Subject: CDC AIDS Daily Summary for 12/17/02 Date: Tue Dec 17 11:41:08 PST 2002 (378 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Tuesday, December 17, 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 "United States Holds Out on How to Give Poor Nations Access to Affordable Drugs" "Cuts in AIDS Drug Plan Could Be Costly" INTERNATIONAL NEWS "Call for TB and HIV Tests on All Immigrants" "Condoms Minor Cause of HIV Decline" MEDICAL NEWS "Correlates of Human Herpesvirus 8 Seropositivity Among Heterosexual Men in Kenya" LOCAL AND COMMUNITY NEWS "Local AIDS Foundation Runs Out of Money for the Moment" "Quiet Care to Close" NEWS BRIEFS "HIV Disclosure Claim Costs Rockland $3,000" "VaxGen's AIDS Vaccine to Be Reviewed by FDA" "One in 10 Russian Prison Inmates Have Tuberculosis: Justice Ministry" "Combined Vaccine Gets FDA Approval" ************************************************************ NATIONAL NEWS ************************************************************ "United States Holds Out on How to Give Poor Nations Access to Affordable Drugs" Associated Press (12.16.02)::Naomi Koppel In Geneva on Monday, the United States held out against other members of the World Trade Organization in negotiations on how to ensure better access to cheap medicines for poor countries. A third draft of an agreement has been produced that would allow some developing countries to ignore patents and buy generic drugs for diseases such as HIV/AIDS and malaria. Many countries said they would accept the document, but the United States, which opposes its application to noninfectious diseases, and some others said changes were needed. The meeting was adjourned without agreement until Tuesday afternoon. The WTO is closed throughout the Christmas and New Year period, so the diplomats have until Friday to beat a year-end deadline. At a meeting in Qatar last November, ministers recognized the right of WTO members to override patents on expensive drugs when public health is at stake. However, drugs made under such compulsory licensing were only to be used domestically, not exported. That means a country without a drug industry would be no better off, since it could neither make the drugs nor buy them. Developing countries, led by South Africa and Brazil, accepted the declaration reluctantly rather than cause the collapse of the bid to launch a wider trade round. In return, the WTO was instructed to solve the problem by the end of this year. The biggest problem is agreeing which diseases to cover. Poor countries want to use the rules to deal with anything they consider a health crisis, but the United States, with support from a few other countries with large drug industries, wants it limited to infectious diseases. That would mean countries could not override patents on drugs for illnesses such as diabetes, cancer or asthma. "Cuts in AIDS Drug Plan Could Be Costly" Austin American Statesman (12.14.02)::Mary Ann Roser Next year, two out of 10 Texans now enrolled in the AIDS Drug Assistance Program will be cut off under a plan to keep the financially drained initiative afloat. Of the 12,500 Texans enrolled in the program, 2,500 clients are expected to be cut from the program. Another 1,700 new clients who would have signed on to the program next year would be excluded based on new income guidelines the Texas Board of Health is expected to approve in February. The program has a $58 million annual budget, but with demand growing and drug costs soaring, the Texas Department of Health expects a shortfall of $34 million in the next two-year budget cycle, which starts in September. Department officials are proposing tightening income eligibility so that anyone making more than 140 percent of the federal poverty level, or $12,400 a year, no longer would qualify. Today, the income cutoff is 200 percent of the federal poverty level, or $17,720, but that can be raised to cover medication costs. That means an individual can now have an annual income of $26,000 and still get the benefit. The Health Department has received more than 2,500 comments about the proposal, most of them urging the agency to abandon the cuts. "No one likes the idea of having to do this," department spokesperson Doug McBride said. But cutting costs is probably the only way to keep the program alive, said Linda Moore, director of clinical resources in the department's bureau for prevention of HIV and other STDs. "The bottom line for us is, we're running out of money. We've got to do something," Moore said. "If we don't do something, we will have to close the program." Moore said the Health Department is concerned about how the cuts will effect clients. If its board approves the change, affected clients would get six months to move out of the program. The department will try to connect them with free drug programs offered by pharmaceutical companies, Moore said. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Call for TB and HIV Tests on All Immigrants" Times (London) (12.13.02)::Anthony Browne Lord Turnberg, the former chair of Britain's Public Health Laboratory Service, is calling for medical tests for immigrants before they are allowed into the country. Turnberg said the measure is needed to combat the spread of tuberculosis and HIV, since the recent surge in cases is largely the result of increased immigration from countries with high levels of the infections. His call reflects the growing concern in the medical profession that the National Health Service is being over- extended by the cost of treating imported illnesses. "If they are coming for economic reasons, I would be inclined to have the tests before they leave, but if they are coming to join a husband and wife, I would be less severe," Turnberg said. At the very least, all immigrants should have health tests on entry, so they could be treated for any illnesses they carried. The only medical tests for immigrants to Britain are voluntary after arrival. A recent report showed that the level of TB in Britain has risen sharply in recent years, largely because of immigration. In parts of London with the largest number of immigrants, TB levels are now higher than in many Third World countries. PHLS also attributed the recent rise in HIV cases to immigration. Nearly half of the 4,658 cases diagnosed in Britain last year were acquired overseas, with 1,926 involving people from Africa. Government figures showed that 92 percent of those were immigrants rather than Britons acquiring the infection in Africa. One in four people undergoing HIV treatment in Britain is an African immigrant. "Condoms Minor Cause of HIV Decline" Africa News Service (12.16.02)::New Vision A new report says that the decreased level of HIV infection in Uganda resulted mostly from abstinence and faithfulness, and to a lesser extent from condom use. The report, produced by a team of American and Ugandan researchers, is based on analysis of the changes in people's behaviors as seen in demographic and health surveys. In their report, "What Happened in Uganda," the researchers say condom promotion "has played a key but evidently not the major role" in reducing infection rates. Their argument is that HIV prevalence started declining in 1992. This, they say, must have been the result of a reduction in new infections about 1989. By that time, they argue, very few people were using condoms. The researchers, however, agree that increased use of condoms during the mid and late 1990s must have further slowed the spread of the virus. According to demographic survey reports, in 1989 only 1 percent of Ugandan women had ever used a condom, but this increased to 6 percent in 1995 and 16 percent in 2000. The figure for men rose from 16 percent in 1995 to 40 percent in 2000. Edward Green, of the Harvard Center for Population and Development Studies and the lead author of the report, said large numbers of Ugandans must have heeded President Yoweri Museveni's earlier warning that "you abstain, be faithful or die." Green says the fact that fewer Ugandans are having casual sex has contributed the most to the decline. Researchers show that the number of people who have sex with more than one partner has declined since the late 1980s. Also, younger people engage in sex at a later age, and the percentage of teenagers who are sexually active has dropped. "There is some power in promoting abstinence and being faithful," said Green. However, the latest demographic survey shows that between 1995 and 2000, the number of unfaithful men and women has slightly increased. ************************************************************ MEDICAL NEWS ************************************************************ "Correlates of Human Herpesvirus 8 Seropositivity Among Heterosexual Men in Kenya" AIDS (10.18.02) Vol. 16; No. 15: P. 2073-2078::Jared M. Baeten; Bhavna H. Chohan; Ludo Lavreys; Joel P. Rakwar; Rhoda Ashley; Barbra A. Richardson; Kishorchandra Mandaliya; Job J. Bwayo; Joan K. Kreiss Few studies have examined heterosexual HHV-8 transmission, which is endemic in African populations. Research has implicated HHV-8 as a causal agent of Kaposi's sarcoma. HHV-8 infection is more common in Africa than in Western populations, and studies have found evidence for both sexual and non-sexual transmission. The current study was a cross-sectional survey of 1,061 men enrolled in a prospective cohort study of risk factors for HIV-1 acquisition among heterosexual trucking company employees in Mombasa, Kenya. Forty-three percent of participants were HHV-8 seropositive. Seropositivity increased with age, suggesting that some transmission occurs during adulthood in this population, although there is also a prevalence of HHV-8 among adolescents. Men who were uncircumcised and had ever had syphilis were more likely to be seropositive. However, researchers found no significant association between HHV-8 seropositivity and recent sexual behavior, a history of sexual encounters with prostitutes, or HIV-1 status. The authors found a history of condom use to be associated with decreased likelihood of HHV-8 infection. The researchers also found that Christian religion was positively associated with HHV-8 infection, possibly reflecting differences in sexual behavior or sexual mixing within that population. The cross-sectional design of the study is a limitation, as it does not account for prepubertal acquisition of HHV-8. Although the current study provides new evidence that HHV-8 transmission occurs during adulthood in African heterosexual populations and may be associated with sexual activity, the researchers stress the need for prospective studies that measure a variety of exposures to establish temporality and causality of risk factors for HHV-8 acquisition among heterosexual populations. "Our finding that being uncircumcised was independently associated with HHV-8 is novel and suggests possible mechanisms by which HHV-8 may be transmitted. Moreover, our data are the first to suggest that condom use may be protective for HHV-8 infection. Prospective studies are needed to document whether safer sexual practices are able to reduce HHV-8 acquisition," the authors concluded. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Local AIDS Foundation Runs Out of Money for the Moment" Corpus Christi Caller-Times (12.14.02)::Joy Victory The Coastal Bend AIDS Foundation is out of money as the result of a contract dispute that forced it to go without its main source of funding for three months. In September, Bexar County Housing and Human Services agreed to disburse funds of at least $500,000 annually to the foundation. However, a clause in the contract discussing liability is still in dispute, holding up the money. "We as an agency have to additionally list them as insured, which is an extra $8,500. It was something that wasn't budgeted for," said Racheka Hook, foundation executive director. Prior to September, the money was disbursed directly from the Texas Department of Health HIV/STD resources department. Bexar County now handles disbursement for Corpus Christi, Uvalde and Victoria. The Texas Department of Health held an emergency meeting in Austin on Friday to discuss sending funds directly to the foundation, which serves more than 400 Corpus Christi people with HIV/AIDS. Hook said the agency is owed more than $240,000 in back funding, but hopes to get at least $75,000 to continue operation through the holidays. Bexar County Commissioners Court should meet this week to clear up the discrepancy and release all of the funds, Hook said. If no money is sent to CBAF in the next several days, it will have to stop services until it receives state funds, he said. Meanwhile, Hook's staff has agreed to work for reduced pay, so clients can still receive medical care and home assistance during the holidays. "Quiet Care to Close" St. Cloud Times (12.13.02)::Kirsti Marohn Last week in Minnesota, nurses at Stearns County's Quiet Care Clinic tested for HIV for the last time, after offering twice weekly HIV/STD testing for 17 years. The St. Cloud area's only public clinic will test until the end of the year for other STDs, then close permanently. Budget problems are forcing Stearns County to close Quiet Care, which treats 900 to 1,000 patients every year. "We're in tough times," said Renee Frauendienst, county public health director. Quiet Care opened in 1985 and operates two days a week. HIV testing was added in the late 1980s. The clinic is one of eight similar public testing sites in Minnesota. Its patients have ranged in age from 12 to more than 70, Frauendienst said. A $10 donation for clinic visits and $20 for an HIV test is requested, but not required. State grant funding has declined since the clinic opened, said Frauendienst. Now, the county pays most of the clinic's costs - about one full-time nursing position, she said. Under a tight budget, the Stearns County human services department is reevaluating the services it provides - how much they are used, if they are provided elsewhere in the community, and how much outside funding they get - Frauendienst said. The clinic's patient load has declined since a peak in 1991. About 500 patients tested for HIV that year, compared to an average 200 now, she said. There were 244 cases of chlamydia diagnosed in Stearns County last year, and about 10 percent of those were diagnosed by Quiet Care, said John Clare, epidemiology field services supervisor for the Minnesota Department of Health. Sixty-five of the Stearns cases were between ages 15 and 19. Betty Johnson, nurse for the Rocori school district, said she is afraid students will not get tested without the clinic because they are too embarrassed or too poor to be tested by their family doctor. "Some of these people who go to the clinic have no other resources," she said. "It's not like we've wiped out STDs. They're rampant." ************************************************************ NEWS BRIEFS ************************************************************ "HIV Disclosure Claim Costs Rockland $3,000" Bangor Daily News (12.14.02)::Leanne M. Robicheau In Rockland, Maine, city councilors voted last Wednesday to pay $3,000 to settle a potential lawsuit by a "John Doe" because a former police officer allegedly disclosed the man's HIV status following his arrest. Doe claimed that after his arrest for driving under the influence of intoxicants in December 2000, the officer told one of Doe's co-workers about his medical condition, after which word spread and he was forced to take stress leave. The officer resigned shortly after a human rights complaint was filed in February 2001, according to the Maine Human Rights Commission, which says Doe has HIV and hepatitis. In March, 2001, the city received notice of a claim from Doe alleging he was subjected to unlawful discrimination. The commission dismissed the complaint, ruling there were no reasonable grounds to believe the city discriminated against Doe on the basis of disability in violation of the Maine Human Rights Act. City Attorney Greg Dorr said the settlement - which admits no wrongdoing and releases the city from further claims - cost the city less than it would have spent to hire an attorney to represent the former officer. "VaxGen's AIDS Vaccine to Be Reviewed by FDA" New York Times (12.17.02)::Reuters VaxGen Inc. said yesterday that the Food and Drug Administration had agreed to an accelerated review of its experimental AIDS vaccine. VaxGen is testing the vaccine for preventing HIV infection in a pivotal stage, or phase III, trial among 5,400 people in the United States, Canada, the Netherlands and Puerto Rico. The company said it expects to announce preliminary results in the first quarter of 2003. Another pivotal-stage trial of a vaccine version intended to fight HIV subtypes prevalent in Southeast Asia is being conducted in Thailand, and those results are expected in the second half of next year. "One in 10 Russian Prison Inmates Have Tuberculosis: Justice Ministry" Agence France Presse (12.17.02) Some 90,000 Russian prisoners, or one out of every 10, have tuberculosis, the Interfax news agency reported Tuesday, quoting a justice ministry official. Some 30,000 new TB cases are registered each year, Vladimir Yalunin said, adding that 400,000 inmates, or almost half of all 890,000 Russian prisoners, have health problems. A highly resistant form of TB has appeared in Russian jails in recent years and could trigger a major health disaster, the Russian non-governmental organization Center for a Prison Reform warned in a study earlier this year. With 630 prisoners per 100,000 inhabitants, Russia has the second highest rate of imprisonment in the world, after the United States. "Combined Vaccine Gets FDA Approval" New York Times (12.17.02)::Donald G. McNeil Jr. A vaccine that protects infants against five diseases has been approved for use in the United States, its manufacturer, GlaxoSmithKline, announced yesterday. The new vaccine, Pediarix, could mean as many as six fewer injections in the first year for many babies. It combines vaccines against diphtheria, pertussis (whooping cough), tetanus, hepatitis B and polio, and is intended to be given three times, at 2, 4 and 6 months of age. Children in the United States are typically given up to 15 injections in their first year, a schedule that experts say has led some parents to resist immunizations. The combined vaccine should cut that number to 9 for many children.