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CDC HIV/STD/TB Prevention News Update
Thursday, November 13, 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
CALIFORNIA: "Experimental AIDS Vaccine Fails Major Test in
Thailand"
ALABAMA: "Bisexuality, Abuse, Drugs Behind AIDS Spread Among
South's Rural Blacks, Researcher Says"
INTERNATIONAL NEWS
CONGO: "Cycle of War Is Spreading AIDS and Fear in Africa"
BOTSWANA: "Botswana's Brain Drain Cripples War on AIDS"
INDIA: "India's AIDS Epidemic Could Grow to African Levels:
Activists"
SWAZILAND: "Illegal Immigrants Replace Workforce Decimated by
AIDS"
MEDICAL NEWS
UNITED STATES: "Cost Comparison of Three HIV Counseling and
Testing Technologies"
LOCAL AND COMMUNITY NEWS
NEW YORK: "Central Harlem-Morningside Heights HIV/AIDS Rates
Surge to Highest in NYC"
NEWS BRIEFS
AFRICA: "Central African Region Adopts AIDS Plan"
CHINA: "AIDS Research Center Opens in Beijing"
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NATIONAL NEWS
************************************************************
CALIFORNIA:
"Experimental AIDS Vaccine Fails Major Test in Thailand"
Associated Press (11.12.03)::Paul Elias
The Brisbane, Calif.-based based biotechnology company
VaxGen announced Wednesday that a trial of its AIDS vaccine in
2,546 participants in Thailand had failed. The poor results were
widely anticipated after the company announced in February that a
much larger trial of its vaccine had failed in North America.
VaxGen's AIDS vaccine contained small, man-made genetic bits of
the virus that scientists had hoped would provoke an immune
response strong enough to stop the virus from invading healthy
cells.
Three years ago, the company enrolled 2,546 people in and
around Bangkok who injected drugs and were considered high-risk
because of their needle-sharing habits. Half were given the
experimental vaccine and half were given a placebo. All
volunteers were given extensive risk-reduction counseling, VaxGen
said.
In the end, 105 people given the placebo became infected
with HIV and 106 people given the vaccine tested positive.
Most AIDS researchers agree that vaccines will be the only
way to control the pandemic that has killed 28 million people and
infected 42 million more.
"The outcome of this trial is one more reminder of how
difficult it is to combat HIV and how important it is for the
international public health community to redouble the effort to
develop an effective vaccine," said Dr. Donald Francis, VaxGen's
president.
Now that VaxGen's vaccine has failed, attention has turned
to the two dozen other experimental vaccines being tested on
12,000 human volunteers in trials worldwide. None of those is now
at as advanced a stage as VaxGen's candidate had been, and any
successful candidate is years away.
ALABAMA:
"Bisexuality, Abuse, Drugs Behind AIDS Spread Among South's Rural
Blacks, Researcher Says"
Associated Press (11.09.03)::Jay Reeves
Bisexuality, abuse of women and drugs and an environment of
oppressive need are among factors underlying the faster rate of
contracting HIV among rural Southern blacks compared with whites,
according to research based on hundreds of clinical interviews
conducted over a decade by a University of Alabama scientist.
"Poverty is the driving force," said Bronwen Lichtenstein, the UA
researcher and member of the governor's AIDS commission.
Most AIDS educators said the findings mirrored what they see
going on in areas like Alabama's fertile Black Belt farming
region, where Lichtenstein performed much of her research.
While Lichtenstein's work showed homosexuality even less
accepted among blacks than whites, some rural men are having sex
with men, whether for pleasure, cash or drugs. The same men are
often in sexual relationships with women, sometimes several at
one time, who usually have no idea their partner is bisexual or
infected.
"Some men know they have [HIV]; some don't," said
Lichtenstein. "But the women feel very victimized." Lichtenstein
interviewed about 55 black women with HIV at Montgomery AIDS
Outreach Center.
Men prone to transmitting HIV were often physically abusive,
the research showed, and many were involved in the drug trade.
But even with these problems, such men are able to maintain their
relationships with women who fear being left without a
breadwinner, sending them deeper into poverty, according to the
research.
However, AIDS in Minorities Executive Director Tony Morris
said Lichtenstein may be overestimating the role of bisexuality
in spreading AIDS in rural areas. "I think 100 percent of it is
linked to drug use or the drug trade," said Morris.
The problems Lichtenstein uncovered during her research also
make it hard for health workers to peel away layers of secrecy
and get at the root causes of transmission.
Despite comprising only one-quarter of the population, about
60 percent of Alabama AIDS patients are black men (46 percent)
and women (14 percent).
************************************************************
INTERNATIONAL NEWS
************************************************************
CONGO:
"Cycle of War Is Spreading AIDS and Fear in Africa"
Washington Post (11.13.03)::Emily Wax
Africa's cycle of war is spreading HIV. In Congo, about 5
percent of the population was infected before the recent war.
Now, in the eastern parts of the country that have suffered the
most during fighting, 20 percent of the population is estimated
to be HIV-infected, according to the UN AIDS program in Kinshasa
and the government's Health Ministry.
As the Congolese Rally for Democracy, the country's largest
rebel group, fought other rebel groups in the dense jungle,
reports that a great many women were being raped by fighters
streamed in this fall from hospitals, church health clinics and
traditional healers. Of those women who came to hospitals for
treatment, about half were HIV-positive.
Workers with the aid group Population Services
International, recounting a session held last summer in which
they showed about 30 teenage fighters unnerving photos of young
people wracked with HIV/AIDS, said they knew they did not have an
attentive audience. "It's hard to convince an unpaid fighter to
wear a condom knowing they are going to go out and rape someone.
It's hard to change that sort of mind-set," said Dieudonne
Ziriane of the Bukavu-based group.
Congo's war has been particularly conducive to the spread of
HIV/AIDS. At times, more than five neighboring armies were drawn
in and fighters brought soaring rates of HIV along with them.
Nearly a quarter of Ugandan soldiers who invaded Congo over four
years ago and backed rebel proxy fighters tested positive for
HIV, a US Agency for International Development study said.
Rape is not the only reason for high HIV levels in the
military. Prostitutes are often drawn to soldiers to make money
in desperately poor war economies, and casual liaisons are common
among soldiers away from home for lengthy periods.
Last month, Doctors Without Borders began treating 10
patients in eastern Congo with AIDS drugs. Since Congo has no
functioning government, the group brought in low-cost generic
drugs that other African governments have rejected. The
initiative marks the first time that an aid group has dispensed
antiretrovirals in Congo, where the fighting has not stopped,
although a fragile peace plan is in effect. DWB hopes to have 150
patients in treatment by January 2005.
BOTSWANA:
"Botswana's Brain Drain Cripples War on AIDS"
New York Times (11.13.03)::Celia W. Dugger
Yesterday at a conference in Washington, Botswana's
president, Festus G. Mogae, told delegates that one of his
country's biggest obstacles to rapidly expanding HIV/AIDS
treatment is a dearth of doctors, nurses, pharmacists and other
health workers. He said nonprofit groups, foreign governments and
international organizations that have come to help Botswana cope
with its HIV/AIDS crisis have hired many skilled professionals
away from the public health system with offers of better pay and
benefits. Doctors and nurses leaving for other countries, he
added, compounded the internal brain drain. The shortage of
people and a slower-than-expected pace at building clinics,
laboratories and drug warehouses have impeded the expansion of
Botswana's AIDS program.
Two years ago, the well-run nation began an effort to
provide free antiretroviral therapy to its estimated 110,000
HIV/AIDS patients. So far, only about 10,000 people have accessed
the treatment. Botswana pays for 70 percent of the program with
donations of $50 million each from the Merck Company Foundation
and the Bill and Melinda Gates Foundation.
Dr. Ernest Dakoh, operational manager of the treatment
effort, said the loss of skilled people to the government's
private partners is a serious problem. Mogae said Botswana is
seeking to counter the loss by recruiting health professionals
from poorer African countries - which have their own AIDS crises
- and from India and Cuba.
Mogae spoke at a daylong conference convened to reflect on
the lessons of Botswana, sponsored by the Center for Strategic
and International Studies. Senate Majority Leader Bill Frist
introduced Mogae and praised him for his outspoken leadership. He
also noted Mogae's decision to publicly announce he had been
tested for HIV.
The Bush administration has committed to a five-year, $15
billion AIDS plan for Africa and the Caribbean, more than half of
it for drug treatment. Congress is expected to appropriate about
$2 billion this year.
INDIA:
"India's AIDS Epidemic Could Grow to African Levels: Activists"
Agence France Presse (11.13.03)::Uttara Choudhury
A study funded by the Bill and Melinda Gates Foundation,
released today, says India could face an AIDS epidemic similar to
the one in Africa. The report cited figures from the Indian
National AIDS Control Organization, which counted 4.58 million
Indians with HIV/AIDS at the end of 2002, compared to 3.97
million in 2001.
"HIV/AIDS is now spreading to the general populace in India
and if knowledge of the disease, preventive measures and
counseling is not made universal then India could see an epidemic
similar to that of some of the African countries," said a release
by the Washington-based Population Reference Bureau, which co-
authored the study with the Population Foundation of India.
India, with more than a billion people, has the second
highest number of HIV/AIDS cases after South Africa, which has 5
million infected people in a 42 million population.
Study co-author A.R. Nanda, who heads the PFI, said the
problem would have been worse had the Indian government not
addressed the issue as soon as its first AIDS case was diagnosed
in Madras in 1986. "But the trends still indicate the need to
remove the social stigma currently associated with HIV/AIDS and
ramp up efforts to fight the disease," Nanda said. He pointed out
that rural villagers display "colossal ignorance," about
HIV/AIDS.
"Three out of four rural women living in the populated
states of Bihar, Gujarat and Uttar Pradesh said they had never
heard of HIV/AIDS," he said. "And three out of 10 men were not
aware of the condom's protective value."
The study said 90 percent of urban people have heard of
HIV/AIDS, but only 72 percent of rural people have. At least 85
percent of India's population lives in villages and small towns.
SWAZILAND:
"Illegal Immigrants Replace Workforce Decimated by AIDS"
Inter Press Service News Agency (11.10.03)::James Hall
Recently, Swaziland has been inundated with a flow of mostly
illegal immigrants from neighboring Mozambique. Swazi authorities
are tolerant toward the influx of undocumented workers, although
many Swazis are upset.
With AIDS decimating the workforce in Swaziland, and many
Swazis reluctant to do menial work, poor Mozambicans see
opportunity across the border. Up to 40 percent of Swaziland's
adult population is HIV-positive.
"Where are the factories going to get laborers? Where are
businesses going to find staff? Unemployment is high and
opportunities are limited, so the young educated class of Swazis
goes to South Africa.... The less educated are being decimated by
AIDS," said an official with the Swaziland Chamber of Commerce
and Industry.
In Manzini, Swaziland's most populous urban center,
Mozambican immigrants sell sweets, combs and other items at the
city's central bus stop. Some Manzini residents show their
dissatisfaction with the Mozambican influx through vigilante
activity. In the crowded bus stop, people suspected of stealing
are set upon by an instant mob brandishing axe handles. The mob
beats the accused then marches him or her to the police station.
Barring actual evidence of a crime, police hold suspects for a
few hours, then release them to get medical attention.
Because of the rise in vigilantism, police patrol the
Manzini bus stop in greater numbers. They intervene when a mob
finds a suspected criminal, and take the suspect away before the
crowd gets violent.
The Swaziland Action Group Against Abuse, a nongovernmental
organization that provides counseling and medical and legal
assistance to abuse survivors, said Mozambicans make up a small
minority of reported abusers.
Although Mozambique has one of the highest economic growth
rates in Africa, it is currently the world's poorest country
following two decades of civil war and post-war instability.
************************************************************
MEDICAL NEWS
************************************************************
UNITED STATES:
"Cost Comparison of Three HIV Counseling and Testing
Technologies"
American Journal of Preventive Medicine (08.03) Vol. 25; No. 2:
P.112-121::Donatus U. Ekwueme, PhD; Steven D. Pinkerton, PhD;
David R. Holtgrave, PhD; Bernard M. Branson, MD
The current study examines and compares the economic costs
of three HIV testing protocols at publicly funded HIV counseling
and testing clinics. Of the approximately 2.3 million HIV
antibody tests conducted in both 1997 and 1998, an average of 35
percent of HIV-positive clients and 42 percent of HIV-negative
patients did not return for their test results, which can take up
to two weeks with standard tests. New rapid antibody tests can be
done in 30 minutes or less, and give clients preliminary or
confirmed same-day results.
"Rapid HIV antibody tests have an indispensable role to play
in the national effort to increase the number of clients who
learn their HIV serostatus as early as possible," the researchers
wrote, and receive appropriate post-test counseling. "These tests
have been recognized as an important component of an overall
strategy to achieve the national HIV strategic objective of
reducing the annual number of new HIV infections to 20,000 by the
year 2005 and have been highlighted by US agencies such as the
Centers for Disease Control and Prevention (CDC)."
In the United States, only two rapid tests - both requiring
a two-step protocol - are licensed by FDA: the Single Use
Diagnostic System (SUDS) for HIV-1 manufactured by Abbott/Murex
and the OraQuick rapid HIV antibody test, manufactured by OraSure
Technologies Inc. In the two-step process, blood specimens
repeatedly reactive for HIV antibody on the rapid screening test
are sent to a lab for a confirmatory Western blot test, so the
client must return for a second visit to receive the confirmed
result. Clients who test negative receive their results on the
same day, without further testing. In the one-step rapid protocol
recommended by WHO, a combination of two or three additional
rapid assays is used to confirm an initial reactive result,
giving the client all test results on the same day.
Rapid tests have been shown to increase the acceptability of
HIV testing and to increase the number of persons who learn their
HIV status. However, "no study has systematically analyzed the
costs of these newer technologies compared with the standard
protocol," the researchers noted. They developed a cost-analysis
model to calculate the intervention costs associated with
providing HIV counseling and testing (CT) services with each of
the three protocols: standard CT, two-step and one-step rapid
test.
All three protocols include client registration, pre-test
counseling, risk assessment, discussion of testing, informed
consent, and blood draw.
"The one-step protocol - where combinations of rapid tests
are used to provide a definitive HIV tests result - was
consistently the least expensive of the three protocols," the
authors concluded. "In particular, the one-step rapid protocol
was substantially less costly per HIV-positive person tested
because it required neither follow-up clinic visits nor use of
the expensive Western blot confirmatory assay."
"The comparison between the standard protocol and the two-
step rapid protocol," they continued, "indicated that the
standard protocol costs less per HIV-positive client who receives
his or her test results, but costs more than the two-step
protocol per HIV-negative client. For most publicly funded
testing programs in the United States, where more than 98% of
clients test negative, the two-step rapid protocol would be less
expensive than the standard algorithm. This is because the lower
cost of the rapid protocol for the large number of HIV-negative
clients more than offsets its higher cost for the small number of
HIV-positive clients."
************************************************************
LOCAL AND COMMUNITY NEWS
************************************************************
NEW YORK:
"Central Harlem-Morningside Heights HIV/AIDS Rates Surge to
Highest in NYC"
Columbia Spectator (11.05.03)::Josie Swindler
A report from New York City's Department of Health and
Mental Hygiene shows that the combined neighborhoods of
Morningside Heights and Central Harlem have the highest HIV rates
of 42 neighborhoods surveyed throughout the city's five boroughs.
Two percent of those neighborhoods' populations have HIV, with
infection rates disproportionately high among African Americans,
Hispanics and those who have been in jail.
New York is the most HIV-infected state in the United
States, with 20 percent of the nation's HIV cases and AIDS
deaths, according to CDC. New York City is the state's most
infected city, Manhattan the most infected borough.
Health experts caution, however, that circumstances are
different in Morningside Heights and Central Harlem. "It's
important to understand that the aggregation of data from
Morningside Heights and Central Harlem, two qualitatively
different areas, distorts the true dynamic," said Beverly
Watkins, an assistant professor of clinical public health at
Columbia University.
Central Harlem is home to large African-American and
Hispanic populations, both groups statistically more likely to
contract HIV. Watkins said that large numbers of black and
Hispanic men have passed through the state's prison system, which
has 25 percent of the nation's inmates with HIV/AIDS.
Cassandra Ritas, a policy analyst with the Harlem Urban
Research Center, said, "[Early] prevention messages were directed
to a white and gay audience. Those prevention messages are just
now beginning to be translated into cultural terms."
The Chelsea-Clinton neighborhood - last year's HIV leader -
ranked closely behind Morningside Heights-Central Harlem in its
infection rate, yet its death rate was barely a third that of
Morningside Heights-Central Harlem. "Understanding health
disparities is perhaps the greatest challenge facing the field of
public health in the 21st century," Watkins said.
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NEWS BRIEFS
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AFRICA:
"Central African Region Adopts AIDS Plan"
Agence France Presse (11.13.03)
According to a communiqué issued late Wednesday, 11 central
African countries have adopted a $3.7 million joint action plan
to fight AIDS, which kills more than 400,000 people in the region
annually. The two-year program will coordinate national AIDS
programs with funds from the Central African Economic and
Monetary Union and international donors. The plan was agreed to
at a meeting of CEEAC in Brazzaville, Congo. UNAIDS chief Peter
Piot sent a message to the meeting urging health ministers to
"widen the response against AIDS to all levels of society, to
increase budgets devoted to the fight against the pandemic, and
to strengthen policies and good governance."
CHINA:
"AIDS Research Center Opens in Beijing"
Xinhua News Agency (11.13.03)
The Chinese Academy of Medical Sciences and the Beijing
Union Medical College opened an AIDS research center Tuesday in
Beijing. Former President Bill Clinton, on hand for the event,
called the center's opening an important step in AIDS prevention,
control and research. Gao Quiang, executive vice minister of
public health, expressed hope that the center would work closely
with international research agencies. The academy and the college
have become crucial sites for the treatment of AIDS patients.
Professor Wang Aixia of the college diagnosed China's first AIDS
patient in 1985.
************************************************************
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