[CDC News] CDC HIV/STD/TB Prevention News Update 11/03/03

CDC HIV/STD/TB Prevention News Update
Monday, November 03, 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
ALABAMA: "Jail Contractor to Treat Hepatitis C"
CALIFORNIA: "When 'Friends' Talk, Teens Listen"

INTERNATIONAL NEWS
UGANDA: "Teaching Safe Sex, Ugandan-Style"

MEDICAL NEWS
NEW YORK: "Using a Telephone Support Group for HIV-Positive 
Persons Aged 50+ to Increase Social Support and Health-Related 
Knowledge"

LOCAL AND COMMUNITY NEWS
OHIO: "Hospital to Test All Employees for Tuberculosis"
FLORIDA: "An In-Your-Face Strategy Teaches Latinos About HIV"
LOUISIANA: "HIV/AIDS Levels Remain Constant for Region"

NEWS BRIEFS
SOUTH AFRICA: "German Foreign Minister Meets with South African 
AIDS Activists"
JAPAN: "Fifty Thai Prostitutes Dying of AIDS Every Year in Japan: 
Report"
NORWAY: "Bill Clinton to Visit Norway, Discuss Global Efforts to 
Fight HIV/AIDS"
DELAWARE: "Health Care Worker Has Tuberculosis"

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                        NATIONAL NEWS
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ALABAMA:
"Jail Contractor to Treat Hepatitis C"
Birmingham News (11.02.03)::Carla Crowder
    Medical costs in Alabama prisons are expected to rise as the 
new medical contractor begins treating hepatitis C. On Monday, 
the state's three-year, $142 million contract with Brentwood, 
Tenn.-based Prison Health Services takes effect, assuming care 
previously provided by Birmingham-based Naphcare for about $29.5 
million a year. 
     According to Ronald Cavanaugh, director of treatment for the 
Alabama Department of Corrections, it will be the first time 
state prisons will offer HCV treatment and have a protocol for 
prevention and education. The new HCV treatment and prevention 
program alone will cost the department $3 million to $8 million. 
     In addition, the new contract will include greater 
accountability, better staffing and improved treatment for 
hepatitis as well as HIV. Currently, Alabama prisons are facing 
at least four class-action lawsuits relating to adequacy of care, 
with allegations that Naphcare and other providers failed to 
provide adequate care for prisoners with chronic conditions such 
as HIV and diabetes. 
     Many inmates contract HCV through high-risk lifestyles prior 
to incarceration. Cavanaugh said he has seen national estimates 
as high as 40 percent for the rate of HCV-infected prisoners. 
Most reports put the number at 17-30 percent nationwide. The 
exact rate in Alabama is unknown. In the general US population, 
HCV infection rates are about 1.8 percent, according to CDC.
     A window for HCV treatment often comes while prisoners are 
incarcerated. If care is not provided, the disease can progress 
and lead to a need for costly care once they are released, or it 
can become fatal, experts say. State prison health workers will 
begin identifying patients who would be appropriate candidates 
for treatment. Cavanaugh estimated a couple hundred prisoners 
initially may be identified. 
     Charles Edwards, community resource officer for Pardons and 
Paroles, said he welcomes the improved care. Parolees with HCV 
regularly report to his office; because the disease creates a 
greater susceptibility to illness, they "have a hard time holding 
jobs." HCV-infected parolees often need extra medical care, but 
most have no insurance. 

CALIFORNIA:
"When 'Friends' Talk, Teens Listen"
USA Today (11.03.03)::Marilyn Elias
     A "Friends" episode that aired Oct. 11, 2001, might have 
taught teenagers more about safe sex than hours of adult 
preaching, a survey suggests. Rebecca Collins, a RAND senior 
behavioral scientist, surveyed 506 frequent viewers ages 12-17 
within a few weeks of the episode, then six months later. Her 
report shows that many got the safe sex facts. The article, 
"Entertainment Television as a Healthy Sex Educator: The Impact 
of Condom-Efficacy Information in an Episode of Friends," 
appeared in Pediatrics (2003;112:1115-1121).
     On "Friends," Rachel told Ross she was pregnant even though 
they had used a condom. The show twice mentioned that condoms are 
97 percent effective. According to Nielsen Media Research, about 
1.7 million children ages 12-17 saw the episode. 
     About two-thirds of the viewers in Collins' study recalled 
that condom failure had resulted in pregnancy. Roughly a third 
even remembered the success rate for condoms. 
     Approximately two out of five children surveyed had watched 
with an adult. Collins found that watching with an adult helped 
teens have clearer recall about condom effectiveness and talking 
to an adult about the show increased their knowledge.
     Vicky Rideout of the Kaiser Family Foundation said prime 
time TV is "saturated with sex." According to Kaiser's 2003 
report, about seven out of 10 shows have sexual content, 
averaging six sexual references an hour. But she added that one 
out of four shows that talk about or depict sex also mention 
safer sex, waiting or consequences, up from about 14 percent in 
the foundation's survey four years ago. In the 20 top shows 
watched by teens, almost half the episodes about sex mention 
safer sex.
     A recent Kaiser study showed 70 percent of teens said 
television sex influenced the behavior of kids their age. Tamara 
Kreinin, president of the Sexuality Information and Education 
Council of the United States, said parents should try to watch 
television with their teens so they can help interpret and even 
magnify positive messages.

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                        INTERNATIONAL NEWS
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UGANDA:
"Teaching Safe Sex, Ugandan-Style"
Boston Globe (10.28.03)::Rachel Scheier
     Traditionally in Uganda, a senga, or paternal aunt, trained 
a young girl in all matters of love and marriage prior to her 
wedding night, said Phoebe Nakibuule Mukasa, a retired 
schoolteacher and local talk show expert in traditional romantic 
etiquette on Radio Simba. The "aunties" have become so popular 
recently that health officials and cultural leaders are trying to 
harness the old tradition as an AIDS awareness vehicle.
     The idea is that if young adults will listen to sengas talk 
about erotic techniques and relationships, they may also listen 
to them teach HIV prevention and sex education. 
     Robert Ssebunnya, a Kampala businessman, won government 
funding for a plan to train a number of working sengas in the 
basics of AIDS prevention - abstinence, fidelity and condom use - 
who would pass on the lessons to youths in villages and schools. 
His plan also includes a "senga manual," which would offer 
guidelines on such topics as how boys and girls should behave at 
parties and guarding against premarital sex. 
     However, when Ssebunnya presented the idea recently at 
Makerere, Kampala's largest university, he was booed. AIDS 
education in Africa needs a more contemporary approach, the 
students argued. 
     There is a widespread belief among Ugandans that modernity 
and moral decadence are to blame for social maladies such as 
AIDS, said Carolyn Nakazibwe, a 28-year-old journalist for the 
Monitor newspaper. "A lot of men believe we have a lot of HIV 
because women dress indecently, which is, of course, ridiculous." 
Still, reviving old cultural practices like virginity testing for 
young girls has become fashionable elsewhere in Africa in the age 
of AIDS.
     But the Medical Research Council, an AIDS research 
organization in Uganda, recently found that using sengas to teach 
sex education to adolescent girls showed promising results. Brent 
Wolff, a behavioral scientist, said researchers deliberately did 
not tinker with any of the senga's traditional teachings.

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                        MEDICAL NEWS
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NEW YORK:
"Using a Telephone Support Group for HIV-Positive Persons Aged 
50+ to Increase Social Support and Health-Related Knowledge"
AIDS Patient Care and STDs (07.03) Vol. 17; No. 7: P. 345-
351::Kathleen M. Nokes, PhD, RN; Lee Chew, MSW; Carolyn Altman, 
CSW
     Twelve percent of the total number of people living with 
AIDS in New York City through 2001 were age 50 or older. Of 
people who received an initial HIV diagnosis between June 1, 
2000, and December 31, 2002, 18.4 percent were ages 50-98.
     Middle-aged and older persons living with HIV/AIDS have more 
chronic medical conditions than younger people, more physical 
limitations, and report that they disclose their HIV status to 
fewer people. In addition to living with a chronic illness, these 
people have to address the physical, mental and social challenges 
associated with normal aging.
     "In order to address the health-related information and 
support needs of middle-aged and older persons with HIV/AIDS, two 
community-based organizations received funding to offer a 
telephone psychoeducational support group," according to the 
study. The current report describes that intervention.
     Psychoeducational groups emphasize learning rather than 
self-awareness. Telephone support groups have the advantages of 
anonymity, ability to bring people together who may not be able 
to participate in face-to-face groups, and the chance to give and 
take risk-free support. Disadvantages include the lack of 
nonverbal cues and the difficulty of maintaining boundaries of 
respect in a teleconference as opposed to an in-person group.
     The New York Association on HIV over Fifty (NYAHOF), a 
volunteer coalition that works to influence outcomes related to 
middle-aged and older HIV-infected and -affected adults, and 
SAGE, a social service and advocacy organization dedicated to 
meeting the needs of the senior gay/lesbian/bisexual/transgender 
(GLBT) community, received external funding to offer a telephone 
support group for GLBT people 50 and older. SAGE had a prior 
relationship with DOROT, an organization dedicated to improving 
the lives of Jewish and other elderly people in the greater New 
York metropolitan area, and whose University Without Walls is a 
telephone conference educational and support program. DOROT gave 
the project 10 caller slots.
     Ten-week groups took place April through June 2001 and 
November 2001 through January 2002. A male social worker and a 
female registered nurse with experience in the field 
cofacilitated the sessions, which took place on Fridays for 50-60 
minutes. Participants were not charged; roughly one to five 
clients participated in each session, with an average of three. 
Participants were recruited by flyers advertising the group as 
providing a chance to learn more about living with HIV/AIDS. 
     Five gay men participated in the first group. Problems with 
recruitment for the second group led the researchers to open 
enrollment to NYAHOF members not necessarily GLBT, and one 
heterosexual 56-year-old woman whose son had died of AIDS joined 
the five gay men in the second group. The group addressed issues 
of staying healthy, symptom management, understanding various 
chronic illnesses, understanding diagnostic tests, strategies for 
effective interactions with health care providers, optimizing 
HIV/AIDS medication use, understanding new treatment 
developments, coping with losses, and finding commonalities.
     "Middle-aged and older adults need concrete information, the 
ability to assess their symptoms clearly, and understanding about 
both effective and ineffective medications and treatments," the 
authors concluded. "The psychological concerns of this often 
neglected population of persons living with HIV/AIDS are very 
real as well and encouraging group members to open up to one 
another, create a cohesive community of sharing is important. 
Although the use of teleconference technology makes this more 
challenging, the attempt to create a situation that facilitates 
connections with another individual promotes feelings of 
connection."

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                    LOCAL AND COMMUNITY NEWS
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OHIO:
"Hospital to Test All Employees for Tuberculosis"
Associated Press (11.01.03)
     Cuyahoga County health officials plan to test all employees 
at Cleveland's St. Michael Hospital for tuberculosis following 
the death of its newly appointed chaplain. The Rev. Norbert 
Atimnedi, 36, died Oct. 24 at a hospital in Canton after showing 
symptoms of the disease. Lab tests confirmed the infection. 
     Infectious disease experts do not consider this a public 
health emergency or believe the case is connected to an earlier 
TB infection at Marion-Sterling School in Cleveland. There, after 
the discovery of one TB case, seven people tested positive while 
424 tested negative. The seven at the school and any St. Michael 
employees who have positive skin tests will need follow-up tests. 
Active cases can be treated effectively with oral antibiotics, 
which in some cases must be taken for up to a year. 
     Atimnedi, a native Ugandan who arrived in Cleveland in 
August, had only been rotating through the hospital's workforce 
for about one month. His visits there were confined to one shift. 
St. Michael has an average of 60 patients per day, health 
officials said. 
     St. Michael is scheduled to close on Dec. 19; this 
complicates the matter, since the skin test needs to be repeated 
in 12 weeks. 

FLORIDA:
"An In-Your-Face Strategy Teaches Latinos About HIV"
Miami Herald (10.30.03)::Andrea Robinson
     From the Borinquen Health Care Clinic bus in Miami, AIDS 
outreach counselor Richana "Cha Cha" Nieves spots a small group 
of Hispanic teenagers chatting in a parking lot. Offering brown 
paper bags containing condoms, she asks, "When was the last time 
you took [an HIV] test? If you don't use a condom you're gonna 
die." There is dead silence as Nieves explains the risks of 
unprotected sex. "Naw, I'm a church man," one young man said. 
Everyone walks away except one girl who goes to the bus for an 
HIV test. 
     Nieves is one of a growing number of outreach workers in 
Latino neighborhoods working to fight the fourth-leading cause of 
death among Hispanics ages 25-44. The outreach is the brainchild 
of regional and local organizations in their effort to attract 
the attention of those who influence government AIDS policy, said 
Alberto M. Santana of the National Alliance of State and 
Territorial AIDS Directors. 
     Many Latinos are still leery of talking about AIDS because 
it requires broaching two taboo subjects: sex and drug abuse. 
Latino men often shy away from HIV testing for fear it will raise 
questions about their masculinity or sexual orientation. Some 
undocumented migrants believe a positive diagnosis could mean 
deportation. And activists criticize the dearth of brochures 
written in the language of Miami's immigrant groups.
     Latinos too often do not find out they are HIV-infected 
until they wind up in the emergency room with AIDS, said Vincent 
Delgado, director of Borinquen's Phoenix AIDS outreach program.
     Florida received more than $32 million from federal and 
state sources for prevention and monitoring programs statewide. 
Parts of those funds were allocated to local health departments 
to provide training and supplies for community groups such as 
Borinquen's.  
     In Miami-Dade County, Hispanics comprise 57 percent of the 
population and 33 percent of cumulative AIDS cases. But the total 
number of Latino cases is more than double that of non-Hispanic 
whites, said Dr. Louis Miguel Garcia, surveillance specialist 
with the county Health Department.

LOUISIANA:
"HIV/AIDS Levels Remain Constant for Region"
Beauregard Daily News (11.03.03)::Timothy P. Bush
     According to Anthony James, a case manager for the Southwest 
Louisiana AIDS Council, HIV/AIDS levels in Region V are remaining 
constant, although cases have risen in other areas. Region V 
comprises five parishes - Allen, Calcasieu, Jefferson Davis, 
Beauregard and Cameron - which have a total of 930 cumulative HIV 
cases. Six of those are pediatric.
     As of June 2003, 311 people in Region V had died of AIDS, 
including one child. At present, 403 people in the area have HIV 
and 349 have AIDS. In DeRidder, 24 people have HIV and 45 have 
AIDS.
     James said actual numbers are probably higher because 
everyone infected does not get tested. James said the AIDS 
council gives assistance to people living with the virus and does 
prevention and education. Many still believe AIDS is a gay 
disease, according to James. "I don't know how many people come 
in saying 'I'm with my wife, so I don't have anything to worry 
about' and because of that they have a false sense of security," 
he said.
     While people with HIV/AIDS are living longer due to new 
medications, James stressed that these drugs are not a substitute 
for safe sex. "In order for medication to be effective, a person 
has to be 95 percent compliant in taking their medication," he 
said. "You can only miss once or twice for the medication to be 
effective. There isn't much room for error when it comes to HIV." 
He added that the best way for all people to protect themselves 
is to reduce their number of sexual partners and always practice 
safe sex. 

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                        NEWS BRIEFS
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SOUTH AFRICA: 
"German Foreign Minister Meets with South African AIDS Activists"
Associated Press (11.01.03)::Elliott Sylvester
     On Saturday in Cape Town, German Foreign Minister Joschka 
Fischer met with AIDS activists to discuss generic drugs and 
funding to combat the epidemic. "The minister understands well 
the urgency with which we need to approach the fight against 
AIDS," Treatment Action Campaign leader Zackie Achmat said after 
the meeting. "He was sympathetic to the fact that we need more 
funding." Achmat said the two also discussed German and European 
Union efforts to make generic drugs more affordable. Fischer, who 
is on a three-nation tour of Africa, praised South Africa for its 
largely peaceful transition from apartheid into a multiracial 
democracy, a process he likened to the unification of East and 
West Germany in 1990.

JAPAN:
"Fifty Thai Prostitutes Dying of AIDS Every Year in Japan: 
Report"
Agence France Presse (11.02.03)
     According to a report in the Nation newspaper on Sunday, 
Kasit Pirom, Thailand's ambassador to Japan, said that more than 
50 Thai women forced into prostitution in Japan die there each 
year from AIDS. So far this year, the embassy in Japan has sent 
back to Thailand the ashes of 50 Thai women, Kasit said. Every 
month, he said, the mission helps at least two women escape from 
brothels, and last week it was approached by a Thai woman with 
AIDS who asked officials to send her home to die. Many of the 
women from Thailand's impoverished north and northeast are 
tricked into prostitution. Some agreed to marry Japanese men but 
leave their husbands because of cultural difficulties and end up 
being harshly treated in brothels, said Kasit, who added that the 
women also live in fear of the yakuza, Japan's mafia, which 
controls the sex trade.  

NORWAY:
"Bill Clinton to Visit Norway, Discuss Global Efforts to Fight 
HIV/AIDS"
Associated Press (10.31.03)
     Former President Bill Clinton is scheduled to visit Oslo, 
Norway, Tuesday and meet with leaders about efforts to combat 
HIV/AIDS, the prime minister's office said Friday. While there, 
Clinton is to meet Prime Minister Kjell Magne Bondevik. On 
Wednesday, Clinton will meet Development Aid Minister Hilde 
Frafjord Johnson. Last week, Clinton said he secured a deal with 
four generic-drug companies to provide low-cost AIDS drugs for 
the developing world.  

DELAWARE: 
"Health Care Worker Has Tuberculosis"
News-Journal (11.03.03)::Mike Chalmers
     Delaware public health officials are monitoring a trainee at 
two Brandywine Hundred assisted-living facilities who has tested 
positive for tuberculosis. The employee, whose identity was not 
released, worked at Shipley Manor on Shipley Road and Foulk Manor 
South on Foulk Road, said Heidi Truschel-Light, spokesperson for 
the state Division of Public Health. Truschel-Light said it is 
unlikely the trainee infected patients and co-workers at the 
facilities because the trainee had limited duties and no close 
contact with others. The patient showed no coughing or other 
symptoms, officials said. The worker was diagnosed by a positive 
culture on Oct. 9 after an abnormal X-ray in July. The trainee is 
receiving treatment and last worked on Oct. 3. The division 
helped both facilities test their employees and residents, as 
well as the trainee's close contacts. 

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