Subject: CDC AIDS Daily Summary for 12/11/02 Date: Wed Dec 11 11:41:03 PST 2002 (410 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Wednesday, December 11, 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NATIONAL NEWS "Web Filters Block Safe-Sex Sites" INTERNATIONAL NEWS "Canada Panel Pushes 'Safe' Drug Injection Sites" "Outdated Contraceptive May Help in Third World" MEDICAL NEWS "Study: Screening Teen Girls for Chlamydia Could Lower Infertility" "Study Looks at Condoms, Wart Virus Transmission" "Antiretroviral Therapy Restores Some Anti-TB Immune Activity" LOCAL AND COMMUNITY NEWS "'Mistakes' Rile AIDS Activists" NEWS BRIEFS "Juvenile Hall Detainees to Be Tested for STDs" "Second TB Scare for Drinkers" "Insurance Firms to End Sexual History Questions" "New Hampshire AIDS Treatment Program" ************************************************************ NATIONAL NEWS ************************************************************ "Web Filters Block Safe-Sex Sites" Wall Street Journal (12.11.02)::Yochi J. Dreazen The Centers for Disease Control and Prevention's Web site on sexually transmitted diseases does not make the cut. Neither do the Food and Drug Administration's site on birth control failure rates, Princeton University's site on emergency contraception, or dozens of other health, safe sex and pregnancy sites. They are blocked by many of the most popular Internet-filtering programs installed in US schools and libraries to keep children away from online pornography, according to a Kaiser Family Foundation study. The report, "Does Pornography-Blocking Software Block Access to Health Information on the Internet?" is published in today's Journal of the American Medical Association (2002;288:2887-2894). The Internet has become an important place for American teenagers and adolescents to learn about health and sexuality. "A lot of teenagers don't go to their doctors with sexual questions, because they're embarrassed or worried about confidentiality, and the Internet is an important way for them to get those questions answered," says Caroline Richardson, a University of Michigan Medical School-Ann Arbor researcher and coauthor of the report. The Children's Internet Protection Act of 2000 required the use of Internet filtering software in all federally funded schools and libraries. The law was struck down as unconstitutional this year by a federal appeals court, but the Justice Department appealed that decision to the Supreme Court, and oral arguments are set for early next year. The Kaiser study found that running the filters at their highest configuration results in blocking a large percentage of legitimate health sites, while only marginally increasing the amount of pornographic content interdicted by the software - from 87 percent to 91 percent. As a result, the report's authors suggest using the software's lower settings. Richardson says that of the 20 libraries surveyed for the report, only one used its filter's least restrictive settings. "There are valid reasons to be concerned about things like pornography, but it's important that we don't let those concerns thwart the potential of the Internet to give young people the information they need about their health," says KFF Vice President Vicky Rideout. Social conservatives, however, are likely to vehemently oppose any move to make the filters less restrictive. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Canada Panel Pushes 'Safe' Drug Injection Sites" Reuters (12.10.02)::Randall Palmer The Canadian House of Commons Special Committee on the Non- Medical Use of Drugs recommended Monday that Canada establish "safe" injection sites as a way to cut the spread of diseases such as HIV among drug addicts - a proposal that generated criticism from police and opposition politicians. The safe site proposal draws on experiences in European countries such as the Netherlands. "People are using drugs. Let's deal with the health problem," committee Chair Paddy Torsney said after submitting an interim report after 1.5 years of study. "They're somebody's brother or sister, and they're deserving of our care." The proposal would allow addicts to bring their own heroin or other illegal drugs to a room where they can inject the drugs without penalty, under the supervision of medically trained personnel. The idea is harm reduction: to reduce blood- transmitted infections like HIV/AIDS and hepatitis C, as well as to reduce overdose deaths. The committee also hopes to cut back on seedy drug scenes, like the Downtown Eastside of Vancouver, British Columbia. The right-wing Canadian Alliance, the largest opposition party in Parliament, dismissed the findings of the Liberal- dominated committee, saying they were a recipe for "harm extension." The Alliance's Randy White said the European facilities the committee visited made no checks for the safety of drugs used, and opening safe sites did not succeed in cleaning up nearby neighborhoods. "Surrounding the facilities, I saw human carnage for blocks, as well as a substantial gathering of addicts and pushers in the areas where trafficking and using were reluctantly permitted," White said. Police also blasted the idea of safe sites, saying they would do nothing to deal with the violent crimes committed by addicts who need to fund their habits, and would merely further encourage the drug culture. "Our concern is that we're sliding down a slippery slope to the point where it won't be long that we'll be hearing calls for dispensing drugs in those sites as well," said Canadian Police Association spokesperson David Griffin. "Outdated Contraceptive May Help in Third World" San Jose Mercury News (12.10.02)::Barbara Feder Ostrov Some researchers and activists are making a concerted push to resurrect the diaphragm to prevent AIDS among the people now most threatened by the disease: women in developing countries. More than half of the world's people now infected with HIV are women, most of them in developing countries, epidemiologists at the UN and the World Health Organization have reported in recent weeks. The diaphragm protects the cervix, a newly discovered "hot spot" for HIV infection. New designs and novel materials could make diaphragms cheaper, more comfortable and easier to use. The diaphragms probably would be used with microbicides - gels or creams that help prevent HIV infection. No such microbicide yet exists, but scientists are studying a number of promising candidates. Researchers believe that diaphragms could help keep microbicides near the cervix, where they could do the most good. Some AIDS experts caution that while using diaphragms to prevent AIDS is an intriguing and potentially lifesaving proposal, it's also a risky one: the scientific basis for diaphragms preventing AIDS is more theoretical than clinically proven. Experts worry that women and their partners may eschew condoms in favor of diaphragms before they are shown to truly help. Pressure for AIDS prevention methods that women can control themselves is growing. Biologically, women are four times more vulnerable to HIV infection than men, and women in some cultures are unable to refuse sex or force men to use condoms. The female condom has not gained wide acceptance. Cervical caps have also been discussed for HIV prevention, but some scientists believe they are less feasible than diaphragms because they are more difficult to fit properly and can dislodge more easily. "Women in developing countries are extremely motivated" to protect themselves, said Jerry Florence, CEO of New Jersey-based SILCS, which is working on a more user-friendly diaphragm made of silicon, rather than latex. "If you can make diaphragms inexpensively enough, I think they could be mass-produced and mass-distributed to developing countries. The condom really has not been as effective as it was supposed to be. You're asking men to take responsibility for this. Clearly they haven't." ************************************************************ MEDICAL NEWS ************************************************************ "Study: Screening Teen Girls for Chlamydia Could Lower Infertility" Associated Press (12.10.02)::Margie Mason Changing physicians' behavior to give sexually active teenage girls a urine test for chlamydia during routine doctor visits is an effective way of detecting chlamydia and helping prevent infertility problems later in life, according to a new study. University of California-San Francisco researchers worked with physicians at 10 Kaiser Permanente managed care pediatric clinics in Northern California from April 2000 to March 2002. They found that routine screening revealed that 5.8 percent of sexually active girls ages 14-18 - who otherwise would not have been tested - were positive for chlamydia. That rate is on track with the 6 percent to 9 percent national infection rate found in routine screening, CDC reports. Chlamydia is the most common bacterial STD in the United States, with about 3 million new cases annually. Teenage girls are six times more likely to contract it than adult women. Because more than 75 percent of cases have no symptoms, many teens do not discover they are infected until they try to get pregnant years later, said lead author Dr. Mary-Ann Shafer, associate director of adolescent medicine at UCSF. The full report, "Effect of a Clinical Practice Improvement Intervention on Chlamydia Screening Among Adolescent Girls," is published in today's Journal of the American Medical Association (2002;288:2846-2852). The new and promising result from this study, Shafer said, is that pediatricians were receptive to changing their behavior regarding the sensitive topic of sexual health. Last year, the US Preventive Services Task Force urged doctors to screen all sexually active women 25 and younger; CDC has since issued similar guidelines. However, nationally only about 20 percent of women ages 15 to 25 who belong to managed care organizations are screened, according to the study. The reasons involve physicians' reluctance to ask adolescent patients about their sexual histories, and teenagers' reluctance to undergo pelvic exams, together with teens' fears that the results will not remain confidential. HMOs currently pay for the test, and it is often administered free at public health departments. However, many providers may not view the screening as cost effective, especially if the patients are teenage girls who will be most likely to switch to another doctor later in life, said Dr. Kathleen Irwin, chief of CDC's Health Services Research Division of STD Prevention. Irwin said the study was a great example of what could be accomplished if chlamydia screenings became a regular part of preventative care, similar to annual Pap tests. "Study Looks at Condoms, Wart Virus Transmission" Reuters Health (12.10.02) While condoms can help prevent other sexually transmitted diseases, evidence remains inconsistent as to whether or not they will prevent transmission of the human papillomavirus (HPV), a new report suggests. HPV, which can cause genital warts and increase the risk of cancers of the cervix, vulva, vagina, anus, and penis, infects up to 50 percent of sexually active men and women ages 15 to 49 at some point in life. Most clear the infection on their own and do not develop cancer. Lisa E. Manhart and Laura A. Koutsky of the University of Washington-Seattle analyzed 20 previously published studies of condoms, genital warts, and HPV. Their full report, "Do Condoms Prevent Genital HPV Infection, External Genital Warts, or Cervical Neoplasia? A Meta-Analysis," was published in the November issue of Sexually Transmitted Diseases (2002;29:725- 735). The report stated, "The studies included here represent the best available data describing the relationship between condoms and HPV-related conditions." The investigators found that condom use did seem to protect against genital warts, though the effect was slightly stronger in men than women. Results varied in terms of protection from some other HPV-related problems. Six of eight studies showed that women whose partners used condoms had at least some protection from advanced precancerous changes in the cervix; four out of five studies showed at least some protection from invasive cervical cancer. The authors noted that their analysis was limited because the studies lacked information about how and when participants used condoms - either before or after HPV infection. "Complete protection from genital HPV infection may be impossible because infections may occur at... sites not covered by the condom," they wrote. They stated that people using condoms for contraception - as opposed to disease prevention - might be more likely to have genital contact allowing transmission of the virus. The findings suggest that condoms may help prevent warts and other HPV-related problems, possibly by cutting down on the amount of the virus transmitted, "but perhaps not actual infection by HPV," the researchers concluded. "Antiretroviral Therapy Restores Some Anti-TB Immune Activity" Drug Week (11.22.02)::Michael Greer Researchers report that antiretroviral therapy (ART) for HIV infection restores some immune defense against tuberculosis. Neil W. Schluger and colleagues at Columbia University in New York City evaluated antituberculosis T-cell activity in a group of ART-treated patients. Researchers measured T-cell activity in 10 HIV patients, who tested negative for TB, before and every two months after ART was initiated. ART was associated with modest improvements in cell-mediated responses to TB infection. ART was highly effective in reducing viral loads to undetectable or very low levels in this cohort. T-cell gamma interferon responses to in vitro TB exposure also improved, as did proliferative responses by peripheral blood mononuclear cells, the data showed. TB-induced production of cytokines other than gamma interferon did not change during ART, the authors reported. Their full report, "Reconstitution of Immune Responses to Tuberculosis in Patients with HIV Infection Who Receive Antiretroviral Therapy," was published in the journal Chest (2002;122(2):597-602). The authors noted that the improvements were not seen until several months after the start of ART treatment, and did not quite reach the threshold of statistical significance. "ART restores immune responses to M. tuberculosis, although this restoration is delayed and does not reach levels seen in healthy, HIV-negative control subjects," Schluger and colleagues concluded. "These results may explain in part the phenomenon of paradoxic reactions to antituberculosis therapy in patients with HIV infection." ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "'Mistakes' Rile AIDS Activists" Miami Herald (12.11.02)::Andrea Robinson Dozens of families may be in jeopardy of losing their homes or their utility services, activists say, because the city of Miami misused federal housing funds meant to assist patients with utility and mortgage payments. Now the city may award $3.3 million in new contracts, without a bidding process, to the same agencies that activists say wrongly received money last year. Those agencies specialize in AIDS education and prevention, but the funding was supposed to be used for housing needs. The contracts are to be voted on Thursday. Activists John Muhammad and Marc Cohen want commissioners to reject the contracts and order city officials to draw up a new plan with their input. Dan Fernandez, acting director of community development, said there was no bid process this time around because the four agencies - Spanish American Basic Education and Rehabilitation, Bethel A.M.E. Church, Care Resource and the Center for Positive Connections - were previously approved by the city for AIDS prevention. Fernandez said his office did not deliberately violate federal rules in awarding housing funds to prevention agencies. Positive Connections Executive Director Sherri Kaplan said she did not think it would be difficult to offer housing services. At issue is how the city administers the $13 million Housing Opportunities for Persons with AIDS program. Activists contend that for the past five years the city has refused to consult with the county's HIV/AIDS citizens advisory board on its spending priorities. Earlier this year, the Department of Housing and Urban Development ordered the city to repay more than $500,000 in housing funds that went to three agencies providing AIDS prevention and education - a violation of federal rules. The same agencies are up for approval again, this time to provide housing services. More recently, the city was forced to suspend its utility and mortgage payment programs because it failed to follow disbursement guidelines. Muhammad, who chairs Miami-Dade's HIV/AIDS planning advisory board, said about 60 families were notified this month they would not get the assistance. City officials said the number was lower. Fernandez said the city is creating an emergency program to help with missed payments. ************************************************************ NEWS BRIEFS ************************************************************ "Juvenile Hall Detainees to Be Tested for STDs" Los Angeles Times (12.10.02) Teenagers accused of committing crimes in Kern County, Calif., will be asked for a urine sample to test for STDs. The county has the state's third-highest rate of chlamydia and fourth-highest rate of gonorrhea. Both diseases are prevalent among 15- to 24-year-olds, said Dr. Boyce Dulan, director of disease control at the county Health Department. Those who test positive will be given free medication, officials said. "Second TB Scare for Drinkers" BBC News (12.09.02) Three regulars at a British Legion club in Cumbernauld, Scotland, have been struck by tuberculosis. The cases emerged just days after health officials confirmed that two men had died after contracting TB in a Glasgow pub. Dr. George Venters, National Health Service Lanarkshire's public health consultant, said on Monday that three cases of infection had come to light in Cumbernauld over an 18-month period. "They are being treated at home and they are doing very well," he said. People in the British Legion club and the men's close contacts have all been screened and no further cases have been found. Last week it emerged that 170 people had been screened in Glasgow after the deaths of Eddie Weldon, 74, and John Calderwood, 56, who contracted TB at the Lord Darnley pub in the Pollokshields area of the city. Five people were diagnosed with the disease after a cluster of cases was traced back to a former barmaid. There are about 400 cases of TB every year in Scotland. "Insurance Firms to End Sexual History Questions" Guardian (London) (12.10.02)::John Carvel British insurance firms agreed Monday to stop prying into their customers' sexual histories to find evidence of a possible future risk of contracting HIV or other serious infections. In a deal with the British Medical Association, the companies said they would not seek information from doctors that might unnecessarily deter patients from seeking help. It was thought that people were not being tested for HIV or STDs for fear they might be refused life insurance. Under the new guidelines from BMA and the Association of British Life Insurers, doctors will not be expected to disclose episodes of STDs, provided there were no long-term health implications. Insurers agreed not to ask whether an applicant had taken an HIV, hepatitis B or C test, had counseling for such a test, or had a negative test result. Insurers have agreed to ask only for positive test results, information that a test result is awaited, or evidence that the patient is receiving treatment for HIV/AIDS or hepatitis B or C. "New Hampshire AIDS Treatment Program" Associated Press (12.10.02) HIV/AIDS patients in southern New Hampshire have a new place to turn. Manchester and Nashua on Tuesday announced the beginning of the Southern New Hampshire Integrated Care Program to help low-income people living with or at risk of contracting HIV/AIDS. Dartmouth-Hitchcock Medical Center is leading the project with a $1.3 million federal grant.