Subject: CDC AIDS Daily Summary for Date: Fri Oct 26 11:31:01 PDT 2001 (364 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 "Senate Okays Foreign AIDS Money" "Big Spike in Syphilis Cases; Gay, Bisexual Men Affected Most" "Vilsack Says Keep Up Fight Against AIDS" INTERNATIONAL NEWS "Developing Nations Emboldened by US in Drug Demands" "City Ponders Retractable Needles for Pilot Project" MEDICAL NEWS "Diabetes, Cyclosporine Use Are Risk Factors for Posttransplant Tuberculosis" LOCAL AND COMMUNITY NEWS "Disarray Intensifies as Second Hope House Chief Quits" NEWS BRIEFS "Abstinence Programs Receive Federal Welfare Dollars" "Colleges Participate in AIDS Seminar" "Papua New Guinea: Health Official Reports HIV/AIDS Victims on Increase" CORRECTION "World's First AIDS Vaccine Factory to be Built in Inchon" ************************************************************ NATIONAL NEWS ************************************************************ "Senate Okays Foreign AIDS Money" Reuters Health (10.25.01)::Todd Zwillich The Senate on Wednesday night approved $415 million in international aid next year geared toward prevention and treatment of HIV/AIDS. The package includes $40 million for the Global Fund for AIDS, TB, and Malaria announced by UN Secretary- General Kofi Annan last summer. That money is in addition to $50 million for the fund approved earlier this fall, and $100 million expected in upcoming Senate Labor/Health and Human Services appropriations bill. It puts the Senate on pace to contribute $190 million to the fund in Fiscal 2002, $10 million shy of the $200 million President George W. Bush had requested as an initial investment for the global fund. Fifteen million dollars of the total $415 million for international AIDS work is earmarked toward development of HIV microbicides, while $10 million was steered toward an international AIDS vaccine fund. The bill gives an additional $175 million to address other infectious diseases, including TB and malaria. Several legislators, including Sens. Joseph Biden (D-Del.) and William Frist (R-Tenn.), have proposed spending $750 million on the fund over the next two years, though their efforts have been largely sidelined as the legislators prioritize security and terrorism issues in the wake of the Sept. 11 attacks. Annan has said that the fund will require $7 billion to $10 billion to be effective in drastically reducing the rate of HIV infections in poor African and Asian countries. The House earlier this year approved $250 million for the fund, meaning that Congress could eventually meet the president's request when the two bodies negotiate final numbers. The money came as part of a broad foreign aid spending package. Senators approved the measure 98-2 after disputes over the pace of judicial nominations held up a vote on the legislation for days. "Big Spike in Syphilis Cases; Gay, Bisexual Men Affected Most" San Francisco Chronicle (10.26.01)::Christopher Heredia Syphilis is spreading at "startling" rates in San Francisco, especially among the city's gay and bisexual men, according to Dr. Jeffrey Klausner, director of STD prevention for the city's Department of Public Health. Similar syphilis spikes have been detected in San Diego, Florida, Boston and Chicago, Klausner said. The data -which show syphilis cases increasing among the city's gay and bisexual men from 10 in 1998, to 29 in 1999, to 47 in 2000, and to 93 through September 2001 -will be presented Saturday in San Francisco at the meeting of the Infectious Diseases Society of America. This year and last, 23 percent of San Francisco men with syphilis reported meeting their sex partners in sex clubs; 20 percent in adult bookstores; 19 percent on the Internet; and 18 percent in bathhouses outside the city. The new data will show that in the syphilis cases involving gay and bisexual men this year, the 93 men reported having 1,225 sexual partners. The men could identify only 8 percent of their partners by name, making it difficult, if not impossible, to notify partners to get a checkup and possible STD treatment, Klausner said. Officials say an America Online (AOL) chat room for gay and bisexual men in San Francisco is partly to blame for the syphilis surge. Last year, 10 cases were associated with the site; this year so far, 16 cases have been traced to it. Klausner said efforts to get AOL to post syphilis warnings on the site have met with resistance. Instead, AOL has offered health officials free memberships so that counselors could enter the chat rooms and post prevention messages. But the health department has declined the offer, saying it would be an ineffective STD prevention tool. "This is the proverbial canary in the coal mine," Klausner said. "People are using the Internet for sex and transmitting syphilis." AOL spokesperson Andrew Weinstein said the company had been working with the CDC to develop STD prevention messages for its online bulletin boards. He did not know when the postings would be ready, or whether they would specifically target gay chat rooms. "Vilsack Says Keep Up Fight Against AIDS" Des Moines Register (10.24.01)::Lynn Okamoto While a handful of deaths caused by anthrax has captured the nation's attention, Iowa must not forget that it has another deadly disease -HIV/AIDS -that more than 1,000 Iowans are living with each day, Gov. Tom Vilsack said Tuesday. "The fact that we have these tough issues to face doesn't mean that the issues that were here in this country before Sept. 11 need to be pushed aside," Vilsack told about 220 participants at the state's 4th annual HIV/AIDS Conference in Des Moines. "It will do no good for us to deal with the national threat of anthrax if we do not also deal with the international threat of AIDS," Vilsack said. As of Sept. 30, Iowa had 1,025 people with HIV/AIDS. This is the first time the state topped the 1,000 mark since it began tracking the disease in the 1980s. Randy Mayer, the state's HIV/AIDS surveillance coordinator, said a larger pool of people are living with the virus because better treatment has reduced the number dying. Iowa had 39 AIDS deaths in 1990 and 105 in 1995. That number dropped to 27 last year. In 2000, 70 percent of Iowans learned of their HIV infection within six months of being diagnosed with AIDS, and 58 percent received both diagnoses at the same time. Vilsack urged Iowans to continue their fight against the deadly disease, despite the difficult time we are going through as a nation. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Developing Nations Emboldened by US in Drug Demands" Wall Street Journal (10.26.01)::Rachel Zimmerman; Geoff Winestock AIDS activists and developing nations are seizing on US Health and Human Services Tommy Thompson's threat to bust the patent on the antibiotic needed to fight the anthrax attack. They want poor countries also to be allowed to exercise such powers to improve access to essential medicines. The issue will reach a peak at the November 9 World Trade Organization (WTO) meeting in Doha, Qatar. In threatening Bayer AG, Thompson was able to negotiate a steep discount with the company to produce a large batch of Cipro, the current antibiotic of choice for inhalation anthrax. The threat, however, represents a sharp departure from the United States' longstanding position that countries must honor patents -a departure argued for by developing countries fighting patent laws to provide drugs for millions of individuals with AIDS. "The events of the past few days have made those of us from developing countries think, what we have been fighting for is fair," says Nelson Ndirangu, a WTO delegate from Kenya. "If the US can tell Bayer: 'Reduce the price -or else.' Why can't Kenya tell [AIDS drug maker GlaxoSmithKline PLC]: 'Reduce the price - or else?" Brazil, India and other developing countries in the WTO are pushing for broad rules that would "permit governments to take measures protecting public health," according to a document presented at a WTO meeting this week. In general, global health and AIDS activists want the United States to issue a strong, straightforward declaration that trade agreements should not block poor countries' ability to purchase life-saving medicines. Many feel that Thompson has helped crystallize the argument. Industry representatives, as well as US officials, point out that Thompson stopped short of breaking an existing patent. They note that their position at WTO has been a limited pledge guaranteeing "access to medicine at affordable prices" for poor countries. That pledge allows them, according to Robert Zoellick, US trade representative, to move promptly to support the use of flexibility under international intellectual property rules to deal with health emergencies. "In the past few weeks, we have suggested additional ways to help sub-Saharan African countries deal with the HIV/AIDS crisis and other pandemics," he said. The issue remains complicated because the United States and the European Union already changed enforcement policies of drug patent rights when the United States dropped its complaint in the WTO against Brazil for a law that allows the government to break patents on HIV/AIDS drugs. The United States also backed off a similar confrontation with Thailand over its HIV/AIDS policies. Drug companies dropped a lawsuit against South Africa for similar measures, and offered sharp discounts on AIDS drugs in some developing countries. "City Ponders Retractable Needles for Pilot Project" Ottawa Citizen (10.24.01)::Bev Wake Ottawa's health department announced Tuesday it is considering a pilot project that would replace standard syringes in its needle exchange program with special ones featuring a retractable needle. After an injection is complete, the needle automatically retracts back into the plunger of the syringe. Retractable needles would not only prevent people from being stuck by a discarded needle but would also prevent people from reusing needles, reducing the chances of spreading HIV and other diseases. If launched, the pilot project may be the first of its kind in the world. "I think what we've seen looks very interesting," said Dr. Geoff Dunkley, the city's associate medical officer of health. "But we have to move carefully because it's not being done elsewhere." Dunkley said he didn't want to oversell the project; however, he expects something to be in place within a few months. The project will only work, he said, if the clients like the needles. The chair of the Community Advisory Committee on Syringe Program, Cheryl Parott, said the needles will improve safety for all -from emergency workers to injection drug users to children playing at the beach. Councilor Elisabeth Arnold said she was excited by the proposal, particularly since the discarded needles are a problem in her Somerset Ward. "It's extremely important to me that we have a safe and effective program," she said. "This is very exciting. I think everybody will be really happy if this works." ************************************************************ MEDICAL NEWS ************************************************************ "Diabetes, Cyclosporine Use Are Risk Factors for Posttransplant Tuberculosis" TB & Outbreaks Week (10.16.01) P 2 Researchers in India have identified some of the factors that put kidney transplantation patients in danger of potentially deadly postoperative TB. "Post-transplant tuberculosis (post- TxTB) occurs in 12 to 20 percent of patients in India and results in the death of 20 to 25 percent of those patients," according to Dr. George T. John and colleagues at Vellore's Christian Medical College and Hospital. Despite this, "prospective studies on post-TxTB are few," researchers said. John and coworkers evaluated more than 1,200 kidney transplant patients to determine the risk factors for postoperative TB. Patients who had other infectious complications were among the most likely to develop posttransplant TB, study data showed, with a risk 2.4 times greater than other patients. Other significant risk factors included diabetes and chronic liver disease, which increased the chances of postoperative TB 2.2 and 1.7 times respectively. These conditions were associated with a high mortality risk, as was hyperglycemia, the researchers noted. In addition, the use of cyclosporine therapy in lieu of treatment with prednisolone and azathioprine also led to a pronounced increase in TB risk after transplantation. "Cyclosporine therapy is associated with early post-TxTB," John and colleagues concluded. Of 166 patients who contracted postoperative TB, 17 succumbed to the infection, 11 of whom had other concomitant infections. The report, "Risk factors for post-transplant tuberculosis," was published in Kidney International (September 2001;60(3):1148-1153). ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Disarray Intensifies as Second Hope House Chief Quits" South Florida Sun-Sentinel (10.26.01)::Shana Gruskin Turmoil continued at Hope House, Palm Beach County's biggest provider of housing for people with HIV/AIDS, this week with the resignation of its second interim director, Bruce Halstead. Halstead replaced interim Director Bruce McDonald this summer. McDonald, a former Palm Beach County school administrator who served as the Urban League of Palm Beach County's CEO for 18 months, stepped in after the resignation of David Walker. Walker, credited with righting the agency after a financial crisis in 1996, resigned in February after serving for five years. Hope House, incorporated in 1987, provides housing, outreach, case management, teen pregnancy prevention and other programs to hundreds of people affected by HIV/AIDS across the county. Last May, United Way of Palm Beach County withdrew its financing, prompting concern in the community about the solvency of Hope House. A major scandal in the mid 1990's had set Hope House back when Director Robert Greijack pleaded guilty to stealing the agency's money and was ordered to repay $313,870. Last year the agency faced another challenge: a lawsuit filed against it by the Quantum Foundation. Quantum maintained that half of its support grant was supposed to be used for cottages for children on the grounds of St. Mary's Medical Center. The suit was settled in a confidential agreement. Shortly after, United Way conducted an audit that found Hope House suffering money problems, and the agency pulled the remaining funds from its $85,300 grant. While the money made up a very small percentage of Hope House's $2.3 million budget, the loss of United Way's endorsement hurt the agency. "It's just really a tragedy to have an organization that's so needed be so defunct," said Bruce Lewis, a United Way member and former consultant to Hope House. No matter what Hope House's future holds, however, the community will find alternatives. "What I think will happen is because the need is there, there will probably be a reorganization of that organization internally first," Lewis said. "They'll present themselves in a new light and ... rebuild their relationship with the community and move forward." ************************************************************ NEWS BRIEFS ************************************************************ "Abstinence Programs Receive Federal Welfare Dollars" Associated Press (10.24.01) Louisiana will use $150,000 of federal welfare funds to pay for programs to encourage abstinence and reduce STDs and unwanted pregnancies. The Joint Legislative Committee on the Budget unanimously approved giving the money to the Governor's Program on Abstinence on Wednesday after disagreeing about the item last week. The money will be spread among 13 existing abstinence programs. Several legislators, including Rep. Yvonne Welch (D- Baton Rouge), walked out in protest before the vote. Welch complained that the state Department of Social Services did not give groups that help abused women, provide child care, and programs that offer other alternatives to abstinence a chance to apply for the money. Don Richey, director of the Governor's Program on Abstinence, said those programs could not have qualified, since the money was earmarked as part of a five-year federal grant for the abstinence program. "Colleges Participate in AIDS Seminar" State (Columbia, S.C.) (10.26.01) Students from the state's historically black colleges answered the call to "Save Yourself! Save Your Community!" by attending an AIDS awareness seminar at South Carolina State University in Orangeburg on Thursday. The college joined the S.C. Legislative Black Caucus and the S.C. Department of Health and Environmental Control to present the summit, which was timed to coincide with the college's homecoming this weekend. Before the summit began, Gov. Jim Hodges proclaimed the day Historically Black Colleges and Universities HIV/AIDS Awareness Day. "Papua New Guinea: Health Official Reports HIV/AIDS Victims on Increase" BBC (10.17.01) HIV/AIDS is on the rise in Papua New Guinea, Health Secretary Dr. Puka Temu said last week. Statistics showed that of AIDS patients, 17 percent were children; 21 percent were housewives; and 24 percent were unemployed. Only 8 percent were sex workers. "The whole community is in trouble. We need to be serious about this problem," he said. "HIV cases are going up every year." ************************************************************ CORRECTION ************************************************************ "World's First AIDS Vaccine Factory to be Built in Inchon" Korea Times (10.22.01) Thursday's Prevention News Update summary of this article incorrectly stated the size of the VaxGen factory to be built in Inchon. The facility will be 99,000 square meters in size.