Subject: CDC AIDS Daily Summary for 12/26/02 Date: Thu Dec 26 11:11:05 PST 2002 (394 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Thursday, December 26, 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 "AIDS Group Seeks Rejection of Money" "TV Teaches Teenagers About Sex - Media Project Teaches TV" INTERNATIONAL NEWS "Oprah Winfrey Moved to Expose the Plight of AIDS Victims in Africa" MEDICAL NEWS "Public Health Impact of Targeted Tuberculosis Screening in Public Schools" "Tenofovir Potent Anti-Hepatitis B Treatment for HIV-Coinfected Patients" LOCAL AND COMMUNITY NEWS "A Day Off Becomes a Day of Charity" "Two Groups Seek to Direct AIDS Care" NEWS BRIEFS "Bangladeshi Schools to Have Sex Education from 2004" "Simpler Therapy Can Help HIV Patients" "Non UN-Member Taiwan Makes Donation to Global Fund for AIDS" ************************************************************ NATIONAL NEWS ************************************************************ "AIDS Group Seeks Rejection of Money" Seattle Times (12.23.02)::Warren King Washington state's Governor's Advisory Council on HIV/AIDS has written a letter asking Gov. Gary Locke to reject federal money for educational programs that emphasize abstinence as the only prevention for STDs and pregnancy. Such programs "do not give students complete information that they need to help them make responsible choices about their sexual activity," said GACHA Chair Judith Billings in the letter to Locke. "To deny them a balanced program that offers life-saving knowledge is irresponsible." The council wrote to Locke this month amid indications of Bush administration support for increasing abstinence-based education. GACHA believes stricter federal requirements are about to be imposed on the content of those programs, including strong assertions that sex outside of marriage is psychologically and physically harmful and that there are likely harmful consequences for children born outside of marriage. Since 1997, Washington has received about $739,000 a year in federal funds for abstinence-based education, involving about 1,300 students in voluntary programs. The programs generally teach high- or middle-school students about teen pregnancy, decision-making and communication skills. State law requires state officials to apply annually for the federal grant, which must be matched by about $554,000 in state funds. The governor would carefully examine any changes in the federal requirements before supporting rejection of the funds, said Victor Colman, a policy analyst for the state Department of Health and representative of Locke. Condoms or any other form of contraception may not be discussed in programs using the federal grants. About 50 schools and four community-based programs use abstinence funds in Washington. Most of the money is used in programs that teach students how to develop media campaigns on abstinence. Sex education is not required in Washington, but all students must receive instruction on AIDS, including mention of condoms and abstinence as ways to reduce or eliminate risk of infection. "Council members are strongly in favor of comprehensive health education which includes abstinence as a choice, but just as strongly unanimously oppose attempted indoctrination to a particular political/moral dogma that attempts to pass as good public education," the members wrote. "TV Teaches Teenagers About Sex - Media Project Teaches TV" Associated Press (12.20.02)::Lynn Elber Without a direct hand in creating or writing any TV series, the Media Project, a nonprofit advisory group, has helped shape the media's handling of sexual topics - particularly those concerning teenagers. Media Project Director Robin Smalley said like it or not, Hollywood serves as a sex education counselor for many youngsters. "Writers will say, 'It's not our responsibility to educate. It's our responsibility to entertain.' And they're right," Smalley said. "They shouldn't be put in the position of being educators - but you know, that's what they are." One survey, conducted in 2000, found that teenagers ages 13-15 ranked entertainment media as the leading source of information about sexuality and sexual health. The Media Project's goal is to help the media fill that role in an informed way, Smalley said. Now in its 18th year, the group represents a partnership between Advocates for Youth and the Henry J. Kaiser Family Foundation. The project offers "one-stop shopping for anything having to do with sexuality," Smalley said. Research and news reports on subjects ranging from teen pregnancy to STDs to parent-child communication are available through the group, which also lines up experts and those with firsthand experience for TV writers and producers (and, less frequently, for filmmakers). A Kaiser study of major broadcast networks and cable channels found TV's sexual content was increasing, with nearly 70 percent of shows in the 1999-2000 season featuring talk about sex or depictions of sexual behavior. The figure was 56 percent in a study of the 1997-1998 season. The industry is receptive to guidance, said Smalley. She works regularly with about 20 shows in a season and fields calls from others. Dr. Neal Baer, executive producer of "Law & Order: Special Victims Unit" and a pediatrician, is one longtime customer. While working with "ER," Baer sought details for stories including one about a medical assistant with HIV and another about the STD linked to cervical cancer. "That was very big," Baer said of the February 2000 episode that cited the human papillomavirus. A follow-up survey showed that among "ER" viewers, knowledge of the virus had tripled from 9 percent to 28 percent. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Oprah Winfrey Moved to Expose the Plight of AIDS Victims in Africa" Associated Press (12.21.02) Oprah Winfrey, who has been traveling in South Africa for the last three weeks, vowed to use her name to help humanize the AIDS pandemic ravaging sub-Saharan Africa. Cuddling children who had lost parents to the disease, Winfrey said in a Saturday Star interview that she feels a "higher calling" to raise international awareness of the plight of children who not only lose their parents but also die of the disease themselves. "What happens to a generation of children left to fend for themselves?" Winfrey asked. "Unless someone does something now the orphans will change the face of this country and the continent," she said. A photograph with the interview showed Winfrey at the bedside of a dying woman attended by her young daughter. "I felt angry that this mother has to suffer, that this little girl will not have a mother," she remarked. "You know, I heard antiretrovirals were not available to people, but it is a completely different, shocking experience to stand before someone who could be receiving it." Winfrey and Nelson Mandela have been visiting AIDS orphanages and distributing gifts to needy children. Winfrey's foundation distributed 70 million rand (US$7 million) worth of Christmas gifts to about 50,000 South African children during her visit. UNAIDS reports that 75 percent of HIV-positive people worldwide live in sub-Saharan Africa, with South Africa having the highest number of HIV-infected individuals. The government, which has been criticized for not taking sufficient steps to curb the pandemic - South African public hospitals do not distribute AIDS drugs - has recently shown signs of taking the issue more seriously. South African lawmakers have warned that over the next decade, 2 million children will have lost at least one parent to AIDS. ************************************************************ MEDICAL NEWS ************************************************************ "Public Health Impact of Targeted Tuberculosis Screening in Public Schools" American Journal of Public Health (12.02) No. 12; Vol. 92: P. 1942-1945::Soju Chang, MD, MPH; Lani S.M. Wheeler, MD, FAAP; and Katharine P. Farrell, MD, MPH People born where TB is prevalent are at higher risk of contracting the disease. In Anne Arundel County, Md., where only 3 percent of the population is foreign-born, foreign-born persons comprised 40 percent of active TB cases in 1998. In 1987, two foreign-born students in the Anne Arundel County public school system contracted active pulmonary TB. Thirty-five school contacts developed latent TB infection (LTBI). Two years later, the county Department of Health, in collaboration with the public school system, instituted a policy of targeted screening, with the tuberculin skin test (TST) of all foreign-born students entering public schools, under the guidelines of the American Academy of Pediatrics, the Advisory Committee for Elimination of Tuberculosis of CDC and the American Thoracic Society. Students born outside the United States, even American citizens, must show TST documentation before enrolling in school. Those with a history of TB must show documentation of treatment. In 1999, the county Department of Health reviewed data on students the department had screened from 1993 to 1998 to evaluate the impact of targeted TB screening. In that time period, 706 foreign-born students took TSTs. One hundred sixteen were positive (median age 14) and 590 were negative (median age 10). Physicians evaluated students with positive TSTs, and the students received chest x-rays. Median time between TST readings and x-rays was 26 days. Only one student had active TB. One hundred seven of the 115 candidates eligible for LTBI took isoniazid under parental supervision. Six students refused treatment, and two candidates, contacts of a child with isoniazid-resistant TB, took rifampin. Adherence rate to the treatment was 90 percent. The authors estimate that without treatment, 11 cases of active TB would have occurred during the lifetimes of those with LTBI. About six to eight cases were averted with isoniazid treatment, assuming an isoniazid efficacy of 69-99 percent in children, the study reports. Economically, staff salaries and benefits accounted for 85 percent of the intervention cost, an estimated $32,617 for six years. The researchers estimated the potential cost of lifetime disease averted at $98,350, giving a net savings of $65,733. "From the societal long-term perspective," the study reports, "$2 was saved for every $1 invested." The authors concluded that, "As US rates decline, the treatment of LTBI and the control of imported TB become priorities. Despite its limitations, targeted school screening followed by LTBI treatment can be cost-effective against TB in recent immigrants (< five years). This study offers further support for the recommendations of the American Academy of Pediatrics, the CDC and the American Thoracic Society." "Tenofovir Potent Anti-Hepatitis B Treatment for HIV-Coinfected Patients" Reuters Health (12.16.02) The nucleotide analog tenofovir disoproxil fumarate exhibited potent activity against chronic hepatitis B virus (HBV) infection in patients coinfected with HIV in a prospective pilot study reported by physicians at the Washington University School of Medicine. Dr. Pablo Tebas and colleagues report on results in six such patients who had failed treatment with lamivudine and interferon-alpha. Their study, "Tenofovir Disoproxil Fumarate Therapy for Chronic Hepatitis B in Human Immunodeficiency Virus/Hepatitis B Virus Coinfected Individuals for Whom Interferon-Alpha and Lamivudine Therapy Have Failed," was published in the Journal of Infectious Diseases (2002;186(12):1844-1847). Treatment with tenofovir 300 mg q.d. was added to their antiretroviral regimen, and five patients continued therapy with lamivudine or emtricitabine. By week 12, HBV RNA serum levels declined from a median of 7.95 log10 copies/mL to 4.8 log10 copies/mL. Further treatment until week 24 resulted in an additional decline to 3.6 log10 copies/mL. In two patients, HBV RNA was undetectable by study end. Furthermore, among three subjects in whom HIV RNA was above measurable levels at baseline, the HIV viral load decreased by .7 log10 copies/mL from a median of 3.1 log10 copies/mL. Tebas and associates note that tenofovir was well tolerated, with only a mild increase of alanine aminotransferase by 17 U/L after 12 weeks of treatment from 53 U/L at baseline. "The anti-HIV activity of tenofovir, which adefovir lacks, and its excellent tolerability in patients with advanced HIV infection, makes it more attractive for the patient with limited therapeutic options in which the goal of antiretroviral therapy is... to try to lower as much as possible the HIV RNA load," the team wrote. The researchers suggest that combination treatment with lamivudine and tenofovir may augment antiviral activity and increase the "genetic barrier for the development of resistance." ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "A Day Off Becomes a Day of Charity" Baltimore Sun (12.26.02)::Stephanie Desmon On Christmas Day, volunteers from Temple Beth El in Baltimore County, Md., packed and delivered meals for Moveable Feast so that regular volunteers could spend Christmas with their families. Moveable Feast, started in one man's kitchen in 1989, is a nonprofit outreach group that provides meals and groceries for 600 poor, homebound HIV/AIDS patients in the Baltimore and Eastern Shore areas. Volunteers come in daily to pick up groceries, a week's worth of freshly prepared meals, and items such as toothpaste and sport drinks to deliver to Moveable Feast's clientele. "I come out to help people that are unable to take care of themselves," said Fran Berkowitz. "I go to shul on Saturday and pray some day these people will be able to take care of themselves." On Christmas, volunteers brought wrapped gifts for patients with young children, a reminder of the changing face of AIDS. Moveable Feast Director Vic Basile noted that while AIDS was once a disease found mainly among white men, 40 percent of the charity's clients are now women. Most are African American, and many have children. The shut-ins the organization serves rely on the meals the volunteers bring, as well on as their kindness. "Without them, I don't know what I'd do," said Brian Cox, 42, who has been HIV- positive for twenty years, "because they provide such good food, and they really care. Without them, I wouldn't have lived this long." After the Temple Beth El volunteers visited more than 200 shut-ins, they moved on to Hope Lodge, a home run by the American Cancer Society, to prepare Christmas dinner for its residents. "We feel that we know a little bit about the needs of the people," said Stan Schneider, a volunteer whose son died of AIDS 12 years ago. "He would have helped if he were here." "Two Groups Seek to Direct AIDS Care" Buffalo News (12.22.02)::Thomas J. Prohaska Niagara County, N.Y.'s AIDS case management program has been cut out of the 2003 county budget. Two agencies - AIDS Community Services of Western New York and Circle of Hope - have expressed interest in taking over the service. The first group is Buffalo- based; the second a subsidiary of Lockport-based Niagara Hospice. The case management program, which has been allocated two months' worth of funding to make the transition, serves 60 clients. "Most of our clients are on fixed incomes and don't have their own transportation," said Paul LaDouceur, director. He is one of five employees whose jobs will be eliminated. The agency's full-time van driver will work in another county department. LaDouceur, two case managers and an administrative assistant will be looking for work. Clients will receive letters announcing the change, LaDouceur said. "We'll be breaking down the program and letting the clients know what their options are... so they have their needs met and won't be left with nothing," he noted. The program is largely state-funded, so New York state's AIDS Institute will decide which agency gets the program. The 2003 county budget would have allocated $267,099 to the program, including $66,583 from property taxpayers, $45,000 in state aid, and a $50,516 Ryan White grant. The two-month funding costs $48,256. "I think once they knew there was interest in the private sector, they saw an opportunity to divest themselves of the program," said Public Health Director Paulette M. Kline. The county program will accept no new clients after January 1. Applicants will be referred to other community-based groups, according to Wanda Smiley, director of patient services for the County Health Department. ************************************************************ NEWS BRIEFS ************************************************************ "Bangladeshi Schools to Have Sex Education from 2004" Agence France Presse (12.25.02) On Wednesday, the newspaper Bangladesh Today quoted Education Secretary Mohammad Shahidul as saying the nation will introduce sex education in schools beginning in 2004 in the hope of stemming the spread of STDs. "With the alarming rise in incidences of sexually transmitted diseases and the emergence of [the] AIDS pandemic, sex education has come to the forefront," he said. Sunity Achariya, UN Population Fund Representative to Bangladesh, said the nation's young "should be given proper sex education. The children and adolescents are receiving wrong sex education from the Internet, pornographic books and commercial sex workers," she said. Government figures show that 248 people in Bangladesh have HIV and 20 have died from AIDS. The UN's estimate - 13,000 Bangladeshis with HIV - is still far below neighboring India, where at least 3.97 million people have HIV. "Simpler Therapy Can Help HIV Patients" Washington Times (12.25.02) United Press International A new study concludes that HIV patients with cognitive impairment need simpler drug therapies to prevent them from failing to take their medications, which can lead to the development of drug-resistant strains of the virus. A three- times-daily medication regimen, which is often prescribed for HIV patients, caused patients with cognitive impairment to fail to stay on their medication schedule far more often than those taking medicine once or twice daily. The research does not prove that cognitive impairment causes HIV patients to lapse in their medication schedules; "in fact, it could be the opposite - poor adherence to one's medication schedule may have many damaging consequences, including cognitive impairment," the researchers wrote. The full report, "Medication Adherence Among HIV+ Adults: Effects of Cognitive Dysfunction and Regimen Complexity," was published in Neurology (2002;59(12):1944-1950). "Non UN-Member Taiwan Makes Donation to Global Fund for AIDS" Agence France Presse (12.17.02) Taiwan, a non-member of the UN, has donated EUR1 million (US$1.03 million) to the UN-initiated Global Fund to Fight AIDS, Tuberculosis and Malaria, Taiwan's cultural and economic delegation announced in Geneva recently. "Through this donation, Taiwan is showing once again its commitment in the area of world health, commitment that it would want to see developed thanks to its admission to the World Health Organization," the Taiwanese mission said. In May, WHO's annual assembly refused to grant Taiwan observer status because of opposition from Beijing. It was Taiwan's sixth attempt to gain observer status.