Subject: CDC AIDS Daily Summary for 12/09/02 Date: Mon Dec 9 11:11:06 PST 2002 (446 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Monday, December 09, 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 "Supreme Judicial Court OK's Programs' Needles" INTERNATIONAL NEWS "Haiti Receives Assistance to Fight AIDS Epidemic" "Pint-Sized Public Health Ambassadors; Babies on HIV-Screening Posters Help Raise Awareness, Ease Stigma" MEDICAL NEWS "HIV Infection and Pregnancy Status Among Adults Attending Voluntary Counseling and Testing in 2 Developing Countries" LOCAL AND COMMUNITY NEWS "Campaign Personalizes Numbing HIV Statistics" "AIDS Message Delivered in Poetry" "A House for People with AIDS Will Close at the End of the Month" NEWS BRIEFS "UN: West's Response to AIDS Inadequate" "Mandela to Host Concert for AIDS Victims" "China to Lift Ban on Condom Advertisements" "AIDS Dead Could Be Buried in Mines" ************************************************************ NATIONAL NEWS ************************************************************ "Supreme Judicial Court OK's Programs' Needles" Boston Globe (12.07.02)::Kathleen Burge The Massachusetts Supreme Judicial Court ruled Friday that people who receive clean syringes through a state-sanctioned needle exchange program in one community cannot be arrested for carrying them in another. The SJC decided the case involving Maria Landry, a member of Cambridge's needle exchange program who was charged last year with carrying illegal drug paraphernalia - the needles - in Lynn. The justices "understood the public health values that were at stake here," said Sarah Wunsch, the American Civil Liberties Union of Massachusetts lawyer who represented Landry. A 1993 law allows communities to host pilot needle exchange programs run by the state Department of Public Health. Four cities - Boston, Cambridge, Northampton and Provincetown - sponsor exchange programs that served 3,000 people in the past year, according to Dr. Howard Koh, state public health commissioner. Needle exchange supporters say clean needles can prevent the spread of deadly bloodborne diseases like hepatitis C and HIV. Jean McGuire, director of the MDPH's AIDS/HIV bureau, said 60 percent of the state's hepatitis C cases and 42 percent of HIV/AIDS cases are related to intravenous drug use. SJC Justice Judith Cowin wrote that the needles are still part of the state-sanctioned program even if participants carry them across municipal boundaries. SJC also ruled that police officers may not arrest people for hypodermic possession if they carry a needle exchange card, unless they suspect the card is fraudulent. Lynn city lawyers had argued that even if SJC ruled for Landry, police officers should still be able to arrest card- carrying needle exchange participants like her because they would be able to argue they were program participants in court as a defense. Lynn does not offer needle exchange, and city officials argue that as they fight a heroin epidemic, they should not be bound by the decisions of other communities. James Lamanna, the lawyer who argued Lynn's case, said that local officials were disappointed by the decision and may lobby the Legislature to restrict the needle exchange law. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Haiti Receives Assistance to Fight AIDS Epidemic" Miami Herald (12.06.02)::Tim Johnson The Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria agreed last week to give $24.7 million to combat AIDS in Haiti, which has the worst AIDS epidemic in the Americas. The fund may disburse as much as $70 million there over the next six years. "It's going to make a dramatic impact," said Anil Soni, an advisor to the Global Fund, a group founded last year at the urging of UN Secretary General Kofi Annan. Last year, 30,000 Haitians died of AIDS, twice the number of those who perished in the United States. Some 250,000 of Haiti's 8 million citizens carry the virus. The nation has been hit so hard that the average life span, 46 years, has fallen five years since the epidemic erupted in the early 1980s. The grant will provide antiretroviral therapy for 1,300 people a year; offer HIV testing to about 40,000 people; distribute 15 million condoms; and offer community education programs. By the end of the first year, the program hopes to provide antiretroviral drugs to hundreds of HIV-positive women in an effort to reduce mother-to-child transmission. Community-based efforts will include foster care for orphans of parents who die of AIDS, micro-credits to foster parents, distribution of food and hygiene packets and home visits to families living with HIV, Soni said. A political stalemate over disputed parliamentary elections two years ago has left Haiti deprived of hundreds of millions in foreign aid. "We are not giving a single cent to the government," Soni said. "Haiti came to us and said, 'Give us money but don't give it to the government.'" Instead, the government agreed that the fund's grant should go to international agencies, like CARE and the Red Cross, and to local community-based organizations including Partners in Health, Soni said. "Pint-Sized Public Health Ambassadors; Babies on HIV-Screening Posters Help Raise Awareness, Ease Stigma" Record (Ontario) (12.04.02)::Anne Kelly When Amanda Mandawoub's obstetrician recommended she be screened for HIV, she was shocked and a little offended. But it didn't take her long to agree to test while pregnant with her daughter Maegan, now almost two. "Anything that's going to protect me and my daughter, I'll do," the first-time mother said on Dec. 3 at the launch of a poster to promote HIV screening in the Waterloo Region for all pregnant women and women planning a pregnancy. The poster is part of an awareness campaign by the Region of Waterloo Public Health. Maegan and four other babies featured on the poster are all healthy and HIV-free, as are their mothers. But in 2001, two HIV- infected babies were born in Waterloo Region to mothers who had not received screening. Drug therapy during pregnancy dramatically lowers a mother's chance of transmitting the virus to her baby. Regional screening rates in 2001 were only 45 percent, compared to 54 percent provincially. But public health staff members have been educating doctors and midwives and, in 2002, the rate rose to 71 percent - just shy of the provincial average of 73 percent. Since 1998 in Ontario, all pregnant women are to be offered an HIV test, performed only after counseling and informed consent. Previously, screening was only offered to those with identified risk factors. Some physicians feel the time and education required for pre-natal counseling, informed consent and testing "is a little onerous in a busy office practice," said Dr. Stephen Halmo, chief of reproductive medicine at Grand River Hospital. Also, he said, there is still stigma around HIV screening. The poster of the babies will help reduce the stigma, he said. Halmo said it would be more effective if Ontario would adopt universal pre-natal screening for HIV, as is done for other STDs such as syphilis and hepatitis. Alberta began universal screening in 1998 and its testing rate jumped to 96 percent. Ontario women can still opt out if they wish. ************************************************************ MEDICAL NEWS ************************************************************ "HIV Infection and Pregnancy Status Among Adults Attending Voluntary Counseling and Testing in 2 Developing Countries" American Journal of Public Health (11.02) Vol. 92; No. 11: P. 1795-1800::Andrew D. Forsyth, PhD; Thomas J. Coates, PhD; Olga A. Grinstead, PhD, MPH; Gloria Sangiwa, MD; Donald Balmer, PhD; Munkolenkole C. Kamenga, MD; Steven E. Gregorich, PhD The effect of an HIV diagnosis on reproduction planning in developing countries is not well understood. Clinical symptoms of disease, coexisting sexually transmitted infections, and HIV- induced amenorrhea are associated with reduced fertility. HIV infection may also result in pregnancy complications such as decreased birthweight, prematurity, and elevated risk of preterm delivery. Psychosocial factors also affect reproduction planning and fertility among individuals infected with HIV, both in developed and developing countries. Many studies lack consideration of the effect of intention to bear offspring on reproduction following HIV diagnosis. In developed countries, HIV diagnosis appears to lead many women to avoid pregnancy or to undergo pregnancy termination, decisions that may be attributed in part to availability of and access to voluntary counseling and testing (VCT), modern contraception, and safe and legal abortion services. By contrast, studies in several African countries have suggested that HIV diagnosis has little effect on subsequent childbearing. Yet, one limitation of these studies is that none have directly examined the effect of intention to reproduce on reproduction following HIV diagnosis. The authors examined the association of intention to bear children and knowledge of HIV serostatus with subsequent reproductive behavior among men and women receiving HIV voluntary counseling and testing in Kenya and Tanzania. In addition to providing descriptive analyses, the authors tested the direct and interactive effects of HIV serostatus and intention to reproduce on pregnancy status 6 months post-VCT. Assuming that the desire to avoid vertical transmission would outweigh contextual factors favoring reproduction among infected individuals, the authors hypothesized that participants diagnosed with HIV infection who also reported intention to reproduce before learning their serostatus would be less likely than uninfected participants to be pregnant or to have a pregnant partner 6 months post-VCT. All participants included in this analysis were drawn from the Voluntary HIV Counseling and Testing Efficacy Study, a randomized controlled trial evaluating the efficacy of VCT in changing sexual risk behavior among adults in Nairobi, Kenya, and Dar es Salaam, Tanzania. The target study population included individuals and couples seeking HIV-related services in an urban public hospital in Dar es Salaam and a free-standing clinic in a low-income suburban settlement in Nairobi. The study involved a longitudinal design with assessments at baseline (time 1), 6 months post-VCT (time 2), and 12-month follow-up (time 3). Participants were randomized to 1 of 2 conditions: an ideographic VCT intervention designed to facilitate HIV risk behavior change, or a comparison condition in which participants received general health information relevant to HIV. At time 2, participants in the comparison group received the VCT intervention, such that by time 3 all participants had received VCT when they returned for assessment. Given that the focus of this study was pregnancy status within 6 months of HIV serotesting, only data corresponding to pre (baseline) and post- VCT (follow-up) assessments were used for this study. Only participants unaware of their HIV serostatus at screening were eligible to enroll in the study. There were 2,942 eligible participants for primary data analysis. The authors then excluded participants based on sexual abstinence, being pregnant, men 60 years or older, women 40 years or older, same sex partners and women with a history of tubal ligation, leaving 1,634 eligible participants for secondary analysis. The authors found that women who were younger, not using contraception, aware of the risk of vertical transmission, and HIV infected were more likely than those with the opposite characteristics to be pregnant at time 2. Although pregnancy planning showed no main effect on pregnancy status for women, fewer of those who tested negative reported a pregnancy at 6 months post-VCT. Taken together, these findings suggest that diagnosis with HIV may have precipitated a reduction in fertility among less healthy women, independent of the effects of relationship status, number of children, and frequency of sexual activity. Men who were younger, married or cohabitating, not using contraception, and aware of risks of vertical transmission were more likely to report that their partners were pregnant at 6 months post-VCT, regardless of their HIV serostatus. The latter findings suggest that men's awareness of their HIV serostatus and baseline intention to reproduce were unrelated to partner pregnancies reported 6 months later. "HIV diagnosis may influence reproduction planning for women but not for men," the authors wrote. "Future VCT intervention research would do well to tailor protocols to appeal to men and increase their participation, incorporate family planning issues in VCT programming (including alternatives to child-bearing), and enhance VCT messages to appeal to participants' desire to ensure the well-being of their offspring." ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Campaign Personalizes Numbing HIV Statistics" Houston Chronicle (12.01.02)::Leigh Hopper In Harris County, Texas, black women account for 77 percent of all HIV-infected women. They represent a particularly vulnerable population, contracting the virus from undiagnosed partners, potentially passing it to children, and becoming sick from lack of treatment. That is why Amanda Johnson, 41, and three other women took the extraordinary step of making their faces and their stories public. They are part of an unprecedented, $60,000 public awareness campaign by the Harris County Hospital District and the Houston Department of Health and Human Services aimed at black men and women, whose infection rates are dramatically higher than those of other ethnic groups. Blacks now make up nearly half of local HIV/AIDS cases - up from less than one-third a decade ago. Beginning Dec. 2, Metro buses are featuring placards depicting "The new faces of HIV in Houston." Barber shops, beauty salons and music stores will display posters and brochures that say, "What's worse than a bad hair day? Not knowing your man is HIV positive. Or that you are." Johnson and the other women - Dena Gray, 33; Reachelian Ellison, 28; and Johnetta Evans-Thomas, 48 - are in good health. But all have battled depression, a profound sense of shame, relationship problems and serious setbacks in supporting themselves. They met one another in the course of seeking treatment and in classes designed to teach the medical, political and social aspects of HIV. Seeing the plight of others in similar situations ignited a passion to help, and all of them are pursuing that goal in some form. "Women who were infected through their relationship with a man [experience] such a deep sense of disempowerment: 'I didn't know he had it. I didn't know I got it,'" said Sue Gallego, an Austin social worker who has written about and counseled HIV- positive women for 15 years. "If we can get them into a women's group, all sorts of things happen," she said. "They become willing to come out and help others. That's putting them in control." "AIDS Message Delivered in Poetry" South Florida Sun-Sentinel (12.04.02)::Nicole T. Lesson A media campaign sponsored by a federally funded program called Racial and Ethnic Approaches to Community Health, also known as REACH 2010, recently launched public service announcements targeting Broward County residents ages 18 to 39 who are African-, Caribbean- or Hispanic-American. The PSAs are being exposed through TV, radio and newspapers. The campaign, in emphasizing that HIV is everyone's business, uses a combination of approaches to reach the general public. "We can't just rely on the PSAs, but will also have outreach programs to the communities," said Dr. William Darrow, the REACH 2010 project leader and a professor of public health at Florida International University. Six of the public service announcements feature spoken word poetry, in which people use theatrics while they read aloud original poems. The performances are filled with a range of emotions and expressions, everything from a comic approach to sadness and tragic tones. It's an art form that is becoming popular with young people. The public service announcements feature club scenes and an assortment of other social scenarios. Spoken word artist Amy Baez, 25, of Miami, wanted to represent Hispanics, so she volunteered for the campaign. "I wanted to represent the Hispanic community so they could see another face that they could identify with," said Baez, who is of Puerto Rican descent. To broaden its impact, REACH 2010 has teamed up with three Broward organizations - the Urban League of Broward County, Hispanic Unity of Florida and Minority Development and Empowerment Inc., known as the Broward Coalition - to educate minorities. The coalition was formed in 1999 as a part of a national effort by the CDC to make the public aware of how racial and ethnic differences have played a role in spreading HIV. The Broward campaign was financed by a four-year grant by the CDC. Since 1999, the REACH 2010 program in Broward has received $3.2 million. "A House for People with AIDS Will Close at the End of the Month" Wichita Eagle (12.04.02)::Karen Shideler A Wichita, Kan., house for people with AIDS will close at the end of the month, the victim of financial woes and the changing nature of the disease. "We were losing money hand over fist" because funding sources have dried up, said Joe Kelly, executive director of ConnectCare, the AIDS service organization that runs the house. Other ConnectCare services - a drop-in center, a food pantry and case management - will remain open. ConnectCare is helping the six residents of the house to find other places to live, Kelly said. When the house opened in the late 1980s, it served as a hospice where people with AIDS could spend their final days. It is licensed as an assisted living facility, which means it has to be staffed 24 hours a day, seven days a week, by people who can give medication and help with bathing and other daily needs. But with the development of new medications, AIDS is no longer a death sentence. Residents in recent years have not needed hospice and assisted living services, said Sheryl Kelly, a nurse who works with AIDS patients. Instead, they're homeless people with AIDS who need help finding jobs or other services to enable them to live on their own. In addition, funding sources for housing are diminishing. The majority of the grants made to AIDS organizations now must be used for prevention and education. Sheryl Kelly said some ConnectCare offices and services that are located off site will be consolidated at the house. The house manager will be laid off, but two case manager positions that are vacant will be filled after the first of the year. ************************************************************ NEWS BRIEFS ************************************************************ "UN: West's Response to AIDS Inadequate" Associated Press (12.08.02) The Western world's response to Africa's unfolding humanitarian crisis caused by AIDS and hunger is woefully inadequate, Stephen Lewis, the UN top advisor on AIDS in Africa, said Sunday. While people in developed countries who contract HIV can live for years, Africans contracting HIV are condemned to death, Lewis said. "There must be something terrible with the moral quotient of the world," he said at the start of a three-day visit to Malawi. Aid workers say the AIDS epidemic has claimed the lives of about 7 million agricultural workers since 1995, which has added to widespread food shortages. An appeal launched by UN Secretary-General Kofi Annan for countries to donate $10 billion to combat AIDS, tuberculosis and malaria had so far collected only $2.1 billion, he said. "We know there is a lot of money out there, we know there is plenty of food... but something must be profoundly wrong somewhere, something is morally wrong somewhere," said Lewis. "Mandela to Host Concert for AIDS Victims" Associated Press (12.07.02) Former South African President Nelson Mandela announced in Cape Town Friday that he will host a Feb. 2nd concert featuring some of the world's leading entertainers to raise funds for Africa's millions affected by AIDS. U2 star Bono, Macy Gray and Shaggy had already agreed to perform at the show, to be held on Robben Island, a rocky outcrop off the Cape Town coast where Mandela spent nearly two decades as a prisoner of the apartheid regime. Michael Jackson, Sting, Bruce Springsteen, Bob Dylan, Elton John and Janet Jackson have also been approached to play at the event - "Mandela SOS" - for an audience of 3,000 invited guests. "The concert will focus on the growing impact that AIDS has had on human life, not only in South Africa but throughout the world," Mandela said. "We must never allow those who are infected and affected by AIDS to become statistics." Among the guests will be talk-show host Oprah Winfrey and Nobel Peace laureate Archbishop Desmond Tutu. "We overcame apartheid, we will overcome AIDS," said Tutu. "China to Lift Ban on Condom Advertisements" Agence France Presse (12.02.02) China's State Administration of Industry and Commerce, whose 1989 regulations banned the advertisement of all products related to sexual activity, announced on World AIDS Day it will begin allowing condom ads next year. "The ban should have been lifted a long time ago because condoms are the most effective tools not only for avoiding pregnancy, but also protecting people and their partners from sexually transmitted disease," An Bohua, a state family planning official, told the China Daily. "AIDS Dead Could Be Buried in Mines" New Scientist (12.02.02) In an effort to accommodate the increasing numbers of people dying of AIDS, the Johannesburg City Parks agency could turn disused mineshafts into catacomb-style cemeteries. "This year we will bury about 20,000 people. In 2010, unless someone develops a cure for AIDS, we expect that figure to be about 70,000," said Alan Buff, the City Parks official responsible for cemeteries. Old gold mines could be converted into underground streets lined with tombs, accessed from ground level by elevators. Cremation would help solve space problems in cemeteries, but only 6 percent of people who die in Johannesburg choose the procedure. Officials are also considering alternative disposal methods, such as powdering bodies using liquid nitrogen, as well as burying bodies in mass graves.