[CDC News] CDC HIV/STD/TB Prevention News Update 11/26/03

CDC HIV/STD/TB Prevention News Update
Wednesday, November 26, 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 
investigation into the facts and statements made in the articles 
being summarized, and therefore readers are expressly cautioned 
against relying on the validity or invalidity of any statements 
made in these summaries. This daily update also includes 
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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
UNITED STATES: "Where They Must Wait; AIDS Patients in 10 States 
Can't Get Life-Saving Drugs"
KANSAS: "Teen-Sex Law Enforcement Before Judge"

INTERNATIONAL NEWS
GLOBAL: "Grim World AIDS Statistics Show Disease's Global Grip"
AFRICA: "Africa Has More than 11 Million AIDS Orphans - UNICEF"
EASTERN EUROPE, COMMONWEALTH OF INDEPENDENT STATES: "Generation 
at Risk as AIDS Peril Advances in Former Soviet Bloc"
ASIA: "Drug Use, Prostitution Put Asia's 'Big Three' at Risk"
UNITED KINGDOM: "Britain to Fund AIDS Treatment in Developing 
Countries for First Time"

MEDICAL NEWS
EUROPE: "HIV Prevention: Clear Proof Offered That HIV Virus 
Cannot Pass Through Condoms"

LOCAL AND COMMUNITY NEWS
ILLINOIS: "AIDS: 'A Silent Storm'"

NEWS BRIEFS
AFRICA: "US Group to Visit Four Countries to Examine Projects 
that Combat AIDS" 
GLOBAL: "Hunger Worsens in Many Lands, UN Says"

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                            NATIONAL NEWS
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UNITED STATES:
"Where They Must Wait; AIDS Patients in 10 States Can't Get Life-
Saving Drugs"
Newsday (11.26.03)::Laurie Garrett
     At a time when the Bush administration has asked Congress 
for $15 million to help fight AIDS overseas, some US patients are 
being denied access to antiretroviral treatment. Ten states 
currently have waiting lists for the AIDS Drug Assistance 
Programs that provide medication to low-income HIV/AIDS patients 
with little or no insurance who do not qualify under Medicaid. 
ADAP was set up under the Ryan White CARE Act of 1990. In states 
that offer HIV medications through Medicaid, only those with 
fully developed AIDS qualify. ADAP is the only program that 
offers free HIV/AIDS drugs to indigent patients whose HIV has not 
progressed to AIDS.
     Nationwide, some 700 people are now on ADAP waiting lists. 
Because people on ADAP rolls are living longer, fewer program 
slots are opening due to deaths. As HIV caseloads climb and 
states are trying to juggle budget deficits, ADAPs are 
restricting  eligibility guidelines. Although ADAP is federally 
supported, funding has not kept pace with the increase in 
patients, and budget deficits have rendered many states incapable 
of augmenting ADAP funds. Federal funds for 2004 are $793 
million, a rise from this year's $714, but below the $928 million 
experts estimate is needed.
     West Virginia (23 people on the waiting list), Kentucky 
(130), Alabama (141), North Carolina (100), Colorado (130), 
Indiana (47), Nebraska (30), Oregon (24), South Dakota (49) and 
Montana (1) are the states that have waiting lists. Five more 
states have imposed limits on the number of patients ADAP could 
serve, meaning they too will soon have waiting lists.
     Some 850,000-950,000 people in the United States have 
HIV/AIDS, the largest number of cases in this country since the 
epidemic began, according to a report CDC released yesterday.

KANSAS:
"Teen-Sex Law Enforcement Before Judge"
Wichita Eagle (11.26.03)::Ron Silvester
     On Tuesday, doctors and lawyers squared off in federal court 
in a case involving how much discretion to give physicians and 
prosecutors in reporting sexual practices among people under age 
16.
     Last summer, Kansas Attorney General Phill Kline presented a 
controversial opinion that said doctors, psychologists, nurses 
and other health care providers should report all suspected 
sexual activity in that age group. Under a 20-year-old state 
statute, any sexual contact by someone under 16 can lead to 
criminal charges. Before Kline's opinion, health care providers 
were only required to report instances where they believed sexual 
activity had harmed a young person. Now doctors fear the law will 
silence teens and put them at risk.
     Health experts say teens will not stop having sex because of 
the ruling but will stop seeking the health care that can prevent 
STDs and unwanted pregnancies. Doctors agree that cases of sexual 
abuse - such as rape, incest or molestation - should continue to 
be reported.     
     Jonathan Klein, an expert on adolescent medicine, coauthored 
a study showing that most teens do not access health care due to 
fear and embarrassment. That can lead, he cautioned, to young 
people not seeking contraceptives or counseling on sexual 
practices.
     Health care providers asked for an injunction so prosecutors 
cannot charge them with a Class B misdemeanor for not reporting 
less serious cases. Some doctors testified that such a charge 
could put their licenses at risk or cause them to face ethical 
violations.
     Aid to Women, a health service that provides abortions, is 
bringing the class action. Clinic officials fear Kline's action 
gives the state too much authority to target teens and health 
care providers for criminal investigations.
     The judge in the case is expected to rule by late December.

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                       INTERNATIONAL NEWS
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GLOBAL:
"Grim World AIDS Statistics Show Disease's Global Grip"
Newsday (11.26.03)::Laurie Garrett
     As many as 46 million people worldwide are HIV-infected, and 
more than 3 million people will die of AIDS by the end of this 
year, UNAIDS said yesterday in its annual report. HIV is now the 
leading cause of death in Africa, and the fourth-leading cause of 
death worldwide. Ten new infections occur every minute.
     In a separate US report, CDC said an epidemic resurgence may 
be underway in the United States. A survey of 29 states that 
require HIV reporting found a 5.1 percent increase in new 
diagnoses from 1999 to 2002. More than half those new infections 
were among African Americans, whose infection rate had grown to 
10 times that of whites by 2002. For African Americans ages 25-
44, AIDS was the third-leading cause of death. In 1999-2002, new 
HIV diagnoses fell by 19 percent in African-American women but 
soared among men. 
     New HIV diagnoses were up 26 percent among Latinos, 8 
percent among whites and 17 percent among gay men of any race. 
"We have to raise the possibility that this could be indicating a 
resurgence of HIV in that [gay male] population," said Dr. Ronald 
Valdiserri, CDC's deputy director of HIV prevention. The new HIV 
figures follow last week's CDC report that syphilis had climbed 
for the second year in a row, with nearly half the new cases 
among gay men.
     The 29 states covered do not include New York, California, 
Illinois and Washington, D.C., which have recently switched from 
tracking only fully developed AIDS cases to monitoring HIV 
infection. Because these four locations are home to a large 
segment of the nation's gay and Latino populations, infection 
rates among gays and Latinos might be steeper if data from these 
states were available, Valdiserri said. 

AFRICA:
"Africa Has More than 11 Million AIDS Orphans - UNICEF"
Reuters (11.26.03)
     In a report released today, UNICEF said that by the end of 
2001, more than 11 million African children under age 15 were 
orphans as a result of the AIDS pandemic. The study called for 
quick international aid to families and communities struggling to 
care for AIDS orphans, calling it a "crisis of gargantuan 
proportions."
     UNICEF Executive Director Carol Bellamy said, "We must keep 
parents alive and ensure that orphans and other vulnerable 
children stay in school, and are protected from exploitation and 
abuse."
     By 2010, the report said, about 20 million African children 
will have lost one or both parents to AIDS. In countries worst 
hit - such as Botswana, Lesotho, Swaziland and Zimbabwe -  more 
than one in five children will be orphans by 2010, 80 percent of 
them because of AIDS. Even in countries where HIV prevalence has 
been stabilized or lowered, such as Uganda, the orphan crisis 
will grow as already-infected parents die.
     Extended families are caring for 90 percent of Africa's AIDS 
orphans, putting added burden on family networks increasingly 
headed by women and grandparents. "Most worryingly, it is 
precisely those countries where the extended family is already 
most stretched that will see the largest increase in orphans," 
according to UNICEF.
     Noting that many of the most severely affected countries 
have no national policies to deal with orphans' needs, UNICEF 
called for immediate assistance for programs to support, educate 
and care for the vulnerable population.
     "[This] assistance can mean that many orphans who might 
otherwise be separated from their families are able to remain 
with them," Bellamy said. "The future of Africa depends on it."

EASTERN EUROPE, COMMONWEALTH OF INDEPENDENT STATES: 
"Generation at Risk as AIDS Peril Advances in Former Soviet Bloc"
Agence France Presse (11.25.03)::Richard Ingham
     From Estonia to Kazakhstan, unsafe sex and rampant IV drug 
use in Eastern Europe and the former Soviet bloc are exposing 
teenagers and young adults to HIV/AIDS, UNAIDS and the World 
Health Organization said Tuesday. In the region, the UN estimated 
about 230,000 people became infected with HIV in 2003, raising 
the region's HIV/AIDS cases to 1.5 million. About 30,000 people 
there will die from AIDS this year.
     An estimated 1 million people ages 15-49 have HIV in Russia. 
A Moscow survey of boys ages 15-18 cited in the UN report found 
that 12 percent had used injection drugs. In St. Petersburg, 30 
percent of drug users were male teenagers. And while females 
comprised 24 percent of new HIV diagnoses in 2001, they 
represented 33 percent in 2002. Consequently, there was a sharp 
rise in mother-to-baby transmission.
     HIV epidemics continue spreading in Belarus, Moldova, 
Kazakhstan, Kyrgyzstan and Uzbekistan. "Driving these epidemics 
is widespread risky behavior - injecting drug use and unsafe sex 
- among young people," the report said. 
     "Extraordinarily large numbers of young people regularly or 
intermittently engage in injecting drug use, and this is 
reflected in increasing HIV prevalence among drug users 
throughout the former Soviet Union," said the report. "Condom use 
is generally low among young people, including those at highest 
risk of HIV transmission in Eastern Europe and Central Asia."
     In Ukraine, a quarter of people diagnosed with HIV are 
younger than 20; in Belarus, 60 percent are ages 15-24; and in 
Kazakhstan and Kyrgyzstan, more than 70 percent are under 30. 
More than 80 percent of those HIV-infected in the region are 
under 30 years old, the report noted.
     Poland's HIV infection rate has stabilized since the mid-
1990s, as had happened in the Czech Republic, Hungary and 
Slovenia since the late 1990s. However, in the former war-torn 
Balkans, drug injecting and risky sex have increased.   

ASIA: 
"Drug Use, Prostitution Put Asia's 'Big Three' at Risk"
Agence France Presse (11.25.03)::Richard Ingham
     China, India and Indonesia - which are home to 40 percent of 
the world's population - now face HIV epidemics that could leap 
out of risk groups and into the mainstream, UNAIDS and the World 
Health Organization warned Tuesday in their annual "AIDS Epidemic 
Update." "Injecting drug use and sex work are so pervasive in 
some areas that even countries with currently low infection 
levels could see epidemics surge suddenly," it said.
     Of the estimated 40 million HIV infections worldwide, around 
7.4 million live in Asia and the Pacific. A million people in 
this region will have become HIV-infected this year, and half a 
million will have died from the disease. 
     In China, "...serious, concentrated epidemics have been under 
way for many years in certain regions (such as Yunnan, Xinjiang, 
Guangxi, Sichuan, Henan and Guandong) and are poised to take off 
in several others." The current source: increasing numbers of 
injection drug users (IDUs) sharing needles, as well as low 
condom use among sex workers and gays.
     In India, epidemics are under way in several states - 
including Maharashtra and Tamil Nadu (where sex worker HIV 
prevalence in some cities exceeds 50 percent), and in Manipur 
(with HIV prevalence among IDUs between 60-75 percent). The 
epidemic is spreading to rural areas and the wider populace,  
said the UN agencies.
     In Indonesia, "Over 90 percent of injecting drug users have 
been found to use unclean injecting equipment in three major 
cities, and in one of these, as many as 70 percent report having 
had unprotected sex with sex workers." Fewer than 10 percent of 
the 7 million to 10 million Indonesian men who frequent sex 
workers use condoms consistently.   
     While Cambodia and Thailand got high marks for promoting 
condom use in the sex industry, Vietnam "faces the possibility of 
a serious epidemic" arising from drug users, and Mynamar "has 
little time to lose," with an epidemic growing among IV drug 
users and migrant workers.
     
UNITED KINGDOM:
"Britain to Fund AIDS Treatment in Developing Countries for First 
Time"
Independent (11.26.03)::Jeremy Laurance
     Hilary Benn, the United Kingdom's International Development 
Secretary, announced yesterday that Britain will fund AIDS 
treatments for the developing world for the first time. His 
announcement came at the launch of UNAIDS' annual report. 
Previously, the Department for International Development backed 
HIV prevention but did not support treatment programs. Lower 
antiretroviral drug prices, and the realization that whole 
regions of the world face economic ruin, led to the change.
     "Generations are being wiped out by the disease," Benn said. 
"If we are honest, we should have done more sooner."
     Spending on AIDS programs had increased sevenfold since 
1997, according to Benn, making Britain the second largest donor 
to the developing world. By 2005-6, spending in Africa would rise 
to £1 billion (US $1.7 billion), he said.
     The move reflects growing international concern about the 
pandemic's potential to destroy young, economically active 
populations in developing nations. The UNAIDS report said 
spending on AIDS programs rose 50 percent last year, an indicator 
that governments are taking the disease more seriously. Although 
world governments spent £4.7 billion (US $8.03 billion) to fight 
HIV/AIDS last year, this fell far short of what was required.
     In a separate development, the European Union announced 
plans to cut funding, starting in 2004, for European centers that 
monitor AIDS, tuberculosis and sexually transmitted diseases. The 
cut comes as HIV/AIDS is on the rise in Baltic states such as 
Estonia, slated to join the European Union.

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                            MEDICAL NEWS
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EUROPE:
"HIV Prevention: Clear Proof Offered That HIV Virus Cannot Pass 
Through Condoms"
AIDS Weekly (11.10.03)
     Recently, questions have arisen regarding whether HIV can 
pass through pores in latex condoms. European Union research 
projects provide extensive proof that it cannot. 
     Over the past 15 years, the European Commission has 
supported numerous research projects to study - directly or 
indirectly - condom use as a preventive measure against STDs 
including HIV/AIDS. The projects were conducted in Europe, Asia 
and Africa. Each study concluded that the male condom is an 
effective way to prevent transmission of HIV, with close to 100 
percent efficacy when used properly.
     "I rely on statements that are based on sound scientific 
evidence - and we can demonstrate that condoms are the best way 
to prevent HIV infection. Statements not supported by sound 
scientific evidence are not plausible," said European Research 
Commissioner Philippe Busquin.
     The European Commission-funded project, "Assessment of 
Methods for Finding Holes in Condoms," evaluated their safety and 
effectiveness. Researchers on the project analyzed water, ion and 
air permeability for setting quality control standards for 
condoms. Their conclusions were used to standardize the 
evaluation methods for producing safer and more secure condoms.
     A European multicenter study funded by the European 
Commission through several research projects including "AIDS: 
Heterosexual Transmission" and "EC Concerted Action on the 
Heterosexual Transmission of HIV," followed 563 couples with one 
seropositive partner over 12-21 months. Among the 123 couples 
using condoms for each instance of vaginal or anal intercourse, 
no seroconversions occurred. Among 122 partners who did not 
regularly use condoms, 12 seroconversions occurred. The 
consortium concluded that no HIV transmission occurs among 
systematic condom users.
     Another EU-funded project studied 866 female European 
prostitutes. "HIV Infection in Female Prostitutes" concluded that 
HIV infections were associated with a lack of condom use, and 
stated that petroleum-based lubricants can diminish the efficacy 
of condoms.
     
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                   LOCAL AND COMMUNITY NEWS
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ILLINOIS:
"AIDS: 'A Silent Storm'"
Chicago Sun Times (11.24.03)::Cathleen Falsani
     Though much has been done in HIV/AIDS prevention work in the 
last 20 years, AIDS activists say something dramatic needs to 
happen to reverse the foothold the disease has established in the 
African-American community, where HIV infection rates continue to 
rise.
     Churches, the cornerstone of the community, can play a role, 
but pastors have been reluctant to preach about HIV prevention. 
Gina Lathan-Whitener, assistant chief of the HIV/AIDS section of 
the Illinois Department of Public Health, told a recent gathering 
of clergy at Chicago's Liberty Baptist Church, "Twenty years into 
this epidemic, there is no vaccination and the face of HIV has 
changed to the color of yours."
     In Illinois, more than half of those people living with AIDS 
are African-American, even though they comprise just 15 percent 
of the total population, said Lathan-Whitener. Almost 69 percent 
of HIV-positive women and 65 percent of women living with AIDS in 
Illinois are African-American, she said.
     "Clearly we have a problem," said Lathan-Whitener, who 
started an HIV ministry at her church. "Often we don't like to 
talk about certain lifestyles and behaviors. But through our 
silence, we have created a silent storm, a silent merciless storm 
that fills the hearts of its victims with loneliness, fear and 
shame."
     A recent survey of 100 black Chicago ministers found that 80 
percent had some kind of HIV ministry in their churches, and many 
also provide faith-based social services.
     But, the black church must rid itself of the stigma - 
spiritual and social - attached to HIV/AIDS, said the Rev. Doris 
Green, corrections coordinator for the AIDS Foundation of 
Chicago. Green said many ministers have had difficulty bridging 
the gap between a spiritual responsibility and the reality of 
many of their congregants' lives, where sex and often drugs are 
part of life. 

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                          NEWS BRIEFS
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AFRICA:
"US Group to Visit Four Countries to Examine Projects that Combat 
AIDS" 
Associated Press (11.25.03)::Harry Dunphy
     Health and Human Services Secretary Tommy Thompson said 
Tuesday that he and a group of 80 US lawmakers, business people 
and members of religious organizations will travel to Africa next 
week to mark World AIDS Day and to examine efforts aimed at 
fighting the epidemic. The group will visit Zambia, Rwanda, 
Kenya, Uganda and Cameroon, said Thompson, who heads the Global 
Fund to Fight AIDS, Malaria and Tuberculosis. The delegation will 
include Randall Tobias, recently named to coordinate the $15 
billion, five-year US international AIDS effort, and Richard 
Holbrooke, former US ambassador to the UN and now president of 
the Global Business Coalition for HIV/AIDS. Thompson said he will 
be joined in Zambia for a World AIDS Day observance by Dr. Lee 
Jong-Wook, the new director-general of the World Health 
Organization, and Dr. Peter Piot, head of UNAIDS. "This is the 
largest and most diverse single mission of its kind, bringing 
leaders from across the spectrum to witness what AIDS is doing in 
Africa and what we can do to help Africa fight back," Thompson 
said. 

GLOBAL:
"Hunger Worsens in Many Lands, UN Says"
New York Times (11.26.03)::Somini Sengupta
     On Tuesday, the UN Food and Agriculture Organization 
reported that worldwide hunger and malnourishment have swelled in 
recent years, particularly in sub-Saharan Africa, because of war, 
drought, AIDS, and trade barriers. The AIDS pandemic in southern 
Africa has cut a devastating swath through what would otherwise 
be its most productive citizens, taking from families their 
breadwinners and forcing some to abandon their fields. Hunger has 
exacerbated the pandemic, driving rural people to the cities, 
where infection rates are high, and forcing women and children to 
trade sex for money and food, the report found. Countries that 
successfully reduced hunger were those where agricultural 
production rose, population growth slowed, and HIV rates were 
relatively low.

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