Subject: CDC AIDS Daily Summary for 12/16/02 Date: Mon Dec 16 11:31:07 PST 2002 (384 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Monday, December 16, 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 "US Isolated at Population Conference over Its Anti-Abortion Stand" INTERNATIONAL NEWS "Vietnam Needs to Tackle Malnutrition, Trafficking, HIV: UNICEF" "Uganda Stands Firm on Health Spending Freeze" MEDICAL NEWS "Therapy Adherence and Highly Active Antiretroviral Therapy: Comparison of Three Sources of Information" "Computer Education May Bridge Affordability Gap" LOCAL AND COMMUNITY NEWS "SRQ Employees to Be Tested for TB" EDITORIALS AND COMMENTARY "India's Voiceless Women Are Easy Prey for AIDS" NEWS BRIEFS "2.2 Million Ethiopians Living with HIV/AIDS in 2001" "Uganda - Refugees to Get Free HIV Drugs" "Zambia to Share Global Funds on HIV/AIDS" ************************************************************ NATIONAL NEWS ************************************************************ "US Isolated at Population Conference over Its Anti-Abortion Stand" Associated Press (12.16.02)::Alisa Tang At the UN-sponsored Asian and Pacific Population Conference in Bangkok, Thailand, on Monday, the United States was criticized for its rigid stand against abortion and its advocacy of abstinence over condom use for adolescents. Ministers and officials from more than 40 countries are participating in the conference, which is held every 10 years and focuses on family planning, population, reproductive health, HIV/AIDS and their effect on poverty. Delegates say the United States has threatened to withdraw its support for an international family planning agreement, reached in 1994 in Cairo, claiming some phrases in it can be read as promoting abortion and underage sex. The United States wants many such phrases removed from the action plan that is to be adopted Tuesday at the end of the two-day conference. Among paragraphs the United States wants changed are some that advocate providing sexual and reproductive health information to married and unmarried adolescents. One phrase it wants struck out says "consistent condom use" is a way to reduce vulnerability to HIV infection. US delegate A. Eugene Dewey told a news conference the "improvements" his side is seeking would ensure that the texts "do not imply an advocacy or a support for abortion." Dewey acknowledged the United States is isolated in its position: "Everyone else seems to be very happy with the language," he said. Dewey said it is untrue that the United States preaches only abstinence to adolescents. Rather, abstinence is preferred over condoms, he said. UN Population Fund Executive Director Thoraya Ahmed Obaid said the phrase "reproductive health services" is not a code for "abortion services." The Cairo declaration clearly stated that abortion should not be promoted as a method of family planning, she said. Earlier this month, the Bush administration blocked $34 million in funds appropriated by Congress for the UNPF. Dewey said that was because China, one of the countries where UNPF operates, has a "coercive" abortion and sterilization program. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Vietnam Needs to Tackle Malnutrition, Trafficking, HIV: UNICEF" Agence France Presse (12.16.02) UNICEF's annual flagship publication, "The State of the World's Children 2003," reported that sexual exploitation, malnutrition, inadequate sanitation and HIV transmission are just some of the problems facing children in Vietnam. "Vietnam has made tremendous progress over the past decades in improving the well-being of its children," said UNICEF Regional Director for East Asia and the Pacific Mehr Khan. "However, several major challenges still remain." Khan said the government needed to tackle high malnutrition rates that result in one-third of all Vietnamese children being below the weight and height they should be. In addition, two out of three minors in rural areas do not have access to adequate sanitation facilities, she said, while one-quarter of all children who enroll in school leave before completing fifth grade. UNICEF officials stressed that HIV/AIDS education among Vietnam's youth needs to be strengthened to contain the pandemic, which has already infected at least 56,000 across the country. "In Vietnam, young people constitute a third of the Vietnamese population; however, only 60 percent know that consistent condom use can protect them from HIV/AIDS infection," Khan said. Official figures show that condom sales rose from 3.5 million in 1991 to 92 million in 2000, but aid workers say that remains very little in a country with 80 million people. International health experts have long criticized Hanoi for focusing on HIV/AIDS as a "social evils" problem - affecting drug addicts and prostitutes - rather than raising awareness about the virus among the wider population. "Uganda Stands Firm on Health Spending Freeze" Lancet (12.07.02)::Charles Wendo Uganda's Ministry of Finance is standing firm on its decision that, despite an expected grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the country's total health expenditure will not exceed a pre-determined limit of $107 million for the 2002-2003 financial year. Finance officials maintain that they are not going to adjust the allocation for the health sector no matter how much donors, who meet nearly half of Uganda's health expenditures, are willing to provide. The restriction, they say, is part of a wider policy to control expenditures in all government departments, in order to stabilize the national economy and reduce dependence on donors. The ministry is particularly concerned about temporary, unsustainable inflows that might cause distortions in the economy. According to a report released at an October meeting of donors and government officials in Kampala, health sector funding had increased by 52 percent since the previous financial year but remained far short of what is needed. Health officials say that because HIV/AIDS is one of the country's top problems, the strict limitation in health expenditure will not restrict the amount of money flowing in the fight against HIV/AIDS. They hope to receive $52 million from the global fund to spend on HIV/AIDS over the next three years. Clinicians estimate only 2 percent of individuals who need antiretroviral therapy can afford the drugs. Epidemiologists fear that Uganda's HIV prevalence, declining for a decade now, seems to be stabilizing. Health officials are hoping the global fund grant will help them in overcoming these challenges. However, the spending limits imply that the budgets of some units within the health sector may have to be cut to make way for the global fund grant, which must be spent on HIV/AIDS interventions approved by the Fund. ************************************************************ MEDICAL NEWS ************************************************************ "Therapy Adherence and Highly Active Antiretroviral Therapy: Comparison of Three Sources of Information" AIDS Patient Care and STDs (10.02) No. 10; Vol. 16: P. 487- 495::John Vincke, PhD; Ralph Bolton, PhD Patient adherence, a critical component in the management of HIV, has become a behavioral problem since the advent of HAART. Failure to adhere to a therapeutic regimen can dilute beneficial effects of the drugs and cause the emergence of drug-resistant strains of HIV. A central limitation to studying adherence to HAART is that often researchers have to rely on self-reported measures of adherence, which tend to overestimate. The current study combines information on adherence from several sources: patients' self reports, perception of adherence reported by the patients' designated most significant others, evaluation of adherence by the physicians in charge of treatment, and HIV-1 RNA levels. Investigators gathered data from 86 participants in the French- and Flemish-speaking areas of Belgium. The study used variables based on the health belief model, a value-expectancy theory that views behavior as a function of the subjective value of an outcome and the subjective expectancy that a specific action will result in the outcome. To improve the explanatory power of the health belief model, the authors also measured adherence-specific social support, and satisfaction with the patient-provider relationship. The researchers found that the best results for explaining adherence were those reported by the medical staff in charge of treatment. Perception of barriers to following the complicated treatment regimen was the most important predictor of adherence. The impact of received benefits was the second most important predictor. Doctors noted that patients who report high benefits from the regimen were more compliant. Female patients also showed to be more compliant than males. Adherence varied with the complexity of the treatments. More complex treatments resulted in lower adherence. Contrary to expectations, the authors found that a higher satisfaction with the doctor-patient relationship, as reported by medical staff, resulted in lower adherence. Adherence reported by the participants had only one significant predictor, perceived self-efficacy. Respondents with high self-efficacy reported fewer missed doses of medication. None of the variables as seen by respondents' most significant other had a significant impact on adherence. The study found older participants to have higher viral load levels, and lower levels of viral particles in the blood of respondents reporting high levels of perceived benefits in following HAART therapy. "We did find that the health belief model is able to explain a considerate amount of the variation in adherence as reported by the medical staff," the authors noted. "Benefits and barriers are related to adherence. We also found for HIV-1 RNA levels that perceived barriers were significant." Since little is currently known about the long-term outcomes of HAART, the researchers suggested that adherence could become more stringent as treatment effects stabilize over time and benefits become more visible. "While this study has limitations related to sample size, statistical power, and missing data, nonetheless, we strongly believe that relying on and combining different sources of information on therapy adherence will sharpen our insights into the complex process of adherence and produce more effective therapeutic outcomes," the researchers concluded. "Computer Education May Bridge Affordability Gap" AIDS Alert (11.01.02) Researchers from CDC, the University of Washington-Seattle, California State University-Long Beach, and the Indiana University School of Medicine-Indianapolis, are collaborating with Resources Online, a Seattle computer consulting business, to create a computer-assisted, client-centered, educational CD-ROM product to encourage risk-reduction behaviors and testing for HIV and other STDs. Studies show that client-centered counseling is more effective than simply providing educational materials. Since many venues have neither the time nor the skilled counselors to provide this service, this product is designed to be an effective replacement for face-to-face counseling. The program will have a user-friendly interface that asks patients risk assessment questions, followed by individualized counseling messages and negotiation of a realistic prevention plan based on their responses. The CD-ROM is based on well- validated elements, programmed into the computer, incorporating common scenarios and probing techniques used by good counselors. Although the early versions of the program will be in English, eventually it may be available in a variety of languages. Researchers are building the program so it is appropriate for various at-risk populations and age groups. They are designing the program to be run on a wide variety of computers, reflecting the reality of the type of hardware found in clinics. When the CD-ROM has been fully developed, the research team intends to distribute it widely, perhaps at no or low cost to health clinics and on a sliding income scale to venues such as emergency rooms and private practices. Users would be able to customize the program by adding phone numbers for local resources and language modules when those become available. The team's goal is for people to use the CD-ROM in medical venues where no human counselors are available, or as an initial interview with follow- up by a counseling staff. The ultimate goal is to test more people for HIV. Development funding began in October 2002 with a plan to begin pilot testing and to design a randomized trial of the intervention in 2003. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "SRQ Employees to Be Tested for TB" Bradenton Herald (12.16.02)::Aaron Quinn All airline employees and skycaps at Sarasota-Bradenton International Airport in Florida are scheduled to undergo TB testing today by Manatee County health officials following news that two skycaps tested positive for the illness. One of the two men has died, but it was unclear whether TB was the cause of death, according to Fred Piccolo, the airport's president and CEO. The man died sometime within the past month, Piccolo said. The second skycap's case, he said, was confirmed Friday. The men's names were not released. A memo written by Piccolo and dated Dec. 13 outlines the details of the testing. Health officials plan to return to the airport Wednesday to check the results. Although the airline employees have been made aware of the skycaps' illness, the general public has not been notified, according to airport officials. "It's a Department of Health issue, not an airport issue," Piccolo said. Manatee County Health Department could not be reached for comment. Sarasota-Manatee Airport Authority Board Member Bob Waechter, said the decision was made to keep the information between the airport and the health department because he contends there is no reason for alarm. "Tuberculosis takes consistent, prolonged contact to pass along to another person," Waechter said. ************************************************************ EDITORIALS AND COMMENTARY ************************************************************ "India's Voiceless Women Are Easy Prey for AIDS" Los Angeles Times (12.01.02)::Meena Seshu; Joanne Csete "The $100 million that Bill Gates' philanthropy will add to the battle against HIV and AIDS in India is a welcome expression of concern for what Gates rightly portrays as one of the worst epidemics in the world. But the Gates Foundation's generous support may be undone by factors that neither the government of India nor its donors are addressing: the voicelessness of women and increasing violence against those most affected by the epidemic. ... "The long-standing insubordination of women and girls in Indian society takes on lethal dimensions with the rapid spread of HIV. Though men can experiment with sex outside of marriage without any social stigma, women do not even have the status to demand that husbands who may bring sexually transmitted diseases home use condoms. ... "...Prostitutes are continually subjected to violence by police officers, who take their cue from society's condemnation of these women. ...The violence of AIDS-related stigma also confronts AIDS educators, homosexual men and other marginalized people. "The most effective education on HIV transmission is done by those trusted by the community at risk. This means that sex workers have the best chance of helping other sex workers protect themselves from HIV. But... the police apparently do not recognize the lifesaving work done by AIDS educators, and these people face consistent abuse. "Finally, the Indian government and its well-meaning donors seem to think that HIV prevention alone can succeed, ignoring the needs of millions already living with HIV and AIDS. These people continue to face abuse and discrimination in the health care system, and unless they are rich they can hardly hope for the basics of treatment of even secondary infections, let alone medicines for HIV itself. "India is one of the biggest producers of the drugs that have transformed the lives of people with AIDS in wealthy countries, yet millions of Indians cannot get these medicines. "The Gates Foundation can do India and its own investment a favor by insisting that the money be used to help the voiceless women with HIV and AIDS." Seshu is founder and general secretary of Sangram, which works with sex workers and rural women in Sangli, India. She has been named a Human Rights Defender by Human Rights Watch. Csete is director of the HIV/AIDS and human rights program of Human Rights Watch. ************************************************************ NEWS BRIEFS ************************************************************ "2.2 Million Ethiopians Living with HIV/AIDS in 2001" Xinhua News Agency (12.12.02) The Ethiopian Health Ministry reported on Thursday that an estimated 2.2 million people in the nation are living with HIV/AIDS, including 200,000 children. HIV prevalence had decreased from 7.3 percent the previous year to 6.6 percent. The urban rate (13.7 percent) remained considerably higher than the rural rate (3.7 percent). "Uganda - Refugees to Get Free HIV Drugs" Africa News (12.11.02)::New Vision The UN High Commissioner for Refugees will soon start distributing free nevirapine to expectant mothers in refugee camps in Uganda to curb mother-to-child transmission of HIV/AIDS. Paul Spiegel, a senior UNHCR technical officer, said last week that UNHCR would also carry out several programs with the government and nongovernmental organizations to sensitize refugees about the dangers of the pandemic. Although most camps have counseling and voluntary testing services, Siegel said, more programs are needed to give refugees equal opportunities. "Zambia to Share Global Funds on HIV/AIDS" Xinhua News Agency (12.12.02) At a meeting with Zambian cabinet ministers Thursday in Lusaka, UN Special Envoy on HIV/AIDS in Africa Stephen Lewis said he would get in touch with those responsible for the global fund for HIV/AIDS to ensure the country receives its share. Lewis stressed that HIV/AIDS has further compounded the hunger crisis in Zambia. He said the UN intended to study the relations of hunger to the HIV/AIDS pandemic so that it could identify areas in which it can help. About 14 million people in the region - where more than 20 percent of people are HIV-positive - face possible starvation.