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CDC HIV/STD/TB Prevention News Update
Wednesday, November 05, 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
SOUTH DAKOTA: "South Dakota Sees New Cases of Syphilis"
CALIFORNIA: "Law Aims to Boost Anti-HIV Medicine"
INTERNATIONAL NEWS
NORWAY: "Former President Clinton Seeks Support for AIDS Measures
from Norway"
SOUTH AFRICA: "Irish Priest First Person in South Africa to
Participate in Human Trials of HIV Vaccine "
MOZAMBIQUE: "Mozambique Struggling to Feed Growing Number of AIDS
Orphans"
AUSTRALIA: "Calls to Rethink Position on Male Circumcision"
MEDICAL NEWS
TEXAS: "Many Teen Girls Date More Than One Person at a Time"
LOCAL AND COMMUNITY NEWS
ILLINOIS: "Aldermen Lobby for AIDS Funding"
NEWS BRIEFS
WISCONSIN: "Students, Faculty Offered TB Tests"
OHIO: "20 New TB Cases Routine, School Safe, Officials Say"
SOUTH AFRICA: "Ministers Stay Away from AIDS Body's Launch"
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NATIONAL NEWS
************************************************************
SOUTH DAKOTA:
"South Dakota Sees New Cases of Syphilis"
Associated Press (11.04.03)
After a 10-year lull, South Dakota is seeing a rise in new
syphilis cases. Since June, five cases have been reported in the
southeastern portion of the state. Previously, the state had just
three cases in the last five years.
The state Department of Health is trying to contain the
disease by monitoring syphilis patients and following up with
their sex partners. But the department does not have a clear
explanation for the rise.
"We've been in a phase of having syphilis eradicated from
South Dakota in the last decade," said state epidemiologist Lon
Kightlinger. "When you have such low numbers for such a long
period of time, people just don't think about it." According to
Kightlinger, that could lead to complacency and an increase in
unprotected sex or sex with multiple partners.
"One of the scary things about syphilis is having syphilis
lesions makes you more susceptible to HIV, because the syphilis
lesion provides an easy entry point," noted Kightlinger.
Though the outbreak has not reached a point where a public
education campaign is necessary, the state has alerted physicians
to be on the lookout, said Kightlinger, adding that there had
been local transmission in the southeast, not just infections
brought in from outside the state.
Kate Looby, state director of Planned Parenthood, said she
is alarmed by the new cases. Planned Parenthood has been placing
signs with syphilis information in men's restrooms in Sioux Falls
bars and casinos since September. Looby said young men are the
group most at risk for contracting syphilis.
Looby believes more STD information is needed statewide. "It
would be hard for me to say that we're doing enough, because
we're continuing to see so many patients that have [STDs]," she
said.
In South Dakota, chlamydia is the most common STD with 2,215
cases last year. There were 263 cases of gonorrhea and 21 new HIV
infections in 2002.
CALIFORNIA:
"Law Aims to Boost Anti-HIV Medicine"
Sacramento Bee (11.02.03)::Jim Sanders
California Gov. Gray Davis recently signed into law AB 879,
a measure potentially bringing post-exposure prophylaxis to
people who have HIV risk for non-occupational reasons. PEP
typically involves the same types of drugs that are prescribed
for HIV/AIDS patients, but with the goal of preventing infection
after HIV exposure.
For years, PEP has been used in cases involving sexual
assault or accidental needle sticks to health care workers.
Doctors have not been prohibited from prescribing PEP for the
general public, but faced a dilemma: PEP must be started within
72 hours of exposure, but many doctors do not feel qualified to
prescribe it without consulting experts or making referrals, said
AIDS experts.
AB 879 mandates creating a state task force of up to 10
members to develop guidelines to help practitioners assess
patient HIV risk and whether to prescribe PEP. Guidelines will
cover issues such as how soon after exposure PEP should be
initiated, what medication is appropriate, how long pills should
be taken, what behavioral counseling should be recommended, and
what follow-up is needed.
PEP side effects can include headaches, diarrhea, fatigue,
vomiting and, in rare cases, liver or bone marrow problems.
California Medicaid and some private insurers - including Kaiser
Permanente and Blue Cross of California - already pay for PEP
treatment deemed necessary by a physician. The un- and under-
insured slip through the cracks, say advocates.
The push to increase PEP availability has some concerned
that it could increase risky behavior. Assemblymember Robert
Pacheco (R-Walnut) said he is sympathetic to using public funds
for PEP for occupational or rape cases, but not for those that
occur during sex, sharing needles or other intentional acts. But
Assemblymember Paul Koretz (D-West Hollywood), who proposed AB
879, pointed out that while PEP costs up to $1,700, this pales in
comparison with the estimated $195,000 cost of lifetime HIV
treatment. Two states - Rhode Island and Massachusetts - have PEP
guidelines for sexual exposure in the general population, Koretz
said. CDC neither recommends nor discourages PEP for non-
occupational exposures, according to AIDS experts.
************************************************************
INTERNATIONAL NEWS
************************************************************
NORWAY:
"Former President Clinton Seeks Support for AIDS Measures from
Norway"
Associated Press (11.04.03)::Doug Mellgren
On Tuesday, former President Bill Clinton, speaking in Oslo,
said terrorism and HIV/AIDS are both threats to world stability
and must be stopped. Clinton said if AIDS cases rise from 40
million to 100 million worldwide in the next decade, as
projected, the epidemic could cause massive political instability
and the collapse of democracies in places like former Soviet
republics and nations in the Caribbean.
"And it's crazy because this is 100 percent preventable," he
said.
Last month, Clinton announced that he had secured a deal
with four generic-drug manufacturers to provide low-cost AIDS
drugs to the developing world. In Oslo, Norwegian Prime Minister
Kjell Magne Bondevik said his country would cooperate with the
William J. Clinton Presidential Foundation in Tanzania and
Mozambique, where Norway already supports HIV/AIDS programs.
Norway will continue to channel support directly to those
countries, reaching $20 million to $25 million within five years.
Clinton said that when he left office, he decided to
campaign against AIDS as a global problem. "When I became
president in 1993, America had the biggest [AIDS] problem in the
world," he said. "Everybody has forgotten that. In my second
term, it became obvious to me that I had, in trying to deal with
it properly at home, not done enough abroad."
SOUTH AFRICA:
"Irish Priest First Person in South Africa to Participate in
Human Trials of HIV Vaccine "
Associated Press (11.04.03)::John Henry Boudreaux
On Tuesday, cameras flashed and film rolled as Kieran
Creagh, the first person to participate in a human HIV vaccine
trial in South Africa, rolled up his sleeve to show the injection
site. Creagh, a 41-year-old Irish priest from Belfast, Northern
Ireland, and medical staff shared a glass of champagne at the
Chris Hani Baragwanath hospital in Soweto. He is one of 24
volunteers who will be participating in South African clinical
safety trials of the potential vaccine.
Like many volunteers, Creagh knows people with HIV and was
moved to want to do something about the pandemic. "I was a bit
apprehensive the last few days... but reality set in," he said.
"This is a good thing to be a part of, so bring it on."
Creagh said the Catholic church's efforts against HIV,
including education and abstinence drives, have fallen short, and
he now believes that only medical research can provide a
solution. "I don't want the young people to suffer any more," he
said.
The vaccine, developed by researchers in the United States
and South Africa, contains parts of a weakened strain of
Venezuelan equine encephalitis and a harmless gene from the HIV
strain most prevalent in South Africa.
Creagh was asked to keep a daily record of his temperature,
any soreness and a general description of the injection site for
further research. He does not know if he received the drug or a
placebo.
MOZAMBIQUE:
"Mozambique Struggling to Feed Growing Number of AIDS Orphans"
Associated Press (11.05.03)::Elliott Sylvester
The plight of AIDS orphans has been a theme at two separate
AIDS conferences underway this week in Mozambique. One meeting,
organized by Metropolitan, a South African financial services
company, seeks to encourage public-private sector partnerships.
The other is considering ways to mitigate HIV's effects on
regional food production.
Battling food shortages and overwhelmed by HIV, the
government lacks the means to feed the growing number of AIDS
orphans. About 1.7 million of Mozambique's 17 million people are
infected with HIV, and some 400,000 children have been orphaned
by AIDS.
Extended families have traditionally cared for orphans in
Mozambique. But given the effects of AIDS and drought, many
families are unable to care for their own children, let alone
others. The cash-strapped government relies on international aid
from the World Food Program and UNICEF to feed its orphans, but
officials say they do not even have the means to determine how
many children need help. By 2010, UNICEF predicts the country
will be home to 1.2 million orphans, 926,000 the result of AIDS.
"If we do not stem the tide now, it will be nearly impossible to
feed these children in the future," said Atieno Odenyo, a UNICEF
officer in Maputo.
Natalie Simione runs Liberdade ("Freedom" in Portuguese),
where children receive three nutritious meals a day. Thirty-five
children, most of them AIDS orphans, share five bedrooms. Simione
said her group would not be able to keep going without the help
of WFP and other aid agencies. "We are barely surviving from day
to day with food aid to keep our children healthy," Simione said.
"We can't save them all, but we will do our best with the ones we
reach."
AUSTRALIA:
"Calls to Rethink Position on Male Circumcision"
Australian Associated Press (11.03.03)::Judy Skatssoon
On Monday, at the Fertility Society of Australia's Annual
Scientific Meeting in Perth, experts were told the nation needs
to rethink its opposition to male circumcision amid growing
evidence the practice offers significant health benefits for men
and women. Professor Roger Short of Melbourne University said
Australia has an "unduly negative" attitude toward male
circumcision, which recent studies showed protects men against
HIV and lowers the risk of cervical cancer in their female
partners. "Evidence shows male circumcision reduces by two- to
eight-fold a man's risk of becoming HIV-positive," Short said.
The reason for the findings is simple, Short said. "The main
site by which HIV enters the penis is through the inner aspect of
the foreskin, where there's no keratin covering which normally
keeps the virus out and there's a very high concentration of
cells with receptors for the virus that internalize it. If you
take the foreskin away you remove most of the receptor sites for
HIV so you drastically reduce risk."
Other studies, Short said, had shown that circumcised men
were less likely to be infected with human papillomavirus, which,
when transmitted to women, is responsible for 99 percent of
cervical cancer cases.
Circumcision should be considered as a cheap and effective
protective measure in places like Africa, where HIV is out of
control and there is little access to medicine, he said. "I
certainly wouldn't say every newborn baby boy ought to be
circumcised," Short said. "But now with this data showing there
is a major effect on female reproductive health even in developed
countries irrespective of the HIV scene, I really think we've got
to do a big rethink."
"Review of the literature in relation to risks and benefits
shows there is no evidence of benefit outweighing harm for
circumcision as a routine procedure," says a position paper from
the Royal Australasian College of Physicians.
************************************************************
MEDICAL NEWS
************************************************************
TEXAS:
"Many Teen Girls Date More Than One Person at a Time"
Reuters Health (10.22.03)::Alison McCook
About half of teenage girls have been in a "non-exclusive"
relationship, in which they and their partners could date other
people, according to a survey of 12- to 15-year-old girls. And
while having more partners can increase the risk of sexually
transmitted diseases, less than half of the girls who date more
than one person at a time said they had sex in the outside
relationships, say the authors of the report.
Study author Dr. Mary Short, of the University of Texas
Medical Branch Children's Hospital-Galveston, and colleagues
surveyed 160 girls about their romantic relationships once every
six months for three years. A total of 72 girls (45 percent) said
they had been in a relationship in which they and their partner
could date other people. Twenty-three girls said they had had sex
in that outside relationship.
The investigators found that girls who were younger and
believed their boyfriends were dating other people were more
likely to have an outside relationship. Furthermore, girls who
said their parents did not always know their whereabouts were
more likely to be in a non-exclusive relationship, while girls
who spent a lot of time without adult supervision were more
likely to have sex in their outside relationships.
These results suggest that parental monitoring of kids'
activities - through communication and supervision - "is just a
good thing," said Short. "Parents need to talk to their children,
set developmentally appropriate limits, and know their children's
- and teens' - friends, activities, reading materials, and TV and
movie watching habits," added Short.
Being in a non-exclusive relationship may not necessarily be
a bad thing, Short noted. Relationships help people learn about
themselves and how to relate to others, and the more
relationships one has, the more one may learn, wrote the authors.
However, Short cautioned, "We are not encouraging adolescents to
cheat, even if it happens. It is better to have one boyfriend at
a time or to be dating than to be having outside relationships."
The study, "Non-Exclusivity in Adolescent Girls' Romantic
Relationships," was published in the journal Sexually Transmitted
Diseases (2003;30(10):752-755).
************************************************************
LOCAL AND COMMUNITY NEWS
************************************************************
ILLINOIS:
"Aldermen Lobby for AIDS Funding"
Chicago Tribune (11.04.03)::Jimmy Greenfield
A majority of Chicago aldermen are prepared to back a
proposed amendment that would add an additional $1 million to the
$3.7 million already earmarked in the 2004 city budget for AIDS
prevention and care. On Wednesday, Ald. Thomas Tunney (44th) plans
to introduce the amendment at the Chicago City Council meeting
with the support of 27 of the city's 50 aldermen.
Mayor Daley has asked for an increase of $100,000 over the
$3.7 million designated in last year's budget to fight HIV/AIDS.
City funding is down from $3.9 million in 1997, though the number
of new AIDS cases has remained stable at about 1,000 per year.
"I do certainly respect what the budget office has to deal
with and what the mayor's priorities are," said Tunney, whose
ward has the city's largest gay and bisexual population. "But I
also think the mayor has told the aldermen, 'You do what's best
for your community and you fight for the issue that's important
to your community.' This is a priority for my community," Tunney
explained.
Tunney said other strong supporters of the amendment include
Alds. Ed Smith (28th) and Walter Burnett (27th), whose wards are
predominantly African-American. According to the AIDS Foundation
of Chicago, the rate of AIDS infection is most prevalent among
African Americans, who make up 61 percent of recently diagnosed
AIDS cases in the city.
"It's just imperative that we reach out to all parts of the
city to really educate people on prevention," added Tunney.
David Munar, associate director of AFC, said that if the
additional $1 million is approved, a lot of credit will go to
Tunney, the council's only openly gay alderman. "Tunney has a
long history [working] with this epidemic, and he's seen it in
its worst times," said Munar.
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NEWS BRIEFS
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WISCONSIN:
"Students, Faculty Offered TB Tests"
Milwaukee Journal Sentinel (11.04.03)::Scott Williams
Students and faculty at Waukesha County Technical College
are being offered free TB tests following the news that a female
student was diagnosed with the disease. The student is
recuperating at home and doing well. Health officials said there
is no reason to believe anyone has been infected through casual
contact with the student. Officials said they found no connection
between the student and a Marquette University professor reported
last week to have contracted tuberculosis. Wisconsin reported 78
TB cases last year.
OHIO:
"20 New TB Cases Routine, School Safe, Officials Say"
Plain Dealer (11.05.03)::Amanda Garrett
Cuyahoga County health officials said Tuesday that 11 of 142
adults and nine of 471 students tested positive for tuberculosis
at Marion-Sterling Elementary School in Cleveland, but that the
building is safe and that children should be in school. Of those
testing positive, four had been previously diagnosed with TB,
while the test results of four others are in dispute. Having a
positive skin test does not mean that a person has active TB.
Those testing positive have the option of being treated with oral
antibiotics. Officials discovered the school cases last month
while investigating how someone connected with the school
contracted TB. In a separate TB investigation underway following
the death of a chaplain at St. Michael Hospital, tests of more
than 300 workers and 15 patients have revealed no additional
cases. Cuyahoga County has seen no surge in TB, said Dr. Richard
J. Blinkhorn Jr., director of the county Tuberculosis Clinic.
There were 71 TB cases last year, 67 in 2001 and 86 in 2000. The
county estimates there will be 60 cases this year, said
Blinkhorn.
SOUTH AFRICA:
"Ministers Stay Away from AIDS Body's Launch"
allAfrica.com (11.04.03)::Business Day
Just two of the 10 cabinet ministers nominated to serve on
the newly reconstituted South African National AIDS Council
attended last weekend's inaugural council meeting, surprising
some who expected more symbolic support from the cabinet's senior
members. Deputy President Jacob Zuma, who is the chair, and
Education Minister Kader Asmal attended the first meeting, a
source said. Health Minister Manto Tshabalala-Msimang, Labor
Minister Membathisi Mdladlana, Correctional Services Minister Ben
Skosana, Agricultural Minister Thoko Didiza, Public Service
Minister Geraldine Fraser-Moleketi, Arts and Culture Minister Ben
Ngubane, Transport Minister Dullah Omar, and Social Development
Minister Zola Skweyiya are members of the council. Omar is on
sick leave. While New National Party health spokesperson Kobus
Gous was pleased there were no high-profile HIV/AIDS dissidents
on the council, he was concerned that no high-profile AIDS
scientists had been appointed to it.
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