Subject: CDC AIDS Daily Summary for 12/19/02 Date: Thu Dec 19 13:31:10 PST 2002 (431 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Thursday, December 19, 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 "CDC Fact Sheet Not Promoting Condom Use Anymore" "Budget Cuts Threaten AIDS Funding" INTERNATIONAL NEWS "Older AIDS Caregivers Face Stigma" "Sex Museum Aims to Break Indian Taboo" MEDICAL NEWS "Increasing Hepatitis B Vaccination Among Young African-American Men Who Have Sex with Men: Simple Answers and Difficult Solutions" LOCAL AND COMMUNITY NEWS "HIV Infections Down 24 Percent Since 1999 in West Baltimore" "Helping Hands Reach Out to Patients with AIDS" NEWS BRIEFS "13 Airport Workers Test Positive for TB, but May Not Be Infected" "Housing Education Grant Awarded to AIDS Legal Referral Panel" "4 Agencies in the City Get HIV/AIDS Funding" "New AIDS Drug Likely to Fall Short of 2003 Demand" ************************************************************ NATIONAL NEWS ************************************************************ "CDC Fact Sheet Not Promoting Condom Use Anymore" Associated Press (12.18.02)::Laura Meckler A government fact sheet that long promoted condoms as "highly effective" in preventing HIV and other STDs now offers a more neutral summary of the pros and cons of condom use, and Congressional Democrats charge that politics are trumping science. They also note that a National Cancer Institute fact sheet now says the evidence regarding a link between abortion and breast cancer is not clear; until this summer, it said women who had abortions face no increased risk of breast cancer. The alterations and deletions "appear to be a part of an Orwellian trend at HHS," Rep. Henry Waxman (D-Calif.) and 13 other Democrats said in a letter Wednesday to Health and Human Services Secretary Tommy Thompson. "Simply put, information that used to be based on science is being systematically removed from the public when it conflicts with the administration's political agenda." HHS officials say the revisions are consistent with the science and deny any political interference. The condom fact sheet on the CDC Web site had said that refraining from sex was the best way to avoid HIV and other STDs, and it added: "But for those who have sexual intercourse, latex condoms are highly effective when used consistently and correctly." The revised version says that condoms "can reduce the risk of STD transmission. However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD." It explains that condoms are highly effective in preventing HIV, but that there is no evidence condoms prevent transmission of human papillomavirus. Given the mixed evidence, CDC opted for a more neutral introduction to the fact sheet, said Dr. David Fleming, CDC's deputy director for science. "This fact sheet is designed to be as scientifically accurate as possible," he said. "We specifically tried not to nuance it in the direction either of encouraging or discouraging use of condoms. The interpretation really is in the eyes of the beholder." Fleming said the fact sheet was written with the help of people at HHS headquarters, but said he stands by it from a scientific point of view. "Budget Cuts Threaten AIDS Funding" Bay Area Reporter (San Francisco) (12.12.02)::Joe Dignan California Gov. Gray Davis' office has asked a group of HIV/AIDS service organizations to suggest how to cut $20 million to $40 million out of next year's state AIDS budget, according to Dana Van Gorder, director of state and local affairs for the San Francisco AIDS Foundation. "Our biggest concern is to protect [the AIDS Drug Assistance Program]," he said. If ADAP cuts go through, Van Gorder fears California will have to resort to a waiting list, as many states have, or to removing drugs from the formulary. The cost of California's ADAP was approximately $185 million in 2002-2003, of which the state contributed $67 million. Van Gorder expects the program's needs to grow by another $20 million to $30 million in the next budget cycle to keep pace with growing enrollment and increasing drug costs. California's 2002-2003 AIDS budget is approximately $834 million, of which the federal government funds $432 million. Davis already announced that provider rates for Medi-Cal, which serves as an HMO to many AIDS patients, will be cut by 10 percent this year as a result of emergency reductions to the budget, if the Legislature concurs. San Francisco's general fund and other state funds have always had to chip in to make up the difference, said Jimmy Loyce, deputy AIDS program director for the San Francisco Department of Public Health. According to Eric Bauman, Davis' aide, the $10.2 billion in mid-term cuts to this year's budget do not include any direct cuts to HIV services. "Obviously the 10 percent reduction will have some impact, but AIDS prevention, ADAP, and other services are not directly impacted," Bauman said. The Legislature convened in a special session on Dec. 9 to consider the mid-year cuts. Democrat and Republican leaders immediately began debating fee increases versus program cuts. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Older AIDS Caregivers Face Stigma" AllAfrica.com (12.16.02)::Namibian Older people who care for their HIV-infected adult children or orphaned grandchildren also face the harsh realities of stigma attached to the disease, according to a World Health Organization study released last week. The "Impact of AIDS on Older People in Africa," based on a case study done in Zimbabwe, noted that older people are largely left on their own in providing care and support for their terminally ill adult children and, following their deaths, the orphans. The study was conducted in 2001 in six of Zimbabwe's 10 provinces. It used a mix of qualitative and quantitative research methods to interview 685 older people - 40 percent from urban and 60 percent from rural households - all of them providing HIV/AIDS-related care. Two-thirds of these caregivers were women. The report found that older people face: *Loss of economic support through loss of remittances from their sick/dead adult relatives; *Lack of access to basic needs such as food, clothing and medical care; *Limited access to care services due to transportation difficulties and high cost of services; *Financial hardships leading to inability to pay for medical or school fees; *Stigma and negative attitudes of health workers towards older persons, as well as towards people living with HIV/AIDS; *Physical and emotional stress resulting from increasing levels of violence and abuse - often as a result of accusations of witchcraft. The study identified older people as a vulnerable group as a result of a lifetime of hardship, malnutrition and poverty. Because of their age, they were at high risk of suffering from chronic diseases. "The AIDS pandemic is now posing an additional burden on them, further increasing their vulnerability. Thus, their health is seriously compromised," the report said. The study recommended that older people's caretaker role be recognized and supported and stresses that unless these care providers are in good health, they cannot continue providing care. "Sex Museum Aims to Break Indian Taboo" South China Morning Post (12.17.02)::Amrit Dhillon The organizers of India's first sex museum in Mumbai, who also run a clinic for STDs just one floor below, were incredulous at the level of ignorance about sex when they visited local schools. Male teenagers thought babies came out of a woman's stomach, had no clue what a woman's genitals looked like or how reproduction happened. Girls thought they had suffered some strange internal damage when their periods began. Indeed, many rural men rarely even see their wives completely naked. Given the taboo on the subject of sex, museum organizers have been deliberately explicit. The museum exhibits include fiberglass models of men, women and their genitalia, explanations of how a baby is conceived, models explaining how to use condoms, and illustrations on menstruation and AIDS. AIDS workers believe it is time for such explicitness. With 4 million Indians HIV-infected, awareness campaigns will be crucial in stopping the spread of AIDS. This is why Chandrababu Naidu, the chief minister of Andhra Pradesh, is using shock tactics. He wants condoms displayed at all official functions, handed out free at all liquor shops, and made available through vending machines at roadside cafes on the highways and railway platforms. Naidu upset legislators recently by displaying a 2.3-meter condom inside parliament. When they grumbled at the "indecency," he told them it was precisely this kind of attitude that had to be fought. Few Indian parents tell their children about sex, so Naidu made sure normal classwork was put on hold recently so that children could be taught about AIDS. UNICEF helped design the special course, making it interactive and child-friendly. Students will also have to prepare projects on AIDS, which will be evaluated and graded. Targeting the young is important: 45 percent of all HIV-infected people in the state are ages 15-24. ************************************************************ MEDICAL NEWS ************************************************************ "Increasing Hepatitis B Vaccination Among Young African-American Men Who Have Sex with Men: Simple Answers and Difficult Solutions" AIDS Patient Care and STDs (11.02) Vol. 16; No. 11: P. 519-524:: Scott D. Rhodes, PhD, MPH; Kenneth C. Hergenrather, PhD, MRC, MSEd; Leland J. Yee, MPH Hepatitis B virus infection continues to be one of the most frequently reported preventable diseases in the United States, despite the licensure of a vaccine in 1982. Currently, an estimated 1.25 million individuals are chronically infected with HBV in the United States. HBV can be spread both parenterally and through sexual activity. CDC and the US Gay and Lesbian Medical Association recommend vaccination against HBV for all men who have sex with men, a group among whom HBV has been identified as one of the most important STDs. However, available national epidemiologic data and results from community-based HBV vaccination programs indicate that the majority of MSM are not vaccinated. In this study, the authors identified correlates of vaccination against HBV among African-American MSM that could inform future interventions designed to enhance vaccination rates within this population. While the association of race with HBV incidence and prevalence presumably is a proxy for some other characteristic, understanding vaccination behavior among subgroups is essential to ensure that appropriately tailored, effective intervention strategies are designed and implemented. During September 2001, the authors anonymously collected data in two predominantly African-American, male, gay bars in Birmingham, Ala. All bar patrons were asked to participate regardless of gender by one of four trained recruiters who explained the study and assessed sobriety of potential participants using established criteria to ensure informed consent. Questionnaires were self-administered and completed in secluded areas of bars. Items measured demographics, health insurance coverage, sexual and nonsexual risk behaviors, vaccination status, vaccine awareness, and resources used to obtain information about hepatitis. Of the participants who completed the questionnaire, 170 self-identified as African-American or black and reported knowing their HBV vaccination status. The remaining participants self- identified as: white, Hispanic/Latino, or Native American; female; male and reported no same-sex sexual behavior within the past 5 years; or self-identified as male and reported same sex sexual behavior within the past five years but reported not knowing whether they had been vaccinated against HBV. Of the 170 participants, the mean age was 26.3 years. Nearly 40 percent reported being vaccinated against HBV while 21.8 percent reported never having heard of HBV. Over half of the participants reported 10 or more different lifetime male sexual partners, and fewer than half reported two or more different male sexual partners within the past 30 days. More than one-third reported having had sex with females as well as males within the past five years. Not including HIV seropositivity, nearly 11.2 percent of this sample reported a lifetime history of STD diagnosis, and 5.9 percent reported that they had received an STD diagnosis within the past 5 years. Approximately 7 percent of the sample reported receiving blood or blood products before 1992, and 4.7 percent reported ever having injected drugs or steroids; only two participants reported ever having shared injecting drug equipment. Twelve characteristics - including younger age, higher educational attainment, homosexual as opposed to bisexual behavior, and the timing of the most recent health care provider visit - were associated with an increased likelihood of being vaccinated against the hepatitis B virus. Understanding correlates of HBV vaccination among African- American MSM is not only crucial for the development and evaluation of tailored interventions aimed at increasing vaccination against HBV, but also provides the framework for developing future vaccination strategies for diseases such as HIV. Focus must be placed on increasing vaccination against HBV through innovative and well-tailored strategies, according to the authors. "A large majority of our sample reported engaging in behaviors that put them and their partners at risk for infection with HBV, yet we found many participants unaware of HBV and HBV vaccination," the researchers concluded. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "HIV Infections Down 24 Percent Since 1999 in West Baltimore" Baltimore Sun (12.19.02)::Jonathan Bor State health officials yesterday declared a possible turning point in Maryland's fight against AIDS: The rate of new infections is declining in a wide swath of West Baltimore, the only area in the state where the infection rate had been rising. The three-year decline in an area riddled with poverty, crime and drug abuse is due to stepped-up prevention efforts by the Maryland AIDS Administration, the city Health Department and a constellation of community groups, according to Liza Solomon, director of the Maryland AIDS Administration. An expanded needle exchange program, prevention-oriented billboards and bus placards, and new places for people to be tested and referred for treatment helped spark a 24 percent decline in new cases of HIV infection from 1999 through 2001. The state spent $1.5 million on prevention efforts targeted to the area, and private groups won an additional $1.5 million in grants. The rate of new infections declined from 209 cases per 100,000 in 1999 to 159 cases per 100,000 last year. "This clearly says we can make a dent," said Solomon. "A 24 percent decline... translates into people's lives saved." But Baltimore still has the third-highest rate of new AIDS cases in the country, trailing New York and Miami. Community activists, while glad to see their efforts pay off, warn that the fight must continue. "It doesn't surprise me because there has been a concentrated effort over the last several years," said the Rev. Debra Hickman, director of Sisters Together and Reaching. "But I have a concern: We can't let up." Angelique Mason, director of Becoming a Responsible Teen, a prevention program at Southwestern High School, said, "The population we work with... think [HIV]is not going to happen to them." Mason works with the Payne Memorial AME Church. Solomon said news of progress should not undermine Mayor Martin O'Malley's state of emergency against AIDS, declared December 2. "We should not be sanguine right now," she stated. "We have a lot of problems." "Helping Hands Reach Out to Patients with AIDS" Associated Press (12.14.02)::Dann Denny When Sierra Launer was in the first grade, she was taking pills five times daily to help manage HIV, with which she was born. "She had trouble remembering to take them when I wasn't with her," said Debra Launer, who adopted Sierra as an infant. So when Debra learned of a project called Secret Santa, in which donors anonymously give gifts to HIV-positive people during the holiday season, she requested a $40 wristwatch with five alarms to remind the youngster when to take her lifesaving medicines. "It was such a wonderful gift," said Debra, a single woman in Bloomington, Ind., who cares for seven special-needs children - three adopted plus four in foster care. "It enabled Sierra to manage her own health care." The watch for Sierra is just one of hundreds of gifts given to people with HIV/AIDS during the past eight years through the Secret Santa project, renamed Helping Hands this year to avoid the misconception that it's only for Christians. "It's especially important this time of year that we more openly express our care and concern for [area AIDS patients] so they do not feel left out or forgotten," said Daniel Soto, the project's founder and coordinator. Soto said the Helping Hands project relies on Positive-Link, a Bloomington Hospital program that provides HIV/AIDS services, to contact patients in Monroe, Ind., and surrounding counties, asking them if they would like to participate in the project. "If they say yes, they are asked to list an item or two they would like for Christmas," said Soto. Soto then solicits donors, who agree to buy holiday gifts anonymously for participating patients. Once donors buy and wrap their gifts, they take them to one of several drop-off sites in Bloomington. Soto collects the gifts and gives them to Positive-Link, which delivers them to the recipients. "These anonymous expressions of generosity send a message of care, love and human compassion," Soto said. ************************************************************ NEWS BRIEFS ************************************************************ "13 Airport Workers Test Positive for TB, but May Not Be Infected" Associated Press (12.19.02) Thirteen Sarasota-Bradenton International Airport workers have tested positive for TB, and another 28 workers asked to be tested for the disease, Manatee County health officials said. County epidemiologist Dr. James Ogedegbe said Wednesday the 13 positive tests were not alarming given that 299 employees have been tested since Monday. "If you test the normal population, you would expect 8 to 10 percent to come up positive," he said. "What we have now is less than 10 percent." The tests were called for after two skycaps were found to be infected; one died in October of a heart attack. Airport officials maintain that travelers passing through the facility are not in danger of contracting TB. "Housing Education Grant Awarded to AIDS Legal Referral Panel" Bay Area Reporter (San Francisco) (12.12.02)::Zak Szymanski The federal Department of Housing and Urban Development has awarded a grant to help the AIDS Legal Referral Panel fight illegal housing discrimination against people with HIV/AIDS. The grant, the second ALRP has received from HUD, consists of $68,000 over 18 months. "Certainly having one of [the] tightest housing markets in the country helped to make the compelling case that what housing is available must be accessible to people with disabilities including people with HIV," said ALRP Executive Director Bill Hirsh. ALRP is one of 99 groups funded throughout the country for such work. The funds will be used to promote awareness and knowledge of fair housing laws among people with HIV/AIDS; to help social service providers and community-based organizations offer their clients sound advice for finding and maintaining housing; and to educate developers, landlords, rental managers, real estate agencies, and property owners on the need to make informed choices around providing accessible housing. "4 Agencies in the City Get HIV/AIDS Funding" Indianapolis Star (12.19.02) The Indiana AIDS Fund awarded $85,000 for 13 agencies across the state to provide emergency housing, transportation, food and/or medical care to people with HIV/AIDS. Four Indianapolis agencies will share the grants. This is the second year the fund has awarded the Gregory R. Powers Direct Emergency Financial Assistance grants. Last year, the fund distributed $39,100. "Since we were able to more than double the grant amount in only our second year, more clients will get access to support they desperately need," said Keith Norwalk, president of Indiana AIDS Fund. The Indianapolis recipients are Clarian Health Partners Life Care ($12,000); the Damien Center ($12,000); Ebenezer Missionary Baptist Church Foundation ($2,500); and Wishard Memorial Hospital Infectious Disease Clinic ($7,500). Founded in 1994, the Indiana AIDS Fund is the state's largest private funder of HIV/AIDS programs. "New AIDS Drug Likely to Fall Short of 2003 Demand" Reuters (12.19.02) A new AIDS drug will be available to only about 15,000 patients by the end of 2003. Roche Holding AG, a Swiss healthcare group, said its manufacturing plant in Boulder, Col. has been working to meet the challenges to making the complex drug Fuzeon, but initial yields had been lower and cycle times longer than projected. Roche, developing the drug with the Durham, N.C.-based Trimeris Inc., said earlier this year it was targeting 25,000 patients. Injectable Fuzeon is designed for patients resistant to current antiretroviral therapies. Fuzeon is the first of a new group of drugs called fusion inhibitors that are designed to block HIV from entering healthy human immune cells. The companies expect to supply it to a maximum of 32,000 patients by the end of 2004 and 39,000 in 2005.