Subject: CDC AIDS Daily Summary for 12/05/02 Date: Thu Dec 5 11:01:03 PST 2002 (400 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Thursday, December 05, 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: South Leads Country in New HIV Infections, AIDS" "TV 'Roadblock' Serves AIDS Fight" "AIDS Risk for Latinas Climbs Still" INTERNATIONAL NEWS "AIDS Takes Center Stage on World Awareness Day" MEDICAL NEWS "Initiation of Services in the Boston HAPPENS Program: Human Immunodeficiency Virus-Positive, Homeless, and At-Risk Youth Can Access Services" LOCAL AND COMMUNITY NEWS "Residents Celebrate World AIDS Day" EDITORIALS AND COMMENTARY "AIDS Sufferers Face a World of Hostility" NEWS BRIEFS "Students to Get Free Treatment for STDs" "Nigeria's President: At Least 4.2 Million HIV-Infected in Africa's Most Populous Nation" "World Bank Gives Tanzania US $136 Million Grant" ************************************************************ NATIONAL NEWS ************************************************************ "Report: South Leads Country in New HIV Infections, AIDS" Associated Press (12.04.02)::Rachel La Corte Officials at a regional AIDS conference in Tampa, Fla., said on Wednesday that the South leads the country in new HIV infections and overall AIDS cases - yet lags in the amount of federal funding when compared to other regions. In the South, more than 130,000 people have AIDS, compared to just over 100,000 in the Northeast, 36,000 in the Midwest and nearly 62,000 in the West, according to CDC figures cited in the "Southern States Manifesto," written by AIDS directors from various states. The manifesto, produced on Nov. 4, was studied during the two-day Southern AIDS Conference aimed at developing a strong lobbying effort at local, state and federal levels for fair funding of HIV/AIDS efforts in the South. Alabama, Arkansas, the District of Columbia, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia and West Virginia were represented. Florida AIDS Action Executive Director Dr. A. Gene Copello said Florida receives roughly 5 percent of the nation's prevention funds, but has approximately 12 percent of US AIDS cases. "We intend to be very loud about it and very forceful, because our people are dying all over the South," Copello said at a news conference. The southern states, he said, are in the process of organizing a two-fold approach: pushing for fair funding for the region, and for a core set of services for anyone with HIV/AIDS. A network of groups is being set up to lobby lawmakers on the state and federal levels. The manifesto will be sent to members of Congress as well as members of state legislatures, said David C. Harvey of the AIDS Alliance for Children, Youth & Families. "This conference represents an increasing awareness that this is an epidemic that's out of control in the South," Harvey said. "TV 'Roadblock' Serves AIDS Fight" Wall Street Journal (12.03.02)::Vanessa O'Connell At precisely 7:59 p.m. on Sunday, a group of about 100 cable outlets voluntarily showed "Kids," a 30-second AIDS awareness commercial. This Madison Avenue version of a television "roadblock" intended to force a large number of viewers to watch the commercial. "The idea was that you can't change the channels to miss the message," says Steve Villano, CEO of Cable Positive, the New York nonprofit cable and telecommunications industry AIDS action group that organized the roadblock. The ad features the voice of Michael Douglas. As somber music plays, AIDS orphans walk the streets alone and try to get through life's daily tasks without adults. Douglas equates the 14 million children orphaned by AIDS with every child under the age of five in America. "AIDS is preventable. Apathy is lethal," the ad warns. "The spot was moving for our viewers," says Carole Black, CEO of Lifetime Entertainment Services, which has two cable networks aimed largely at women. Cable Positive provided the spot to the cable networks, such as Lifetime, Discovery, the Food Network and SoapNET, through a satellite feed. Villano estimates that 35 million to 50 million cable television households saw the AIDS message during the roadblock Sunday night. The creative content of the "Kids" ad is sponsored by the UN Foundation in partnership with the Advertising Council, a nonprofit that in 1988 was one of the first organizations to use the word "condom" in a commercial for AIDS awareness. "Kids" is the primary vignette in a broader AIDS campaign. AOL Time Warner has agreed to place some of the ads prominently in its media properties. Julie Hughes, director of outreach at the UN Foundation, said she hopes network and cable outlets will continue to show the ads in the coming months. On average, only 0.4 percent of airtime goes to public service announcements, and 43 percent of those commercials are presented between midnight and 6 a.m., according to the Kaiser Family Foundation. "AIDS Risk for Latinas Climbs Still" Philadelphia Inquirer (12.02.02)::Marina Walker While the number of new US AIDS cases has been declining since the mid-1990s, the proportion of new cases that occur among Latino women is rising. Their risk is significantly higher than that of white women, though much lower than that of African-American women. In 2001, women made up 23 percent - 1,894 people - of new Latino AIDS cases in the United States, up from 15 percent - 730 people - in 1990, the CDC reported. In 2000, AIDS was the fourth-leading cause of death for Latinas ages 35 to 44 in the United States, compared with the ninth-leading cause for white women, according to the CDC. Latinas constitute about 13 percent of the female population of the United States, but accounted for 21 percent of all female AIDS deaths since 1981. Of the 67,557 women who have died of AIDS, 14,236 have been Hispanic. Many of these Latinas are middle-aged and were infected by husbands or boyfriends who are bisexual or intravenous drug users. "Poverty, traditional gender-role beliefs, sexual coercion, sexual abuse, and difficulties talking about sex may all contribute to these findings," said Barbara Marin, guest researcher at the CDC. The CDC estimates that Latinas represent 18 percent of new HIV infections among women in the United States. In New Jersey, women age 35 and older made up 45 percent of Latina HIV cases during 1996-2000. A California study among Latinas found only 41 percent had ever used a condom. "In Latino culture, a woman that asks for safe sex can be considered a loose woman," said Cynthia Gomez, codirector for the Center for AIDS Prevention Studies, University of California-San Francisco. In North Philadelphia, an area where many Hispanics live, counselors go to nightclubs to distribute condoms and offer saliva testing for HIV. They also visit Hispanics working at mushroom farms in Kennett Square, Chester County. In New Jersey, programs offer day care for children so their HIV-infected mothers can see the doctor. ************************************************************ INTERNATIONAL NEWS ************************************************************ "AIDS Takes Center Stage on World Awareness Day" News Mexico (Mexico City) (12.02.02) Safe sex and AIDS prevention were the main items on the agenda Sunday in World AIDS Day commemorations in Mexico City - where disease is now the third-leading cause of death. Some 25,000 people attended a rock concert in the city's main square, organized by the government's AIDS program and the Institute for Youth. Meanwhile, local government and community organizations concluded two months of work highlighting the problem of AIDS in the city and educating residents on how to prevent it. "On the average, we are opening 100 [new] files a month," said Carmen Soler, a coordinator with the government's HIV/AIDS program. "Almost 80 join our [antiretroviral] medication program, which shows they come to us very late, when the effects of the illness are already advanced." Mexico City is home to 28 percent of all the HIV/AIDS cases in the country, according to the National Center for the Prevention and Control of HIV/AIDS. People ages 25 to 35 are most likely to be infected, and sexual contact is the main form of transmission, said Soler. These patients typically became infected five years ago, a figure that is important in designing prevention strategies, Soler said. Following worldwide trends, women are increasingly infected. According to the Mexico City HIV/AIDS program, one in six AIDS patients are women, compared to one in 20 during the 1980s. Despite free provisions of antiretroviral medication as part of the government's HIV/AIDS program, patients must frequently foot the bill for treating opportunistic diseases. According to Graciela Gutierrez, a representative of Vanguard for People Affected by HIV, AIDS-related infections are a dangerous and costly problem for patients, together with adverse reactions to prescribed medications. Omar, 25, who was recently diagnosed with HIV/AIDS, said, "The antiretrovirals will be provided free by the HIV/AIDS program, but the cancer they detected in my face and the effects it's having on one of my ears, I'll have to pay for myself." ************************************************************ MEDICAL NEWS ************************************************************ "Initiation of Services in the Boston HAPPENS Program: Human Immunodeficiency Virus-Positive, Homeless, and At-Risk Youth Can Access Services" AIDS Patient Care and STDs (10.01.02) Vol. 16; No. 10: P. 497- 510::Elizabeth R. Woods, MD, MPH; Cathryn L. Samples, MD, MPH; Maurice W. Melchiono, RN, MS, C-FNP; Peter M. Keenan, RN, MS, PNP; Durrell J. Fox, BS; Sion Kim Harris, PhD; Boston HAPPENS Program Collaborators HIV-positive, homeless, and other youth at-risk for HIV present a challenge to those who would connect them to health care. There is a need for more youth-friendly services and street outreach so that hard- to-reach youth will have access to health care, and for early HIV case identification. Of the 793,026 cases of AIDS the CDC reported in the United States as of June 2001, 4,219 cases fell in the 13-19 age range, and 27,880 cases fell in the 20-24 age group. Many of the young adults were infected during adolescence. The proportion of women with HIV in the younger age groups is increasing, and the African-American and Hispanic adolescent and young adult populations show high rates of HIV. Homeless and runaway youths are especially vulnerable to HIV infection because of substance abuse and/or survival sex (exchanging sex for food, shelter, or drugs). The Special Projects of National Significance Program (SPNS) of the Health Resources and Services Administration funded the Boston HAPPENS (HIV Adolescent Provider and Peer Education Network for Services) Program in 1993 as a model of care to help meet the needs of HIV-positive, homeless, and at-risk youth in metropolitan Boston. Nine core agencies and institutions formed the network: three teaching hospitals, three multiservice outreach agencies, and three community health centers. This study's purpose was to describe the initiation of care among HAPPENS clients. Specifically, the study aimed to evaluate the roles of outreach and HIV counseling and testing services (CTS) in connecting youth to services, describe the kinds of services most frequently obtained at the first encounter, evaluate youth transition from initial contact into medical care, and determine whether there were different types of youth seeking care at different sites. All sites in the HAPPENS network offered adolescent-oriented HIV counseling and testing services. The program developed a mechanism for communication, collaboration, and integration of adolescent care across sites. Service providers at participating sites collected program data between 1994 and 1998. HAPPENS served 2,116 youth from 12-24 years old. Sixty-four percent of the subjects were female; 45 percent were youth of color; 16 percent were gay/lesbian, bisexual, or undecided; and 10 percent were homeless or runaways. The mean age of participants was nearly 20; approximately 2 percent of the subjects were confirmed HIV- positive, with young men having double the percentage of young women. Both genders had high rates of unprotected sexual intercourse. Analyses of this study's data support the findings of other studies: outreach services were instrumental in connecting youth to care, and HIV CTS was crucial to identifying HIV-positive youth who needed care. In HAPPENS, 56 percent of participants received outreach services at first contact with the program. Compared to those not receiving outreach services, the youth who did included significantly higher proportions of the homeless or runaways, those involved in the mental health system, gay/lesbian, or subjects with a history of sex with IDUs. Outreach services were a critical first step in connecting at- risk youth to other sources of care. HIV CTS was another entry point into care. Of participants with an intervention service at the first visit, 55 percent received HIV counseling and testing. Hospitals offered HIV CTS to the largest number of young people, followed by outreach agencies, then community health centers. HIV CTS was itself a prevention intervention, the authors say, because the visit included personalized risk assessment and harm reduction counseling. HIV CTS facilitates the success of case identification and early HIV treatment interventions, all the more important now that effective HIV therapies are available. Different agencies reached different at-risk populations. Outreach agencies, the study shows, were relatively better at reaching males, older youth, gay/lesbian/bisexual, and questioning youth. Hospitals and community health center sites saw a higher proportion of young women, youth with a history of STDs, pregnant women, people of color, and youths engaging in unprotected sex with opposite gender partners. The results indicate that a variety of confidential, comprehensive care sites are needed to optimize access and care for the full range of youth sub-populations. "Comprehensive networks of care offering a continuum of services and a variety of entry routes and types of care sites are needed to connect underserved youth to health care," the authors stated. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Residents Celebrate World AIDS Day" Associated Press (12.02.02) A group of about 100 people joined the World AIDS Day observance at Spalding University in Louisville, Ky., over the weekend, spreading a message of compassion, hope and understanding. Participants in Sunday night's ceremony heard inspirational songs by Voices of Kentuckiana, a choral group that includes gay and lesbian members. Members of the clergy read scores of names of the dead from the podium at the university's Eagan Leadership Center as audience members lighted candles in remembrance. Others, such as Daniel Coe, who has lived with AIDS for 12 years, shared their experiences. "The day I was diagnosed was the worst day of my life, and I've since lost nearly all the friends I had then," said Coe, 49, who is secretary of the Louisville AIDS Walk and runs the children's support group, Heart to Heart. "But I've formed even greater friendships and gained a new perspective on life and have new hope. AIDS no longer means 'Acquired Immune Deficiency Syndrome.' To me it means 'Any Individual Deserves Self-worth.'" The Kentucky AIDS death rate has declined since 1995, and the state is 29th in the nation in reported cases per 100,000 people, according to the latest Kentucky HIV/AIDS Semi-Annual Report. Its most populous counties - Jefferson, Fayette and Kenton, among others - lead in the number of diagnosed cases. Hardest hit is the black community, with 29 percent of reported AIDS cases. African-Americans make up 7 percent of Kentucky's population. ************************************************************ EDITORIALS AND COMMENTARY ************************************************************ "AIDS Sufferers Face a World of Hostility" Boston Herald (12.01.02)::Ray Hammond "Not since an Indiana community ran off a 13-year-old hemophiliac - shaming itself and prompting national soul searching - has overt discrimination against people with AIDS been socially acceptable. Yet more than a decade after the death of Ryan White, AIDS-related stigma continues on a more subtle, but still painful, level. Around the world, discrimination against people with AIDS is alive, well - and deadly. ... "Poverty, ignorance, promiscuity and women's unequal status all play a part in the spread of AIDS in developing countries. So do stigma and discrimination. "Those who have experienced the sting of alienation learn quickly to hide their disease. Many never get tested, seek treatment or find the support they need to live with AIDS. They see what happens to those who admit their HIV status: eviction, unemployment, violence, even murder. They see children stigmatized by their parents' disease. ... "To its shame, the church has been largely silent - even complicit - in the mistreatment of those with AIDS. Distracted, perhaps, by the desire to separate themselves from the perceived sins of those with the virus, many Christians have neglected their first call: to love the sick and hurting. ... "Despite the best work of science, neither a vaccine nor a cure is on the horizon. New strategies are needed to fight the disease. We must allow those with AIDS to feel safe admitting their illness. We must embrace them, regardless of our opinion of their sexual practices. We must help them find medical care and we must provide them, and their families, with emotional care. "Each of us can play a part: *Volunteer with a local organization serving people affected by AIDS. ... *Write to your representatives in Congress. Let our political leaders know that you support increased funds to stop AIDS internationally and in the United States. *Give to organizations fighting AIDS internationally. ... "Ryan White and his family brought the plight of those infected with and affected by this disease into our living rooms. What many of us did not know then, we cannot deny today: Love, acceptance, support and care are life-affirming answers to the AIDS pandemic - and our best weapons in fighting this disease." The author is founder and pastor of Bethel African Methodist Episcopal Church in Jamaica Plain, Mass., and a graduate of Harvard Medical School. ************************************************************ NEWS BRIEFS ************************************************************ "Students to Get Free Treatment for STDs" USA Today (12.02.02) Philadelphia's public high school students will be offered free STD screenings and treatment after tests showed girls at two schools were twice as likely as other teens in the city to have chlamydia. The voluntary, confidential testing is part of a citywide Health Department plan to cut the rate of STDs in teens. The more than 50,000 students who attend Philadelphia's 40 public high schools will be offered tests beginning in December. The school district will notify parents about the project by mail, but state law allows for confidential STD testing and treatment for minors. "Nigeria's President: At Least 4.2 Million HIV-Infected in Africa's Most Populous Nation" Associated Press (12.02.02)::Haruna Bahago In a strongly worded speech the day after World AIDS Day, Nigerian President Olusegun Obasanjo declared his nation is on the "edge of a precipice" as a result of the worsening AIDS epidemic. A minimum of 3.5 million Nigerian adults and 700,000 children are living with HIV, he said, but he noted that incomplete records and strong social stigma mean a true count is impossible: "There must be at least twice that number of people living silently with the infection and its accompanied diseases," he said. He promised his government will enact laws "making it an offense to deny any HIV-positive person access to social services or gainful employment." "World Bank Gives Tanzania US $136 Million Grant" Associated Press (12.03.02) The World Bank has given Tanzania $136 million for AIDS and poverty reduction projects, said Rosalie Ferrao, a bank spokesperson. About half of the money, $70 million, will be used in the fight against AIDS and the balance will be spent on reducing poverty. "The bank has earmarked these resources with a clear sense of urgency needed to deal with the devastating effects of HIV/AIDS, and to do so in innovative ways particularly targeted to support community-based interventions," the bank said in a statement. Tanzania owes the World Bank $2.6 billion in loans. Tanzania's central bank says the country's total external debt is $6.56 billion. In November last year, the International Monetary Fund approved debt relief in the amount of $3.3 billion for Tanzania to be spread over 20 years.