Subject: CDC AIDS Daily Summary for 12/02/02 Date: Mon Dec 2 11:21:02 PST 2002 (453 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Monday, December 02, 2002 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 "Americans Observe World AIDS Day with Songs, Stars and Prayers" "Powell Plans AIDS Message for Envoys" INTERNATIONAL NEWS "Millions Observe World AIDS Day" "Global Fund to Fight Illnesses Issues Checks to Three Nations" MEDICAL NEWS "Risk of HIV Infection Attributable to Oral Sex Among Men Who Have Sex with Men and in the Population of Men Who Have Sex with Men" LOCAL AND COMMUNITY NEWS "Mobile Clinic to Fight TB in Cook" EDITORIALS AND COMMENTARY "AIDS Is Not a Death Sentence" NEWS BRIEFS "Stigma Major Barrier to Fighting AIDS, Says Piot" "WTO Negotiations on Drug Access Stall" "Brazilian Students Commemorate World AIDS Day" "Gates Foundation Selecting Areas for Anti-AIDS Projects in India" ************************************************************ NATIONAL NEWS ************************************************************ "Americans Observe World AIDS Day with Songs, Stars and Prayers" Associated Press (12.02.02)::Leon Drouin Keith With songs, stars and prayers, Americans recognized World AIDS Day as a time to focus on a cure, on making treatment more available around the world, and on remembering the millions who have already died. *In New York City, the HIV+ Sinikithemba Choir, composed of HIV- positive South Africans, raised their voices in Zulu and English songs in a Harlem church. "Most South Africans don't get tested because they know there's no cure, and they cannot get the drug treatment because it is too expensive," said Mimi Badumuti, 32. *In Lincoln, Neb., Irish rocker Bono kicked off a tour with Ashley Judd by speaking to about 2,300 people about the AIDS crisis in Africa. During his seven-day tour, Bono will urge Americans to call on the US government to forgive the debts of African nations and provide more funds to fight AIDS in Africa. "It's not about charity. It's about justice and equality," Bono told the Nebraska crowd. *In San Francisco's Golden Gate Park, about 250 people gathered at the National AIDS Memorial Grove to remember those who have died from the disease and hear messages of hope for a cure. "I came today to remember," said Hank Donat, 36, a San Francisco writer. "The gay community in San Francisco was devastated in the early years. We'll never be able to know the full breadth of the loss to our culture. But we feel it, we measure it in our hearts." *President George W. Bush, in his World AIDS Day proclamation, praised groups that are working to combat AIDS and help the people who suffer from it, and noted that his administration is seeking increases in spending for domestic and international AIDS programs. "By working together, we can provide hope and comfort to all those affected by this devastating disease," Bush said. "Powell Plans AIDS Message for Envoys" Associated Press (11.29.02)::George Gedda The entire diplomatic corps is invited to the State Department Tuesday to hear Secretary of State Colin Powell deliver a message he hopes they will convey to their governments: Political leadership is an essential component in the fight against HIV/AIDS. It is believed to be the first time all ambassadors from governments accredited in Washington will have gathered to hear a message on a public health issue, said Jack Chow, the US ambassador on AIDS. "We know that national political leaders who are willing to speak out and commit their governments to a course of constructive action in combination with public health investment can make a difference," Chow said. He cited the example of Ugandan President Yoweri Museveni, who early in his presidency recognized AIDS as a national security threat and personally oversaw the creation of a joint center for research. As a result, Chow said, Uganda is one example of a country where "a leader made a tangible, concrete difference at the grass roots level." Assertive leadership in Senegal and Thailand has produced similar results, he said. While he would not say HIV/AIDS is declining in these countries, he contended they have "been able to deflect the rate below that of their neighbors." He hopes the experiences of these countries can be replicated in the "special risk countries" - Nigeria, Ethiopia, China, India and Russia - all of which face a growing incidence of HIV/AIDS. The potential for catastrophe is high, he said, since all the countries have high population densities with relatively weak public health systems. "It is a personal honor to be America's first ambassador dedicated to health," Chow said, citing as a cause for optimism the downward-trending prices of antiretroviral drugs. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Millions Observe World AIDS Day" Washington Post (12.02.02) On Sunday, millions of people around the world marked World AIDS Day with marches, prayers and hope - even as grim statistics show the epidemic is outpacing efforts to control it. *In China, officials instructed 1 million students to launch a national AIDS campaign. *Officials in Britain warned that the country is likely to have a 20 percent increase in new HIV cases this year: twice that reported at the end of the 1990s. "We are moving in the wrong direction, and that is extremely worrying," said Barry Evans of the Public Health Laboratory Service. *In South Africa, the country hit hardest by AIDS, activists held a mass funeral for babies; the ashes of some were interred during a Johannesburg ceremony. *Thousands took to the streets of Hanoi and Bangkok to promote AIDS awareness. "Silence is death when it comes to fighting HIV/AIDS," Jordan Ryan, the UN resident coordinator in Vietnam, told some 3,000 demonstrators in Hanoi. *In India, where 4 million people are HIV-infected, officials in the eastern city of Bhubaneshwar unfurled a 3.7-mile-long banner to mark the day. *In Malawi, where about 9 percent of the population is HIV- positive, the government said AIDS is decimating the civil service and the economy. "Every day we are burying our workers, our teachers, our doctors and other professionals," Vice President Justin Malewezi said in a statement issued with the findings of a new study. *In politically troubled Zimbabwe, President Robert Mugabe acknowledged that 2.2 million of the nation's 13 million people are HIV-positive, and 700,000 children have been orphaned by AIDS. *In South Africa, Deputy President Jacob Zuma said, "there is no longer a distinction between those living with HIV/AIDS and those who are not. We are all living with the disease and are affected by it in many ways." More than 40 million people worldwide are HIV-infected, according to the UN. This year, AIDS will kill 3.1 million people, and another 5 million will be infected by HIV, according to UNAIDS. "Global Fund to Fight Illnesses Issues Checks to Three Nations" Wall Street Journal (12.02.02)::David Bank The $2.2 billion Global Fund to Fight AIDS, Tuberculosis and Malaria has issued its first checks, for programs in Ghana, Haiti and Tanzania, as officials try to demonstrate the effectiveness and accountability necessary to attract the billions more needed to stem the devastating epidemics. Such accountability was put to the test last month, when the fund held up a two-year, $12 million grant for an innovative malaria-prevention program in Tanzania after the country's finance ministry made a last-minute demand that the funds be deposited in the ministry's account, rather than the health program account itself. After fund officials rejected the revised terms because of the potential for corruption and delays, the ministry relented, and an agreement was signed in Dar es Salaam during the weekend. The Global Fund, based in Geneva, was established early this year as an independent body by the world's industrial nations. The executive director of the Global Fund, Richard Feachem, has been on a worldwide fundraising tour in conjunction with World AIDS Day. This week, he is in Washington to meet with Secretary of State Colin Powell and other administration and congressional leaders. The fund has issued a call for an additional $2 billion for next year and $4.6 billion for 2004. Feachem said "a reasonable contribution" from the United States during that period might be $2.5 billion to $3 billion. "We are looking for a greatly increased contribution from the US, alongside others," Feachem said. The United States, the fund's largest donor, has pledged $500 million. The recently issued checks are part of a first round of 37 projects approved in April. A second round, to be approved in January, will effectively exhaust the fund's current resources. The first slate of projects is intended to demonstrate the fund's ability to work with private organizations as well as governments. Compliance with the grant agreements is to be audited by KPMG and PriceWaterhouseCoopers. ************************************************************ MEDICAL NEWS ************************************************************ "Risk of HIV Infection Attributable to Oral Sex Among Men Who Have Sex with Men and in the Population of Men Who Have Sex with Men" AIDS (11.22.02) Vol. 16; No. 17: P. 2350-2352::Kimberly Page- Shafer; Caroline H. Shiboski; Dennis H. Osmond; James Dilley; Willi McFarland; Steve C. Shiboski; Jeffrey D. Klausner; Joyce Balls; Deborah Greenspan; John S. Greenspan Since HIV was identified as being sexually transmitted, there has been considerable interest in the risk associated with performing fellatio. Although early studies found no independent risk for fellatio, the high correlation among multiple sexual practices raised the possibility that risk existed but could not be detected. Subsequently, case reports accumulated, largely among men who denied other risk behaviors. Researchers acknowledged that fellatio, although not an efficient route of infection, nonetheless appeared to carry a small risk. Current safe sex guidelines specify that unprotected orogenital sex is unsafe but low risk. A recent study of primary infection in San Francisco reported that 8 percent of HIV- positive participants acquired HIV from fellatio. This finding has been widely interpreted that as many as 8 percent of HIV infections among MSM are attributable to fellatio. The population-attributable risk percentage (PAR%) is of special interest, because even a low-risk exposure could result in a substantial proportion of infections. The authors present preliminary results from an ongoing study investigating orally acquired HIV infection demonstrating: that such infection is rare; and conduct analyses using previously published data to show that the PAR% of HIV attributable to fellatio is also extremely low. From December 1999 to 2001, individuals seeking HIV testing at an anonymous testing site in San Francisco were screened to identify those who in the past 6 months reported no anal or vaginal sex, had not injected drugs, and had performed fellatio on at least one male partner. Eligible participants completed a pre-HIV test survey, measuring a 6-month history of sexual practices. Post-interview HIV serology was conducted to determine participants' HIV serology using enzyme immunoassays, Western blot confirmation, and a sensitive/less sensitive enzyme immunoassay strategy to identify recently acquired infection. Of 10,283 anonymous testing site clients, 413 (4 percent) were eligible, and 243 (2.3 percent) participated. Of those, 239 (98 percent) were men, whose median age was 39 years, and all were MSM. Four women were dropped from the analysis. No recently acquired HIV infections were detected and the estimated probability of orally acquired HIV was 0. The median number of fellatio partners in the past 6 months was three, almost all (98 percent) were unprotected. One-third (35 percent) reported getting semen in their mouth, and of those, 70 percent swallowed it. Fellatio on a known HIV-positive partner was reported by 28 percent; of those, 81 percent did not use a condom, and 39 percent had swallowed ejaculate. The PAR% rises as the number of partners increases: PAR% for one fellatio partner was estimated at 0.18 percent, for two fellatio partners at 0.25 percent and for three fellatio partners as 0.31 percent. The cumulative PAR% for one to three fellatio partners could thus be 0.74 percent. The authors' results are based on a modest sample size; therefore, they cannot rule out the possibility that the probability of infection is indeed greater than zero. The calculations showing very low PAR% are consistent with the findings of extremely low individual risk. In addition, if one considers that only a fraction of those who report fellatio are actually exposed to semen (35 percent), the PAR% will be considerably lower. "These data confirm that the risk of HIV infection attributable to fellatio among MSM and in the MSM population is especially low," the authors concluded. "It is important that health professionals, including HIV counselors have valid information to impart to their sexually active clients. If individuals believe that the risk of HIV from fellatio is high or on a par with well-documented high-risk exposures such as anogenital sex, they may not feel that sexual behavior choices make a difference. Acquiring HIV through fellatio is significantly less risky than from anal sex, and therefore one's choice of sexual practices do matter." ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Mobile Clinic to Fight TB in Cook" Chicago Tribune (11.25.02)::Colleen Mastony The Suburban Cook County, Ill., Sanitarium District will soon start a mobile clinic to reach immigrants who contracted TB in their native countries and have settled in Chicago suburbs, far from traditional clinics set up to treat them. In suburban Cook County, immigrants make up a higher percentage of active TB cases every year. In 1999, foreign-born people accounted for 45 percent of active cases in the suburbs. In 2001, they accounted for nearly 60 percent of cases - the highest rate ever. Without aggressive TB outreach programs, Dr. James B. Gallai, head of field operations for SCCSD, said he would "guarantee the numbers would rise." Outreach programs have kept the number of active cases in the suburbs at about 140 cases a year since 1999. Still, health officials estimate there could be an additional 80,000 to 140,000 people in the suburbs with latent TB. If untreated, about a tenth of those cases will develop into active TB, which is contagious. "Over the last 10 years we've treated roughly 50,000 cases of latent TB," Gallai said. "Theoretically, that means we've prevented about 5,000 active cases." Health officials are targeting the suburbs - from Cicero to Schaumburg to Skokie - where active TB cases have been found. They will conduct free testing and hand out TB information translated into a dozen languages, including Spanish, Polish, Russian, Italian, Hindu, Portuguese and Punjabi. Officials will unveil a $200,000 mobile TB clinic in early December. Soon after, a doctor, a nurse and an X-ray technician will begin making the rounds in the custom-made, 35-foot converted mobile home, complete with reception, consultation, interview, X-ray and darkroom areas. Immigrants must show they do not have active TB when applying for legal entry, but because the disease can remain dormant for years, health officials say immigrants should be screened in America too. ************************************************************ EDITORIALS AND COMMENTARY ************************************************************ "AIDS Is Not a Death Sentence" New York Times (12.01.02)::William Jefferson Clinton "Historians will look back on our time and see that our civilization spends many millions of dollars educating people about the scourge of HIV and AIDS.... But what they will find not so civilized is our failure to treat 95 percent of people with the disease. "Given that medicine can turn AIDS from a death sentence into a chronic illness and reduce mother-to-child transmission, our withholding of treatment will appear to future historians as medieval, like bloodletting. "...Some people argue that treatment is less important than prevention; a dollar spent on prevention, they say, goes further in slowing the spread of the disease than a dollar spent on treating someone who already has it. But this is a false choice. Prevention doesn't work unless large numbers of people agree to be tested. They won't agree to be tested if all they will learn is that they are going to die. "...If we focus on treatment in addition to prevention, several good things would result. More people will stop suffering in silence and be willing to get tested for HIV if we offer treatment .... People who have the disease will live longer, healthier lives. ... "...With a new generation coming of age every few years, the need for AIDS education remains high, and no amount of mass marketing can match the power of one-to-one advice - the kind that can be provided by the trained professionals at clinics where AIDS testing and treatment occur. ... "...The more that people understand that AIDS is not only a preventable disease but a treatable one, the less likely they will shun those who have it. ... "Can treatment work? It has in Brazil, where virtually all AIDS patients are given access to life-saving, generic drugs manufactured in that country. ...Brazil's death rate from AIDS and related illnesses is down 50 percent, and the infection rate is low and getting lower. ... "More must be done by governments... especially in answering the call of Kofi Annan, secretary general of the United Nations, for $10 billion to fight AIDS worldwide. Governments must also push pharmaceutical companies to make good on their commitments to provide drugs at discount prices or to stop trying to block the purchase of generic drugs by poor countries. ... "...Now that we have the medical capacity to save and improve the lives of millions of people, there is no other moral or practical choice." The author was the 42nd US president. ************************************************************ NEWS BRIEFS ************************************************************ "Stigma Major Barrier to Fighting AIDS, Says Piot" New York Times (11.30.02)::Reuters On the eve of World AIDS Day, UNAIDS head Peter Piot said that stigma and discrimination remain major barriers to controlling the pandemic in Africa, where close to 30 million people are infected. Speaking to an audience in Addis Ababa, Ethiopia, Piot said the social prejudices suffered by people with AIDS could be as destructive as the disease itself. "Stigma silences individuals and communities, saps their strength, increases their vulnerability, isolates people and deprives them of care, of support," he said. "We must break down these barriers or the epidemic will have no chance of being pushed back," he added. Piot said there are encouraging signs that prevention efforts are bearing fruit among young people in Ethiopia and South Africa. "WTO Negotiations on Drug Access Stall" Associated Press (11.29.02)::Alexander G. Higgins Negotiators in the current World Trade Organization talks failed Friday to resolve differences between the United States and developing countries over access to essential medicines, but hope to renew efforts in early December, trade officials said. The United States, wanting to protect its pharmaceutical industry patents, said it remained committed to supporting poor countries' access to drugs to fight AIDS and other epidemics, but it opposed extending an accord to other health issues such as diabetes and cancer. The African group, supported by developing countries, expressed disappointment at what they described as proposals that would narrow the accord reached at a meeting of trade ministers in Doha, Qatar, last year; this recognized the right of WTO members to override patents on expensive Western drugs and make the products themselves when public health is at stake. "Brazilian Students Commemorate World AIDS Day" Associated Press (11.29.02) As part of commemorations for World AIDS Day, 800 high school students placed 15,000 red ribbons before Brazil's Health Ministry Friday to symbolize the number of Brazilians who became infected with HIV this year. Dr. Paulo Roberto Teixeira, coordinator of Brazil's AIDS program, said the number of people infected annually with HIV has fallen from 15.9 cases per 100,000 people in 1998 to 12.4 per 100,000 in 2001. Brazil's AIDS program distributes millions of free condoms and has been providing free AIDS drugs to all who need them since 1996. "Gates Foundation Selecting Areas for Anti-AIDS Projects in India" Associated Press (11.28.02) A team of experts from the Bill & Melinda Gates Foundation arrived in India last week to select areas where the foundation can put its money to work preventing the spread of HIV/AIDS, officials said. The team is surveying areas of southern Andhra Pradesh state, where the foundation has already allocated $25 million for a hepatitis vaccination program. "They are surveying some of the worst affected districts of the state," said K. Sivaprasad Rao, Andhra Pradesh's health minister. "On the basis of their findings, the foundation will prepare an action plan." Microsoft Chairman Bill Gates said during a visit to India last month that his foundation would spend $100 million on HIV/AIDS prevention projects in India. ************************************************************ ANNOUNCEMENT: On Dec. 2, the HIV/AIDS Clinical Trials Information Service (ACTIS) and the HIV/AIDS Treatment Information Service (ATIS) will be merged into AIDSinfo. The AIDSinfo project will include all of the services currently available from ACTIS and ATIS, as well as quick and easy access to wide-ranging federal resources on HIV/AIDS clinical research, HIV treatment and prevention, and medical practice guidelines for health care providers and consumers. For more information, visit www.AIDSinfo.nih.gov.