Subject: CDC AIDS Daily Summary for 01/17/03 Date: Fri Jan 17 11:41:01 PST 2003 (387 lines) From: National AIDS Info Clearinghouse Copyright 2003, Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Friday, January 17, 2003 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 "Black Media Unite for AIDS Prevention Campaign" "Budget Crunch Means State Could Cut Off HIV Medicine" "See No Evil" MEDICAL NEWS "Methamphetamine Use Strongly Exacerbates Virus-Induced Neuronal Damage" "Pregnancy May Not Imperil HIV-Negative Prostitutes" LOCAL AND COMMUNITY NEWS "Harford School Board Eyes Sex Ed Changes" EDITORIALS AND COMMENTARY "In South Africa, a Hero Measured by the Advance of a Deadly Disease" NEWS BRIEFS "Democrats Propose Nearly $1 Billion in Emergency Aid to Africa" "FDA Proposes New Warning for Over-the-Counter Contraceptive Drugs Containing Nonoxynol 9" "Prosecutor Recommends Dropping Charges Against Former Health Minister in Tainted Blood Scandal" "Rare HIV Trial Begins Next Week in Iowa City" ************************************************************ NATIONAL NEWS ************************************************************ "Black Media Unite for AIDS Prevention Campaign" Newsday (New York) (01.17.03)::Aileen Jacobson A coalition of black print, broadcast and Internet media on Thursday announced a massive campaign to prevent the growing spread of AIDS among African Americans. Valued at more than $5.7 million in airtime and other costs, the multiyear campaign includes cover-blurbed articles in the February issues of nine magazines, an eight-part series to run during Black History Month in the 200 newspapers of the National Newspaper Publishing Association, programs on Black Entertainment Television, a Web site at www.blackaids.org and radio public service announcements. Called the Drumbeat Project, the campaign is "designed for 100 percent penetration of the African-American market," said Jerry Lopes, president of program operations and affiliations at American Urban Radio Network and one of the speakers Thursday at Manhattan's Overseas Press Club. Messages will run on his network's 400 affiliates, he said, and be distributed to "every black station in America." More than 50 percent of new AIDS cases in the United States are in the black community; 64 percent of new cases among women involve blacks; and AIDS is the leading cause of death for black men ages 25- 44, said Phill Wilson, executive director of the Black AIDS Institute, which organized the Black Media Task Force on AIDS. "We are diagnosed later in the course of the disease... and die faster," said Wilson, who has been affected by HIV/AIDS for 23 years. Many black women are in denial about the infection, according to Amy DuBois Barnett, editor-in-chief of Honey, and Shani Saxon, executive editor of Vibe. "We're fighting for our lives here," said Barnett. "Budget Crunch Means State Could Cut Off HIV Medicine" Associated Press (01.16.03)::Connie Mabin Seventy-nine people - many of them HIV patients who depend on the Texas HIV Medication Program to survive - pleaded with officials in Austin Thursday not to cut their access to the lifesaving drugs. "Can any one of you look me in the eyes and sentence me to a slow, painful death without medication?" asked Bill Cooksey of Houston, who has HIV and receives state assistance to buy his expensive medications. "Is my life not worth a little red ink on a page? I think it is," he said. The Texas Department of Health says a $37 million deficit in the HIV agency's budget is forcing the state to consider cuts in the program. A decision is expected Feb. 27. Officials are considering whether to reduce qualifying income levels for participants, making only the poorest of the poor eligible. The change would affect as many as 2,500 people - about 20 percent of the 12,000 Texans who use the program. Costs are going up because more people are eligible for help, and because the average annual cost per client has nearly doubled since 1996 to about $9,500. Thursday's emotional testimony came from infected mothers, siblings of infected persons, and parents of grown children with HIV. Dr. Wayne Bockmon of Montrose Clinic in Houston said the drugs give hope to the 1,000 patients he treats. Those patients are productive members of society who work and pay taxes, he said: "I don't know how to explain to them that their lives cost too much." At the Capitol, Gov. Rick Perry said the state will prioritize spending to cover a $10 billion shortfall and vowed again not to raise taxes. When asked what he would tell patients who could be cut off from the HIV program, he said, "I think you are making a doomsday scenario out of a piece of information that may or may not be true. We are a long way before the budget is written so I am sure that there will be lots of horror stories," Perry said. "See No Evil" Los Angeles Times Magazine (01.12.03)::P.J. Huffstutter In the heterosexual adult film industry, which is legal and utterly unregulated, actors and actresses are often discouraged from using prophylactics during filming because porn producers believe the public wants to see unprotected sex. The adult film business, which has expanded to include the most risqué forms of sex widely referred to as "triple-X," has a modest form of self-regulation in which some companies request health tests before performers go on camera. But even that practice is neither widespread nor tightly monitored. Some companies, such as Vivid Video Inc. in Van Nuys and VCA Pictures in Chatsworth, insist that performers bring a recent HIV test result to the set and use condoms when they perform. But dozens of triple-X filmmakers have no such requirements. Even when they do, the rules can be easily overlooked, according to interviews with more than three dozen actresses working for various triple-X companies. "It's up to the talent to say [to other performers], 'Let me see your HIV test,' or 'Hey, I need a condom,'" says Robert Herrera, production chief of Simon Wolf Productions in Chatsworth. "It'd be great to have everyone wear a condom and a good thing to force everyone to test for everything. But it's impossible to do that in this business." Gay pornographers abide by a different set of rules: No condom, no HIV test, no audience. Nearly all gay triple-X production studios throughout the industry demand condom use and other protections. The decision is rooted in financial concerns. While there is a niche audience for films that depict unprotected sex, few retail and Internet outlets will carry such movies for fear of drawing public criticism. "They all wear condoms," says Roger Tansey, former executive director of Aid for AIDS, a West Hollywood-based nonprofit that provides financial assistance for people with HIV. "Gay actors and gay viewers don't see unprotected sex as a fantasy. They see it as watching death on the screen." The extent of infection among porn industry actors is unknown because no government or regulatory medical agency has ever tracked the industry consistently. The limited data that do exist are alarming. The Adult Industry Medical HealthCare Foundation, an industry- backed clinic in Sherman Oaks, administered voluntary tests to a group consisting primarily of adult film workers. Of 483 people tested between October 2001 and March 2002, about 40 percent had at least one disease. Nearly 17 percent tested positive for chlamydia, 13 percent for gonorrhea and 10 percent for hepatitis B and C, according to Sharon Mitchell, a former adult actress who founded AIM. None of the tests came up positive for HIV, Mitchell said. The chlamydia rates in the porn industry are about 57 times higher than the level defined as epidemic. But that and other statistics can also be explained by the small size of the population and its abnormally high rate of sexual activity. There are two leading candidates for tracking the San Fernando Valley porn industry. But officials of the Los Angeles County Health Department said they do not have the staff or the money to monitor it. And a spokesperson for the California Division of Occupational Safety and Health called the industry "too fragmented, too hard to track. We rely on employees to give us tips about unsafe working conditions." ************************************************************ MEDICAL NEWS ************************************************************ "Methamphetamine Use Strongly Exacerbates Virus-Induced Neuronal Damage" AIDS Weekly (01.13.03)::Michael Greer HIV patients who use methamphetamine may dramatically increase their risk of neurologic complications, warn William F. Maragos and colleagues at the University of Kentucky-Lexington. "The human immunodeficiency virus (HIV)-1 transactivating protein Tat may be pathogenically relevant in HIV-1-induced neuronal injury," Maragos explained. "The abuse of methamphetamine (MA), which is associated with behaviors that may transmit HIV-1, may damage doperminergic afferents to the striatum." The researchers found that combining HIV Tat protein and MA synergistically augmented their neurotoxic effects in animals. They assessed the effects of Tat and MA on striatal dopamine levels in animals treated with one or both of the toxins. The animals received the highest dose of each agent that would not cause significant declines in dopamine output, the report states. Striatal dopamine levels dropped by 7 percent and 8 percent in MA- and Tat-treated animals respectively, data showed. Animals exposed to both toxins lost nearly 65 percent of their striatal dopamine. The researchers observed similar results when human fetal neurons were exposed to MA and viral Tat in vitro. The full report, "Human Immunodeficiency Virus-1 Tat Protein and Methamphetamine Interact Synergistically to Impair Striatal Dopaminergic Function," was published in the Journal of Neurochemistry (2002;83(4):955-963). "This study demonstrates that the HIV-1 'virotoxin' Tat enhances MA-induced striatal damage," Maragos and colleagues concluded, "and suggests that HIV-1 infected individuals who abuse MA may be at increased risk of basal ganglia dysfunction." "Pregnancy May Not Imperil HIV-Negative Prostitutes" Reuters Health (01.07.03) In a study of prostitutes in India, women who had been repeatedly exposed to HIV without becoming infected had normal pregnancies and gave birth to healthy babies. Neither the babies nor the mothers became HIV-positive during the study. Researchers are not sure how the women have been able to stay HIV- negative, but they suggest that some people may have some sort of natural immunity against the virus. Several studies have found that a small number of people who are exposed to HIV over and over again never test positive for the virus. Either their body does not produce antibodies in response to HIV infection or they do not become infected at all. The full report, "Course and Outcome of Pregnancy in 54 Persistently HIV-1 Seronegative Sex Workers and Their Infants," was published in the Journal of Reproductive Medicine (2003;47:1016-1020). In the study, researchers identified 98 prostitutes who, despite routinely having unprotected sex with many clients, remained HIV- negative for at least three years. Fifty-four of these women, who were all sex workers in Manipur, India, became pregnant. Pregnancy's effect on a woman's ability to avoid HIV infection is uncertain, so the researchers followed the pregnant prostitutes and compared them to 58 pregnant women living in the same city who were also HIV-negative, but who were not sex workers. Pregnancy and childbirth were similar for both groups of women. Women in both groups remained healthy during pregnancy, and their children were born healthy and HIV-negative. According to the team led by Dr. Rachana M. Chibber of King Faisal University in Al-Khobar, Saudi Arabia, this study shows that there are some people who seem to be protected from HIV infection. Rather than having an HIV infection that failed to show up on lab tests, these prostitutes appeared to have some sort of "natural protective immunity" to the virus, according to the study. ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Harford School Board Eyes Sex Ed Changes" Baltimore Sun (01.14.03)::Lane Harvey Brown Maryland's Harford County Board of Education is scheduled to vote Feb. 24 on proposed changes in the middle school sex education curriculum - to include material on STDs and teen pregnancy - that would bring the school system in line with most others in the state. The school board last year asked the family life committee to research what other counties were teaching in middle schools. The group talked with 22 of the state's jurisdictions and found that "Harford County is the only county... that has not included information about STDs - except for HIV/AIDS - or teen pregnancy in the middle school curriculum," said Joan Hayden, a committee member who teaches at Bel Air High School. The committee recommended the changes in the fall after finding that Harford lagged behind most other systems in its curriculum. The HIV/AIDS curriculum has not been updated since 1983, said committee member Sue Garrett. School spokesperson Don Morrison said the administration office has received about a dozen e-mails since early last month on the issue. And at a public meeting last month, all but one citizen spoke in favor of change. Teachers have had to address a range of situations, some sexually based, in an "around-the-barn kind of manner," Hayden said, because they cannot discuss pregnancy and STDs as potential consequences of poor decision-making. "We've really had our hands tied," Hayden said. "We haven't been able to find any written documents that said this wouldn't be taught," she said. "It just never has been." Parents can comment on the curriculum plans at board meetings on Jan. 27 and Feb. 10. The Harford public schools' Web site also includes curriculum information and a link for comments at www.co.ha.md.us/harford_schools. ************************************************************ EDITORIALS AND COMMENTARY ************************************************************ "In South Africa, a Hero Measured by the Advance of a Deadly Disease" New York Times (01.13.03)::Tina Rosenberg "...[Zackie] Achmat, 40, is South Africa's most prominent AIDS activist, and chairman of the Treatment Action Campaign. He found out that he was HIV positive in 1990, and has had AIDS since 1997. He can afford antiretroviral drugs, but in 1998 he vowed not to take them until everyone in South Africa could. That day is inching closer, largely due to the work of the campaign. For Mr. Achmat, it may not arrive soon enough. "...President Thabo Mbeki and some of his aides have questioned HIV's role in AIDS, minimized South Africa's problem and tried to cut the AIDS budget. Government officials have accused those promoting AIDS treatment of conspiring to slander and poison black people. While constant criticism and the exploding AIDS epidemic have led Mr. Mbeki to mute his views, his government is a long way from mounting the energetic assault on AIDS that is possible and necessary in South Africa. "...The government is being dragged into saving its people, in no small measure because of the Treatment Action Campaign, which is by all accounts the largest and most effective AIDS group in the third world. The campaign can mobilize thousands of people for protests and has hundreds of activists who speak about AIDS treatment to labor and civic groups.... "The campaign has also used South Africa's progressive new Constitution to advantage. It sued the government to force it to provide HIV-positive mothers with nevirapine, which may save half the babies born with HIV. Today South Africa has the world's largest program to prevent mother-to-child transmission of HIV, although some provincial governments are still resisting. Recently, government, business, labor and civic organizations negotiated an AIDS plan that includes treatment in South Africa's public health system, although the government has still not signed on. If it does, says Mr. Achmat, he will take his pills. "[Former President Nelson] Mandela is one reason the government is changing. At first reluctant to challenge Mr. Mbeki, his protégé, and divide his party, Mr. Mandela is now photographed wearing a T-shirt that says 'HIV Positive,' the campaign's trademark.... "...'Almost everyone I meet tells me, "take your medicine," but also says this has made us think,' says Mr. Achmat. "The country is realizing that people can actually buy life, and that this is unacceptable.'" ************************************************************ NEWS BRIEFS ************************************************************ "Democrats Propose Nearly $1 Billion in Emergency Aid to Africa" Associated Press (01.16.03) Senate Democrats on Thursday proposed $900 million in emergency relief for Africa, primarily to help the estimated 38 million people they said face starvation. The Africa Famine Relief Act includes $600 million in food aid, $200 million for disaster assistance and $100 million to combat HIV/AIDS. President Bush on Wednesday laid out his own plan to help Africa, including an extension of relaxed trade rules and a 50 percent increase in developmental aid. Sen. Patrick Leahy (D- Vt.), who joined Senate Minority Leader Tom Daschle (D-S.D.) in introducing the bill, said the administration's proposals do not address the emergency of the famine. Democrats are considering introducing a similar bill in the House. "FDA Proposes New Warning for Over-the-Counter Contraceptive Drugs Containing Nonoxynol 9" Associated Press (01.16.03) The Food and Drug Administration proposed new warning labels Thursday for over-the-counter contraceptive drugs that contain the spermicide nonoxynol 9. The warning would state that vaginal contraceptives containing nonoxynol 9 do not protect against infection from HIV or other STDs. The proposed label warnings would also tell consumers that the use of these contraceptives can increase vaginal irritation, which may raise the risk of HIV and other STDs. The proposals are based on recent studies that showed nonoxynol 9 is ineffective in the prevention of HIV infection. "Prosecutor Recommends Dropping Charges Against Former Health Minister in Tainted Blood Scandal" Associated Press (01.16.03)::Pierre-Antoine Souchard French judicial officials said Thursday that prosecutors have recommended dropping charges against former Health Minister Claude Evin, who is suspected of a role in the tainted blood scandal that shook the nation a decade ago. Evin was placed under investigation in 1999 for "involuntary homicide" after a complaint was filed by the family of a woman who died of AIDS in 1991. She was one of hundreds to die after being transfused with HIV-tainted blood products. An investigating commission of the Court of Justice - a special body that alone can try ministers charged with crimes committed while in office - will decide in coming months whether Evin will face trial. The scandal has resulted in trials for former Socialist Prime Minister Laurent Fabius and Social Affairs Minister Georgina Dufoix (who were acquitted) and former Health Minister Edmond Herve (whose sentence was suspended). "Rare HIV Trial Begins Next Week in Iowa City" Associated Press (01.17.03) In Iowa's Johnson County District Court, trial is set to begin next week for Aaron James Dahlberg, a Minnesota man charged with criminal transmission of HIV. The charge is based on allegations that Dahlberg did not reveal his HIV-positive status to an Iowa City man before they twice had unprotected sex over the night of March 31-April 1, 2000. The formal charges against Dahlberg list 12 state witnesses, including three alleged victims, law enforcement officers and a physician. Iowa City Detective Jenny Clarahan said the Iowa City man reported that he asked before their encounter whether Dahlberg had any STDs, including HIV, and Dahlberg said no. The trial, which begins Tuesday, is expected to last two or three days. Only a handful of similar cases have been tried in the four years since Iowa enacted the law. ************************************************************ ANNOUNCEMENT: Prevention News Update will not be published Monday, Jan. 20, in observance of the Martin Luther King Jr. Holiday. Publication will resume on Jan. 21. ************************************************************