[CDC News] CDC HIV/STD/TB Prevention News Update 11/24/03

CDC HIV/STD/TB Prevention News Update
Monday, November 24, 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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abstracted below for full texts of the articles.

HEADLINES

NATIONAL NEWS
MISSISSIPPI: "US Syphilis Rate Increases; Mississippi Decreases"
NEW JERSEY: "Gormley to Co-Sponsor State Needle-Exchange Program"
NEW YORK: "HIV Advocates Oppose GOP Medicare Deal"

INTERNATIONAL NEWS
CHINA: "AIDS Care in Rural China Now Better Than Nothing"

MEDICAL NEWS
UNITED STATES: "The Effect of HAART and HCV Infection on the 
Development of Hyperglycemia Among HIV-Infected Persons"

LOCAL AND COMMUNITY NEWS
CALIFORNIA: "San Francisco Has Nation's Highest Rate of Syphilis"
MARYLAND: "Baltimore's Rate of New Cases of Syphilis Falls to 
Behind Georgia's Rate"
INDIANA: "Study Shows Drop in City's Syphilis Rate"
FLORIDA: "Teens Broach Subject of Sex"
 
NEWS BRIEFS
SINGAPORE: "HIV/AIDS Infection Rises in Singapore"
MICHIGAN: "TB Testing Continues for Sebewaing-Area Students"

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                         NATIONAL NEWS
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MISSISSIPPI:
"US Syphilis Rate Increases; Mississippi Decreases"
Associated Press (11.21.03)::Sheila Hardwell Byrd
     State Epidemiologist Mary Currier said Mississippi's 
syphilis rate continues to decline due to measures taken in the 
1990s to reduce the number of cases. While the nation's syphilis 
rate has climbed for the second year in a row, Mississippi's 
cases dropped from 140 in 2001 to 48 in 2002. Currier said the 
state had more than 2,000 cases in 1994.
     "What we started doing in the mid-90s, when we had such an 
increase of syphilis cases, was we put more people in the field 
to look for syphilis cases, to find their contacts and to provide 
preventative therapy to those contacts so that we can try and 
stop the spread of the disease," Currier said.
     Currier said the state Health Department cooperates with 
community organizations, hospitals and clinics to keep them 
informed of syphilis outbreaks and to help them identify syphilis 
symptoms. 
     According to CDC, national syphilis rates rose 9.1 percent 
between 2001 and 2002 after having dropped every year between 
1990 and 2000. The actual increase was small - 759 new cases for 
a total of 6,862 - but the rise among gay and bisexual men has 
caused concern over the erosion of the public health safeguards 
and safe-sex practices adopted over the last twenty years.
     "We're seeing syphilis rise primarily in groups of gay and 
bisexual men," said Dr. John Douglas, director of CDC's division 
of sexually transmitted diseases.
     In Mississippi, however, two-thirds of last year's syphilis 
cases were female. "That spread was likely heterosexual in that 
case," Currier said. "Certainly, when any high-risk group is 
identified in the nation, it's another reason for us to be sure 
that we're providing prevention education to the groups."

NEW JERSEY:
"Gormley to Co-Sponsor State Needle-Exchange Program"
Press of Atlantic City (11.19.03)::Pete McAleer
     A bill permitting over-the-counter sales of hypodermic 
needles and allowing for state-regulated needle exchange programs 
will be introduced with bipartisan support when the New Jersey 
Senate returns for the start of its lame-duck session Nov. 24. 
     Co-sponsoring the legislation is state Sen. Bill Gormley (R-
Atlantic), who said he previously opposed needle exchange 
programs because they condone drug use. "I'd prefer an 
alternative, but I don't know of an alternative," said Gormley. 
"It's a serious health issue that has to be addressed. It's time 
we addressed it."
     At a Statehouse press conference Tuesday, members of the 
Drug Policy Alliance, a national group that lobbies for changes 
in drug laws, presented state Department of Health statistics 
showing that 46 percent of HIV infections in New Jersey are 
related to shared needles, compared to a national average of 25 
percent. The group also released a report from Donald Scarry, 
principal economist with New Jersey Economics, stating the state 
would save $227,000 in medical costs for each AIDS case avoided 
as a result of access to clean needles, which cost 10 cents each. 
     The new legislation, to be introduced by Gormley, Sen. Joe 
Vitale (D-Middlesex) and Sen. Robert Singer (R-Ocean), will not 
cost the state a penny, according to its sponsors. It would 
permit pharmacies to sell needles without a prescription and 
allow for privately funded needle exchange programs to set up 
according to Department of Health guidelines, with the approval 
of local municipalities. 
     The City Councils of Camden, Newark and Jersey City all have 
passed unanimous resolutions in support of a state Assembly bill 
sponsored by Reed Gusciora (D-Mercer) that legalizes the sale of 
hypodermic needles and allows municipalities to make needle 
exchange a part of its HIV-prevention programs. Atlantic City 
Council will consider a similar resolution.

NEW YORK: 
"HIV Advocates Oppose GOP Medicare Deal"
Gay City News (11.20.03)::Duncan Osborne
     "GMHC is opposing the Medicare bill and urging New York 
State Senators Clinton and Schumer to oppose and filibuster the 
bill," David C. Wunsch, director of health policy at Gay Men's 
Health Crisis, said recently. "Not only does the bill wholly 
undermine the Medicare program, but it does specific harm to HIV-
positive folks who are on Medicare."
     Some 50,000 people with AIDS, including 20,000-25,000 New 
Yorkers, receive health insurance from Medicare, which 
traditionally covers health costs for senior citizens. But 
because Medicare does not pay for prescription drugs, Medicaid - 
the health insurance plan for the poor and disabled - pays for 
their drugs. Such "dual eligibles" may see their drug coverage 
cut under a plan to add prescription drug coverage to Medicare 
that passed Senate and House earlier this year. A conference 
committee released its bill on Nov. 17. [Editor's note: The House 
passed the bill 220-215 early Saturday morning. Debate continued 
Sunday in the Senate.] 
     "This bill would give the state the option to require dually 
eligible folks to get their drug benefit under Medicare," Wunsch 
said. The bill would require Medicare to pay for only two drugs 
per class, meaning that HIV drug cocktails, which typically 
contain three drugs, would only be partially covered for dual 
eligibles. "Medicare can have very restrictive formularies. That 
is an absolute catastrophe for standard, state-of-the-art HIV 
therapy which requires three drugs." The bill bars states from 
using federal Medicaid funds to pay for additional Medicare drug 
coverage for dual eligibles as they have in the past. 
     States could likely use their own Medicaid funds to cover 
those costs, but most states are facing large deficits and are 
cutting Medicaid expenses. AIDS Drug Assistance Programs might 
cover some dual eligibles, but many states have ADAP waiting 
lists and are restricting the drugs they pay for. 

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                      INTERNATIONAL NEWS
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CHINA:
"AIDS Care in Rural China Now Better Than Nothing"
New York Times (11.21.03)::Jim Yardley
     Recently, top health officials in China announced they would 
give free HIV/AIDS drugs to all infected poor people. At present, 
the free drug program is accessible to only a minute portion of 
Chinese HIV/AIDS patients.
     Chinese health officials now acknowledge that HIV/AIDS may 
affect 10 million citizens by 2010. The Chinese health system is 
so inadequate that experts are skeptical it can monitor the broad 
program effectively.
     "This is not the same as hunger relief, where you can drop 
the food and leave," said Dr. David Ho, the New York-based 
researcher who is focusing much of his work on China. 
     But villagers in Dongguan in Henan province, where blood 
buying in the 1990s spread HIV/AIDS, say they receive their 
medications from a clinic that is sometimes closed, and rarely 
see a doctor. HIV/AIDS drug regimens need to be closely monitored 
so that patients do not develop drug-resistant strains of the 
virus or stop taking the pills due to side effects.
     Chinese HIV/AIDS patients are getting four low-cost generic 
medications that China can produce because the patents have run 
out. The government is negotiating with pharmaceutical companies 
so that it can cheaply produce a broader range of drugs 
domestically.
     Government statistics show that through October 5,289 
patients had enrolled in the drug program. However, roughly 20 
percent had already told health workers they had stopped taking 
the medicine. AIDS researchers say many others may have dropped 
out without telling anyone.
     Chinese officials estimate roughly a million people have 
died of AIDS or are HIV-positive. But some experts suspect that 
Henan, with nearly 100 million people, might have a million cases 
itself. A recent story in the official news media, by contrast, 
estimates Henan's cases at 35,000.

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                         MEDICAL NEWS
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UNITED STATES:
"The Effect of HAART and HCV Infection on the Development of 
Hyperglycemia Among HIV-Infected Persons"
Journal of Acquired Immune Deficiency Syndromes (08.15.03) Vol. 
33: P.577-584::Shruti H. Mehta; Richard D. Moore; David L. 
Thomas; Richard E. Chaisson; Mark S. Sulkowski
     Several reports have documented an increase in the 
occurrence of metabolic abnormalities including hyperlipidemia, 
hyperglycemia, insulin resistance, and overt diabetes mellitus 
among HIV patients taking HAART, particularly HIV-protease 
inhibitors. Some studies have suggested removal of the PI or 
replacing it with a nonnucleoside reverse transcriptase inhibitor 
such as nevirapine can normalize glucose levels and sometimes 
reverse diabetes mellitus. 
     Hepatitis C infection has been independently associated with 
diabetes mellitus in nearly 30 studies. Due to shared routes of 
transmission, HCV coinfection occurs in 15-30 percent of HIV 
patients. The objective of this study was to examine the 
prevalence and incidence of hyperglycemia according to HCV 
infection and the type of HAART taken.
     The researchers studied 1,230 persons receiving their first 
HAART regimen from January 1996 through May 2002, and followed 
them up at six-month intervals. Of the sample, 579 (47 percent) 
were HCV-negative and 651 (53 percent) were HCV-positive. Persons 
with HCV coinfection were older, more often African-American, and 
more likely to use or to have used injection drugs. At baseline, 
the investigators found no significant differences between HCV-
coinfected and uninfected patients in the prevalence of chronic 
hepatitis B virus infection, baseline CD4 cell counts, HIV RNA 
levels, or random glucose levels. Subjects with HCV coinfection 
had significantly higher alanine aminotransferase (ALT) levels 
and aspartate aminotransferase (AST) levels compared to those 
without HCV coinfection.
      Twenty-two percent (269) were taking a HAART regimen 
containing an NNRTI, 845 (69 percent) were taking a regimen 
containing a PI, and 116 participants were taking a regimen 
containing both a PI and an NNRTI. Persons prescribed PIs were 
more often male and less frequently African American than 
participants on other regimens. At baseline, subjects prescribed 
PIs had lower glucose levels than those on other regimens.
     "Among HIV-infected adults receiving medical care in an 
urban clinic, we observed an increased prevalence of 
hyperglycemia among persons with HCV coinfection compared with 
those without HCV infection prior to the initiation of HAART. 
Moreover, both HCV coinfection and PI use appeared to increase 
the risk of new-onset hyperglycemia during HAART. Both of these 
effects were independent of other risk factors of hyperglycemia 
including age, race, and body weight," the study reported. 
    "In conclusion," the authors noted, "we observed an increased 
prevalence and incidence of hyperglycemia among HIV-infected 
adults with HCV coinfection compared with those without HCV 
infection. PI use also appeared to increase the risk of 
hyperglycemia compared with persons receiving NNRTI-containing 
HAART regimens. Additional prospective studies are needed to 
better understand the pathogenesis of hyperglycemia among HIV-
infected patients receiving HAART, particularly those coinfected 
with hepatitis C without previously described risk factors such 
as obesity."

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                   LOCAL AND COMMUNITY NEWS
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CALIFORNIA:
"San Francisco Has Nation's Highest Rate of Syphilis"
Los Angeles Times (11.22.03)::Lisa Richardson
     San Francisco has the nation's highest rate of syphilis 
cases, according to new CDC data. San Francisco's highest 
syphilis rate since 1999 - 40.6 cases per 100,000 in 2002 - was 
apparently driven by infections among gay and bisexual men. The 
city's rate compares to a national syphilis rate of 2.4 cases per 
100,000 people in 2002, itself a 9.1 percent increase from 2.2 
cases per 100,000 in 2001.
     The city's increase in syphilis cases may be attributable in 
part to improved screening and outreach efforts, health officials 
said. The city, in conjunction with community groups, has opened 
three testing sites and Web page-initiated testing, and testing 
increased 33 percent from 1999 to 2002. 
     However, increased screening is not solely responsible for 
the rise. "We know that the increased number of cases is 
definitely related to increased transmission," said Dr. Jeffrey 
Klausner, San Francisco's director of STD control. "People are 
coming in with lesions; people have sores, and there is an 
increased number of syphilis cases of the brain. That's real 
disease and real transmission," Klausner said.
     California's syphilis cases almost doubled from 2001 to 
2002, rising to 1,046, according to state health officials. 
Preliminary 2003 estimates indicate the infection rate is 
slowing.
     While releasing the CDC data, officials cited a New York 
study comparing the behavior of gay and bisexual men with 
syphilis and without syphilis. Men with syphilis were more likely 
to report engaging in unprotected anal intercourse, attending 
private sex parties to meet partners, and using methamphetamine 
and Viagra or other drugs before having sex. They were also more 
likely to have HIV. According to Lee Klosinski of AIDS Project 
Los Angeles, "Most people are finding sex partners on the 
Internet, and the Internet has emerged as a more problematic area 
in terms of syphilis transmission."

MARYLAND:
"Baltimore's Rate of New Cases of Syphilis Falls to Behind 
Georgia's Rate"
Associated Press (11.22.03)
     Baltimore's syphilis rate has declined from the worst in the 
nation in 1997 for new cases to the number five spot, despite the 
fact that rates are rising nationally. City Health Commissioner 
Dr. Peter Beilenson attributes the improvement to a campaign to 
stem the disease's spread among drug users, including those who 
trade sex for crack cocaine. 
     Beilenson said the city had hired more clinicians at its STD 
clinics and tested and treated people taken to the Central 
Booking and Intake Center. "It was an 82 percent drop from [1997] 
to 2002, which we think is the biggest [five]-year drop in any 
American city ever," he said. Cases went from roughly 662 in 1997 
to 121 last year.
     San Francisco had the highest rate of new syphilis cases in 
2002, with 40.6 cases per 100,000 people, or 315 new cases. 
Detroit, Atlanta and Newark also had higher rates than 
Baltimore's 18.6 per 100,000. In 2001, Baltimore ranked third, 
behind Detroit and Atlanta, in rate of new syphilis cases.
     However, Beilenson voiced concern that an increasing number 
of teenage girls reported contracting syphilis from older male 
partners. He also said syphilis is on the rise among men who have 
sex with men. About 22 percent of Baltimore's cases last year 
involved men having sex with men, according to Beilenson, and 
approximately 10 percent involved females ages 15-29.
     
INDIANA:
"Study Shows Drop in City's Syphilis Rate"
Indianapolis Star (11.22.03)::Diana Penner
     Indianapolis dropped from seventh place in 2001 to 24th place 
in 2002 in the national rankings of syphilis cases per 100,000 in 
major cities, according to new CDC data. Indianapolis reported 36 
new cases of syphilis in 2002, compared with 128 in 2001. The 
figures represent a 71.8 percent drop in the city's syphilis 
cases - from 14.9 cases per 100,000 residents to 4.2 per 100,000. 
     In 1999, the city ranked number one for new syphilis cases, 
with the infections largely occurring among heterosexuals. When 
the number of Marion County cases soared, CDC awarded the county 
health department a grant to combat the problem. The grant paid 
off, said Dr. Virginia Caine, director of the department, by 
allowing the county to concentrate people and programs to fight 
the disease.
     But nationally, syphilis is increasing among men in their 
30s, and that could be the next problem for the city, local 
officials said. The new surge is being seen among men who have 
sex with men but do not necessarily consider themselves to be 
gay. "So we're trying to plan for that," said Caine. 
     Marion County was one of three metropolitan areas involved 
in demonstration projects, in which CDC helped mount "a full-
court press, in terms of responding to syphilis," said Dr. John 
Douglas, director of CDC's Division of STD Prevention. "And we 
have, in fact, in those three counties seen among the largest 
decreases," he said in a telephone news conference.
     For three years beginning in 2000, the county has received 
$600,000 to $800,000 to battle syphilis, Caine said. The grants 
will likely be reduced by 25-50 percent because of Indianapolis' 
improvements and the needs of other cities. However, anti-
syphilis efforts will continue, including 24-hour testing at 
Wishard Memorial Hospital's emergency room, and outreach 
targeting MSM. Community groups can help organize that response 
in meetings to be held in the coming months, said Caine. 

FLORIDA:
"Teens Broach Subject of Sex"
Florida Today (11.19.03)::James Dean
     First Defense, a Melbourne, Fla.-based sex education group 
presented a three-day workshop to eighth-grade boys, and then to 
girls, at Southwest Middle School in Palm Bay recently. Steve 
Smith, the group's director, gave statistics on STDs and teen 
pregnancy and cautioned that condoms are not foolproof protection 
against either.
     First Defense promotes sexual abstinence until marriage, in 
accord with Brevard School District standards. Its 12 volunteers 
have presented five-day workshops to many South Brevard high 
schools over the past six years. Southwest is the first and only 
middle school to invite the group to work with eighth graders, 
although principal Robin Novelli thinks the group's effective 
communication about the risks of sex may attract more schools.
     "You can bet all the students were listening very 
carefully," Novelli said. "It's a subject we need to address 
because kids are getting involved in sexual activity younger 
without information to make good decisions."
     A survey by the Kaiser Family Foundation showed half of all 
high school students report being sexually active. The report 
also noted that one in ten high school girls ages 15-19 becomes 
pregnant.
     Debra Hauser, vice president of Washington-based Advocates 
for Youth, said teaching kids about sex as early as possible is a 
good idea, but questioned whether Brevard's abstinence-only 
approach, which does not allow discussion of contraception, was a 
successful method.
     "Clearly in middle school, an age appropriate message is to 
delay [having sex]," she said. "However, many young people in 
middle school are sexually active, and an abstinence only until 
marriage lesson is completely irrelevant and leads them to high 
risk." 

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                         NEWS BRIEFS
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SINGAPORE:
"HIV/AIDS Infection Rises in Singapore"
Agence France Press (11.24.03)
     Singapore's HIV infection rate is up, with 201 people 
diagnosed in the first 10 months of this year, compared to 189 
for the same period last year, the government said today. In a 
statement, the Ministry of Health said 198 of the 201 new cases 
were infected via sexual transmission, 78 percent of which were 
heterosexual transmissions. About 88 percent of the new cases 
were males. "Among those who acquired the infection through the 
sexual route, about 88 percent had sexual exposure to prostitutes 
(locally and overseas) and/or casual sex partners," said the MOH. 
"The Ministry would like to emphasize that the only way to avoid 
AIDS is to remain faithful to one's spouse and to avoid casual 
sex and sex with prostitutes. Persons who engage in casual sex or 
sex with prostitutes are advised to lower their risk by wearing 
condoms," it said. A total of 2,034 Singaporeans have been 
infected with HIV/AIDS since the city-state's first cases were 
detected in 1985.  

MICHIGAN:
"TB Testing Continues for Sebewaing-Area Students"
Associated Press (11.21.03)
     Sebewaing-area students and teachers continue to be tested 
for tuberculosis, and two more cases have been identified, in the 
wake of 34 people testing positive for TB late last month. A 
senior and a staff member at Unionville-Sebewaing Area High 
School had positive skin tests for the disease, the Huron Daily 
Tribune of Bad Axe reported. TB skin tests were administered at 
the high school after 30 teachers and four middle school students 
in the Thumb district tested positive last month. More than 400 
students were tested earlier after a fifth-grade teacher and an 
eighth-grade student were found to have active TB in October. 
Health officials said it is likely the teacher had active TB 
during the previous school year, but did not know what it was 
until she was tested. None of the 36 positive skin tests in the 
Sebewaing area has been diagnosed as active cases. 

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