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CDC HIV/STD/TB Prevention News Update
Tuesday, October 21, 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
"US Agency Opens Beijing Office to Help Fight AIDS amid New
Candor by China"
"US Clears GlaxoSmithKline, Vertex AIDS Drug"
"Thai HIV Victims Meet US First Lady, Say US Needs to Do More to
Fight AIDS"
INTERNATIONAL NEWS
"Study: South Africa AIDS Epidemic Peaked in 2002"
"AIDS Follows Afghanistan's 'Miniglobalization'"
MEDICAL NEWS
"HIV Prevalence in 72,000 Urban and Rural Male Army Recruits,
Ethiopia"
LOCAL AND COMMUNITY NEWS
"Salt Lake City Gay Men's Health Summit Looks Beyond AIDS"
"Ad Campaign Focuses on AIDS in Black Women"
NEWS BRIEFS
"EU Rejects Vatican Claim that Use of Condoms Does Not Protect
Against AIDS"
"US Researchers Identify HIV-Friendly Proteins"
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NATIONAL NEWS
************************************************************
"US Agency Opens Beijing Office to Help Fight AIDS amid New
Candor by China"
Associated Press (10.20.03)::Christopher Bodeen
Aiming to bolster China's newfound willingness to fight
HIV/AIDS, CDC opened an office in Beijing on Monday. CDC and
Chinese officials said the office will enhance China's ability to
care for an estimated 1 million HIV-positive people, as well as
prevent the disease from spreading beyond high-risk groups.
"Both the US and China made strong commitments to the
awareness that AIDS is a major health threat to China," CDC
Director Dr. Julie Gerberding said at a dedication ceremony.
The office is CDC's 25th outpost of its Global AIDS Program -
an effort to improve prevention and care in nations with large
HIV-infected populations, including South Africa, Brazil and
Thailand.
New HIV infections in China have been growing by about 30
percent per year. For now, HIV/AIDS is still mostly confined to
IV drug users and people infected by unsanitary blood-buying, CDC
said in a statement given to reporters.
The Chinese government publicly acknowledged the scale of
the problem only last year, and activists say local governments
continue to conceal the extent of the epidemic. According to
Gerberding, China has to change that if it is to avoid a major
outbreak.
Without a cure, "the best vaccine for now is information,"
said Gerberding. "China has a unique opportunity of combating HIV
and preventing it escaping in a way that it has in sub-Saharan
Africa and other parts of the world."
CDC's statement said fear and discrimination against people
with HIV/AIDS are obstructing efforts to fight the disease.
In attendance at the opening of the CDC office was Chinese
Vice Health Minister Huang Jiefu, who repeated assurances that a
new education, prevention and treatment campaign is being
planned, but gave no details. "Swift and meaningful action will
start," said Huang, stressing that officials are now pledged to a
"transparent, open manner."
"US Clears GlaxoSmithKline, Vertex AIDS Drug"
Reuters (10.20.03)::Lisa Richwine
On Monday, the US Food and Drug Administration approved a
new protease inhibitor developed by GlaxoSmithKline Plc and
Vertex Pharmaceuticals Inc. The drug, previously known as 908,
will be sold under the brand name Lexiva. FDA approved Lexiva for
use with other HIV-suppressing medications.
Dr. Debra Birnkrant, director of FDA's division of antiviral
products, said Lexiva offers patients a new option that allows
them to reduce the number of pills they must take daily. Dosing
options include taking two pills twice daily, or taking one pill
twice daily with ritonavir, Birnkrant said, noting that other
medicines can require as many as eight pills twice daily. "Pill
burden-wise, [Lexiva] is somewhat of an improvement, she said.
The new drug's dosing flexibility offers "a huge advantage
to patients and doctors," said Vertex CEO Joshua Boger. He said
Lexiva is less likely to cause diarrhea than Pfizer Inc.'s
protease inhibitor Viracept.
Chemically, Lexiva is similar to Vertex's HIV drug
Agenerase, which had 2002 sales of about $65 million. Vertex
expects Lexiva to take over much of the Agenerase market and to
take market share from Viracept and Abbott Laboratories Inc.'s
Kaletra.
"Thai HIV Victims Meet US First Lady, Say US Needs to Do More to
Fight AIDS"
Associated Press (10.21.03)::Alisa Tang
Today in Thailand, 12 children born with HIV performed for
first lady Laura Bush when she visited the Queen Sirikit National
Institute of Child Health in Bangkok. She was there to see how
the hospital is working to prevent mother-to-child transmission
of the disease.
The hospital has received funds as part of a collaboration
between CDC, the Thai government and the Thai Ministry of Health.
The normal rate of mother-to-child transmission is 33 percent,
according to Wallop Thaineua, permanent secretary of the Public
Health Ministry. The project has found it can reduce the
transmission rate to 9.4 percent using an AZT cocktail treatment
and feeding newborns formula instead of breast milk.
The aunt of one of the infected children said her five-year-
old nephew was not on HIV medication but was taking medicines to
fight colds and coughs. Asked to give a message to the American
visitor, the aunt said, "I want to thank her for coming to visit
the children, but I would ask them to reduce the price of the
[American-made] medication because Thai people don't have that
much money. I feel sorry for the children, and this is how I want
them to help."
According to a US official, the program has received an
estimated $1 million to $2 million over the past ten years. An
estimated 1 million Thais have been infected with HIV since the
nation's first case was detected in 1984. Some 400,000 Thais have
died of AIDS.
Mrs. Bush accompanied President George W. Bush to Thailand,
where he attended a conference of Asian-Pacific leaders. Later
Tuesday, the couple flew on to Singapore.
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INTERNATIONAL NEWS
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"Study: South Africa AIDS Epidemic Peaked in 2002"
Reuters Health (10.20.03)::Andrew Quinn
Research released Monday and published in the African
Journal of AIDS Research suggests the AIDS epidemic in South
Africa, the nation with the highest HIV/AIDS caseload, may be
leveling off. Study authors Thomas Rehle, an independent US
researcher, and Olive Shisana, of South Africa's Human Sciences
Research Council (HSRC), developed a model based on South African
antenatal clinic seroprevalence data. They said the nation's AIDS
epidemic likely peaked in 2002 - when 4.69 million of South
Africa's 45 million people were living with the disease - and
would level off as fewer infections are recorded.
The epidemiological model uses data from South Africa's
first national HIV prevalence study, released in late 2002 by
HSRC and the Nelson Mandela Foundation.
The study projects that South Africa's annual AIDS-related
deaths will peak in 2008 at 487,320, before declining to about
470,000 in 2010. New HIV infections among people ages 15-49 - a
leading indicator of how the epidemic will progress - have
already dropped from 4.2 percent in 1997 to 1.7 percent in 2003.
Overall HIV prevalence among people ages 15-49 is also projected
to drop from 17.3 percent in 2001 to an estimated 15.2 percent in
2010.
Earlier studies placed the incidence, prevalence and
projected death numbers much higher. A US Census Bureau report
estimated that as much as 37.9 percent of South Africa's sexually
active adult population could be HIV-positive by 2010, with more
than 900,000 deaths annually.
Among factors the new study credits with the slowdown are
HIV/AIDS education and prevention programs that have led to
changes in sexual behavior, and the fact that death is quickly
thinning the ranks of the HIV-positive.
There is "still much uncertainty" about the course of the
epidemic, and the authors noted that South Africa's decision to
make antiretroviral treatment more widely available could have a
profound change on future numbers. They also cautioned against
interpreting the new, lower estimate as a sign the country's
problems might have been exaggerated.
"AIDS Follows Afghanistan's 'Miniglobalization'"
Christian Science Monitor (10.17.03)::Scott Baldauf
During its 23-year civil war, HIV/AIDS largely passed over
Afghanistan. Now that the country is experiencing one of the
largest influxes of people in its history, the disease is making
inroads through prostitution and illicit drug use. Eight people
tested positive for HIV last year; this year 15 have been
diagnosed.
Dr. Hedayatullah Stanekzai, a senior planning official at
the Ministry of Public Health, regards AIDS in Afghanistan as a
serious problem. But with one of the highest maternal and infant
mortality rates in the world, unsafe drinking water, poor hygiene
and chronic malnutrition among 60 percent of the population,
health officials have other pressing priorities to address.
Health officials did, however, devote a portion of their
$170 million 2003 budget to setting up an HIV/AIDS department and
to placing stricter screening controls on the Central Blood Bank,
where all 15 of the current cases were discovered.
Some UN and Afghan officials believe the best way to stem
the further spread of HIV/AIDS in Afghanistan is through
education. A recent Health Ministry survey found that 84 percent
of Afghans had never heard of HIV/AIDS. But education about an
STD can be difficult in a country where sex itself is rarely
discussed.
"Islam does not allow you to sleep illegally with another
woman, so how can you encourage a man to use a condom?" asked Gul
Agha, a senior judge and Islamic scholar. "The best way is to
tell people that prostitution is not allowed and to stay away
from it."
"We are going through a miniglobalization here in
Afghanistan, after years of isolation," said Omar Samad,
spokesperson for the Afghan Foreign Ministry. "It is very
difficult to control some of these forces.... What we need is to
preach morality, and to uphold the rule of law."
************************************************************
MEDICAL NEWS
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"HIV Prevalence in 72,000 Urban and Rural Male Army Recruits,
Ethiopia"
AIDS (08.15.03) Vol. 17; No. 12: P.1835-1840::Yigeremu Abebe; Ab
Schaap; Girmatchew Mamo; Asheber Negussie; Birke Darimo; Dawit
Wolday; Eduard J. Sanders
Data on national HIV prevalence in Ethiopia are sparse,
especially in rural areas where more than 85 percent of the
population lives. To support health policy planning, Ethiopia's
Ministry of Defense decided to estimate HIV prevalence in army
recruits. The current study described HIV prevalence in relation
to socio-demographic characteristics among nearly 72,000 men
recruited in 1999 and 2000. It is the first study, according to
the authors, to report extensively on rural areas.
Of 71,626 recruits enrolled in the study 9,713, (14 percent)
were from urban areas and enrolled in 1999, and 61,913 (86
percent) were from rural areas and enrolled in 2000. Compared to
the 1994 population census, the sample of nearly 62,000 rural
recruits was fairly representative of the general population's
marital status and geographical origin, but over-representative
of Orthodox Christians and under-representative of people without
education.
The researchers found an unexpectedly low HIV prevalence in
the army recruits, contrasting with previous HIV estimates based
on sentinel surveillances among pregnant mothers in Addis Ababa
and the Amhara region and recent models suggesting that urban HIV
prevalence peaked at 19 percent in 1995 and declined to roughly
15 percent in 2000, while non-urban HIV prevalence would plateau
at under 10 percent in 2000.
This study found that HIV prevalence in rural recruits was
3.8 percent. Prevalence was lowest in recruits ages 18-19 and
highest in the 25-29 age group. Farmers and students had the
lowest overall HIV prevalence.
In urban recruits, overall HIV prevalence was 7.2 percent.
Prevalence was lowest in the 18-19 age group, increased to 9.4
percent for the 20-24 age group, and rose to 15.3 percent among
the 25-29 age group.
In rural recruits, risk factors for HIV included higher
education levels. "The impact of education on HIV prevalence in
rural areas suggests a role for primary and secondary schools in
(rural) Ethiopian HIV programs," the authors noted. Also, rural
Orthodox Christians were more likely than Muslim recruits to have
HIV. Circumcision was not a factor, as both religions practice
it. "Orthodox church officials should be involved in exploring
their potential role in HIV prevention efforts," the researchers
stated.
Age and urban residence in the Amhara region were risk
factors for urban recruits, while education and ethnicity were
not significantly associated with infection.
The authors pointed out that in Africa, HIV prevalence can
vary widely among geographical areas. This study found pockets of
high and low HIV prevalence, and the investigators suggested that
proximity to road or trading centers and perhaps cultural factors
may account for the regional differences. The Amhara region
appeared to be most affected by the epidemic, with higher HIV
estimates among both rural and urban recruits.
"The impact of religion, education, and region on HIV
prevalence suggests avenues for targeting HIV prevention efforts
in Ethiopia," the authors concluded. "Thus our study may be
instrumental in targeting HIV control efforts in Ethiopia. It
also, for the first time, provides a geographical picture of the
country's HIV epidemic, which can aid in the design and
interpretation of future HIV studies in Ethiopia."
************************************************************
LOCAL AND COMMUNITY NEWS
************************************************************
"Salt Lake City Gay Men's Health Summit Looks Beyond AIDS"
Salt Lake Tribune (10.20.03)::Carey Hamilton
Characterizing the recent three-day gay men's health summit
in Salt Lake City, David Ferguson, a conference coordinator,
said, "The goal of the weekend is to expand the notion of gay
men's health beyond HIV. For about 20 years, gay men's health has
been equated with a person's HIV status. We're not minimizing
HIV, but gay men deal with lots of issues: relationships,
spirituality, substance abuse."
About 160 people attended the conference, which was held
with support from the Utah AIDS Foundation and Planned
Parenthood. Conference discussions and break-out sessions
included aging and HIV, fitness, substance abuse, sex in public
places, bathhouses, self-hypnosis and relationships.
HIV was still a common conference discussion. Kristen Ries,
an infectious disease physician at the University of Utah Health
Sciences, was concerned about the increase of HIV-positive gay
men. In 2002, 151 men tested HIV-positive at her clinic. This
year, the same number of people tested positive by the end of
July. According to the Utah Department of Health, about 1,780
people were living with HIV/AIDS in Utah as of 2001.
"People are tired of being safe," Ries said. "Young people
think there's a cure. And believe it or not, some people haven't
heard about [HIV]."
Reis urged the men also to be vigilant against other STDs.
Gay men are especially susceptible to anal warts, she said.
"Rectal warts are very common," said Reis. "Be aware of warts.
Get them treated early."
Ries' keynote speech touched on many other health issues
that affect gays. Gay men, for example, use drugs, alcohol and
tobacco at a higher rate than the general population and also
have a higher incidence of anxiety, suicide and depression. "I
understand how that comes about when you think about their
childhood," Reis said, considering the difficulty of coming out
and dealing with homophobia.
"Ad Campaign Focuses on AIDS in Black Women"
Alameda Times-Star (10.16.03) Rebecca Vesely
HIV/AIDS is the leading cause of death among African-
American women ages 25-34, and African-American women are the
fastest growing population with AIDS in California, according to
the state Department of Health Services.
In an effort to break down the stigma of the disease, the
Oakland chapter of the National Coalition of 100 Black Women
unveiled a new billboard campaign on Oct. 14. The "Sistahs
getting real about HIV/AIDS" signs in Oakland, Richmond and San
Jose are meant to raise public awareness. They advertise a toll-
free hotline and Internet resources for African-American women
and their families.
As of 2002, approximately 526 women in Alameda County had
been diagnosed with AIDS, representing 65 percent of all female
cases there. The number with HIV is estimated to be much higher.
Only about half of African-American women who are tested in the
county return for their results, compared to about two-thirds
nationwide.
"One of the reasons African-American women don't [return for
their results] is that HIV/AIDS holds a high stigma and women
feel they will be isolated from family and friends," said Shirley
Manly-Lampkin, founder of AllCare Health in Oakland, which runs
support groups for HIV-positive women.
Dr. Lisha Wilson, medical director of the Magic Johnson
Clinic in Oakland and San Francisco, said shame allows the
disease to take its toll on this population. Delayed testing
causes black women to enter treatment sicker, often with AIDS
instead of the more-treatable HIV.
HIV activist Paulette Hogan said she feels the taint of
being infected, saying family and friends "ran away" when she
mentioned her status. "People still have this stupid stigma that
it's a gay man's disease," she said.
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NEWS BRIEFS
************************************************************
"EU Rejects Vatican Claim that Use of Condoms Does Not Protect
Against AIDS"
Associated Press (10.20.03)
The European Union on Monday criticized recent statements by
a top Vatican cardinal that latex condoms do not work as "not
supported by sound scientific evidence" and so "not plausible."
Philippe Busquin, EU research commissioner, added that there is
enough evidence to demonstrate that "condoms are the best way to
prevent HIV infection." EU spokesperson Fabio Fabbi said: "There
is extensive and conclusive scientific evidence that condoms are
the best way to stop and prevent AIDS. The scientific evidence is
there... whatever your beliefs are." Fabbi said the European
Commission has funded several research projects over the last 15
years to prove that latex condoms are an effective way of
fighting the spread of AIDS. The commission said the studies
found that condoms showed an efficacy rate close to 100 percent
when used correctly.
"US Researchers Identify HIV-Friendly Proteins"
Agence France Presse (10.17.03)
US researchers have identified a series of proteins that
enable HIV to bypass the human body's natural antiviral defenses,
a discovery they say could lead to new treatments for HIV/AIDS.
"We've discovered a new link in the chain that allows the HIV to
overcome the cellular resistant factor and to infect human
cells," Dr. Xiao-Fang Yu, associate professor at Johns Hopkins
Bloomberg School of Public Health, wrote in "Induction of
APOBEC3G Ubiquitination and Degradation by an HIV-1 Vif-Cul5-SCF
Complex," published in the on-line edition of Science magazine
(10.16.03; 10.1126/science.1089591). The report noted that HIV
contains a viral infection factor essential to escaping the
body's natural antiviral agent. The virus acts in conjunction
with a group of proteins to modify and disable this protective
agent, according to the researchers.
************************************************************
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