[CDC News] CDC HIV/STD/TB Prevention News Update 11/25/03

CDC HIV/STD/TB Prevention News Update
Tuesday, November 25, 2003

The CDC National Center for HIV, STD and TB Prevention provides 
the following information as a public service only. Providing 
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HEADLINES

NATIONAL NEWS
UNITED STATES: "HIV Secrecy Is Proving Deadly"
MINNESOTA: "Rural Towns Offer Free HIV Testing as Cases Increase"

INTERNATIONAL NEWS
UNITED KINGDOM: "HIV Numbers Rise 20 Percent to Nearly 50,000"
THAILAND: "Report: Asian AIDS Epidemic Is Worsening"
AUSTRALIA: "Health Groups Unite to Fight HIV Rise"

MEDICAL NEWS
CANADA: "Prevalence and Correlates of Untreated Human 
Immunodeficiency Virus Type 1 Infection Among Persons Who Have 
Died in the Era of Modern Antiretroviral Therapy"

LOCAL AND COMMUNITY NEWS
KENTUCKY: "AIDS Group Says Brochures Removed"

EDITORIALS AND COMMENTARY
CHINA, SOUTH AFRICA: "Two Nations Fight AIDS"

NEWS BRIEFS
RUSSIA: "Number of Russians with HIV Jumps Nearly 10-Fold: 
Official"
SWITZERLAND: "UNICEF Appoints HIV-Positive Muppet a 'Champion for 
Children'"
SOUTH CAROLINA: "Two AIDS Programs Receive Grants"

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                          NATIONAL NEWS
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UNITED STATES:
"HIV Secrecy Is Proving Deadly"
New York Times (11.25.03)::Howard Markel
     The failure to disclose HIV infection to partners, whether 
intentionally or unintentionally, is a significant but 
underreported factor many health experts say contributes to the 
continued spread of HIV in the United States. CDC estimates that 
as many as 33 percent of the 900,000 Americans infected with HIV 
may not know it.
     Two Columbia University professors, Dr. Robert Klitzman, a 
psychiatrist, and Dr. Ronald Bayer, an ethicist, have explored 
the range of views and practices concerning HIV disclosure in a 
newly published book, "Mortal Secrets: Truth and Lies in the Age 
of AIDS."
     The authors used oral history interviews of the sexual 
practices of 49 men and 28 women in New York City. Sixty of those 
interviewed are HIV-positive, and there is diverse representation 
in ethnic background and sexual orientation.
     Klitzman said one of the most disturbing findings was that 
about a third of the gay men interviewed "admitted that, at some 
point, they lied about their status, but it is probably a higher 
number." "I was horrified by some of the things people told me," 
said Klitzman, "and at the end of each interview we spoke to the 
subjects about safer sex and the importance of disclosure. But it 
led us to think about the importance of a code of sexual ethics."
     Although the interviews occurred from 1993 to 1996 - before 
the advent of highly active antiretroviral therapy (HAART), 
experts believe little has changed. 
     Sharon Boyd of the Michigan Department of Community Health 
said her current research suggested that as few as 20 percent of 
HIV-infected people in Detroit had told their partner of their 
status. 
     According to Bayer, practicing sexual ethics in real life is 
complicated by many factors, including social stigma or 
acceptance of people with HIV. "Fear and terror often shaped 
their decisions," Bayer said of his study's participants. 
     Mark Barnes, a lawyer and former New York City health 
department official in the early 1990s, recalled being shouted 
down in meetings when he urged those with HIV to disclose their 
status. "It's been woefully lacking in our prevention efforts, 
although there has been a new push by the CDC and local health 
departments to encourage people to disclose," he said. 

MINNESOTA:
"Rural Towns Offer Free HIV Testing as Cases Increase"
Associated Press (11.24.03)
     As part of a wider effort to bring HIV testing and 
prevention information into rural Minnesota, the Rural AIDS 
Action Network has begun to offer free testing in Willmar, 
Morris, Alexandria and Fergus Falls. Though HIV infection rates 
are still low compared to the metropolitan area, the number of 
cases in rural areas of the state is increasing more quickly than 
in the Twin Cities.
     In observance of World AIDS Day on Dec. 1, RAAN has enlisted 
the Minnesota Library Association and rural libraries to hand out 
HIV/AIDS information. In addition, red ribbons and bookmarks will 
be distributed at more than 80 libraries across Minnesota this 
week. 
     According to RAAN, the number of cases in west-central 
portion of the state alone increased 12.4 percent during the past 
year. The state Health Department reports that throughout rural 
Minnesota there has been an average of 32 new cases each year 
from 1998 to 2002. 
     In addition, new HIV cases in the state have been increasing 
after staying below 300 for two years, reports the state Health 
Department. Last year, Minnesota recorded 305 new HIV infections 
- 32 in rural areas and the rest in the metro area. 
     "We have a new HIV case reported every 29 hours in 
Minnesota," said Dr. Harry Hull, state epidemiologist. "Providing 
people with knowledge about how to protect themselves against HIV 
is the only way to begin reducing these rates."
     Rural Minnesota's HIV numbers may actually be underreported 
because people are not being tested, said Kirk Fiereck, 
counseling, testing and outreach coordinator with RAAN. "That's 
another reason why we're trying to get testing available," he 
said of RAAN's effort. "I think we're reaching people who are a 
little more underserved."
     Fiereck said RAAN is trying to fill a void caused by funding 
cutbacks to agencies that provide HIV testing in rural 
communities. He noted that the confidential testing is provided 
twice monthly and the outreach clinics have been testing an 
average of 12 people each time.

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                        INTERNATIONAL NEWS
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UNITED KINGDOM:
"HIV Numbers Rise 20 Percent to Nearly 50,000" 
Guardian (11.25.03)::James Meikle
     Britain's Health Protection Agency reported yesterday that 
the number of UK residents with HIV climbed by 20 percent last 
year. About one-third of the 49,500 infected people do not know 
they have the virus, HPA said.
     Last year's newly diagnosed HIV cases are expected to reach 
6,400. Of the 5,711 analyzed so far, about 1,850 are thought to 
have contracted HIV in Britain. Four-fifths of these patients 
were gay or bisexual. However, heterosexual sex is a much more 
common cause among overseas cases, accounting for 3,305 of all 
new cases. At the same time, the death rate from AIDS has fallen 
to less than 400 a year, thanks largely to effective drug 
therapy.
     HPA also announced a near doubling of gonorrhea among gay 
men, to 3,363 cases in 2002, and a jump in syphilis from 52 cases 
to 607. HPA is calling for sexual health clinics to offer gay and 
bisexual men annual HIV tests, and for more research into 
migrants' sexual behavior.
     Yesterday, the Department of Health announced a £15 million 
(US $25.4 million) package for sexual health clinics. Much of the 
money will be spent on cutting the wait for appointments, which 
can be more than six weeks, and on developing a more reliable 
test for chlamydia.
     "We must make testing for HIV and other sexually transmitted 
infections earlier," said Nick Partridge, chief executive of the 
Terrence Higgins Trust. "People should be able to test when and 
where they want, and get their results much faster."
     The new government commitment is on top of an £11 million 
(US $18.7 million) increase already announced. About £400,000 (US 
$678,000) will go for new public health messages about HIV 
prevention, most likely targeting gay men, African communities 
and other high-risk groups.

THAILAND:
"Report: Asian AIDS Epidemic Is Worsening"
Associated Press (11.25.03)::Vijay Joshi
     "Time to Act," a report released today by ActionAid-Asia, 
says HIV/AIDS has reached a critical point and is now spreading 
faster in Asia than in Africa. The study cites complacent 
governments, inadequate health care and widespread prejudice as 
factors in the epidemic's spread.
     The report warns that seemingly low prevalence rates in 
countries such as China and India mask huge actual numbers of 
HIV/AIDS cases and hotspots of infection. In Asia, roughly 7.2 
million people have HIV, 5 million of them in India and China. An 
estimated half million people died of AIDS and nearly 1 million 
contracted HIV in the last year in Asia. Africa has 29 million 
infections.
     "Asia may not be Africa, but the early warning signals are 
scary and clear. Africa's experience shows HIV/AIDS can destroy 
development gains of several decades and social composition of 
peoples in a single stroke," the report said. 
     The report cites the seriousness of local epidemics in 
several countries such as China, where the public health system 
is in chaos. The report notes that up to 7,000 Nepali girls are 
trafficked into Indian brothels every year; more than 100,000 
work as prostitutes in Bombay, and many are HIV-infected. 
     The study notes that weak laws are failing to protect the 
rights of people with HIV/AIDS, and it calls on governments to 
learn from initiatives that have yielded positive results 
elsewhere.
     "Compassion and a humane response are necessary to deal with 
HIV/AIDS," said John Samuel, ActionAid-Asia's director. "But 
compassion cannot be a substitute for government action. Health 
care is not a matter of charity but a right."
     ActionAid-Asia is part of the global development group 
ActionAid, which works in 40 countries.

AUSTRALIA: 
"Health Groups Unite to Fight HIV Rise"
Sydney Star Observer (11.20.03)::Tim Benzie
     A new HIV prevention campaign developed by New South Wales 
Health in collaboration with major HIV organizations aims to 
combat the recent rise in HIV infections. The HIV Prevention 
Action Plan media campaign has three messages: HIV risk from 
unprotected sex is higher than it was 12 months ago; STDs such as 
syphilis are increasing and having an STD can facilitate both HIV 
acquisition and transmission; and the most effective protection 
is to consistently use condoms.
     Community partners in the campaign include the AIDS Council 
of New South Wales (ACON), People Living with HIV/AIDS New South 
Wales, the Australian Society for HIV Medicine and metropolitan 
health services. 
     "We think that the increase in 2002 was a disturbing 
increase," said Lisa Ryan of NSW Health. "For there to be a 
further increase in 2003, we think there's something really 
significant going on and we would ask gay men who aren't 
consistently practicing safe sex to think really carefully about 
the risk that they may be taking," she said.
     "The increase in figures has meant that we all want to 
invest energy in getting this under control, and if that means 
working more closely together than we may have done previously, 
if that can deliver a better outcome, then that's what we're 
looking for," said ACON President Adrian Lovney. 
     The campaign launch follows the federal government's 
response to the 2002 Reviews of the fourth National HIV/AIDS and 
Hepatitis C Strategies and Strategic Research. Health Minister 
Tony Abbott announced that a fifth national strategy would be 
developed, as recommended in the 2002 reviews. A new panel - the 
Ministerial Advisory Committee on AIDS, Sexual Health and 
Hepatitis - will be formed to help create that strategy.

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                          MEDICAL NEWS
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CANADA:
"Prevalence and Correlates of Untreated Human Immunodeficiency 
Virus Type 1 Infection Among Persons Who Have Died in the Era of 
Modern Antiretroviral Therapy"
Journal of Infectious Diseases (10.15.03) Vol. 188; No. 8: 
P.1164-1170::Evan Wood; Julio S.G. Montaner; Mark W. Tyndall; 
Martin T. Schechter; Michael V. O'Shaughnessy; Robert S. Hogg
     The present study evaluated all HIV-related deaths from 
January 1, 1995 to December 31, 2001 in British Columbia, Canada, 
where HIV care and medications are free, provided by the British 
Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program 
since 1992. British Columbia has a centralized death registry and 
keeps complete prospective records of the dispensation of 
antiretroviral medication. Pharmaceutical sales suggest that less 
than one percent of the province's residents purchase ART outside 
the program. Therefore, the investigators were able to precisely 
determine each individual's level of treatment before death. 
     The researchers used a logistic model to compare people who 
had received antiretroviral therapy before death to those who had 
not received HIV treatment. Overall, 1,239 deaths among those 18 
years and older recorded HIV as either the cause of death or 
underlying cause of death. Four hundred-six occurred among those 
who had never received HIV treatment. Using adjusted analyses, 
the authors found aboriginal ethnicity, female sex, and lower 
median income to be negatively associated with receiving HIV 
treatment before death. Among the 833 people who did get 
treatment before death, only 379 (45.5 percent) had received 
antiretroviral medication = 75 percent of the time during their 
first year of therapy.
     "Even in a setting where all health care is provided free of 
charge by the state, high HIV/AIDS death rates persist because of 
the lack of, or only marginal access to, antiretrovirals," the 
authors wrote. "In the present study, one-third of HIV-related 
deaths occurred among untreated individuals, and those who died 
without ever receiving HIV treatment were more likely to be 
aboriginal, to be female, and to reside in a neighborhood with a 
lower median income. Among those who accessed treatment, fewer 
than half received consistent treatment before death, and similar 
sociodemographic characteristics were associated with elevated 
rates of treatment discontinuation before death."
     Since aboriginal people in North America "(including 
American Indians and Alaska natives)," may be at elevated risk of 
HIV, the authors stress the need for culturally sensitive 
interventions aimed at improving access to antiretrovirals among 
HIV-infected aboriginals. They also recommend interventions to 
improve antiretroviral access, and to reduce therapy 
discontinuation, for women and lower income people.
     The authors point out that addiction has been shown to be a 
barrier to accessing adequate HIV care. They suggest strategies 
that may improve access to and adherence to ART among HIV-
infected injection drug users: improved access to illicit drug 
treatment, directly observed therapy programs, access to medical 
services without appointment, and onsite pharmacists at medical 
clinics.
     "Given that these data were derived in a universal health 
care setting in which all HIV/AIDS care and antiretrovirals are 
available free of charge, it is likely that similar problems 
exist in many other settings in the developed world. To prevent 
ongoing levels of HIV/AIDS mortality, novel health care 
interventions and the expansion of illicit drug treatment will be 
required to improve access to antiretrovirals and HIV/AIDS care 
among populations with poor access," the authors concluded.

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                  LOCAL AND COMMUNITY NEWS
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KENTUCKY:
"AIDS Group Says Brochures Removed"
Lexington Herald Leader (11.22.03)::Steve Lannen
     On Friday, members of Lexington-based AIDS Volunteers Inc. 
(AVOL) at a Scott County High School health fair were told to 
remove brochures about safe sex for gay and lesbian teens, and 
materials containing the gay pride flag or information about 
homosexual acts, according to Cathy Cox, AVOL's executive 
director.
     Principal Doug Southworth said he had a teacher tell AVOL to 
remove a brochure with graphic drawings of homosexual sex and 
postcards with a photo of a shirtless man standing by a horse 
statue. But he was not aware that other brochures were removed. 
Southworth said it is inappropriate to have brochures promoting 
sex, safe sex, or homosexuality in school.
     Cox said the graphic brochure, "Safer Sex Can Be Fun," is   
for adults and a volunteer had placed it on the table mistakenly. 
AVOL staff removed it when they realized the error. 
     A teacher later picked up that brochure and others titled, 
"Young and Gay: Protect Yourself, "Lesbians and HIV: Are You at 
Risk?" and "Safer Sex, Better Too" from an AVOL supply box and 
told AVOL staff they could not display them, said Cox. However, 
brochures with safe sex information not specifically directed at 
gays or lesbians were not removed, Cox said. 
     Except for the brochure targeting adults, Cox said the 
materials are appropriate for high school students. "We're not 
talking about elementary school kids here," she said. 
     The 2001 Youth Risk Behavior Study by the Kentucky 
Department of Education reported that 42 out of 100 high school 
students said they had sex in the last three months. Only 24 
percent of them reported using a condom the last time they had 
sex. CDC figures show half of all new HIV cases among people 
younger than 25.

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                  EDITORIALS AND COMMENTARY
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CHINA, SOUTH AFRICA:
"Two Nations Fight AIDS"
New York Times (11.23.03)
     "In the past few days, two nations with large numbers of 
AIDS-infected people have announced plans to distribute a triple 
cocktail of life-prolonging antiretroviral drugs free to all who 
need it. China has been treating 5,000 patients and plans to 
expand the program to cover everyone in the country. South 
Africa's cabinet approved a plan that includes drugs for all who 
need them.
     "...Both countries have now taken a courageous and essential 
step. But only one is likely to succeed. Indeed, China's program 
is already failing. One in five Chinese who have received 
antiretroviral drugs have already stopped taking them, which can 
lead to the creation of drug-resistant strains of the virus. 
China has only about 100 doctors nationwide with experience in 
treating AIDS. Health workers are simply handing patients bottles 
of pills. Most patients receive no counseling on how to take them 
or deal with their side effects, and little follow-up monitoring. 
China is also still determined to crack down on high-risk groups 
such as prostitutes and drug users, which drives the epidemic 
underground....
     "South Africa's government, by contrast, understands that 
handing out pills is only part of the solution. The program, 
which will cost about $680 million a year by 2007, will spend 
only a third of its budget on buying drugs. Much of the money 
will go instead to establishing clinics and training thousands of 
doctors, nurses, counselors and other workers to staff them....
     "South Africa has an influential national network of 
campaigners for AIDS treatment whose pressure and advice were 
crucial to devising the plan, and who will be crucial to its 
success. It also had help from the foundation led by former 
President Bill Clinton, which negotiated better prices for AIDS 
medicine. China's government, by contrast, made its decisions in 
secret and has yet to permit such widespread citizen activism on 
AIDS. But China has one huge advantage over South Africa: while 
one in nine South Africans has the AIDS virus, China's epidemic 
is far smaller. Now that China has decided to treat AIDS, it has 
a chance to learn from other nations before the deluge."  

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                          NEWS BRIEFS
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RUSSIA:
"Number of Russians with HIV Jumps Nearly 10-Fold: Official"
Agence France Presse (11.24.03)
     A top Russian health official reported Monday that the 
number of HIV-positive Russians has increased nearly 10-fold in 
the past three years. "Only 20 per 100,000 Russians were HIV-
positive in early 2000 and the rate has increased by nearly 10 
times to 180 per 100,000 by November 2003," said Vadim Pokrovsky, 
head of the federal center to fight HIV/AIDS, reported the 
Interfax news agency. Most of those infected with HIV are men 
ages 15 to 30, he said. In May, Pokrovsky said that up to 1.5 
million Russians may have HIV, although the officially registered 
figure is about 238,000 people. Pokrovsky said some experts in 
his department estimate that AIDS deaths may become as numerous 
as those from car accidents in Russia within a few years. Experts 
say about 90 percent of all HIV infections in the country result 
from drug users sharing needles.

SWITZERLAND:
"UNICEF Appoints HIV-Positive Muppet a 'Champion for Children'"
Associated Press (11.24.03)::Naomi Koppel
     UNICEF has appointed an HIV-positive Muppet who stars in the 
South African "Sesame Street" as a "global champion for 
children," agency officials said Monday. Kami, a mustard-colored 
Muppet appearing regularly on "Takalani Sesame," represents a 
five-year-old girl orphaned by AIDS. To help UNICEF promote 
messages of ending HIV stigma, Kami will appear in public service 
ads and as a representative for other joint projects between 
UNICEF and Sesame Workshop, the US-based nonprofit that makes 
"Sesame Street." UNICEF said Kami "has brought levity and 
compassion to a topic that so often evokes the opposite." The 
Muppet will debut her new role Wednesday at the presentation of a 
new UNICEF report, "Africa's Orphaned Generation," which details 
the impact of HIV/AIDS on Africa's children. By 2010, there will 
be 20 million children in sub-Saharan Africa who have lost at 
least one parent to HIV/AIDS, the UN estimates. UNICEF and Sesame 
Workshop will work on projects ranging from literacy and health 
to fostering understanding and respect.

SOUTH CAROLINA:
"Two AIDS Programs Receive Grants"
State (11.22.03)
     Two South Carolina AIDS programs have received Pfizer 
Foundation grants as part of a three-year, $3 million initiative 
targeting underserved populations in the South, the foundation 
announced. Palmetto AIDS Life Support Services in Columbia will 
receive $49,900 to expand its Partners in Prevention program, 
which trains women to become community health educators, said 
Zenethia Brown, special events coordinator for PALLS. Brown said 
the new grant will help expand the program from public housing 
communities into rural areas. In addition, she said, it will 
address the increasing problem of HIV/AIDS in the Hispanic 
community. In Florence, Hope for the Pee Dee will receive $44,000 
for new prevention, outreach and testing programs.

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