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CDC HIV/STD/TB Prevention News Update
Tuesday, October 28, 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
"NIH Questions AIDS, Sex Attitudes Grants"
"With CDC Funds, State Widens Effort to Locate HIV/AIDS
Sufferers"
"Mississippi State University Study Seeks Lower STD Rates Among
Youthful Offenders"
"Abstinence Touted to Teens"
INTERNATIONAL NEWS
"A Battle Line in Botswana AIDS Fight; Patients Who Reject Test
Risk Being Turned Away"
"AIDS Strategy Praised, Criticized"
MEDICAL NEWS
"Coronary Heart Disease in HIV-Infected Individuals"
"Study: Some Men May Be Hard-Wired for Unsafe Sex"
NEWS BRIEFS
"Senate Votes to Restrict Military Aid to Malaysia"
"Iowa on Alert for Syphilis"
"City Teen Birth Rate at 4-Decade Low"
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NATIONAL NEWS
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"NIH Questions AIDS, Sex Attitudes Grants"
Associated Press (10.28.03)::Mark Sherman
In response to complaints from the conservative Traditional
Values Coalition, the National Institutes of Health is
telephoning 157 researchers who were awarded grants for projects
on AIDS and sexual practices. The phone calls are "sending a
dangerous message" that research is being subverted by an
ideological agenda, said Rep. Henry Waxman (D-Calif.).
But NIH spokesperson John Burklow said the agency was simply
responding to a request from Republican lawmakers who were given
a list of research grants. The projects' topics include teen
sexual activity, sex and drug use among truckers, and STDs among
Mexican immigrants. The calls, Burklow said, were not intended to
threaten the researchers' funding but rather to inform them that
their names were on a list being circulated in Washington.
Officials were trying to put the research into the context of
NIH's "scientific mission," Burklow said. TVC Executive Director
Andrea Lafferty called the grants a "total waste of taxpayer
dollars."
"We know for a fact that millions and millions of dollars
have been flushed down the toilet over years on this HIV, AIDS
scam and sham. We know what it takes to prevent getting this
disease. It takes not engaging in risky sexual behaviors," said
Lafferty, who brought her concerns to Rep. Billy Tauzin (R-La.),
chair of the House Energy and Commerce Committee. Ken Johnson,
Tauzin's spokesperson, said the committee is not investigating
individual grants but is "looking broadly at the overall grant
management program."
Committee member Waxman, who has previously criticized the
Bush administration for interfering with science, called the list
a "hit list" and questioned whether federal agencies helped
compile it. NIH is part of the Department of Health and Human
Services; in a letter to HHS Secretary Tommy Thompson, Waxman
said NIH officials could have read the grant applications if all
they sought was information. HHS officials denied any role in
compiling the list; they said all the information is available
through two databases.
"With CDC Funds, State Widens Effort to Locate HIV/AIDS
Sufferers"
Associated Press (10.24.03)::Garry Mitchell
Just as Alabama health officials are stepping-up efforts to
locate residents with HIV/AIDS and get them into clinics, state
budget cuts are reducing drug treatments available for the
potential patients. "We've had projects in the past that focused
more on prevention for people testing negative for HIV," said
Jane B. Cheeks, director of the Alabama Department of Public
Health's HIV/AIDS division. "We're now looking at more secondary
prevention that focuses on persons who are positive to make sure
they have the tools to improve their own health."
CDC funding will allow eight new prevention projects in the
state for between $50,000 and $60,000 per project, beginning Jan.
1, Cheeks said Friday. CDC is providing the funds for groups that
have a science-based and proven prevention method. Nonprofit
groups who believe they can help in the new prevention campaign
can submit proposals to the state health department by Nov. 25. A
panel will rule on their applications.
Schools and community-based groups such as Boys and Girls
Clubs could qualify for the funds if their prevention programs
meet criteria, Cheeks said.
However, the CDC funds will not replace state budget cuts to
the health department that forced a $1 million reduction in the
HIV/AIDS drug program and put 100 people on a waiting list,
Cheeks said. The health department's educational program for
schools also was reduced. Cheeks said CDC's funding for its
initiative, "Advancing HIV Prevention: New Strategies for a
Changing Epidemic," is unrelated to the state budget cuts.
Groups participating in the prevention program will help
identify people with HIV/AIDS, directing them to the nine AIDS
clinics around the state for treatment. Besides improving access
to care, the initiative aims to reduce barriers to early HIV
diagnoses. Alabama has had approximately 720 new HIV/AIDS cases
yearly for about the last five years.
"Mississippi State University Study Seeks Lower STD Rates Among
Youthful Offenders"
Associated Press (10.28.03)
A Mississippi State University sociologist hopes a $1.6
million National Institutes of Health grant will help researchers
determine ways to reduce the spread of STDs among teenagers.
Through a cooperative effort with the University of Southern
Mississippi, the five-year project headed by Angela Robertson, a
research fellow at MSU's Social Science Research Center, will
focus on about 400 high-risk 12- to 17-year-olds incarcerated at
the state's Columbia Training School. "The study will target
females exclusively because girls, especially African-American
girls, are disproportionately at risk," said Robertson.
Robertson, a former mental health counselor, theorizes that
drug and alcohol use, combined with a history of abuse, can be
significant predictors of the likelihood for contracting STDs.
In a study completed earlier this year of more than 780
juveniles at a Mississippi detention center, Robertson found that
nearly 30 percent of girls 13 and older tested positive for
either chlamydia or gonorrhea. "This is a high rate," she noted,
adding that many STDs, left untreated, can lead to pelvic
inflammatory disease, infertility and other health issues.
In the study, a screening for seven illicit drugs found more
than 20 percent of girls and more than 40 percent of males tested
positive for at least one. Eighty percent of males and females
said they were victims of violence, and nearly a third of the
surveyed girls also reported at least one pregnancy.
The grant provides for a full-time nurse and two health
educators on-site at the training school. Participating youths
will be tracked for a year after the intervention, with
researchers collecting behavioral and biological data, said
Robertson.
"Abstinence Touted to Teens"
Times-Picayune (New Orleans) (10.26.03)::Christine L. Bordelon
Erika Harold, Miss America 2003, spoke to an audience of
about 2,000 middle and high school students, teachers and
advisers at the Ponchartrain Center in Kenner, La., on Oct. 20 on
the value of virginity. She appeared at the fall regional
conference of the Governor's Program on Abstinence, one of five
speaking engagements on the GPA conference tour of the state.
Harold, 23, said she has abstained from sex, a decision she
made as an Illinois high school student. She has been speaking to
students about her decision since age 18, and she said deciding
to wait to have sex empowered her as she watched fellow high
school students suffer the emotional scars and consequences of
premarital sex.
She told the audience that choosing abstinence is courageous
and, "It's something that can change the world."
Dan Richey, state coordinator of the abstinence program,
said, "We think the time has come for abstinence. It represents
the new sexual revolution."
Dr. Dee Burbank, medical director of the program, noted that
sex can spread STDs, including HIV, and can crush the dreams of
teens who get pregnant. She cited statistics about the part
alcohol plays in 75 percent of first-time sexual encounters, and
said that STDs have increased from 1 in 300 Americans in 1970 to
1 in 4 having at least one such disease today. Burbank held up a
condom and joked about its ineffectiveness against STDs.
The GPA offers schools a 12-week curriculum, holds four
statewide events a year, and conducts regional and national
seminars in Washington, D.C.
"Not too many programs teach students about abstinence,"
said Lauren Jones, 17, a senior at Xavier Preparatory School in
New Orleans. "It's a good idea to hear that there still are
people who stay abstinent before they get married."
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INTERNATIONAL NEWS
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"A Battle Line in Botswana AIDS Fight; Patients Who Reject Test
Risk Being Turned Away"
Boston Globe (10.24.03)::John Donnelly
In June, Botswanan President Festus Mogae feared the worst
after he fell ill and began to grow thinner: AIDS. "I concluded I
must have the virus. I was psychologically prepared," Mogae said
in an interview. Mogae said he was screened for HIV and relieved
to find he tested negative. The diagnosis was stress-related
diabetes.
Mogae's frank comments - no other African leader has come
close to such an acknowledgement - distinguish him from other
presidents in sub-Saharan Africa, where more than 30 million
people are believed to have HIV/AIDS.
In the nation with the world's highest HIV infection rate
last year, Mogae recently took the step of informing the public,
through a televised address, that hospitals and clinics would
begin routine AIDS testing for everyone seeking treatment for any
malady, although a patient could refuse the test. The policy is a
first for Africa.
But in an interview Thursday, Mogae went further and said
that doctors and nurses should go ahead and test patients unless
specifically told not to, and that health workers should not ask
whether a patient wants to be screened. In some cases, doctors or
nurses could refuse treatment if patients refused to be tested
for HIV.
Botswana offers free antiretroviral drug treatment for those
with HIV/AIDS, but only 9,000 of the 100,000 who need the drugs
are taking them. The coordinators of its program have said that
the greatest impediment to its expansion is that many people do
not know they are infected, as too few people are coming in for
testing.
While complimenting Botswana's plan for routine testing in
hospitals, Paul S. Zeitz, executive director of the Global AIDS
Alliance, said withholding treatment would be "draconian."
"AIDS Strategy Praised, Criticized"
Chicago Tribune (10.26.03)::Gary Marx
With HIV infection rampant in the Caribbean, Cuba has the
lowest rate in the region - .05 percent, officials say. Cuba's
aggressive campaign against HIV/AIDS involves universal treatment
for those who test positive, but it also closely monitors the
lives of patients.
In the early 1980s, Cuban officials noticed that soldiers
returning from Angola had a mysterious illness. The government
tracked down Cubans who had served in Africa since the 1970s,
administered more than 100,000 HIV tests, and checked all blood
donations. By 1986, 99 HIV-positive people were quarantined at
the nation's first HIV/AIDS sanitarium.
Critics condemn the government's program for limiting
individual civil liberties by isolating patients and separating
them from their families. Most HIV-positive Cubans are required
to stay in a sanitarium for at least three months, and can leave
only with staff permission. However, some health officials laud
the campaign's effectiveness. "I have enormous praise for what
they've done," said Peggy McEvoy, a former UNAIDS official in the
Caribbean. "It provides an object lesson in what a socialist
government can do when they want to do it."
Today, about 800 of the 3,892 HIV-positive Cubans live in
the island's 14 sanitariums. Patients deemed at low risk of
infecting others may eventually leave. Any Cuban infected with
HIV must take a course in the fundamentals of the illness and how
to prevent its spread.
The government also runs an extensive outreach program with
television advertisements and volunteers distributing educational
materials and condoms. Cuba provides antiretrovirals, but some
patients say that vitamins, antibiotics and other necessary drugs
are prohibitively expensive and in short supply. The overall HIV
infection rate in Cuba remains low, but an increase in recent
years has health officials concerned about the spread of HIV
among bisexual men.
************************************************************
MEDICAL NEWS
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"Coronary Heart Disease in HIV-Infected Individuals"
Journal of Acquired Immune Deficiency Syndromes (08.01.03) Vol.
33; No. 4: P.506-512::Judith S. Currier, MD, MSc; Anne Taylor,
MD; Felicity Boyd, PhD, MPH; Christopher M. Dezii, RN, MBA; Hugh
Kawabata, MA; Beth Burtcel, PharmD; Jen-Fue Maa, PhD; Sally
Hodder, MD
The current study examined the age-specific incidence of
coronary heart disease (CHD) among HIV-infected and noninfected
men and women in the California Medicaid population. The authors
reviewed administrative claims data and compared the incidence of
and relative risk for CHD using log-linear analyses. They also
assessed the association between exposure to antiretroviral
therapy (ART) and CHD incidence.
Of the 3,083,209 individuals analyzed, 28,513 had HIV. In
that cohort, 20,742 (72.7 percent) were men. The researchers
captured a total of 235,881 CHD diagnoses in the total
population, 1,306 of which came from the HIV-infected group.
Coronary atherosclerosis was the most common diagnosis, followed
by angina pectoris and myocardial infarction.
"Compared with their non-HIV-infected male counterparts in
the Medi-Cal population," the investigators wrote, "CHD incidence
among HIV-infected men was significantly higher in the age
categories of 18-24 years. ...Compared with their non-HIV-infected
female counterparts, CHD incidence among HIV-infected women was
significantly higher among those aged 18-24 years and 35-44
years. CHD incidence among HIV-infected women older than 44 years
was lower than that among the Medi-Cal reference group."
Controlling for recognized CHD risk factors - diabetes,
hyperlipidemia, renal failure and hypertension - the analysts
divided patients into those exposed to ART and those never
exposed to ART. Fifty-two percent of 18- to 33-year-olds, 68
percent of 34- to 49-year-olds, 61 percent of 50- to 65-year-olds
and 30 percent of those 66 and older had been exposed to ART.
"The covariate-adjusted RR [relative risk] for the development of
CHD in individuals receiving ART compared with those not
receiving ART was 2.06," the analysts found, "in HIV-infected
individuals aged 18-33 years. There were no statistically
significant associations between ART exposure and CHD in other
age groups."
"These results help to frame the benefits of highly active
ART in the context of possible CHD risk and suggest that the
timing of aggressive cardiovascular risk assessment and
management may need to be considered at younger ages for this
high-risk subset of patients," the authors suggested. "Strategies
to reduce CHD risk should be incorporated into HIV primary care."
"Study: Some Men May Be Hard-Wired for Unsafe Sex"
USA Today (10.28.03)::Marilyn Elias
A recent Kinsey Institute study of 1,500 gay and
heterosexual men suggests a minority - roughly 10-20 percent -
are most likely to engage in risky sex. The threat of catching a
disease does not seem to cool their desire, as it would for most
people, and depression or stress can send them cruising for
casual sex. All the men filled out questionnaires on arousal,
personality and sexual experience, said John Bancroft, institute
director and study author.
"For most of us, the way our bodies are set up probably
makes it easier to do the right thing," Bancroft said. Past
studies show 40-45 percent have less sexual appetite when
depressed or stressed, with the remainder showing no change. But
a minority feel more aroused. In Bancroft's study, these men did
more cruising for casual sex partners, many of whom they did not
know well.
Sex that could lead to an STD or unwanted pregnancy causes
many men to lose erections, said Bancroft. Men unconcerned with
these situations were more likely to practice unsafe sex,
including anal intercourse or not using condoms. "They get
excited despite the threat," said Bancroft. Indeed, men who
scored high in adventurous "sensation-seeking" were most into
risky sex.
Public health campaigns stressing "safe sex" could backfire
with this minority, said Frank Farley, a Temple University
psychologist who pioneered study of the "Type T" or risk-taking
personality. "They don't want 'safe.' That takes the thrill out
of it." Such risk-takers should instead seek adventure elsewhere,
such as bungee-jumping or mountain-climbing, Farley said.
Men who respond to depression with casual sex may be trying
to get a desired rush of endorphins in order to change their
brain chemistry, said Eli Coleman, director of the human
sexuality program at the University of Minnesota. Genetic
vulnerability and childhood sexual abuse can lead to risky adult
sex. "We know that this trauma can alter the chemistry of the
brain," Coleman said.
HIV prevention workers and public health campaigns would be
far more effective if they emphasized how mental health affects
sexual risk-taking, Coleman said. "Nobody is predestined for
dangerous sex. But telling them, 'Just use a condom' isn't enough
to stop the behavior," he said.
The report on 589 gay men, "Sexual Risk-Taking in Gay Men:
The Relevance of Sexual Arousability, Mood, and Sensation
Seeking," is published in the December issue of Archives of
Sexual Behavior (2003;32(6):555-572). The findings on straight
men will be published in 2004, said Bancroft, who added that the
results are similar. The Kinsey Institute recently started a
similar study with women and men.
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NEWS BRIEFS
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"Senate Votes to Restrict Military Aid to Malaysia"
Washington Post (10.28.03)::Helen Dewar
Among the issues in an $18 billion foreign operations
spending bill on track for Senate approval as early as today is a
proposal by Sen. Mike DeWine (R-Ohio) to increase funding for
AIDS in Africa and Caribbean nations by $289 million. If
approved, the proposal would raise next year's funding to $2.4
billion. President Bush pledged to contribute $15 billion in the
next five years during his State of the Union address. Bush
sought $2 billion for fiscal 2004. The House has approved about
$2.1 billion, an Appropriations Committee aide said.
"Iowa on Alert for Syphilis"
Quad-City Times (Davenport, Iowa) (10.24.03)::Cherie Black
Recently reported cases of syphilis in South Dakota have
prompted the state Department of Health to issue an alert to
surrounding states, including Iowa, informing residents that they
may be at-risk for contracting the disease. Currently, the Iowa
Department of Public Health is following up on three sex partners
of the South Dakota syphilis cases to ensure that they do not
develop the infection and transmit it to others. The department
expects to identify more people possibly exposed to syphilis as a
result of the South Dakota cases. So far in 2003, seven new cases
of syphilis have been reported in Iowa.
"City Teen Birth Rate at 4-Decade Low"
Baltimore Sun (10.22.03)::David Kohn
On Oct. 21, city health officials announced Baltimore's
lowest teen birth rate in at least four decades. They attributed
the decrease to more effective contraceptives, fear of HIV/AIDS,
and increased education efforts. In 2001, 8.3 percent of
Baltimore females ages 15-19 gave birth - two-tenths of a
percentage point lower than the birth rate in 2000. Ten years
ago, 11.4 percent of that age group had babies. "This is a 27
percent drop in a decade, and a 9 percent drop in the last four
years. So we're really making progress," said Dr. Peter L.
Beilenson, Baltimore's health commissioner. He said increasing
concern about AIDS causes teens to use condoms more frequently,
and that abstinence has also played a role.
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