[CDC News] CDC HIV/STD/TB Prevention News Update 11/19/03

CDC HIV/STD/TB Prevention News Update
Wednesday, November 19, 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. The following summaries were 
prepared without conducting any additional research or 
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being summarized, and therefore readers are expressly cautioned 
against relying on the validity or invalidity of any statements 
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abstracted below for full texts of the articles.

HEADLINES

NATIONAL NEWS
CONNECTICUT: "Chlamydia Most Common STD Among State's 15- to 19-
Year-Olds"
NEW JERSEY: "Syringe Study Generates Hope; Children's Home 
Officials Want News About Needle Sharing, HIV and Hepatitis C to 
Spark Action"

INTERNATIONAL NEWS
ARGENTINA: "World Bank Report: Latin America at Risk for Greater 
Spread of HIV/AIDS"
CANADA: "861 Men Given Unsterilized Biopsy Probes: Ontario 
Reports Second Hygiene Breach in 3 Weeks"

MEDICAL NEWS
UNITED KINGDOM: "Human Papillomavirus: Scientists Announce 
Vaccine Hope"
UNITED STATES: "Risky-Sex Study OKs Antibiotic Use"

LOCAL AND COMMUNITY NEWS
CALIFORNIA: "Volume Rising in Needle Exchange Debate"
GEORGIA: "Organization Started by University of Georgia Alums 
Aims to Help Children"

NEWS BRIEFS
UNITED STATES: "FDA Fast Tracks Biosyn Gel Product"
BRAZIL: "Brazil Closes Second Deal This Month for AIDS Drug 
Discount, Two More Under Negotiation"
SOUTH AFRICA: "South Africa Approves Mass HIV/AIDS Drug 
Treatment"
INDIA: "Former US President Clinton to Visit India This Week"

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                         NATIONAL NEWS
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CONNECTICUT:
"Chlamydia Most Common STD Among State's 15- to 19-Year-Olds"
Stamford Advocate (11.15.03)::Alison Damast
     Chlamydia is the most common sexually transmitted disease 
among Connecticut 15- to 19-year-olds, affecting about 10,000 
people in 2002, according to the Connecticut Sexually Transmitted 
Diseases Control Program (CSTDCP). There are likely more cases 
than the 8,000 females and 2,000 males reported last year, but 
many people do not get tested, skewing the data, said Heidi 
Jenkins, CSTDCP director.
     Last year, chlamydia levels peaked in Stamford and Norwalk, 
with about 300 and 244 cases reported respectively, according to 
CSTDCP. In 2003, Norwalk's cases have leveled off, with only 190 
cases reported so far, said Jenkins.
     At a recent conference on adolescent health hosted by the 
Norwalk-based social services agency Human Services Council, Mary 
Barrett, chief clinician with the Norwalk High School-based 
Health Centers, reported, "The pervasive attitude is it won't 
happen to me." The council's health clinics at Brien McMahon, 
Norwalk and Briggs public high schools reported 10 chlamydia 
cases this fall.
     According to Jenkins, many adolescents are having 
unprotected sex, and they are often dishonest about their sexual 
activity with medical practitioners. "You can have an adolescent 
tell you 'I'm a virgin,' while they continue to have oral sex and 
reckless sex," said Jenkins. 
     Carla Gisolfi, director of the Dr. Robert E. Appleby School-
based Health Centers, noted that a major hurdle many of her 
colleagues face is that they are not allowed to give out condoms 
or dispense birth control to students. 
     Other STD rates have also risen recently in Connecticut. 
Over the past year, there has been a slight increase in gonorrhea 
cases reported, and the number of reported syphilis cases 
increased sharply among men having sex with men. Jenkins noted 
that gonorrhea has become most prevalent among the 15- to 19-
year-old age group and the 20- to 24-year-old age group.

NEW JERSEY:
"Syringe Study Generates Hope; Children's Home Officials Want 
News About Needle Sharing, HIV and Hepatitis C to Spark Action"
Philadelphia Inquirer (11.19.03)::Dwight Ott
     A report issued yesterday in Trenton states that the sharing 
of contaminated syringes by drug addicts is the leading cause of 
HIV and hepatitis C infections in New Jersey. Needle exchange 
advocates hope the study will help pass a bill currently before 
the state Assembly to increase addicts' access to syringes. 
     The study, commissioned by the advocacy group New Jersey 
Drug Policy Project-Drug Policy Alliance, indicates that 46 
percent of HIV infections in the state are related to IV drug 
use. Nationally, that figure is only about 25 percent, said the 
report. 
     According to the report, New Jersey is almost alone among 
states that allow absolutely no access to clean syringes. It is 
one of just five states that ban the sale of sterile syringes to 
adults without a prescription. 
     Officials at Dooley House, a transitional home for children 
who are HIV-infected, drug-addicted or frail, said they have 
dealt with the fallout from this situation, handling hundreds of 
HIV-infected babies over the last 15 years. "I'm sure a lot of 
the parents infected wouldn't have been infected had they not 
been using dirty needles," said Emory Troy, president and 
cofounder of Dooley House. 
     The study noted that New Jersey has the fifth-highest adult 
HIV rate, the third-highest pediatric AIDS rate, and the highest 
percentage of women infected with HIV in the United States. 
     The bill, sponsored by Assemblymember Reed Gusciora (D-
Mercer), would allow for increased access to sterile syringes to 
prevent the transmission of HIV, HCV and other blood-borne 
diseases. The proposed legislation would also permit the sale of 
syringes in pharmacies without a prescription and enable 
municipalities and public health providers to incorporate needle 
exchange programs into their HIV prevention programs. 
     Camden City Council recently passed a resolution supporting 
the legislation. Jersey City and Newark have also passed 
resolutions supporting the bill. 

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                     INTERNATIONAL NEWS
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ARGENTINA:
"World Bank Report: Latin America at Risk for Greater Spread of 
HIV/AIDS"
Associated Press (11.18.03)::Alexa Stanard
     While Latin American countries have increased their AIDS-
fighting efforts, these measures are hindered by inadequate 
resources and reporting, poor health care and prejudice, 
according to a World Bank report issued Tuesday.
     According to "HIV/AIDS in Latin American Countries: The 
Challenges Ahead" - which comprises the results of a 2001 survey 
of health workers, governments and organizations in 17 countries 
in the region - 0.5 percent of those ages 15-49 are HIV-infected. 
But under-reporting is so common that the region probably has 30 
percent more AIDS cases and 40 percent more HIV cases than the 
statistics show. 
     Except in Honduras and southeastern Brazil, where HIV has 
reached the general population, infections in the region remain 
concentrated in high-risk groups, such as prisoners, IV drug 
users, sex workers and men who have sex with men. Heterosexual 
sex is the main mode of transmission in southern Brazil and 
Central America. Sex between men is the main transmission mode in 
South America. IV drug use plays a significant role in Argentina, 
Uruguay, Paraguay and Chile. Only Argentina reported IV drug use 
as the main avenue of transmission, accounting for 41 percent of 
cases. 
     In all the countries, more men than women live with AIDS. 
But that gap is closing, thanks to earlier age of first 
intercourse and violence against women. Nine of the nations 
studied lack even a single anonymous testing center. Only Brazil 
provides locally produced antiretrovirals for patients. 
     The authors called for greater cooperation between 
governments and nongovernmental organizations, and they said 
civil organizations should work more closely with high-risk 
groups to prevent HIV from spreading into the general population.

CANADA:
"861 Men Given Unsterilized Biopsy Probes: Ontario Reports Second 
Hygiene Breach in 3 Weeks"
Edmonton Journal (11.18.03)::National Post
     Toronto's Sunnybrook Hospital is urging other hospitals 
across the country to review infection-control procedures after 
an internal audit revealed that 861 men with prostate cancer had 
been exposed to an unsterilized biopsy probe since 1999.
     Hospital officials blamed the men's potential exposure to 
HIV and hepatitis B and C on complex manufacturer's instructions 
for a tool used to take prostate tissue samples. The long, thin 
probe is covered in a rubber sheath and inserted in the rectum. A 
small needle is inserted into the prostate to collect a tissue 
sample that can be tested for cancer cells. The potential 
exposure occurred where the needle pierces the rubber sheath, 
said Dr. Bob Lester, Sunnybrook's vice president of medical and 
academic affairs. The hospital sent letters to men who underwent 
the procedure, offering blood testing at home, at work or at the 
hospital.  
     The incident is the second involving unsterilized medical 
equipment in Ontario hospitals in the last three weeks. A 
hospital in Oshawa is facing two lawsuits worth $81 million (US 
$62.1 million) after throat and colon scopes were cleaned but not 
disinfected. 
     A lawyer working on the Oshawa hospital lawsuits said a 
class-action claim by some or all of the 861 men treated at 
Sunnybrook is likely. Sunnybrook admitted it had not been 
sterilizing the half-dozen biopsy tools since it first began 
using them in December 1999. 
     "The people using the equipment did not understand [the 
instructions] and even I, looking at it now, can see why it would 
be easy to misinterpret," said Dr. Andrew Simor, head of 
microbiology.
     BK Medical of Wilmington, Mass., the manufacturer of the 
probe, did not return calls to answer allegations that the 
equipment's instructions were too complex. 
     Leo Steven, president and CEO of Sunnybrook, emphasized that 
the risk of infection is low: one in 100,000. Ontario Health 
Minister George Smitherman has ordered every hospital in the 
province to conduct an infection-control audit and report the 
results by January.

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                      MEDICAL NEWS
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UNITED KINGDOM:
"Human Papillomavirus: Scientists Announce Vaccine Hope"
Women's Health Weekly (10.02.03)
     Scientists at Cancer Research UK's Paterson Institute, in 
collaboration with doctors at St. Mary's Hospital, tested a 
vaccine, TA-HPV, and found that it shrank lesions in almost half 
of women with a precancerous disease of the vulva. The scientists 
believe the results of their study will help in the search for 
vaccines against vulval and cervical cancer, both strongly 
associated with HPV infection, although they caution that it is 
too early to know how effective TA-HPV will be.
     Eighteen women with vulval intraepithelial neoplasia (VIN), 
a condition in which precancerous lesions appear on the lining of 
the vulva and are difficult to treat, took TA-HPV, a modified 
version of the smallpox vaccine. The researchers monitored the 
vaccine's effect on the size of the women's lesions and conducted 
tests to assess whether the vaccine was stimulating an immune 
response.
     Thirteen of the 18 women developed a specific immune 
reaction to HPV following vaccination. In eight of the patients, 
the diameter of the lesions shrank by at least 50 percent. 
Another four patients experienced significant symptom relief. 
The study marks the first time scientists have used vaccines to 
produce clinical and immunological responses in women with VIN.
    Professor Peter Stern, lead researcher, said, "Our results 
were encouraging, with more than half the women in the trial 
gaining some clinical benefit, although I think vaccines will 
prove most useful as part of a combination of treatments. The big 
advantage vaccines have is that they are relatively free of side 
effects and have far less impact on a woman's quality of life 
than surgery, which is currently one of the mainstays of 
treatment for this condition."   
     Scientists believe vaccines may be particularly useful in 
women whose bodies have already begun to generate an immune 
response against HPV. In this study, women with high levels of 
immune cells within their lesions before vaccination were 
significantly more likely to respond to treatment than women with 
low levels.
     "The suggestion is that vaccines work better in some 
patients than others because there is a need for active immune 
cells or their products in the vicinity of a lesion. It could be 
that we'll need to test women beforehand, to identify a group who 
are most likely to benefit from vaccination," said Stern.
     "It's also possible that repeated vaccination may build up 
the immune response against cancer, in which case it might be 
necessary to give women a number of shots of vaccine during a 
course of treatment," Stern explained.
     Stern and colleagues are currently testing the effect of 
repeat vaccination in ongoing clinical trials.
     Dr. John Toy, medical director of Cancer Research UK, said, 
"There are two kinds of cancer vaccines being investigated at the 
moment: prevention vaccines, to try to stop the disease from 
developing in the first place, and treatment vaccines, like this 
one. In the future it's likely that vaccines will play an 
important role in helping us control certain cancers, 
particularly those like vulval and cervical cancer which are 
associated with persistent HPV infection," Toy said.
     The study, "Immunological and Clinical Responses in Women 
with Vulval Intraepithelial Neoplasia Vaccinated with a Vaccinia 
Virus Encoding Human Papillomavirus 16/18 Oncoproteins," appeared 
in Cancer Research (2003;63:6032-6041).

UNITED STATES: 
"Risky-Sex Study OKs Antibiotic Use"
Advocate (Baton Rouge) (11.12.03)::Joe Gyan Jr. 
     The prophylactic use of antibiotics can be a safe and 
effective way to prevent the spread of syphilis, a Tulane 
researcher said recently. Participants who were given antibiotics 
in a Baton Rouge pilot study reported no increase in unprotected 
sexual activity, according to Tom Farley, chair of the community 
health sciences department at Tulane School of Public health and 
Tropical Medicine. 
     "Until now, public health experts have been reluctant to 
treat people with antibiotics to prevent them from getting 
infected because of concerns that they may get a false sense of 
security and adopt even riskier behavior," said Farley. "Our 
results indicate this is not the case. It didn't get worse."
     Farley said Baton Rouge was mapped to identify syphilis "hot 
spots." A mobile laboratory went into the areas and offered free 
STD testing. Those tested were asked to fill out a questionnaire 
concerning the number of sex partners they had in the past year. 
Respondents were considered at risk for syphilis exposure if they 
reported three or more sex partners in the past year or felt 
certain that one of their partners had other sex partners at the 
same time, Farley said. 
     Of 186 heterosexual black male and female volunteers who 
agreed to take part in the study during 1997-1999, 174 were 
treated and 125 were located for follow-ups, said Farley. 
Volunteers could choose a one-time injection of the antibiotic or 
pills that would require additional visits for more treatment. 
Most chose injection. Nearly all participants said they would be 
willing to take antibiotics again to prevent syphilis and other 
STDs, he said.             
     At one- and four-month follow-ups, participants given 
antibiotics reported reductions in the number of sex partners, 
Farley said. At four months, 1 percent of participants had 
acquired gonorrhea, 5 percent had contracted chlamydia, and none 
had acquired syphilis, he said. "Condom use stayed about the 
same," said Farley. "Controlling syphilis is really key to 
controlling HIV," he said, since HIV is less likely to spread in 
the absence of syphilis sores. 
     The CDC-funded study, "The Acceptability and Behavioral 
Effects of Antibiotic Prophylaxis for Syphilis Prevention," 
appeared in the November issue of Sexually Transmitted Diseases 
(2003;30(11):844-849).

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                  LOCAL AND COMMUNITY NEWS
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CALIFORNIA: 
"Volume Rising in Needle Exchange Debate"
San Luis Obispo Tribune (11.16.03)::Julie Lynem
     San Luis Obispo County does not have a syringe exchange 
program, but the idea of offering clean needles to drug users is 
circulating among some community groups and public health 
officials. In 2002-2003, 78 of 99 people testing positive for 
hepatitis C in the county reported IV drug use as their primary 
risk factor. Of the county's 250 AIDS cases as of June 2003, 39 
percent reported IV drug use as their only risk factor.    
     Officials with the HIV Consortium, Economic Opportunity 
Commission, San Luis Obispo Hepatitis C Project, county Drug and 
Alcohol Service and other agencies plan to meet soon to discuss 
ways to educate the public and county authorities about syringe 
exchange with the goal of getting the Board of Supervisors to 
support a program. 
     To permit such a program, state law requires the county  
public health officer to declare a health emergency, and the 
Board of Supervisors would have to approve the state of emergency 
every two weeks. The unauthorized possession and distribution of 
needles is illegal statewide.
     Some supervisors said they would need more information 
before taking a stand on the issue. "Hopefully, studies will 
educate us enough to come to a decision," said Supervisor Katcho 
Achadijian. Supervisor Shirley Bianchi said she would favor it. 
     "It assists individuals in illegal drug use," County Sheriff 
Pat Hedges said of an exchange program. "It purports to decrease 
the spread of certain types of illnesses and diseases. But I've 
not been made aware of anything that necessarily supports that. 
Providing someone with a new needle does not guarantee they would 
not share that needle with someone else."
     A 1999 Johns Hopkins study found that syringe exchange did 
not generate more crime, increase drug use among IV drug users or 
encourage youths to use drugs. Seven government-funded reports on 
syringe exchange programs found that they reduce HIV transmission 
without increasing drug use, according to a Human Rights Watch 
case study.  

GEORGIA:
"Organization Started by University of Georgia Alums Aims to Help 
Children"
Associated Press (11.14.03)
     Two recent graduates of the University of Georgia (UGA) have 
founded Hearts Everywhere Reaching Out (HERO) for Children with 
the aim of improving the quality of life and emotional health of 
Georgia children who have HIV/AIDS or whose parents have died of 
the disease. 
     The founders, Garrett Gravesen and Ryan Gembala, plan to 
offer children sustainable programs and unforgettable 
experiences, Gravesen said: "These children may not live long 
lives but they still live important ones."
     Saturday was HERO Day at Sanford Stadium in Athens. UGA 
Coach Mark Richt made an announcement to promote the 
organization, and the group sold red-and-black bumper stickers 
reading, "Always a Dawg. Support HERO for Children." People who 
bought the stickers each got a ticket to win a prize including 
dinners with Richt and Athletic Director Vince Dooley, cash, and 
a trip to Las Vegas.
     "They're devoted, idealistic young people who really want to 
make a difference," said Dooley, who serves on HERO's board of 
advisers.
     HERO's goal is to raise $50,000 to implement its programs. 
Initially, Gravesen said HERO hopes to reach 500 children in the 
Atlanta area. Headquartered in Norcross, HERO plans to partner 
with health care providers such as Grady Memorial Hospital on a 
mentoring initiative, a HERO for a Day carnival for children and 
an international pen pal program. Eventually, the group plans to 
expand to other cities and countries. About 4,000 UGA students 
and faculty helped the organization in its first fundraiser.

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                         NEWS BRIEFS
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UNITED STATES:
"FDA Fast Tracks Biosyn Gel Product"
Philadelphia Business Journal (11.17.03)
     Biosyn Inc. of Huntingdon Valley, Pa., announced Monday that 
the Food and Drug Administration had granted "fast track" 
designation to its C31G vaginal gel designed to reduce HIV 
transmission. "We have worked closely with the FDA on the 
clinical path for this candidate since it is an important product 
for the prevention of sexual transmission of HIV," said Anne-
Marie Corner, president and CEO. Fast track programs facilitate 
the development and expedite the review of new drug candidates 
intended to prevent or treat serious or life-threatening 
conditions and that demonstrate the potential to address unmet 
medical needs. Biosyn's gel is entering phase III clinical trials 
for prevention of HIV transmission, prevention of chlamydia and 
contraception.

BRAZIL: 
"Brazil Closes Second Deal This Month for AIDS Drug Discount, Two 
More Under Negotiation"
Associated Press (11.18.03)
     Brazil will buy Merck's AIDS drug Efavirenz at a 25 percent 
discount for its national drug distribution program, Brazilian 
Health Ministry spokesperson Javier Martinez announced on 
Tuesday. This marks Brazil's second accord this month for 
purchasing discounted AIDS drugs. The annual savings from the 
reduced Efavirenz price for Brazil's AIDS program will be $10 
million, said Martinez. Earlier, Brazil obtained a 76 percent 
discount from Bristol-Myers Squibb for its AIDS drug Atazanavir. 
The government is still negotiating potential discounts with 
Roche and Abbott Laboratories. While threatening to strip patents 
from drug producers whose prices Brazil considers to be abusive, 
the country has never had to do so for any of the newer drugs.       

SOUTH AFRICA:
"South Africa Approves Mass HIV/AIDS Drug Treatment"
Reuters (11.19.03)
     South Africa's government today approved a drug treatment 
plan to tackle its HIV caseload, said Health Minister Manto 
Tshabalala-Msimang. After a cabinet meeting, she told reporters 
there will be a national network of antiretroviral distribution 
centers within one year. The government has long resisted making 
the drugs available in the public sector.

INDIA:
"Former US President Clinton to Visit India This Week"
Agence France Presse (11.18.03)
     Former President Bill Clinton will visit India for two days 
starting Friday, sources announced yesterday. He will meet with 
Prime Minister Atal Behari Vajpayee and with AIDS activists in 
New Delhi. The purpose of the trip is to bolster efforts to 
prevent and control HIV/AIDS. India has 4.58 million people with 
HIV/AIDS, the second largest case count after South Africa's 
roughly 5 million. In March 2000, Clinton became the first 
president to visit India in more than two decades, and he has 
become involved in several Indian social activities since leaving 
office in 2001.

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