Subject: CDC AIDS Daily Summary for 12/03/02 Date: Tue Dec 3 11:31:02 PST 2002 (446 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Tuesday, December 03, 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 "Report: Women's AIDS Risk from Heterosexual Sex Rises" "Drug Treatment Advocates Urge Use of 'Harm Reduction' Techniques at Seattle Conference" INTERNATIONAL NEWS "One Million China Students to Lead AIDS Fight" MEDICAL NEWS "HIV Dynamics and Behavior Change as Determinants of the Impact of Sexually Transmitted Disease Treatment on HIV Transmission in the Context of the Rakai Trial" LOCAL AND COMMUNITY NEWS "Mayor Declares an AIDS 'State of Emergency'" "At Meeting, Community Asked to 'Break the Silence' on AIDS" "World AIDS Day Draws Small Crowds for Big Plight" NEWS BRIEFS "Cook Inmates Hear HIV Message" "15 Groups to Discuss Coordinated Africa Hunger/AIDS Response" "Women with HIV a Growing Trend" "HIV/AIDS, Hepatitis Cases Rise in Prison" ************************************************************ NATIONAL NEWS ************************************************************ "Report: Women's AIDS Risk from Heterosexual Sex Rises" Boston Herald (12.02.02)::Michael Lasalandra Heterosexual sex has passed intravenous drug use as the primary way women in Massachusetts are being infected with HIV, according to a state Department of Public Health report released Monday. Since 1999, when the MDPH started tracking HIV cases, more women have been getting infected through sex than drug use. According to the data, the number of women getting HIV from sexual partners not known to have risk factors for the disease has risen to more than 40 percent of all cases among females, while those getting infected as a result of IV drug use has dropped to about 20 percent. Almost 30 percent were infected through sex with partners with known risk factors. Jean Maguire, director of MDPH's AIDS bureau, said the data are troubling because officials are not sure of the best way to reach heterosexual women with the safe sex message. In the past, efforts have been geared toward reaching gay men and intravenous drug users, the groups that made up most HIV/AIDS cases. Black women make up almost half of women newly diagnosed with HIV in the state, and Hispanic women are represented disproportionately to their population. Contributing to these numbers is an increase in reported cases among women born outside the United States, the report notes. Among men, gays represent an increasing number of new HIV cases; male infections from IV drug use have dropped. In 2001, 34 percent of new AIDS cases were among gays, up from 30 percent the year before. Twenty-nine percent were among IV drug users, down from 34 percent in 2000. The report also shows a 6 percent increase in the number of Massachusetts residents living with HIV/AIDS - indicating an increase in new cases and more people living longer with the disease. Some 7,600 men and women are living with AIDS in Massachusetts; another 6,000 more having been diagnosed with HIV. Officials estimate that another 7,000 more have HIV and do not yet know it. "Drug Treatment Advocates Urge Use of 'Harm Reduction' Techniques at Seattle Conference" Associated Press (12.03.02)::Kristen Gelineau The Fourth National Harm Reduction Conference in Seattle has drawn more than 1,000 clinicians, public health workers and researchers interested in harm reduction strategies for fighting drug addiction, such as drug substitution, needle exchange programs, and compassionate counseling for addicts. During Monday's session, panelists slammed the abstinence- only rhetoric used in most drug treatment programs. "Drug prohibition is what causes the greatest harm, not drugs," said Patt Denning, director of clinical services and research with the San Francisco-based Harm Reduction Therapy Center, which helped organize the conference. Denning believes that regarding drug users and nonusers as two separate social groups creates an insurmountable divide that makes effective treatment impossible. The conference includes speakers and workshops on harm reduction in prisons and legal barriers to syringe disposal. Speakers are providing step-by-step instructions on how to use harm reduction techniques. During one panel discussion, Denning dismissed the suggestion that users must "hit rock-bottom" before they can be helped, and she criticized current methods of drug therapy that use punishment to get addicts to kick their habits. "There is no place for punishment in treatment," she said. The keynote speaker at the conference, Alonzo Plough, director of the Seattle-King County Department of Public Health, said local politicians and law enforcement officials have "come a long way" in their acceptance of harm reduction techniques. Plough said more resources need to be poured into harm reduction programs. He suggested making syringes available for sale at pharmacies and expanding syringe disposal locations. He also called Seattle's current methadone program "woefully underfunded." Despite an additional $300,000 allocated in last year's budget to improve the program, the waiting list remains "unacceptably long," he said. In King County alone, where 15,000 to 20,000 people inject drugs an average of three times a day, there are more than 20 million injections each year, Plough said. The five needle- exchange locations in Seattle, where 2 million syringes are exchanged annually, are not equipped to handle that type of volume, he said. ************************************************************ INTERNATIONAL NEWS ************************************************************ "One Million China Students to Lead AIDS Fight" New York Times (12.01.02)::Reuters Long criticized for ignoring a potential explosion of the epidemic, China marked World AIDS Day by launching new prevention and awareness campaigns. At Beijing's Great Hall of the People, the government announced it would send 1 million students into the countryside during the next year to promote HIV prevention and to persuade people not to discriminate against AIDS patients. In a graphic message to the nation's 1.3 billion people that AIDS is not spread by casual contact, top actor Pu Cunxin hugged AIDS patients. Experts fear, however, that the efforts may already be too late to head off a rapid spread. The US Central Intelligence Agency estimates that in just seven years, China will have 10 million to 20 million AIDS patients. India, the CIA predicts, will have the world's most patients: 20 million to 25 million. The UN estimates that all of Asia-Pacific now has 7.2 million HIV patients. While most Asian populations have an HIV prevalence of less than 1 percent, the 7.2 million figure is a 10 percent increase over last year. In some parts of India and China, the UN estimates, infection rates are reaching 10-20 percent. Experts fear that the disease is on the verge of breaking out from the most vulnerable groups - homosexuals and needle-sharing drug users - and into the general population. That is why countries such as China are cranking up their publicity machines. On Saturday, the government brought about 1,000 people to a village hall outside Beijing and showed them documentaries on how AIDS spreads and how to avoid it. The official Xinhua news agency said the programs would be broadcast on 1,000 local TV stations, reaching about half the nation's people. Ray Yip of UNICEF said China has three or four years to contain the spread of HIV so it does not become a "hyper epidemic" country, and he praised the government for starting to make serious efforts. "They're willing to bring out the faces, willing to say that discrimination is unacceptable," he said. ************************************************************ MEDICAL NEWS ************************************************************ "HIV Dynamics and Behavior Change as Determinants of the Impact of Sexually Transmitted Disease Treatment on HIV Transmission in the Context of the Rakai Trial" AIDS (11.08.02) No. 16; Vol. 16: P. 2209-2218::Eline L. Korenromp; Roel Bakker; Sake J. de Vlas; Ronald H. Gray; Maria J. Wawer; David Serwadda; Nelson K. Sewankambo; J. Dik F. Habbema STDs, co-factors in HIV transmission, are quite prevalent in sub-Saharan Africa. Two community-based trials have tested the notion that improved treatment of STDs may be a strategy for HIV prevention. Over a two-year period, improved clinical management of symptomatic STD treatment in Mwanza, Tanzania, showed a reduction of 38 percent in HIV incidence. Over the same interval, with comparable proportional reductions in the treated STDs, periodic mass treatment in Rakai, Uganda, did not reduce the incidence of HIV. One explanation for the discrepancy in these two trials is that STD co-factors may play a larger role in early, concentrated HIV epidemics, such as the one in Mwanza, and a lesser role in mature epidemics such as the one in Rakai. Early in HIV epidemics, infections occur in a core group of highly sexually active individuals, who have high rates of STDs. As an epidemic progresses, more HIV transmissions occurring in stable relationships with lower prevalences of STDs. In addition, as a result of selective HIV-attributable mortality among high-risk individuals, STD prevalences decline. The authors noted that previous model-based studies of the decreasing importance of STD co-factors during an HIV epidemic did not account for two key factors: a high rate of herpes simplex virus type 2 (HSV-2), which enhances AIDS transmission; and reductions in sexual risk behavior. The current study assessed how the impact of STD treatment on HIV transmission would vary over time in an HIV epidemic, taking into account the role of HSV-2 and behavioral change, using the transmission model STDSIM. (STDSIM simulates the natural history and transmission of STDs and HIV in a dynamic population of interacting individuals.) Researchers simulated the spread of curable STDs, HSV-2, and HIV, quantifying parameters to represent the severe HIV epidemic in Rakai, using demographic, behavioral, and epidemiological data from the STD treatment trial and preceding cohort data. Simulations were designed to represent several scenarios: Rakai; a hypothetical Rakai-like population with no behavioral change; Rakai with STD intervention implemented in years 3, 10, or 20 of the epidemic; and a hypothetical Rakai-like population without behavioral change, with STD intervention in years 3, 10, or 20. The model fit the Rakai HIV epidemic assuming a considerable behavioral risk reduction starting at the end of the Ugandan civil war in 1986. (The authors estimate that the epidemic began around 1978). STD prevalences fell after the assumed behavioral risk reduction starting in 1986. The simulated decline in syphilis prevalence approximated the decline observed in Rakai between 1992 and 1996. The model also fit time trends in gonorrhea and HIV prevalence, confirming the adequacy of the assumed behavioral risk reduction. HSV-2 showed a comparatively slow and small decline. The simulations confirm that the proportion of new HIV infections preventable by STD treatment decreases during the evolution of generalized HIV epidemics. For populations with unchanged risk behaviors, the decline in impact is greatest during the first 10 years of the epidemic. The conclusion holds true for populations with varying patterns of sexual behavior and across a range of scenarios of HIV/STD transmission dynamics. The slight decline in STDs over time in simulations without behavior change indicates that HIV-attributable mortality contributes only modestly to the changing role of STDs. The dynamics of the spread of HSV-2 also contributed little to the decreasing impact of bacterial STD treatment on the incidence of HIV. Behavioral change such as that in Uganda is a powerful determinant of the evolution of an HIV epidemic and the relative impact of subsequent STD treatment programs. The authors counsel caution in interpreting the outcome of this model, since the actual magnitude of the change in risk behavior in Uganda is not known, with data lacking up until the late 1980s. Data are subject to reporting biases, and it is not possible to determine the relative contributions of the end of the civil war and the simultaneous implementation of the national AIDS control program. The data do shed light on the discrepancy between the Rakai and Mwanza trials. The Rakai trial began around the 17th year of the epidemic. Mwanza's trial, by contrast, started around the 10th year of the epidemic. Mwanza's population had apparently engaged in no behavioral change, while there had been significant risk reduction in Uganda. The study concludes that the impact of STD treatment on HIV incidence decreases over time as a result of the natural dynamics of the HIV epidemic, the effect mainly being important within the first decade of the epidemic. A stronger contributor to a decreasing role of curable STDs in HIV transmission can be behavior change. The lack of impact of STD treatment in the Rakai trial may be due to the preceding behavioral change in Uganda after the civil war. Improved STD treatment may have more impact in earlier-stage HIV epidemics and in areas such as South Africa where behavior has not significantly changed. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Mayor Declares an AIDS 'State of Emergency'" Baltimore Sun (12.03.02)::Jonathan Bor On Monday, Baltimore Mayor Martin O'Malley declared a "state of emergency" in the city's battle against AIDS and called for a coordinated assault by public and private interests on the disease, which disproportionately affects the black community. His declaration, which promised little money and few initiatives, came after intense lobbying by the National Black Leadership Commission on AIDS, an organization of black ministers, and an AIDS commission spearheaded by City Council President Sheila Dixon, who lost her brother and sister-in-law to the disease. Since June, both groups had asked O'Malley to dedicate more resources to prevention, treatment and education, saying the city's efforts have been woefully inadequate. Dixon said she had been frustrated by the delay and was grateful the mayor had acted. With city Health Commissioner Dr. Peter L. Beilenson, O'Malley made the announcement at a hastily called news conference. "I'm declaring a public health emergency with respect to HIV and AIDS," O'Malley said. "I'm urging all citizens... to step up efforts so this scourge can be conquered in the city, this country and this globe." Similar declarations were made two years ago in Houston and four years ago in Oakland. O'Malley said he intends to create a standing commission of public health officials and other experts to monitor the epidemic and the city's efforts to fight it. AIDS is the second leading cause of death among city residents ages 25-44, trailing only homicide. While new infections and AIDS cases have been declining, Baltimore still has one of the highest per-capita caseloads in the country. In 2000, some 12,000 city residents were HIV-positive. Today, the caseload is 85 percent African-American. The creation of a standing commission was a key recommendation of a report issued in June by an expert panel convened by City Council. That report noted that while Baltimore was blessed with nationally recognized medical institutions, its public health officials had not done enough to coordinate AIDS- fighting efforts, and its business community had not done enough to stop the epidemic. "At Meeting, Community Asked to 'Break the Silence' on AIDS" Baltimore Sun (12.02.02)::Childs Walker At New All Saints Roman Catholic Church in Forest Park, Md., on Sunday, before a group of religious leaders gathered to discuss AIDS in Baltimore's black community, Melanie Reese, 50, rose to reveal she is HIV-positive. She had known she was infected since earlier this year but kept the news secret from everyone but her daughter. Now, she said, she had decided God wanted more from her than silence. "We need to break the silence," she said. "What she said in a few minutes had more impact than any speech I could give," said Joseph F. O'Neill, the Bush administration's AIDS policy director and a speaker at the meeting. O'Neill, a faculty member at the Johns Hopkins School of Medicine who has treated the city's AIDS patients for years, told of one patient who died six years ago. The man kept his illness secret, telling his family and fellow church members only months before his death. The church community embraced the man, a beloved member of the choir. Asked to speak at the funeral, O'Neill said he admired the congregation's outpouring of love, but he also offered sobering words. "I was the only person he told for five years - not his family, not his church - that he was gay and that he was dying," O'Neill said. "That's a shame. We can't let that happen." The crowd at Sunday's meeting murmured and nodded in affirmation. O'Neill followed his story with a promise that the Bush administration would continue spending billions of dollars to fight AIDS worldwide. He said the president believes faith-based efforts are key to the battle. O'Neill splits his week between the White House and the Hopkins AIDS clinic. By bridging the gap between policy makers and doctors, he said, he hopes to show people that the administration shares their pain and worry. "None of this is theoretical to me," he said. "World AIDS Day Draws Small Crowds for Big Plight" New York Times (12.02.02)::Jennifer Medina Hundreds of people gathered across New York City Sunday at rallies and memorials for World AIDS Day, though advocates said the sparse attendance reflected a need to refocus attention on the disease. "It is hard to grasp that we can be this far in the crisis and still have this far to go," Brent Nicholson Earle, a veteran AIDS activist, said during a rally at the Lesbian, Gay, Bisexual and Transgender Community Center in Greenwich Village. Last year, AIDS was diagnosed in more than 6,000 people in New York City. Drug cocktails are allowing people with AIDS to live longer, and young people who have grown up knowing about the disease may not fear contracting it, experts say. Justine Davis, 17, rarely talks about AIDS with her friends at Louis D. Brandeis High School in Manhattan. Except in her health class, sex is never a topic of discussion, she said. "We get embarrassed," said Davis, who attended an event Sunday at St. Luke's-Roosevelt Hospital Center in Manhattan that featured comic books addressing AIDS and a youth theater troupe focusing on HIV/AIDS. The youth theater troupe, NiteStar, performs plays that explore students' attitudes toward sex in schools throughout the city. "On the one hand, you don't want them to be scared of someone with AIDS, but you also don't want them to think it's no big deal if they get it. It's difficult to try to find that balance," said David Williams, who has performed with the group for the last three years. Other events in the city focused on how the disease has spread into all communities. At a 24-hour vigil on 125th street in Harlem, the names of hundreds of people who have died from AIDS were read. "It's time to stop the denial, the partying and the pretension: AIDS kills gay, lesbian, bisexual, transgender and straight people," said Doneley Meris, who runs education services at the LGBT Center. ************************************************************ NEWS BRIEFS ************************************************************ "Cook Inmates Hear HIV Message" Chicago Tribune (12.02.02)::Jon Yates Rainbow/PUSH Coalition leader the Rev. Jesse Jackson spoke to about 200 inmates at Cook County Boot Camp in Chicago to observe the 15th annual World AIDS Day on Sunday. Jackson took the oral HIV test along with 20 of the inmates and delivered a message that jails are the breeding ground for the disease because inmates are predominantly poor, uneducated and disproportionately black. "I wish we were doing this in 500 jails today," Jackson said. Officials said about 100,000 people go through the county correctional system each year. Last year, roughly 8,000 inmates were tested for HIV while incarcerated. Jail officials said 3.5 percent tested positive, almost eight times the rate found in the general public. "If you take the test and you're negative, good news," Jackson said. "If you take the test and you're positive, good news because you can get treatment." "15 Groups to Discuss Coordinated Africa Hunger/AIDS Response" Associated Press (12.02.02)::Foster Klug Fifteen US humanitarian groups are meeting Tuesday with a UN envoy to discuss how to help millions of Africans plagued by famine and AIDS. The relief groups, which include the American Red Cross, Save the Children and Catholic Relief Services, say more than 34 million people in Africa face death by starvation in the next six to eight months. James Morris, the UN Special Envoy for southern Africa, will meet with the relief group representatives before addressing the UN Security Council about the world's food crisis later in the day. "Women with HIV a Growing Trend" Toronto Star (12.02.02)::Nick McCabe-Lokos Health Canada statistics show an estimated 5,956 women have tested HIV-positive as of Dec. 31, 2001. The proportion of newly infected women had risen to nearly 25 percent of all new cases between January 1999 and Dec. 31, 2001. Women accounted for 9.7 percent of new cases between 1985 and 1995. Louise Binder, chair of Voices of Positive Women, said that increase is similar, though "obviously on a smaller scale," to findings in a UN report released last week revealing, for the first time, that women make up nearly half of the HIV-infected people in the world. "HIV/AIDS, Hepatitis Cases Rise in Prison" Star Phoenix (Saskatoon, Saskatchewan) (11.25.02)::Ryan Lorge Cases of HIV/AIDS and hepatitis C are on the rise in Canada's federal and provincial correctional centers, and governments are doing little to help, according to a bleak report card issued in late November by the Canadian HIV/AIDS Legal Network. Known cases of HIV/AIDS in the federal prison system have increased by 35 percent in the last four years; prisoners are now up to 70 percent more likely to be living with HIV than are people in the general population, the report said. And while only 0.8 percent of Canadians have been diagnosed with hepatitis C, up to 80 percent of prisoners are infected. According to the network, the federal and provincial governments are falling short in areas like HIV and hepatitis C education for prisoners and staff, providing prisoners with basic preventative measures and services, and ensuring the availability of treatment for prisoners with HIV.