Subject: CDC AIDS Daily Summary for Date: Tue Oct 30 11:31:01 PST 2001 (405 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 "Feeling the Pinch -Nonprofits Reeling Since Sept. 11" "America Responds: At CDC, Everything Rearranged to Put Anthrax Fight First" "University of Arizona to Study Teens' Risky Sexual Behavior" INTERNATIONAL NEWS "Health Care for HIV/AIDS Needs to Be Priority, Conference Delegates Say" "Safe Sex in Kenya Taxis" MEDICAL NEWS "Differential HIV Risk in Bathhouses and Public Cruising Areas" EDITORIALS AND COMMENTARY "Have They Nothing Better to Do?" NEWS BRIEFS "AIDS Initiative to Receive $10 Million from Gates Foundation" "South Africa Urges Change to AIDS Drug Deal" "New African Soap Opera to Help War Against AIDS" ************************************************************ NATIONAL NEWS ************************************************************ "Feeling the Pinch -Nonprofits Reeling Since Sept. 11" ABCNEWS.com (10.29.01)::Rose Palazzolo The AIDS Walk in Washington, D.C., usually attracts close to 25,000 people and raises up to $1 million for local AIDS services. But this year, only 5,000 people showed up for the walk, which raised only about $400,000. With the public rattled by the Sept. 11 attacks and the ongoing anthrax scare, some people's interest in philanthropy has fallen -just in time for the season when most charities implement their biggest fund- raising efforts. "We've never seen this kind of drop-off that we have since the terrorist attacks," said Bill Primosch, director of Shepherd's Table, a resource center for homeless people in Silver Spring, Md. Because of the sluggish economy, donations to many charities were down even before the attacks. "Many nonprofits are having significant troubles raising money and shoring up support," said Michael Kink, legislative counsel for New York-based AIDS and homeless nonprofit Housing Works. "We have to be conservative in our planning right now," said Michael Cover, a spokesperson for Whitman-Walker Clinic, which runs the Washington walk and benefits from its profits. "We are cutting things like travel and nonessential costs, and we have implemented a hiring freeze. We have also cut some thing like vocational rehabilitation programs." According to Housing Works, which is compiling a survey of Sept. 11's effects, New York-area HIV/AIDS groups -already suffering from less funding than in previous years -will be particularly hurt. "Unlike some other nonprofits, we depend on our private donor base and so it is a great concern," said Marty Algaze, director of communication for the New York-based Gay Men's Health Crisis. "We know that most people are being compassionate and giving to the World Trade Center funds, which is great. We are concerned that people don't forget we are here." It is estimated that Americans have donated more than $1 billion to Sept. 11 relief efforts. "America Responds: At CDC, Everything Rearranged to Put Anthrax Fight First" Atlanta Journal-Constitution (10.28.01)::MAJ McKenna Late Friday afternoon, trucks and cranes surrounded the CDC placing concrete barriers on three sides of its Atlanta headquarters. The safety barrier, mandated by Congress, is one signal of the enormous changes at the CDC as it tries to respond to the ongoing anthrax attack. The changes are extensive. Labs have been commandeered; hundreds of scientists have been pulled from their regular work to the 24-hour struggle to contain the outbreak. It is a different agency than before Sept. 11. "It's probably as major a deployment of people and tasks and commitment by us as anything we've done in over 50 years of history," said CDC director Jeffrey Koplan. In an in-depth interview for this article, Koplan described deep changes. "We have a totally different organizational structure," he said. "We reorganized CDC's approach two weeks ago with a totally different mode of operation. We have pulled people from all over the organization and deployed them full time on anthrax for the foreseeable future." About 500 CDC staff members have been reassigned to anthrax, compared to the several dozen who typically respond to disease outbreaks. The force includes more than the Epidemic Intelligence Service, the elite shock troops of disease detection. It takes in staff from almost all of the CDC's 12 centers and offices. One of every 17 among the CDC's 8,500-member staff is now working on the bioterror threat. "The general community remembers Sept. 11," Gene Matthews, the CDC's general counsel, said last week. "Burned into CDC's consciousness is Oct. 4, the day the first inhalational anthrax case was reported. We are forever changed because of that." All of CDC's staff is working under higher security than before, many in secrecy. The agency's communications office has begun rotating shifts on a firefighter schedule: four days on, three days off, 12-14 hours a day. In labs where there is adequate staff, technicians work eight-hour shifts round-the-clock. Some processes are so specialized, though, that only a few researchers know how to do them. They camp out in their offices, which at the chronically crowded CDC often means a cubicle. They prepare an experiment, take a nap, get up and read the results, set up another experiment and nap again. "Many senior staff are operating on hours that are less generous than when they were interns," said Koplan, who is a doctor. "I'll tell you, you don't do that as well at 56 as you did at 27." As the agency on the front lines of the attack, the CDC has also been the target of criticism that the federal government took too long to realize the dimensions of the attack and failed to explain the dangers to the public. Privately, however, CDC staff say they were kept from speaking out in the early days of the outbreak by orders of the Department of Health and Human Services. They also said that the FBI had not given them full details of the contaminated letter sent to Senate Majority Leader Tom Daschle. CDC researchers have not been able to examine the letters sent to Congress and news organizations, or the spores the letters held. Those remain in Washington under high security. In the past few days, restrictions on the CDC have apparently loosened: Senior staff has begun to hold daily press briefings. Asked whether the past week offered any lessons, Koplan declined to speculate. "Maybe when we get time to reflect sometime in the future, we will find things that are correctable and fixable and helpful," he said, "but at the moment, that perspective eludes me." In closing, Koplan said he sees only work. "Right now, we are working as flat out as we can. I keep thinking, if you know you're in a marathon, you pace yourself for a marathon; if you know you're in a sprint, you pace yourself for a sprint. But our guys are sprinting, and the sprint distance is long over. We're sprinting a marathon." "University of Arizona to Study Teens' Risky Sexual Behavior" Associated Press (10.29.01) University of Arizona (UA) researchers have received a $2.5 million grant to study why some teenagers are more likely to engage in risky sexual behaviors than others. The challenge of getting teenagers to refrain from risky behavior is the reason UA researchers, with Valerie Reyna, director of UA College of Medicine's Informatics and Decision Making Laboratory and principal investigator, were awarded the grant from the National Institutes of Health. The US Department of Health and Human Services has listed reducing risky sexual behavior among adolescents as a national health objective. Slated to begin this fall, the five-year study will survey about 1,000 adolescents and determine how decision processes differ for abstinent versus sexually active adolescents, and for those who engage in high-risk sexual behavior versus those who do not. It will take particular note of previously understudied Hispanic teens and how they make such decisions, Reyna said. The study participants, ages 14 to 18, will be recruited from southern Arizona high schools and charter schools. The study includes an evaluation of the effectiveness of an intervention program designed to reduce risky sexual behavior. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Health Care for HIV/AIDS Needs to Be Priority, Conference Delegates Say" Associated Press (10.29.01)::Angela Potter Workers picketed outside an AIDS clinic in Port-of-Spain, Trinidad, on Monday, complaining of garbage-strewn examination rooms and old equipment. About 20 doctors and nurses protested at the government-funded Queens Park Counseling Center and Clinic before it opened yesterday. Employees said the clinic, which sees 75 patients a day, has examining rooms no bigger than a closet; the examination tables are falling apart; some equipment is shoddy; and the bathrooms are dirty. "In terms of patient comfort and dignity, it doesn't get worse than this," Dr. Amery Browne said. "This is very degrading." Meanwhile nearby, hundreds of health care professionals met at a conference to discuss ways of improving care to patients with HIV/AIDS. Catherine Williams, who works for a nonprofit AIDS counseling center, gave her support to the protest while addressing the 10th International Conference for People Living with HIV/AIDS. "The staff has protested so we can get access to proper health care," said Williams, the activities coordinator for the Community Action Resource Center in Port-of-Spain. On Monday, the conference's 600 participants discussed how governments could be pressed to make HIV/AIDS treatment a priority. In the Caribbean, about 500,000 people are living with HIV/AIDS, according to the Caribbean Task Force on HIV/AIDS. Antiretroviral treatments, available to some in Latin America on a limited basis, can prolong the lives of those living with AIDS for years, organizers said. "Medicines are still expensive," said Williams. "We've started the long journey to access to treatment, but there's still a big gap." "Safe Sex in Kenya Taxis" BBC News (10.22.01)::Noel Mwakugu The Belgium-based International Center for Reproductive Health (ICRH) has started an aggressive initiative to educate Kenyans about safe sex. Kenya's minibus taxis are fast, colorful and often dangerous. Decorated with pictures of music idols and sports stars, the so-called matatus also carry less than encouraging slogans. "Day-Time Lover," reads one, while another welcomes passengers to "The Ticket to Hell." However, a new sticker campaign is using matatus to carry quite a different message -the fight against AIDS. ICRH has published stickers that now serve as the main decorations on the matatus. The campaign is also backed by the United States Agency for International Development (USAID). A recent survey on HIV/AIDS carried out among 3,000 people across the country revealed that many Kenyans have not changed their sexual behavior, even though the disease is killing up to 600 people a day. Despite many AIDS campaigns, Kenyans are still divided on how the pandemic will ultimately be tamed. In an independent poll commissioned by Kenya's leading media organizations, more than 55 percent of those surveyed said they thought condoms encouraged immorality. Mainstream religious leaders are opposed to the distribution of condoms, which they insist promote casual sex, the main source of HIV infection in Kenya. Overall the survey revealed that although most Kenyans know about the disease that is devastating their country, they are confused about how to respond to it. ************************************************************ MEDICAL NEWS ************************************************************ "Differential HIV Risk in Bathhouses and Public Cruising Areas" American Journal of Public Health (09.01)::Diane Binson, PhD; William J Woods, PhD; Lance Pollack, PhD; Jay Paul, PhD; Ron Stall, PhD, MPH; Joseph A Catania, PhD Social scientists have investigated the environments outside the home where men who have sex with men (MSM) meet other MSM for casual, usually anonymous sex. The variety of settings is large, but they generally allow participants to secure a minimum of privacy, at least in terms of not being harassed or interrupted. Some of the venues are purely public spaces (e.g., parks, beaches, alleys, and toilets), and some are commercial environments that can also serve as sex venues (e.g., adult bookstores, pornographic movie houses, backrooms of bars, and traditional Turkish or Japanese bathhouses). The general purpose of all these venues is something other than providing opportunities for sex. Consequently, MSM who frequent these venues share them with people who are not seeking sexual encounters on the premises, and MSM take certain risks in looking for sexual encounters, including risk of discovery, physical harm, or arrest. Because the association between HIV and baths was identified early in the epidemic, investigators have given considerable attention to sex venues generally. Using data from a probability sample of urban MSM, the present analysis describes the characteristics of men according to their pattern of sex venue attendance: whether they went only to public cruising areas ("cruisers"), only to baths ("bathers"), or to both public cruising areas and baths ("multivenue users"). The data are from the Urban Men's Health Study, a telephone survey based on a probability sample of men 18 years or older who self-identified as gay or bisexual or who reported sexual contact with a man since 14 years of age. Briefly, the sample design used multiple data sources to identify geographic areas in New York, Chicago, Los Angeles, and San Francisco that reflected residential clustering of MSM populations. Using disproportionate and adaptive sampling techniques, the researchers then constructed a random-digit-dialed sample for the designated target areas within each city. With computer-assisted telephone interviewing, the authors conducted 2,881 interviews with MSM in English or Spanish, achieving a completion rate of 78 percent. Interviews covered a range of social, psychological, and health-related topics, with an emphasis on HIV-related issues. HIV-status was self-reported. Respondents were asked a series of questions related to frequenting specific sex venues in the past 12 months. Men were also asked to describe their same-sex sexual practices for the past 12 months, including number of partners, number of "one-night stands," whether they engaged in unprotected anal intercourse, and whether such intercourse occurred in group or in public settings or outside the confines of a primary relationship. To control for a major co-factor of HIV risk behavior, the authors included in this analysis usage of four drugs that tend to be associated with casual sex: poppers (i.e., nitrites), ecstasy, methamphetamines, and other party drugs (such as ketamine and rohypnol). For the analyses in this report, the sample was limited to men who reported having sex with a man in the past year (n=2,478). Overall, about half of the MSM in our sample reported going to a sex venue. Younger and less-educated men were more likely to visit a sex venue. Of all the men going to sex venues, 75 percent went to public cruising areas and 61 percent to baths. Bathers and multivenue users were more likely than cruisers to be HIV-positive, to have had a STD, and to report using poppers, ecstasy, methamphetamines, and other party drugs. The multivariate analysis indicated that bathers and multivenue users were significantly more likely to engage in unprotected anal intercourse in a public setting than were cruisers and that frequent venue attendees were more likely to have such intercourse in public than less frequent attendees. The results suggest that sex venues play an important role in the sexual lives of gay men. However, it was encouraging to learn that most of those visiting sex venues did not engage in sexual risk behaviors. Findings associated with serostatus and sexual risk behavior indicated that HIV-positive men remain sexually active, seek sexual partners in the same settings as uninfected men, and are more likely to engage in unprotected anal intercourse in a public setting. The most striking finding was a consistent pattern across all drug- and sex-related risk behaviors: multivenue users were the most likely to report risky behavior and cruisers were the least likely. ************************************************************ EDITORIALS AND COMMENTARY ************************************************************ "Have They Nothing Better to Do?" Washington Post (10.30.01) "Judging from this week's planned assault on the District's fiscal year 2002 budget by a group of willful Republican senators, you might think the nation was not under a bioterrorism attack, the US armed forces weren't fighting a war overseas, the economy wasn't on the brink of a recession and the Senate's legislative calendar was empty. Of course, the situation is starkly otherwise: Urgent business is pressing the Senate from all sides. But America's needs are apparently of secondary importance to some GOP members. The Senate is setting aside time this week for a Republican-led attempt to stop the District from spending its own money on needle exchange and domestic partnership programs. "There is nothing earth-shattering in either program. The District's domestic partnership program would be similar to those offered around the country by more than 4,200 private companies, state and local governments, and colleges and universities. The city's needle exchange program would be comparable to programs adopted by more than 81 cities and 31 states. But to the GOP obstructionists, it matters not. ... "There is nothing the least bit amusing about their pettiness. Left to their own devices, they would destroy a program that is a life-or-death issue in the District. It's hard to find an American city with a higher transmission rate of HIV -more than one-third of DC cases are caused by intravenous drug use. Federally funded studies show that needle exchange programs don't promote drug use; but they do help prevent the spread of AIDS and offer addicts a chance to get tested for HIV, and they also serve as a bridge to drug treatment. As with the domestic partnership program, the House has also agreed that the District can fund a lifesaving AIDS prevention program with its own money if it wishes. At such a parlous moment in the nation's history, the Senate ought to be embarrassed to be jerked around by such unpardonable smallness." ************************************************************ NEWS BRIEFS ************************************************************ "AIDS Initiative to Receive $10 Million from Gates Foundation" Associated Press (10.29.01) Five major humanitarian organizations have become partners to form the Hope for African Children Initiative to benefit children orphaned or otherwise affected by the AIDS epidemic. The Bill & Melinda Gates Foundation will provide $10 million to the project. Plan International, Save the Children, the Society for Women and AIDS in Africa, the World Conference on Religions and Peace, and CARE hope to raise $100 million over the next five years. The new project will work with existing community programs to provide services such as testing children for HIV and ensuring that children continue to receive education and health care following the death of a parent. "South Africa Urges Change to AIDS Drug Deal" CNN.com (10.29.01)::Reuters South Africa urged delegates to the World Trade Organization (WTO) on Monday to make AIDS drugs cheaper for the developing world and said that the drug industry is putting patents before lives. South African Health Minister Manto Tshabalala-Msimang told a group preparing a drug policy statement for the WTO meeting in Doha, Qatar, in November that trade ministers should change the Trade Related Intellectual Property Rights (known as TRIPS) to allow countries to gain better access to affordable medicines. "New African Soap Opera to Help War Against AIDS" Times of India (10.30.01)::Agence France Presse Africa's airwaves are shortly to become a platform for the war against AIDS with Kenyan television stars and numerous government agencies participating in a new soap opera for the continent. "Heart and Soul" will address other issues of concern to the UN but one of the principle "edutainment" themes will be reducing the transmission of AIDS. Funded by the UN and other international backers, the program will begin production next year and air regularly by the end of 2002.