Subject: CDC AIDS Daily Summary for 12/12/02 Date: Thu Dec 12 11:31:04 PST 2002 (439 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Thursday, December 12, 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 "Disparities in Health Care Plague Minorities in Kansas" "AIDS/HIV Housing Earns National Recognition" INTERNATIONAL NEWS "US Doctor Appears in Canadian Court on Charges Linked to Tainted Blood" "HIV Pregnancies on Rise" MEDICAL NEWS "Late Diagnosis of HIV Infection in the Era of Highly Active Antiretroviral Therapy: Consequences for AIDS Incidence" LOCAL AND COMMUNITY NEWS "Some Question Planned Parenthood-Church Sex-Ed Partnership" "HIV/AIDS Organization Struggles to Survive" NEWS BRIEFS "Bush to Offer Smallpox Vaccine to All" "Celera Diagnostics" "Singapore Uses Shocking Images to Turn Students Off Sex" "Zambia Needs $270 Million to Tackle AIDS: Official" ************************************************************ NATIONAL NEWS ************************************************************ "Disparities in Health Care Plague Minorities in Kansas" Associated Press (12.12.02)::Roxana Hegeman Infant mortality among blacks in Kansas is double the statewide average, and black men have the highest rates of prostate cancer, lung cancer and colorectal cancer, according to a study on minorities and health care released Wednesday. The study, Minority Health Disparities in Kansas, prepared by the Kansas Health Institute and the state Department of Health and Environment, also found that although blacks comprise less than 8 percent of the state's population, they constitute almost 18 percent of the diagnosed AIDS cases. The study's authors say language barriers, poverty, lack of insurance and access to medical providers have created a health care gap between minorities and white Kansans. The study was released at a summit on minority health issues. It was funded by the Kansas Health Foundation and the Robert Wood Johnson Foundation. The study looked at minority communities in Wichita, Garden City and Kansas City, Kan. "It is a very important summit - that you here in Kansas may be getting jump on in regards to what is going on in the other states," former US Surgeon General Joycelyn Elders told the group. "You are no different from the rest of this country," Elders said. In Kansas, the leading causes of death are related to cardiovascular health. The study documented that 30 percent of blacks and 35 percent of Native Americans report they have high blood pressure. These minority groups also die from coronary heart disease at a higher rate than the rest of the population. By contrast, Hispanics have a much lower incidence of coronary heart disease. But that is affected by the fact that the state's Hispanic population is relatively young - their median age is 23 years compared to 35 years for the state as a whole, the study found. Almost 100,000 Kansans cannot communicate well enough in English to share their medical histories, symptoms and health concerns with their doctors, the study said. Different minority groups participate at varying levels in public health insurance programs such as Medicaid and the State Children's Health Insurance Program. Blacks were more likely to enroll, Hispanics the least. "AIDS/HIV Housing Earns National Recognition" Associated Press (12.11.02)::Betsy Taylor The Doorways interfaith AIDS residence program was named a "shining star" by the St. Louis office of the Department of Housing and Urban Development. It was one of 11 Missouri programs recognized for spreading light throughout the community. Based on the premise that housing is part of healthcare, Doorways operates five residences in the St. Louis area, with plans to open two more. HUD recently awarded the agency a $1.3 million grant to provide supportive housing for people with HIV/AIDS in 79 of the state's 115 counties. Doorways residents receive a private bedroom and bath. A round-the-clock staff helps them manage medication, offers counseling, and provides services such as meals and laundry. Amenities include a medication room, pool table, hair salon, and kitchens on each floor. Doorways is not a hospice. President Lynne Cooper estimates that about 70 percent of the patients improve and move on to independent housing. Cooper said housing must play a role in battling AIDS. "It used to be when people contracted HIV, they got poorer. Now, it's more poor people contracting HIV," she noted, adding that she's seeing more HIV/AIDS infected people battling multiple issues such as mental health or substance abuse problems. Doorways assists about 450 people a month, and has approximately 100 individuals or families on a waiting list. The agency's levels of assistance range from permanent housing to temporary apartments, from short-term funds to help someone remain at home to simply matching clients up with landlords. Supportive housing residents pay 30 percent of their income. Housing and nursing cost about $200 a day, hundreds less than the cost of clients being hospitalized, Cooper explained. ************************************************************ INTERNATIONAL NEWS ************************************************************ "US Doctor Appears in Canadian Court on Charges Linked to Tainted Blood" Associated Press (12.11.02) A US doctor appeared in Canadian court, charged for his alleged role in a tainted blood supply that sickened thousands in the 1970s and 1980s. Dr. Michael Rodell, 70, spoke his name but said nothing more. He is charged with three counts of criminal negligence causing bodily harm, which carries a maximum 10-year prison sentence, and one count of common nuisance, punishable by up to two years in prison. The Pennsylvania doctor was one of four charged last month in connection with the tainted blood. Rodell's former company, the US blood products firm Armour Pharmaceutical Co., was also charged. Rodell was vice president of scientific and regulatory affairs at the company, which supplied blood products to the Canadian Red Cross. About 1,200 people contracted HIV and thousands more developed hepatitis C after transfusions of tainted blood and blood products. Some of the blood allegedly came from US prison inmates. No figures exist on the actual number of deaths, but organizations involved say there were many. The Canadian Red Cross started screening blood donors for HIV in 1985, and for hepatitis C in 1990. Canadian doctors John Furesz, Wark Boucher, and Roger Perrault also face charges. Perrault is the former head of blood transfusion at the Canadian Red Cross. Rodell's lawyer, Earl Levy, said that a civil case would be more appropriate than criminal charges under the circumstances. "I have serious reservations about the strong arm of the criminal law coming down on these doctors...in the quest for some accountability," he said. "HIV Pregnancies on Rise" Press (Christchurch) (12.04.02)::Brooker Michelle An estimated 60 percent of HIV-positive pregnant women in New Zealand do not know they have the virus, and risk passing it on to their babies. The number of New Zealand babies born with HIV is not high. However, AIDS Epidemiology Group Director Nigel Dickson said numbers had been rising since 1995 as more women were being infected with HIV. "Before 1995, we had just two babies diagnosed with HIV in New Zealand," Dickson said. "But we have had five since 1995. In 1999, there were three children infected perinatally and we know of one child in the past 12 months who was infected." Dickson estimated HIV was discovered in just 40 percent of pregnant women with the disease in New Zealand, because pregnant women are tested for HIV based on their risk of exposure to the disease. He said HIV-positive women were falling through the cracks and there was concern that the number of HIV babies born in New Zealand was increasing while in countries such as the United States and Britain, where pregnant women are routinely offered HIV tests, the number of babies infected is decreasing. The AIDS Epidemiology Group wants to carry out a study to find out how prevalent HIV is in pregnant women in New Zealand. Dickson said this would provide more information on whether pregnant women should be offered voluntary HIV tests when they are tested for hepatitis B, syphilis, rubella and German measles. AEG wants to anonymously test blood taken from babies at birth for HIV antibodies, which are present in the baby's blood regardless of whether the baby has the disease. Dickson said the testing would be done using blood screened for metabolic conditions and without knowing the identity of the mothers. Sexual Health Doctor Sue Bagshaw, who supports voluntary HIV testing, said Christchurch School of Medicine research showed very few general practitioners, midwives, and obstetricians in Christchurch, the West Coast, and the upper South Island asked women whether they might be at risk for HIV. ************************************************************ MEDICAL NEWS ************************************************************ "Late Diagnosis of HIV Infection in the Era of Highly Active Antiretroviral Therapy: Consequences for AIDS Incidence" AIDS (09.27.02) Vol. 16; No. 14: P. 1945-1951::Jesús Castilla; Paz Sobrino; Luis de la Fuente; Isabel Noguer; Luis Guerra; Francisco Parras This study assesses the repercussions of late diagnosis of HIV infection on AIDS incidence in the era of highly active antiretroviral therapy, comparing the trend of late testing versus remaining AIDS cases in Spain. The authors also analyze the factors associated with late diagnosis of HIV infection among AIDS cases, before and after the availability of HAART. Spain offers its entire population free voluntary confidential HIV testing at primary care centers, hospitals, and genitourinary clinics. Additionally, some cities maintain sites that offer anonymous HIV counseling and testing. Since 1997, all patients can receive HAART free of charge, which has led to more than a 60 percent reduction in AIDS incidence and mortality. AIDS cases in Spain are reported to a national system on a specific report form that lists the month and year of AIDS diagnosis and the first positive HIV test result. Researchers also used other variables on the AIDS case report form: sex, age, HIV transmission category, prison record, province of residence, and country of origin. The study focuses on AIDS patients more than fourteen years old whose cases were reported through June 30, 2001, with a first AIDS defining condition diagnosed from January 1994 through December 2000. Researchers define "late testers" as cases reporting the first HIV positive test result in the month in which AIDS was diagnosed or in the preceding month. The authors divided cases into those diagnosed in 1994 through 1996, and those diagnosed in 1998 through 2000. Those time periods pre- and post-date the widespread use of HAART. The authors left 1997 out because that was a transition year during which the treatments became generally available. From 1994 to 1996, 24.1 percent of the 18,755 diagnosed AIDS cases were late testers. From 1998 to 2000, late testers increased to 35.3 percent of the 7,825 cases diagnosed. Among the late testers, 12.7 percent and 11.3 percent respectively died within three months of the date of the first positive HIV test result. From 1995 to 2000, the number of AIDS diagnoses declined by 67 percent among patients who were previously aware of their HIV infection versus a 36 percent decline among late testers. The authors find the greatest decline in AIDS diagnoses, 52 percent, occurred from 1996 to 1998, coinciding with the spread of HAART. The trend among late testers was not directly affected by the introduction of HAART. For each transmission category, AIDS incidence showed a much smaller decline among late testers. Incidence of AIDS attributed to homo/bisexual and heterosexual contact among late testers now exceeds the incidence among non- late testers. Assuming that earlier diagnosis of late-testing AIDS cases would have led to their plotting a trend similar to the remaining cases, the study asserts that AIDS incidence in 2000 would have been 17 percent lower. Among cases diagnosed in 1998-2000, late testers were independently associated with the male sex; older than 44; transmission categories other than injection drug use; residence in provinces with low AIDS incidence; and country of origin other than Spain. Except for province of residence, the same variables were associated with late-testing cases from 1994-1996. Patients in prison or with a prison record were far less likely to be late testers than the remaining cases. Spanish prisons offer voluntary HIV testing and antiretroviral treatment. Women and injection drug users registered lower proportions among late testers, perhaps due to women's greater use of healthcare services and the practice of offering HIV testing to pregnant women, and to drug users' greater awareness of risk and the fact that addiction treatment and harm- reduction programs offer testing. Late testers were more likely to have come from a country of origin other than Spain, reflecting possible cultural and language barriers. Patients from provinces with a low incidence of AIDS registered higher proportions of late testing in the era of HAART, which could be a result of low suspicion of HIV infection in such small towns or rural areas, or cultural taboos that inhibit requesting or prescribing the test. The researchers conclude that disseminating more information to the public about the benefits of HIV testing, and greater availability and accessibility of HIV testing sites could help foster an attitude of normalcy toward HIV testing. They urge clinicians to incorporate HIV testing more frequently (confidentially and with patients' informed consent) into their standard diagnostic procedures. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Some Question Planned Parenthood-Church Sex-Ed Partnership" Fort Wayne News-Sentinel (Fort Wayne, Ind.) (12.11.02)::Jennifer L. Boen Local pastors and pro-life groups are criticizing Planned Parenthood of Greater Indiana after the organization announced last week it will partner with Fort Wayne churches to teach faith-based sexuality classes. Some said Planned Parenthood is jumping on the "faith-based" bandwagon to grab money available to organizations serving the faith community. Others said medically accurate sex education curriculum is already offered by several community organizations, including McMillen Center for Health Education and True Life Choices. Planned Parenthood has received grants totaling $100,000 from the Nina Mason Pulliam Charitable Trust and the Engleberg Foundation to begin the initiative in Fort Wayne and Indianapolis. Such programs already exist in other states. "We need look no further than Planned Parenthood's own Web site to discover the motivation for their new interest in faith-based activities," said the Rev. Steve Jones, pastor of First Missionary Church. According to the organization's Web site, $3.67 million is received annually in federal funding. Kathleen Baldwin, vice president of education and training for Planned Parenthood of Greater Indiana, said the sex-ed curriculum is not yet defined, but it will be fact-based and encompass churches' needs. Abstinence is "part of a comprehensive curriculum," Baldwin said. "But we like individuals to have a backup plan if [it] fails." Jones said it never fails. "If you're sending a mixed signal to kids, it's no wonder they don't abide by what you've taught them," he said. In a letter from black pastors representing Interdenominational Ministerial Alliance, clergy wrote: "Our moral values for family and our young adults, do not allow us to embrace the concepts of Planned Parenthood." Cathie Humbarger, executive director of Right to Life, said although abortions are not done at local Planned Parenthood offices, "The bias of an organization that profits from performing abortions cannot be overlooked when considering their plan to offer sex education and facilitate "value-based" discussions about birth control and abortion." Additionally, Humbarger pointed to a 2001 National Institutes of Health report showing the risk of certain STDs is not reduced by condom usage. Baldwin said three Fort Wayne pastors have already called to express their support of the initiative, but declined to name them. "HIV/AIDS Organization Struggles to Survive" Detroit Free Press (12.11.02)::Patricia Anstett Detroit's oldest agency for HIV-positive women and their children, Children's Immune Disorder, is struggling for survival. "We need at least $50,000 in committed funds for a couple of years," said Kerry Laycock, board chair of CID. "And we have to resolve this by year's end." When it started in 1985, CID was "Michigan's first response to women who were HIV-positive and their caregivers," said Patricia Priebe, CID's cofounder. When CID was strong, it offered support groups, transportation to medical appointments, a preschool counseling program, holiday parties and more. Now CID has one staff person, one weekly evening support group, and a program that distributes food baskets and baby supplies to HIV- positive mothers. "Money is tighter now," said Priebe, who resigned earlier this year as the organization's longtime executive director because of the stresses of keeping the organization going. The Detroit Health Department, which oversees distribution of most federal AIDS grants, "is putting more restrictions in. There's more paperwork and guidelines. When you have a small agency with limited staffing, it gets tough," she said. Jewell Martin, HIV/AIDS coordinator for DHD, one of two city agencies that have funded the group, said there are similar programs. "There will be no gap in services" if CID closes, she said. Detroit's Planning and Development Department also has funded CID since 1999, but a grant to renew $107,000 was rejected when the application was turned in late, said spokesperson Sylvia Crawford. Martin said changes in federal guidelines also may make CID ineligible for funds that focus on HIV-positive people with a co-existing mental health diagnosis. Barb Murray, executive director of Detroit-based AIDS Partnership of Michigan, said she only knows of one other local agency - Simon House, a small shelter program for HIV-positive women - that focuses exclusively on women. Detroit needs more women's services, particularly serving African-American women, she said. Of the 2,429 HIV-positive women in Michigan, 73 percent are black, according to the Michigan Department of Community Health. ************************************************************ NEWS BRIEFS ************************************************************ "Bush to Offer Smallpox Vaccine to All" Associated Press (12.12.02)::Laura Meckler President Bush will announce a program Friday to make the smallpox vaccine available to all Americans, beginning with the military and health workers who would be front-line defenders against a bioterror attack. The vaccine will be mandatory for about 500,000 military personnel and recommended for another half-million who work in hospital emergency rooms and on special smallpox response teams. The first shots for medical personnel are expected to begin in January, senior administration officials said Wednesday. The public will be offered the vaccine on a voluntary basis as soon as large stockpiles are licensed, probably early in 2004, though the government will not encourage people to get them. Federal health officials are preparing a massive public education campaign about both the disease and the vaccine. Certain people should not get the vaccine because they face particular risk of side effects, including cancer patients, organ transplant recipients, people with HIV, pregnant women and people with a history of eczema. People who live with others who have these conditions also should not be vaccinated, because the live virus used in the vaccine can sometimes escape the inoculation site and infect others. "Celera Diagnostics" Washington Post (12.12.02) Celera Diagnostics, an Alameda, Calif., venture supported by Celera Genomics and Applied Biosystems Group, said it received clearance from the US Food and Drug Administration to market a gene-based HIV test. The test is designed to detect mutations in HIV that create resistance to certain drug treatments. Studies have found that up to 78 percent of patients show resistance to drugs used to treat HIV. Genetic testing is common for HIV patients, but Celera Genomics Chief Executive Kathy Ordońez said Celera Diagnostics' test could help standardize the process. A unit of Abbott Laboratories will distribute the system. "Singapore Uses Shocking Images to Turn Students Off Sex" Associated Press (12.11.02) Singapore announced a new strategy to put teens off casual sex. In January, the government's Health Promotion Board will distribute a booklet to 15-year-olds featuring color photographs of people infected with, and disfigured by, gonorrhea, chlamydia, and syphilis. The booklet is a departure from the norm in a country with routine censorship. "It's very graphic, we want to grab their attention and bring across the dangers," said Leona Lo, a Board spokesperson. Teens and parents who saw the images described the booklet as shocking. "The pictures are gross," said student Ben Tay. "But the scarier the better because it's the fear factor that will stop people." Singapore reports one of the lowest STD transmission rates in the world, with a total of 6,500 cases reported last year. "Zambia Needs $270 Million to Tackle AIDS: Official" Reuters Health (12.09.02) Zambia needs to spend at least $270 million over the next three years to fight AIDS, which is killing about 200 citizens each day, Finance Minister Emmanuel Kasonde said. His statement noted that the country needed money to provide free antiretroviral drugs, expand existing programs to reduce infection, and care for AIDS orphans. Zambia has 11 million people. The government estimates that one in five has HIV/AIDS. The pandemic has killed more than 650,000 Zambians since the first case was recorded 18 years ago.