Subject: CDC AIDS Daily Summary for 12/30/02 Date: Mon Dec 30 11:11:01 PST 2002 (402 lines) From: National AIDS Info Clearinghouse Copyright 2002, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Monday, December 30, 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 "Arkansas Sees Drop in Teen Birthrate" "Comedy Show Tackles Risky Subject Matter" INTERNATIONAL NEWS "Iranian Doctors Ordered Not to Turn Away AIDS Patients" "African AIDS Pills Hit Black Market" "Hong Kong Experts Help Tackle Mainland China's Growing HIV/AIDS Problem" MEDICAL NEWS "Primary HIV-1 Infection in African Children Infected Through Breastfeeding" LOCAL AND COMMUNITY NEWS "Citing Bias, Parent Files Complaint over Sex Education Program" NEWS BRIEFS "Singapore to Give Out Condoms to Male Travelers" "HIV Captured on Film in Earliest Stages" ************************************************************ NATIONAL NEWS ************************************************************ "Arkansas Sees Drop in Teen Birthrate" Associated Press (12.29.02) The teen birthrate in Arkansas has reached its lowest level in more than 33 years, but the majority of Arkansas teens say they are sexually active. About 33 out of every 1,000 Arkansas 15- to 17-year-old girls gave birth during 2001, a 10 percent drop from 2000, according to new data from CDC. During the past decade, the birthrate among 15- to 17-year-olds in Arkansas fell about 33 percent. The drop mirrored a national decline in teen births. Experts say the decline is due to an increase in the number of teens waiting to have sex and more frequent use of birth control by teens who are sexually active. "The state has done a good job of making services available," said Bradley Planey, a women's health team leader at the Arkansas Department of Health. "It has to do with risk taking. It has to do with why a person may put off risky behavior in hopes for a positive future." Despite the decline, Arkansas continues to have one of the highest teen birthrates in the nation. In the United States, about 25 out of every 1,000 15- to 17-year-old girls gave birth in 2001 - 23 percent lower than the birthrate among girls that age in Arkansas. About 55 percent of Arkansas high school students have had sex; only Mississippi had more sexually active teens. One out of every five Arkansas high-schoolers have had sex with four or more partners - also the nation's second highest rate. About 65 percent of sexually active Arkansas high-schoolers used a condom the last time they had sex - a 20 percent increase from 1995 About 16,000 Arkansas youths take part in county coalition- sponsored pregnancy prevention programs that include discussion of birth control, according to Arkansas Advocates for Children and Families. One of the groups promoting abstinence is Catherine's House, a Little Rock youth and family center. Catherine's House plans to spend about $1 million over the next three years on programs urging kids not to have sex. "Comedy Show Tackles Risky Subject Matter" Baltimore Sun (12.22.02)::David Zurawik On the same early December day that Baltimore Mayor Martin O'Malley declared a "state of emergency" in the battle against HIV/AIDS, a group of Hollywood writers and producers finalized a script for "One on One," a prime-time television show set in Baltimore, that will treat the HIV/AIDS crisis as an integral fact of life. Last fall, in only its second season, the UPN sitcom became the most popular series on television among African-American viewers. The AIDS episode, titled "The Test" and set to air Feb. 10, is risky business for a show that became No. 1 by "keeping it light," in the words of Flex Alexander, "One on One's" executive producer and star. "I don't think you can be an African-American show and not take on the issue of AIDS, especially an African-American show set in a city like Baltimore," said Eunetta T. Boone, "One on One's" co-executive producer and creator, citing statistics that show Baltimore with one of the heaviest national caseloads of people with HIV/AIDS (12,000 people in 2000, with African Americans accounting for 85 percent of that figure). "The Test" centers on Alexander's character, Mark "Flex" Washington, and his latest romantic interest, Natalie. As he attempts to make love to her for the first time, she stops him cold by asking him when he had his last HIV test. Flex admits never taking one, and Natalie demands he get tested before having sex. In October, Viacom, which owns UPN, joined the Kaiser Family Foundation in planning a worldwide HIV/AIDS awareness campaign in 2003. "The Test" is one of the early products of that initiative. Among the other Viacom-owned or distributed series scheduled to deal with HIV/AIDS in coming months are "Girlfriends," "Half and Half," "Becker," "Frasier," "The District" and "Queer as Folk." "There's a lack of literature, a lack of support groups, lack of information, education and medicine especially in the African-American community. We can help a little with the information," Alexander said. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Iranian Doctors Ordered Not to Turn Away AIDS Patients" Agence France Presse (12.30.02) Doctors in Iran have received a health ministry directive not to turn away patients with HIV/AIDS as part of a new effort to control the spread of the disease, medical workers said Monday. Doctors consulted by people with HIV or AIDS-related illnesses have been ordered to catalog the cases and provide immediate treatment, or else face an undisclosed punishment. "Any refusal to accept those infected with the AIDS virus is against the law and because of the social problem which it creates, any violation will be followed up," the state Islamic Republic News Agency quoted the directive, signed by Deputy Health Minister Mohammad Ismael Akbari, as saying. The directive, addressed to all private and state medical facilities, also called for "all-out support of the nation and the country's health centers for AIDS patients." "There is a long way to go but this is a positive step," said a medical doctor at the forefront of the fight against AIDS, who asked not to be identified. "Before we can even fight the disease, the stigmas need to be removed and doctors need to get on board." The latest official statistics estimate 21,000 HIV-positive people in Iran, with 4,237 people having AIDS. An estimated 65 percent contracted HIV through infected needles used to inject drugs, particularly in prisons, which are packed with drug offenders. Some 300,000 people are believed to inject morphine or heroin in Iran. Since taking drugs is a criminal offense, drug users are reluctant to seek treatment. In addition, because of the societal taboos related to sexual relations in Iran - where sex outside marriage and homosexuality are strictly prohibited and subject to harsh punishments - those who contract HIV sexually are also reluctant to seek medical help. Treatment is complicated by a lack of access to antiretroviral therapy. Authorities are debating how to cut the spread of AIDS among drug users, with needle exchange and methadone treatment under consideration, medical sources said. "African AIDS Pills Hit Black Market" Washington Times (12.30.02)::Rajeev Syal, London Sunday Telegraph Medicines provided cheaply to treat AIDS patients in Africa are being smuggled back to Britain and sold on the black market, and British police believe African officials are making tens of millions of dollars a year on the drugs. British investigators have smashed a smuggling ring in Senegal, West Africa, where a government-appointed official sold $18 million worth of AIDS drugs to pharmacists in Europe. Interpol is investigating another smuggling ring in South Africa. The discovery is an embarrassment to British government ministers who have pressured manufacturers to provide the drugs to Africa at no profit. The ministerial pressure culminated in November when Prime Minister Tony Blair pushed through a two-tier pricing system to ensure the supply of cheap drugs to poorer countries. Hundreds of millions of dollars worth of AIDS drugs are being sold at cost to Africa with the understanding that they will not be sold for profit in developing countries. Investigators working for GlaxoSmithKline discovered in October that millions of dollars worth of Combivir shipped to Africa had been reimported into Europe via France and Belgium. Detectives found that drugs returned from Senegal had been sold by Africa Aids Africa, a Senegalese agency set up by President Abdoulaye Wade and funded by Western governments. AAA head Latife Gueye, who was appointed by Wade, acknowledged selling the drugs to European businessmen but said he did so only because he needed to buy vital equipment. Gueye has been fired and is under police investigation. "This has been a disaster for Senegal's AIDS program," Wade said on Senegalese TV. A GSK spokesperson said further investigations involving Interpol had been initiated in other African countries. Detectives are also investigating the discovery of more than $15 million in AIDS-related drugs believed to have been smuggled out of South Africa, some of which turned up in London. "Hong Kong Experts Help Tackle Mainland China's Growing HIV/AIDS Problem" Lancet (12.14.02)::Mary Ann Benitez Hong Kong's HIV/AIDS groups are gearing up to help mainland China tackle its AIDS epidemic. Next April, Hong Kong's methadone treatment for HIV-positive intravenous drug users will be discussed at a UNAIDS training workshop for experts in the mainland, India and Southeast Asian countries. Hong Kong's IDUs are not thought to share needles, and the methadone maintenance program is believed to be an important factor in the low number of HIV-infected IDUs. Of its 1,863 HIV cases, 48 were IDUs, according to the latest figures until June this year. On the mainland, however, HIV was first introduced through IDUs and, according to a Nov. 26 UNAIDS report, nine provinces are experiencing localized epidemics among IDUs. Homer Tso, chair of Hong Kong's government advisory Council on AIDS, said mainland authorities estimated there are about 900,000 drug users in Guangdong province, which abuts the Hong Kong Special Administrative Region, but did not know how many of them were IDUs. Tso added that outbreaks among IDUs are "spiraling" and warned it was only a matter of time before HIV becomes a real problem in Hong Kong, especially if men travel to the mainland for sex. Another problem is the thousands of AIDS orphans and HIV- infected children on the mainland. In 1994 and 1995, peasants regularly sold their blood for up to 50 yuan (US$6); unsanitary practices led many to be infected with HIV. The Hong Kong-based Chi Heng Foundation is focusing on these children by providing each orphan 200 yuan (US$24) a year to send them to school - paying for their tuition, books and miscellaneous items. A CHF spokesperson estimated that because 1 million people in Henan Province are infected with HIV, there would be about 1.5 million orphans in the next few years. ************************************************************ MEDICAL NEWS ************************************************************ "Primary HIV-1 Infection in African Children Infected Through Breastfeeding" AIDS (11.22.02) Vol. 16: P. 2303-2309::François Rouet; Narcisse Elenga; Philippe Msellati; Crépin Montcho; Ida Viho; Charlotte Sakarovitch; Christine Danel; Christine Rouzioux; Valériane Leroy; François Dabis, for the ANRS 049 Abidjan DITRAME Study Group Little is known about primary HIV infection (PHI) in children. In industrialized countries, infants are infected in utero or perinatally, making it difficult to assess the clinical picture of an acute illness associated with HIV seroconversion. However, in sub-Saharan Africa, where more than 90 percent of infected children are living, about one-third of all transmissions are postnatal (PT), resulting from breastfeeding. The current study compares clinical features in children infected postnatally by breastfeeding and in uninfected children born to HIV seropositive mothers participating in the ANRS 049 DITRAME project on the prevention of mother-to-child transmission (MTCT) performed in 1995-1998 in Cote d'Ivoire. The authors' goals were to estimate the frequency of acute retroviral syndrome (ARS) associated with pediatric HIV-1 infection, and to describe its symptomatology and associated viral parameters. Researchers used a matched case-control study retrospectively within the ANRS 049 DITRAME project. Cases were children infected postnatally through breastfeeding, all of whom were negative by at least 45 days of age, but positive on a subsequent DNA PCR sample. Clinical signs and symptoms occurring between the last negative HIV-1 DNA PCR test and the first positive test were compared to signs and symptoms observed and recorded for uninfected children during the same time period of life. For example, a case infected between three and six months was compared with two controls from three to six months of age. Of the 22 children infected postnatally, 21 exhibited at least one clinical sign associated with PHI. Among the uninfected children, 27 of 44 exhibited a sign/symptom. The authors identified three independent clinical signs associated with pediatric PHI: mononucleosis-like illness (MLI), dermatitis, and generalized lymphadenopathy. The signs are non-specific and do not allow for an easily targeted PHI screening, but in combination they seem to reach better predictive values. MLI was the most sensitive symptom for PHI diagnosis. Generalized lymphadenopathy was the most specific symptom for PHI. A combination of MLI and generalized lymphadenopathy was observed in six infected cases versus one control. There was no significant association between PHI and less common symptoms such as diarrhea, plain fever, otitis, and conjunctivitis, nor was oral candidiasis associated with PHI. Among infected cases, initial median plasma HIV-1 viral load was 5.92 log10 copies/ml; this declined to 4.96 log10 twelve months after the first positive viral load. The authors stated that, to their knowledge, their study is the first one to examine the occurrence of ARS in African children infected through breastfeeding. They mentioned limitations to the study: the lack of information on both the duration of the clinical signs associated with PHI and the rate of progression to AIDS according to the occurrence of ARS; the fact that concomitant CD4 cell count measurements are missing; the fact that the HIV-1 RNA decrease over time may reflect a selection bias considering the declining number of samples tested during follow-up. "However," the researchers concluded, "our retrospective survey provides meaningful information on clinical and virological features associated with PHI in African children infected by breastfeeding. This emphasizes the urgent need to implement alternatives to predominant breastfeeding in order to prevent the high risk of HIV-1 PT observed in African cohorts." Furthermore, the authors suggested the findings could also be useful to identify early cases of PT and encourage adequate HIV screening in corresponding mothers and families. They pointed out that combination antiretroviral therapy during PHI reduces progression to AIDS, and "given the current content of increasing access of antiretroviral drugs in Africa, our study may also be useful to propose effective antiretroviral treatment to control the early viral replication observed in this frequent form of pediatric HIV infection." ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Citing Bias, Parent Files Complaint over Sex Education Program" Contra Costa Times (12.25.02)::Suzanne Pardington A Concord, Calif. mother has called for the end of a sex education program promoting abstinence, saying it gives students biased and graphic information about abortions. Renee Walker wrote a letter of complaint to the Mt. Diablo district and the state superintendent after discovering the eight-day CryBabies curriculum at her son's school is presented by First Resort, an organization that runs Christian pregnancy counseling centers and whose founder, Shari Plunkett, has been quoted as saying the group seeks to reduce the number of abortions in the Bay Area. Defenders point out that CryBabies deters teen sex by showing how it feels to be a parent. Students are required to take care of an electronic doll that cries periodically. After attending the sessions, students can voluntarily sign a pledge to remain abstinent until marriage. Deborah Morris, program director, said CryBabies instructors, in order to comply with state education laws, provide unbiased and factual information about the consequences of sexual activity and students' options should they become pregnant. The message is that abstinence is the only sure way to avoid pregnancy and STDs. "Our goal is to provide students with accurate information to make healthy choices," she said. "There is no hidden agenda." Walker believes the course does not give sufficient information on how to prevent pregnancy or STDs. "My expectation is that education is going to be based on educationally sound, research-based, age-appropriate information," she said. "I don't expect a political agenda in school." CryBabies is supplemental to the regular seventh-grade family life science curriculum, which gives students more in- depth information about contraceptives and preventing STDs. Parents must sign permission slips for children to attend, and they can review the curriculum in advance. The program is largely paid for by a grant from the Contra Costa County Office of Education. "I think where they come from impacts what kind of sex ed they teach," said Phyllida Burlingame, a consultant on sex education issues for the American Civil Liberties Union. She said the messages might not come through in printed materials but in what instructors say in the classroom. ************************************************************ NEWS BRIEFS ************************************************************ "Singapore to Give Out Condoms to Male Travelers" AIDS Weekly (12.23.02) Singapore plans to distribute HIV prevention packs containing condoms to male travelers heading to what it deems high-risk destinations, the Straits Times reported. The Health Promotion Board will distribute the packs, which will also contain information on the dangers of casual sex, through local travel agents. The plan was announced at the third annual Singapore AIDS conference. Homosexual acts are illegal in Singapore, and AIDS is seldom discussed. Over 200 people in Singapore are infected with HIV every year, with the majority contracting the virus from casual sex or sex with prostitutes, the paper said. The target demographic for the program will be blue-collar workers, because more than half of all HIV-positive Singaporeans work in blue-collar jobs, according to Minister of State for Health Balaji Sadasivan. Singapore, a tightly controlled Southeast Asian city-state of 4 million people, has 1,788 HIV cases, with men ages 20 to 59 making up 90 percent of the cases. "HIV Captured on Film in Earliest Stages" United Press International (12.12.02)::Ellen Beck University of Illinois-Chicago researchers have captured for the first time the very earliest stages of HIV infection in living cells. Using protein dyes from jellyfish and time-elapsed microscopy, they saw color images of individual HIV particles traveling to the nucleus of a human cell and beginning the takeover of its genetic machinery. The researchers say the virus can be seen traveling along a part of the host cell's own skeletal framework of microtubules as it makes its way from the outer membrane to the nucleus. The virus hitches a ride aboard the multi-unit protein dynein, commonly referred to as a molecular motor. "They don't make a beeline for the nucleus," said David McDonald, assistant professor of microbiology and immunology. "Their progress is somewhat halting. They appear to jump from one microtubule to another, moving in a jagged path, even sometimes moving backward. But they eventually reach their destination."