held hostage by a societal narrative in which the cycle of early marriage, unprotected sexual behavior, multiple unplanned births, HIV infection and early death is seen as unavoidable, and where patterns of personal behavior are thought to be unalterable. The purpose of MARCH is to intervene in these incapacitating story lines by providing alternative narratives in which individual control over sexual and reproductive behavior is made not only desirable but, more importantly, possible. MARCH combines two key approaches to behavioral change: entertainment- education through broadcast media, and interpersonal reinforcement at the community level. The first component of MARCH is the use of role models in entertainment that educates. Role modeling is accomplished in many ways. In choosing entertainment-education as a major component of their approach, the authors decided to emphasize its narrative, or story-telling, component. In a sense, the MARCH projects can be thought of as a narrative intervention that permits people "to understand the origins, meanings, and significance of [their] difficulties, and to do so in a way that makes change conceivable and attainable." One reason serial drama can educate is because it is closely aligned with the customs and norms of its audience and uses narrative forms with which they are familiar. Entertainment focuses on emotional as well as cognitive factors that influence behavior, and thus it keeps the attention of the intended audience. MARCH's interpersonal reinforcement component is as important as role modeling. MARCH projects seek to involve credible members of the affected community and mobilize them to endorse and support behavior changes among members of their own peer, family, and social networks. In MARCH, the serial drama is used as a vehicle for integrating a wide range of interpersonal reinforcement activities. During the period of the drama broadcast, interpersonal and community communication networks can encourage and reinforce attention to the drama, endorse and support the goals and behaviors of specific characters, distribute health-related materials, link people to community services, and advocate other community-level changes. In the MARCH approach, behavioral change is accomplished by going far beyond the traditional method of promoting the benefits of adopting the desired risk reduction behaviors. Affected populations are helped to identify with new role models, acquire new ways of thinking about and reaching goals, and increase their confidence that they can attain and maintain the behaviors they have been persuaded are necessary for avoiding HIV infection. Although the MARCH approach shares many features with other approaches to using entertainment-education for achieving behavioral change, it is distinct in several important ways. First, the approach focuses as much on enabling men and women to enact and maintain new cognitive and behavioral patterns as on promoting the behaviors themselves. A second distinction of MARCH is that the goal is long-term rather than short-term change. MARCH attempts to do nothing less than change personal, social, and cultural views of sexual and reproductive health behavior, as well as the behaviors themselves, in individual men and women and in their communities. Finally, MARCH has a theory-refining objective, because there are key theoretic questions that may have important implications for public health practice. One question of great interest, on both theoretic and practical levels, is how identification with role models in the media really works to influence behavior. "By combining the reach of radio or television with the power of narrative, and by providing supporting elements in the environment, we may equip young women and men with the resources necessary to rewrite the script," the authors concluded. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Black Coalition on AIDS to Host Open House" Bay Area Reporter (San Francisco) (10.18.01)::Cynthia Laird The Black Coalition on AIDS (BCA) will open its doors to the public today in San Francisco. David Wallace, communications director for the agency, noted that the open house celebration will allow community members to see the agency's new South of Market location and learn more about the programs and services provided in a continuing effort to stop the spread of AIDS in the black community. The co-sponsor of the open house is Arise magazine, a monthly publication dedicated to the lives of diverse people of African descent. Now in its 15th year of service, BCA's focus is expanding to address social factors that contribute to the spread of HIV in the black community. "Factors such as homelessness, violence, homophobia, and other issues must be addressed in our community in order to more effectively deal with this epidemic," said Duane T. Poe, BCA's executive director. Pointing to new collaborations with the San Francisco Sheriff's Department to work with prisoners, and to a grant from the San Francisco Commission on the Status of Women, Poe said he feels these new areas of focus will be successful. The grant from the commission will address how violence against women and girls contributes to HIV/AIDS transmission. The event is free and open to the public today, 3-7 p.m., at 495 Clementina St., San Francisco. For more information, call 415-615-9945. "Students to Seek Expanded Sex Education" Orange County Register (10.22.01)::Theresa Walker Sexuality usually isn't a topic that teens and adults feel comfortable discussing together. However, that's exactly what the 15 teens in the Speak Out! Program, sponsored by Camp Fire USA, plan to do at the Tuesday meeting of the Santa Ana Unified School District board. Speak Out! wants the school district to broaden its sex education program beyond abstinence-only. Members are asking for information on contraceptives, safe sex, relationships, discussing sex with parents, and skills to negotiate with a partner or say "no." The sex education Santa Ana high schools provide is folded into a health unit that covers the reproductive system and some STDs, but otherwise relies on the message "wait until you get married," said Laura Raya, 17, of Santa Ana High. "It's like they are hiding something from you," she said. "They are not giving you enough information to be prepared." A grant from the Berkeley-based California Wellness Foundation provided the means for Speak Out! to spend after- school and weekend hours preparing. They spent the past 18 months doing research, conducting telephone and in-person surveys of teens, parents and teachers, and interviewing community leaders. Two-thirds of those surveyed said sex education in their schools is inadequate. In addition, whenever they tried to talk to their parents, the adults would walk away or hang up the phone, students said. Those dozen or so parents who answered said they wanted their children to be better informed, but didn't know enough themselves to help their children. School board members who have met privately with Speak Out! praised their efforts and their courage in making a public statement on such a controversial issue. "We need to respect their wishes to address that," board member Nadia Marie Davis said. "It's very rare that students are actually coming to us with the problems that they perceive, and that they have solutions for. For the kids to be coming to us is invaluable." ************************************************************ NEWS BRIEFS ************************************************************ "Vietnam's Ho Chi Minh City to Send All Drug Addicts to Rehabilitation Centers" Associated Press (10.13.01) Authorities in Vietnam's Ho Chi Minh City plan to send all of its 17,000 known drug addicts to rehabilitation centers by the end of next year, an official from the city's Anti-Social Vices Department said on Oct. 12. Drug addiction has become an increasing problem in recent years, contributing to the spread of AIDS through the sharing of needles. Under a recent resolution of the city's Communist Party organization, 10,500 drug addicts are to be sent to rehabilitation centers this year, another 5,000 in the first half of next year, and the rest in the second half of next year. The decision was part of a program to reduce crime, drug addiction and prostitution launched by the city government earlier this year. The city has nine rehabilitation centers that can accommodate more than 4,000 drug addicts. Those facilities are already overcrowded and must be expanded and supplemented, officials said. "China to Strengthen Fight Against Tuberculosis" Xinhua (10.18.01) Yin Dakui, vice minister of health, said that China would set up an efficient and ongoing medical system to fight against TB, aiming to cure 4 million TB patients by 2010. According to the official, China is one of 22 countries in the world suffering from severe TB epidemics. The Ministry of Health and some related ministries have a ten-year plan to control the disease. So far, China has used loans from the World Bank to carry out TB treatment projects among 560 million people in 13 provinces across the country. In addition, the country will invest about $4.8 million dollars annually to set up a special foundation to prevent and control the disease. "Number of HIV Infection Cases Doubles This Year in Latvia" Baltic News Service (10.17.01) The number of people with HIV in Latvia has doubled in one year, according to a bulletin of the National Environment Health Center. During nine months in 2000, as many as 303 new HIV cases were registered, while during the same period this year the figure is 648. Data from the AIDS Prevention Center show that from 1987 through mid-October this year, a total of 1,622 HIV patients have been registered in Latvia. The number of full-blown AIDS cases has increased from 17 last year to 28 this year. The most widespread source of HIV infection is intravenous drug use.