[CDC News] CDC HIV/STD/TB Prevention News Update 10/31/03

CDC HIV/STD/TB Prevention News Update
Friday, October 31, 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) 
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Reproduction of this text is encouraged; however, copies may not 
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the articles abstracted below for full texts of the articles.

HEADLINES

NATIONAL NEWS
"Senate Boosts Funds for Africa AIDS Fight"
"Pentagon Stresses Need for Chlamydia Testing"

INTERNATIONAL NEWS
"AIDS Programs Anger Muscovites"
"Appeal for Free Drugs Made at AIDS Conference"

MEDICAL NEWS
"HIV/AIDS Diagnosis: Finger-Stick HIV Test Is Accurate and 
Acceptable to Women in Thailand"
"Gynecology: Intravaginal Ring Could Be Used in New Approach to 
AIDS Prevention"

LOCAL AND COMMUNITY NEWS
"Christiana Care Joins AIDS Study"
"Agency Fills Clients, Homes with New Hope"

NEWS BRIEFS
"Brazil Launches Major HIV Testing Program"
"EU Accelerates Funding for Fights Against AIDS, Tuberculosis and 
Malaria"
"Marquette University Faculty Member Diagnosed with TB"
"Dining Out for People with AIDS"

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                          NATIONAL NEWS
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"Senate Boosts Funds for Africa AIDS Fight"
Associated Press (10.31.03)::Jim Abrams 
     On Thursday, the Senate approved 89-1 an additional $289 
million to fight AIDS overseas next year. The increase would 
bring the first installment of President Bush's $15 billion 
global AIDS pledge to $2.4 billion for the fiscal year beginning 
Oct. 1. Senators Mike DeWine (R-Ohio) and Dick Durbin (D-Ill.) 
sponsored the funding amendment. The Senate later passed the 
overall $18.4 billion foreign aid bill, after rejecting several 
other attempts to boost spending to fight global AIDS.  
     The administration had sought $2 billion for the AIDS 
initiative for 2003, drawing criticism from AIDS advocates who 
demanded the full $3 billion allowable under the five-year 
program. Administration officials argued that $2 billion was 
appropriate for the first year of the initiative and said they 
would live up to the promises made in the AIDS legislation Bush 
signed in May.
     Action on the bill was held up for several days after Senate 
Budget Committee Chair Don Nickles (R-Okla.) demanded reductions 
in other budget areas to cover the extra spending sought by  
DeWine and Durbin. Nickles' office said he supported full funding 
for the AIDS initiative but that it was his job "to make sure 
Congress sticks to its spending limits."
     The global AIDS funding includes an amendment by Sen. Jeff 
Sessions (R-Ala.) setting aside $75 million for blood safety. He 
said 25 percent of the blood in Africa is transfused without 
being tested. 
     The measure, S. 1426, goes to a House-Senate conference 
under a presidential veto threat: The Senate bill, unlike the 
House version, would overturn the administration's policy of 
barring money to international organizations that perform or 
support abortions. The White House has said the president would 
veto the bill if that provision is in the final version. 
     
"Pentagon Stresses Need for Chlamydia Testing"
Stars and Stripes (10.27.03)::Sandra Jontz
     Roughly half of female US military personnel who should be 
tested for chlamydia are not receiving the required exam, and a 
solution to the problem could still be three years away as health 
officials await a computer tracking system.
     In 2001, all services implemented guidelines to routinely 
screen women for chlamydia, with the Air Force, Marine Corps and 
Navy testing all new recruits and the Army testing women upon 
arrival at the their first duty station. The military also 
adopted CDC recommendations to test women 25 and younger during 
routine annual exams.
     But the data are not tracked. Instead, officials rely on 
independent studies to show where potential problems lie, said 
Navy Capt. Katherine Surman, director of women's health policy 
for the Pentagon Health Affairs office. Women listed at-risk for 
chlamydia are those age 25 and younger and those who are sexually 
active.
     In a Defense Department study conducted between April 2000 
and March 2001, just 41 percent of active-duty women were tested 
during the one-year period. Researchers studied 163,299 sexually 
active women ages 16-26 enrolled in the military health system, 
which included civilians, active duty and dependents. Women ages 
16-20 had a 34 percent testing rate, and women ages 21-36 had a 
28 percent testing rate.
     "We do need to do [a] better job of getting the word out to 
troops about sexually transmitted diseases and how to protect 
yourself," Surman acknowledged, adding that more men can now 
expect to be tested for chlamydia with the adoption of easy urine 
exams. "It happens to them as well, and they deserve to be 
treated."
     According to Surman, the PHA office is working on a system 
to ensure that all female patients receive the proper care, and 
it is pinning its hopes on the new computer tracking system 
Composite Health Care System II. CHCS II is a computerized 
medical and dental record database the Pentagon expects to 
install at all the department medical facilities starting in 
January. However, the process is expected to take three years. 

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                      INTERNATIONAL NEWS
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"AIDS Programs Anger Muscovites"
Washington Times (10.31.03)::Jennifer Harper
     Charging that a US-funded AIDS prevention program is 
encouraging Russian girls to "choose prostitution as a career," 
16 Moscow City Duma members have taken their complaints to 
Capitol Hill. The group - which includes cultural, financial, 
health and social policies commissioners - said in an Oct. 8 
letter to Senate Majority Leader Bill Frist (R-Tenn.) and Speaker 
of the House Dennis Hastert (R-Ill.) that the programs promoting 
safe sex alone undermine proposed revisions in Russian law that 
would make prostitution and the trafficking of women major 
crimes. 
     "Now we find ourselves under pressure from the United States 
government-funded 'harm reduction' projects that distribute 
condoms and sex education materials that aim to reduce HIV/AIDS 
among drug-addicted prostitutes while lobbying in favor of 
legalized prostitution," they wrote, charging that morality has 
been overlooked. "They print materials for prostitutes that are 
distributed throughout Moscow schools, institutes and orphanages 
with the effect of encouraging young women to choose prostitution 
as a career. We find this morally unconscionable." 
     The State Department calls the growing HIV/AIDS epidemic in 
Russia "an emerging security threat" and a threat to the 
country's "political, social and economic stability." Russia 
faces an estimated 8 million new HIV infections in the next 
decade, the department says. CDC and the US Agency for 
International Development will spend $4.3 million on Russian AIDS 
programs this year. The International Organization for Migration 
estimates that 50,000 Russian women are trafficked as prostitutes 
in Europe each year. 
     "As Americans, you should apply the same standards to your 
foreign social policy in our country as you do your own. You 
should look to the well-being of our children as if they were 
your children. If a policy is not acceptable in America, please 
do not export it to us," the Duma members wrote.
     The group's demands are under consideration. "We are talking 
with the folks at USAID to evaluate the concerns expressed in the 
letter," Frist spokesperson Nick Smith said yesterday. 
    
"Appeal for Free Drugs Made at AIDS Conference"
Agence France Presse (10.30.03)
     An international conference of people living with HIV/AIDS 
ended in Kampala on Thursday with a call to the global community 
and the world's governments to help patients obtain free drugs to 
fight the disease.
     "The international community should provide more of these 
drugs and give accessibility to them than they are currently 
doing, while national governments should move towards free 
provision of the drugs," said a conference statement read by Stu 
Flavell, international coordinator of People Living with HIV/AIDS 
Global Network.
     "The international community has not given as much as they 
should," said Ugandan army Major Rubaramira Ruranga, who is HIV-
positive. Iranian delegate Amir Morada said his country is 
providing free drugs to 1,000 patients out of the country's 5,000 
known cases. 
     The conference brought together community activists and 
nongovernmental organization workers to give "new positive 
leadership" to the AIDS struggle.
     On Sunday, Ugandan president Yoweri Museveni called on 
fellow heads of state to exert political leadership in the fight 
against AIDS. Conference participants included HIV-positive 
children ages 11-18 who spoke to delegates about their fears, 
hopes and expectations.
     At the start of the conference, Uganda announced that it 
would provide antiretrovirals to people at a cost of less than 50 
cents per day. About 20,000 Ugandans have access to the drugs.

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                          MEDICAL NEWS
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"HIV/AIDS Diagnosis: Finger-Stick HIV Test Is Accurate and 
Acceptable to Women in Thailand"
Women's Health Weekly (09.04.03)
     Alice Liu and colleagues affiliated with the Thailand 
Ministry of Public Health-US CDC Collaboration assessed the 
acceptability of a rapid finger-stick HIV test among Thai women.
"We used the HemaStrip HIV-1/2 test (Saliva Diagnostic Systems, 
Vancouver, Wash.) in a prospective cohort study of HIV 
seroincidence among women in northern Thailand from 1998 to 
1999," the study reported. "Nurses obtained whole-blood specimens 
by finger-stick testing and provided test results and counseling 
at each visit. Acceptability of the rapid test was assessed at 
the first six-month follow-up visit." 
     Liu and her colleagues found that, "HIV-1 seroprevalence 
among the 804 women screened at enrollment was 3.1 percent. 
Positive rapid test results from 25 women were confirmed by 
enzyme immunoassay and Western blot analysis using serum obtained 
by venipuncture. Of the 741 women who returned for follow-up, 56 
percent preferred specimen collection by finger-stick testing to 
venipuncture, 80 percent preferred immediate rather than delayed 
results, 79 percent preferred the rapid test method to typical 
testing methods, and 97 percent were satisfied with the test 
method used."
     The report, "Rapid Whole-Blood Finger-Stick Test for HIV 
Antibody: Performance and Acceptability Among Women in Northern 
Thailand," appeared in the Journal of Acquired Immune Deficiency 
Syndromes (2003;33(2):194-198).

"Gynecology: Intravaginal Ring Could Be Used in New Approach to 
AIDS Prevention"
Women's Health Weekly (10.16.03)
     Scientists at Queen's University, Belfast, Northern Ireland, 
have developed an intravaginal ring that has potential use as 
part of a strategy to combat HIV, the British Pharmaceutical 
Conference has been told. The silicone rubber ring releases the 
antibiotic metronidazole to treat bacterial vaginosis. Patients 
receive a steadily decreasing dose of the drug over 14 days, 
avoiding side effects associated with oral administration and the 
messiness of vaginal gels.
     Dr. Karl Malcolm believes that a ring releasing 
metronidazole, either alone or in conjunction with an 
antiretroviral agent, could potentially prevent HIV infection.
"Bacterial vaginosis, and other sexually transmitted diseases, 
have been widely implicated in an increased risk of sexually 
transmitted HIV infection," he said. "Whereas HIV does not 
survive long in the normal acidic environment of the vagina, it 
thrives at the elevated pH associated with bacterial vaginosis 
infection. Simply treating existing, and in many cases 
asymptomatic, vaginal infections could have a massive impact on 
sexually transmitted HIV statistics." 
     "The chance of an effective HIV vaccine being developed and 
marketed within the next 10 years is slim to say the least," 
Malcolm continued. "Of course, it is imperative that the vaccine 
research continues, but it is equally imperative that alternative 
preventative strategies are pursued. Vaginal microbicides are the 
obvious alternative."

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                   LOCAL AND COMMUNITY NEWS
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"Christiana Care Joins AIDS Study"
News Journal (Delaware)(10.27.03)::Laura Ungar
     Wilmington, Del.'s Christiana Care Health System has joined 
an eight-year study of how best to manage antiretroviral therapy 
for HIV/AIDS patients. Christiana Care is one of 167 facilities 
nationwide participating in the study, sponsored by the Division 
of AIDS at the National Institute of Allergy and Infectious 
Diseases. The study is called Strategies of Management of 
Antiretroviral Therapy (SMART).
     Researchers say SMART is the largest HIV trial ever, 
attempting to track 6,000 patients over nearly a decade. Seven 
Delaware patients are currently participating, and investigators 
hope to enroll at least 20. At present, state statistics show 
2,492 Delawareans living with HIV/AIDS.
     The study randomly assigns patients to one of two approaches 
to drug therapy. The "go" group will take medication continuously 
to keep their viral blood levels as low as possible. The "wait" 
group will take antiretrovirals when T-cell counts fall below a 
certain level, then stop when the T-cells rebound.
     New drug regimens have resulted in a drastically reduced 
AIDS death rate, reflected in Delaware's AIDS statistics. 
According to the state Division of Public Health, 383 Delawareans 
were diagnosed with HIV/AIDS in 2002-2003 and eight people died. 
Ten years ago, 166 Delaware residents died of AIDS.
     However, treatment regimens are complicated and side effects 
can be devastating. It is difficult to stay with a drug regimen 
if a patient feels "sick as a dog," said nurse Renee Beaman, who 
works with AIDS patients at the Beautiful Gate Outreach Center, 
part of Christiana Care. "AIDS is devastating," she said. "HIV is 
just three letters, but it has just ripped apart a lot of things 
in people's lives."      

"Agency Fills Clients, Homes with New Hope"
Los Angeles Times (10.26.03)::Julie Tamaki
     The Los Angeles County nonprofit Project New Hope has been 
helping low-income and homeless families and individuals with 
HIV/AIDS obtain housing since 1990. While many people feel 
squeezed by Southern California's housing market, people with 
HIV/AIDS may also have extremely low incomes because their health 
prevents them from holding jobs, said Renee Ordeneaux, Project 
New Hope's CFO. 
     "On average, our clients' income is $671 a month," Ordeneaux 
said. "The average rent in Los Angeles for a one-bedroom is 
$1,000 a month. It's a problem."
     Half of the people who receive housing through Project New 
Hope were previously homeless, said Ordeneaux. Some clients may 
also have drug or alcohol problems that make it difficult for 
them to find and keep housing.
     "Basically, it's a family," said Martyn Camarillo, a 
resident services coordinator who makes weekly visits to three 
apartment complexes and touches base with his 47 clients at least 
once a month. "They help each other out with rides to the doctor 
and to food banks...."
     Los Angeles has about 53,000 people living with HIV/AIDS, 
and housing services are limited, according to Gunther Freehill, 
a spokesperson for LA County's Office of AIDS Programs and 
Policy. "Housing is critical so people can live stable lives and 
consume HIV medical services," said Freehill. "Some of the HIV 
medications require refrigeration. That's really tough to do when 
you don't have a home."
     Hundreds of names fill the waiting lists for apartment 
complexes offered by the project, which relies on private and 
government funding. The project has constructed, leased or 
refurbished about 125 units in Hollywood, San Pedro, Santa 
Monica, Silver Lake, South Los Angeles and Pico Union, with an 
additional 22 beds at three facilities with 24-hour staffing for 
clients unable to live on their own. It also has 20 beds for 
transitional housing in Pico Union and Lawndale. Ordeneaux 
estimated that 40 percent of the project's clients are Latino. 
     
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                        NEWS BRIEFS
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"Brazil Launches Major HIV Testing Program"
United Press International (10.30.03)
     On Thursday, Brazil's government launched a national 
campaign to encourage more people to be tested for HIV. Using the 
slogan "Get Informed," the effort is aimed at persons who are 
infected but do not know it, according to BBC. Two-thirds of 
Brazil's estimated 600,000 HIV-infected people do not know they 
have the virus. The tests are free and confidential. Brazil 
already pays for antiretroviral treatment for those with HIV, and 
it has pressured drug companies to keep down the cost of 
medications. The government hopes the campaign will lead as many 
as 4.5 million Brazilians to take the HIV test.

"EU Accelerates Funding for Fights Against AIDS, Tuberculosis and 
Malaria"
Associated Press (10.30.03)
     The European Union stepped up its commitment to fighting 
"killer diseases" Thursday, saying it would accelerate a 
contribution of EUR170 million (US$198.2 million) to the Global 
Fund to Fight AIDS, Tuberculosis and Malaria. The move raises 
Western Europe's contribution to 55 percent of the $4.7 billion 
fund, a UN initiative. "These killer diseases deserve our full 
attention," said EU Development Commissioner Poul Nielson. The 
AIDS, TB and malaria epidemics "demand we act on a global scale, 
set in place the right policies and provide predictable 
financing," he added. "This is why our disbursement is being 
speeded up." The EUR170 million contribution was originally to be 
spread over the 2003-2006 period, but Nielson said now it will be 
spent much more quickly.

"Marquette University Faculty Member Diagnosed with TB"
Milwaukee Journal-Sentinel (10.29.03)::Marilynn Marchione
     Milwaukee and Shorewood Health Department officials  
investigating a case of tuberculosis in a Marquette University 
faculty member say there is no outbreak and that none of the 
faculty member's contacts has tested positive for the disease. 
"We do not believe that any Marquette students, faculty or staff 
are at significant risk of having contracted TB," the university 
said in a statement. 

"Dining Out for People with AIDS"
Southern Voice (Atlanta) (10.24.03)::Penny White
     Project Open Hand Atlanta is hosting its annual "Dining Out 
for Life" fundraiser on Nov. 5, when up to 150 restaurants 
throughout Atlanta will donate 20 percent of their day's food and 
alcohol sales to the nonprofit. For 15 years, Project Open Hand 
has prepared and delivered healthy meals for Atlantans with AIDS 
and other serious health conditions. Today, the agency's 58 full-
time employees and up to 100 volunteers deliver 3,000 meals a 
day. The money raised from "Dining Out for Life" is earmarked for 
the project's AIDS programs. "We raised $127,000 last year," said 
Tanya Johnson, development director for POH. "Less than 15 
percent of that was spent on expenses." POH leaders estimate 
40,000 diners will take part in the event. Diners at 
participating restaurants are eligible to enter a contest to win 
two round-trip airline tickets to anywhere in the United States 
or a $1,000 shopping spree at Saks Fifth Avenue. For more event 
information, visit www.diningoutforlife.com.   

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