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CDC HIV/STD/TB Prevention News Update
Tuesday, December 02, 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
information from CDC and other government agencies, such as
background on Morbidity and Mortality Weekly Report (MMWR)
articles, fact sheets and announcements. Reproduction of this
text is encouraged; however, copies may not be sold, and the CDC
HIV/STD/TB Prevention News Update should be cited as the source
of the information. Contact the sources of the articles
abstracted below for full texts of the articles.
HEADLINES
NATIONAL NEWS
INDIANA: "AIDS Cases on the Increase, Especially Among
Minorities"
MAINE: "Rise in HIV Cases Raises Concern that Prevention Message
Goes Unheeded"
CALIFORNIA: "Activists Call on Governor to Maintain Funding for
AIDS Drugs"
UNITED STATES: "Suffer Not the Children"
INTERNATIONAL NEWS
AFRICA: "Thompson Promotes HIV Awareness in Zambia"
CHINA: "Chinese Leaders Break AIDS Taboo"
INDIA: "India Plans Free AIDS Therapy, but Effort Hinges on Price
Accord with Drug Makers"
UNITED KINGDOM: "British Rates of TB 'Are Worse than Third
World'"
MEDICAL NEWS
UNITED STATES: "Female-Condom Use in a Gender-Specific Family
Planning Clinic Trial"
LOCAL AND COMMUNITY NEWS
FLORIDA: "Memorial Service Draws Small Crowd in Broward"
NEWS BRIEFS
CALIFORNIA: "Hispanics in Monterey County Nearly Half of New AIDS
Cases"
CANADA: "Canada Gives $76 Million to Africa's AIDS Battle"
UNITED KINGDOM: "Britain Pledges $10 Million to Fight AIDS in
2004"
AFRICA: "Medecins sans Frontieres Urges Further Cuts in AIDS Drug
Prices for Wider Access"
************************************************************
NATIONAL NEWS
************************************************************
INDIANA:
"AIDS Cases on the Increase, Especially Among Minorities"
Associated Press (12.02.03)
In commemoration of World AIDS Day, Indiana University
students lined the streets and sidewalks around Dunn Meadow in
Bloomington on Monday with 500 luminaries in remembrance of
Hoosiers who have died from HIV/AIDS. Sponsored by the IU chapter
of the Student Global AIDS Campaign and the Community Action
Group, the event was designed to call attention to the continuing
battle against the epidemic.
Cases of HIV/AIDS have risen sharply in the state between
1999 and 2002. In 1999, 312 HIV and 358 AIDS cases were diagnosed
in Indiana. Last year, 314 HIV and 484 AIDS cases were diagnosed.
And for the first nine months of 2003, an additional 274 HIV and
379 AIDS cases were reported - slightly ahead of 2002's pace.
HIV/AIDS is becoming increasingly common among Indiana's
black and Hispanic populations. "AIDS is becoming much more a
disease of minorities," according to Michael Butler, director of
the state Department of Health's division of HIV and STDs.
One-third of new cases involve black residents, although
they comprise just 8.3 percent of the state's population.
Likewise, black women account for 43 percent of the new AIDS
cases among women, said Butler. Hispanics, who make up less than
1 percent of Indiana's population, account for about 4 percent of
the new cases.
According to Butler, three out of four new cases in Indiana
are attributable to unprotected sexual contact, compared to 13
percent resulting from shared needles. From 1982 through the end
of September 2003, Indiana has reported about 4,000 HIV and 7,300
AIDS cases.
MAINE:
"Rise in HIV Cases Raises Concern that Prevention Message Goes
Unheeded"
Associated Press (12.02.03)
A spike in the number of new HIV cases diagnosed in Maine
has raised concerns that AIDS prevention messages are falling on
deaf ears. To date this year, 45 new HIV cases have been recorded
- a 67 percent increase over the 27 new cases in all of 2002.
George Friou, executive director of the Frannie Peabody
Center, a Portland-based AIDS service organization, said he fears
that as people with AIDS live longer, others lose their fear of
the disease. "My concern is that people really don't understand
that living with this disease is horrible," said Friou. "It's
really got us concerned about the entire prevention activities.
Are the messages working? Are the strategies working?"
He fears the answer is no. Friou said he and his staff
continue to struggle with ways to convey the seriousness of
HIV/AIDS to the community.
Cindy Foley, acting director of the Institute of
Contemporary Art at Maine College of Art-Portland, explained that
World AIDS Day began as "Day Without Art," an effort by the arts
community to bring attention to the epidemic. "We now use Day
Without Art - and now World AIDS Day - as an opportunity... to
educate and remind people that AIDS is not something that's gone
off to another country," said Foley.
CALIFORNIA:
"Activists Call on Governor to Maintain Funding for AIDS Drugs"
Associated Press (12.01.03)::Mason Stockstill
On World AIDS Day, JWCH Medical Clinic officials in Los
Angeles called on Gov. Arnold Schwarzenegger to maintain AIDS
Drug Assistance Program funding proportionate to the need.
Schwarzenegger's budget proposal includes capping ADAP
spending and creating a waiting list if client demand exceeds
available funding. California's ADAP helps cover the cost of
HIV/AIDS medication for those earning less than $50,000 a year.
Treatment officials said the plan could be devastating, since the
number of AIDS cases in California is increasing.
"The governor has the money, and we're urging him to spend
it," said John King, executive director of the Weingart Center, a
nonprofit medical and housing organization.
There were 132,988 people in California with AIDS as of Oct.
31 - an increase of 5,000 over the last 12 months - according to
the state Department of Health Services.
In San Francisco, about 100 people gathered under a tent in
the National AIDS Memorial Grove, a seven-acre wooded basin in
Golden Gate Park, to pay tribute to those affected by AIDS.
UNITED STATES:
"Suffer Not the Children"
USA Today (12.01.03)::Steve Sternberg
A few months after her daughter Ariel's death from AIDS in
1988, Elizabeth Glaser, who contracted HIV from blood
transfusions in 1981, gathered two close friends together to help
her launch the Pediatric AIDS Foundation. Glaser was determined
to get her HIV-positive son Jake, 4, access to AIDS drugs then
available to adults but untested and unapproved for use in
children.
Glaser, wife of actor/writer/director Paul Glaser, used her
Hollywood clout to recruit political, health and celebrity
personalities to get behind the foundation. David Kessler,
chancellor of University of California-San Francisco, was the
commissioner of the Food and Drug Administration when Glaser made
her first trip to Washington. Kessler, who now chairs the
foundation's board, said of Glaser, "I've never seen anyone as
focused: 'Why aren't you requiring companies to develop drugs for
children with AIDS?'"
Jake is now in college and doing well, thanks to improved
treatment, said Susie Zeegen, one of the three founders. However,
the medicines that saved him came too late for Elizabeth, who
died in 1994.
Nov. 28 was the 15-year anniversary of the Elizabeth Glaser
Pediatric AIDS Foundation, and health officials credit it for:
*Prompting Congress in November to impose the pediatric rule
requiring drug firms to test all new medicines on children.
*Prevention efforts that have slashed the number of pediatric
AIDS cases in the United States by 89 percent since 1992.
*A global "Call to Action" program to extend that achievement to
17 other countries, including South Africa, India and Russia.
*Direct funding for promising young HIV/AIDS researchers.
*The Glaser Pediatric Research Network, which links researchers
at five top pediatric medical centers to speed research on a
range of other childhood ailments.
*A social calendar of fundraisers that unite donors and
celebrities with kids and families. The foundation's assets now
total about $32 million, with about $13 million earmarked for
programs.
************************************************************
INTERNATIONAL NEWS
************************************************************
AFRICA:
"Thompson Promotes HIV Awareness in Zambia"
Associated Press (12.01.03)::Florence Mwisa
Africa cannot be left to fight alone against the AIDS
epidemic, Health and Human Services Secretary Tommy Thompson said
Monday in Livingstone, Zambia. "This war has caused more
casualties than any other war," Thompson said before joining a
World AIDS Day march with World Health Organization Director-
General Dr. Lee Jong-Wook. "We need America, the European Union
and everybody. Nobody is going to be spared unless we all come
together in the fight against this disease."
Thompson signed an agreement pledging $2.5 million in
assistance from CDC for HIV prevention, monitoring and care in
Zambia, where UNAIDS estimates 22 percent of adults are HIV-
infected. Thompson is leading a delegation of top US health
officials, lawmakers and business executives on the four-nation
tour to assess current efforts and determine how to increase
treatment and decrease HIV transmission.
At a rally in Livingstone's Mukuni Park, Lee said, "The most
important thing to do is to increase awareness of HIV and also to
encourage people to know their HIV status. This will reduce
transmission of HIV from one person to another."
CHINA:
"Chinese Leaders Break AIDS Taboo"
Washington Post (12.02.03)::Philip P. Pan
Premier Wen Jiabao appeared on Chinese state television
Monday night, comforting AIDS patients and appealing to the
nation to treat them with "care and love," signaling a new
commitment by the Chinese government to fight a disease that has
infected up to 1.5 million of its citizens. Wen pledged to put
HIV/AIDS prevention high on the government's agenda, urging
officials at all levels to act with a "spirit of high
responsibility to the people." He is the first senior Chinese
official to publicly address the nation's AIDS epidemic.
The premier's appearance reinforced the impression that
China's new leaders, who took office in March, are more open-
minded than their predecessors and more willing to steer the
country's rigid political system toward helping weak members of
society. Last month, China Central Television aired its first
public service ad endorsing condom use, after a years-long debate
with censors. This week, a 20-part drama about a woman diagnosed
with HIV after getting a blood transfusion from her boyfriend is
scheduled to air.
The government has begun distributing antiretrovirals to
5,000 rural HIV/AIDS patients, although the effort has been
hampered by China's weak health care system and the cost of
drugs. The government hopes to expand the program to 35,000
patients by 2008.
Wen pledged free medical care for all HIV/AIDS patients,
free anonymous testing, free treatment to prevent mother-to-child
transmission and free education for AIDS orphans. AIDS activists
praised Wen's remarks but warned that sustained leadership would
be needed to force government officials obsessed with hiding bad
news to follow through.
Limits on state media have contributed to a general lack of
knowledge and to widespread discrimination against the infected.
Many Chinese hospitals refuse to treat AIDS patients, and
children with HIV are routinely expelled from Chinese schools.
INDIA:
"India Plans Free AIDS Therapy, but Effort Hinges on Price Accord
with Drug Makers"
New York Times (12.01.03)::Amy Waldman
India hopes to begin providing free antiretrovirals by April
2004 to all HIV-positive new parents and all children under 15 in
six states most affected by AIDS, government officials announced
Sunday. All AIDS patients in those states will ultimately be
treated under the plan. The decision, announced by Union Minister
of Health and Family Welfare Sushma Swaraj, is a shift for the
government, which has not previously tried to offer
antiretrovirals on a major scale, though it does offer drugs to
prevent mother-to-child HIV transmission.
The government must still reach an agreement with the
country's generic pharmaceutical firms to reduce the price of
their antiretrovirals. The firms recently cut their prices to
about 37 cents per patient per day in a Clinton Foundation-
brokered agreement involving four African countries and nine
Caribbean nations. India's drug companies have said that past
efforts to work with their own government have been frustrating.
"If the government wants to buy, they must let us know for
how many, when, and do they have the money," said Yusuf K.
Hamied, Cipla's chair and managing director. For two weeks, the
companies and government have been in what one participant called
"backbreaking" negotiations over those issues.
Swaraj has made it apparent that she would like the
companies to provide lower prices in India than those agreed to
with the Clinton Foundation. "That's only natural because these
are companies based in India," she said.
But the Clinton-brokered deal left the industry a small
enough profit margin, and a guaranteed market, that would allow
their companies to grow, representatives said. To go lower, they
said, would require concessions from the government, such as
excise and sales tax exemptions.
On Sunday, one day before elections in four key states,
Swaraj announced an agreement had been reached. Privately,
however, industry and government officials said negotiations were
still ongoing.
UNITED KINGDOM:
"British Rates of TB 'Are Worse than Third World'"
Daily Mail (11.25.03)::Beezy Marsh
A report released Nov. 24 warned that tuberculosis is making
a comeback in the United Kingdom, and levels of the disease are
now higher than is some Third World nations. The report, the
result of a six-month investigation by the London Assembly health
committee, showed a doubling of TB cases since 1987. Lung experts
accused the government of failing to tackle the disease.
Newham in East London now has the highest rate of TB in the
Western World, with 100.6 infections per 100,000 people. Even
affluent parts of London are seeing more TB, with rates in
Islington rising three-fold. "The biggest rises in TB are in
London, but the threat from TB is not exclusive to London," said
Peter Ormerod, a lung specialist at Blackburn Royal Infirmary.
The rise in TB is being blamed on an influx of foreign
nationals from poor countries where TB is rife. "Cases in the
ethnic minority population are growing and a high proportion of
these are born abroad," Ormerod said. Half of those infected with
TB in Newham are thought to be asylum seekers from India,
Bangladesh and Pakistan.
"After a century in decline, TB is making a worrying
comeback in the capital," said Elizabeth Howlett, chair of the
Assembly health committee. Health experts say at least an extra
£10 million (US $16.9 million) is needed for TB screening to help
stop the disease from spreading.
************************************************************
MEDICAL NEWS
************************************************************
UNITED STATES:
"Female-Condom Use in a Gender-Specific Family Planning Clinic
Trial"
American Journal of Public Health (11.03) Vol. 93; No. 11: 1897-
1903::Susie Hoffman, DrPH; Theresa M. Exner, PhD; Cheng-Shiun
Leu, PhD; Anke A. Ehrhardt, PhD: Zena Stein, MA, MB, BCh
The researchers evaluated female-condom use among women
participating in Project FIO (The Future Is Ours), a randomized
trial of a gender-specific HIV/STD preventive intervention that
was successful in reducing unprotected sex. The authors present
data on female-condom use during a 12-month follow-up period
among 360 women recruited from a family planning clinic in
Brooklyn, N.Y. The women were randomly assigned to an 8- or 4-
session intervention group or to a control group, and interviewed
at 1-, 6-, and 12-month intervals.
The investigators found that relative to control subjects,
women assigned to the 8-session group were more likely to report
maintaining consistent safer sexual intercourse practices or
decreasing the number of sexual intercourse occasions not
protected by a male or female condom, at both the 1-month follow-
up and the 12-month follow-up.
The researchers' findings demonstrate a short-term effect of
intervention on female condom use. Women in the intervention
groups assessed the female condom as more effective against STDs
and pregnancy than women in the control group. Although women
assigned to intervention groups were willing to try the female
condom, that did not translate to sustained use.
"The intervention was the most important predictor of trying
the female condom, but repeated use was related to women's
comfort in using the female condom after trying it," according to
the study. "In open-ended responses, 90 percent of women who
found their first experience difficult cited problems with
insertion."
Although the female condom has been touted as a method that
can be used without a partner's support, the researchers found
"several indications of male partners' influence on women's
response to the female condom." They noted that other studies
have also reported that men's reactions to the female condom are
important predictors of women's use.
"From the studies of female-condom interventions conducted
to date, we conclude that cognitive-behavioral interventions
grounded in a gender-sensitive framework can increase women's
ability to negotiate with their partners about female-condom use
and promote first-time female-condom use. At present, however,
the female condom seems to be difficult for women to adopt
without more extensive trainings in its use," the authors
concluded. "Our data suggest that interventions designed to offer
women greater opportunities to become comfortable with insertion
and to garner the support of male partners may be more effective
in increasing long-term use. Public policy changes are warranted
as well, including increased promotion and price support,
especially now that some studies have shown that it is safe to
reuse the female condom after washing. Without concurrent
individual and structural interventions, the potential of the
female condom to contribute to disease reduction will not be
achieved."
************************************************************
LOCAL AND COMMUNITY NEWS
************************************************************
FLORIDA:
"Memorial Service Draws Small Crowd in Broward"
Miami Herald (12.02.03)::Ashley Fantz
About 75 people attended the HIV/AIDS memorial candlelight
vigil outside of Broward County's Main Library for World AIDS Day
yesterday. The Fort Lauderdale Gay Men's Chorus sang for the
small crowd, and the library offered HIV-themed artwork by more
than 30 visual artists and poets to mark the occasion. The
exhibit was inspired by a Day Without Art, conceived in 1989 to
dramatize HIV's effect.
Some of those operating booths in the library's courtyard
were disappointed by the low turnout. Hispanic Unity of Florida
HIV outreach worker Rafaele Narvaez, 33, said AIDS educators face
many obstacles, including conservative religious attitudes and
traditional views held by some in Broward's growing Latin
community. "You have all these confusing messages, and that's
very difficult to battle as an educator," he said.
The city of Miami set out a couple of hundred folding chairs
at its service for the AIDS dead at the Torch of Freedom. The
middle-aged, mostly African-American and Hispanic guests did not
quite fill the seats.
************************************************************
NEWS BRIEFS
************************************************************
CALIFORNIA:
"Hispanics in Monterey County Nearly Half of New AIDS Cases"
Associated Press (11.30.03)
Hispanics in Monterey County accounted for nearly half of
all new AIDS cases since 1997, and they contracted HIV faster
than any other group, the county Health Department's new 2002
HIV/AIDS report shows. With the exception of a 1 percent
proportional increase among Asian and Pacific Islanders,
Hispanics were the only ethnic group whose share of AIDS cases
grew in the past decade - increasing from 25 percent to 44
percent. In contrast, the proportion of white AIDS patients has
dropped 20 percent, and the percentage of black patients dropped
1 percent. Lack of education and access to health care were among
factors cited for the disease's spread in the Hispanic community.
In addition, language barriers and concerns over immigration
status often deter Hispanics from accessing care, local health
officials said.
CANADA:
"Canada Gives $76 Million to Africa's AIDS Battle"
Agence France Presse (12.01.03)
On Monday, the Canadian government said it would give 100
million Canadian dollars (US $76 million) to help Africa fight
AIDS. The International Cooperation Ministry said the money would
be spent over five years and would be concentrated at first on
Tanzania and Mozambique, which have some of the world's highest
infection rates. "Canada's support for these initiatives today
reflects our much deeper commitment to expanding our role in the
fight against this global pandemic," International Cooperation
Minister Susan Wheeler said in a World AIDS Day statement. Canada
said the contribution would support the World Health
Organization's campaign to provide 3 million HIV-infected persons
in developing countries with antiretroviral drugs.
UNITED KINGDOM:
"Britain Pledges $10 Million to Fight AIDS in 2004"
Agence France Presse (12.01.03)
On Monday, British international development secretary
Hillary Benn said Britain would double its contribution to the
global AIDS battle to £6 million (US $10.3 million)in 2004,
adding that Britain is the second-largest donor of bilateral
HIV/AIDS assistance after the United States. Benn urged the
international community to back the World Health Organization's
plan to provide antiretrovirals to 3 million people by 2005, a
program that will cost $5.5 billion. "The scale and devastation
of HIV and AIDS is colossal," Prime Minister Tony Blair wrote in
a letter published by the Sun newspaper.
AFRICA:
"Medecins sans Frontieres Urges Further Cuts in AIDS Drug Prices
for Wider Access"
Agence France Presse (12.01.03)
On World AIDS Day, International medical charity Medecins
sans Frontieres (Doctors Without Borders) urged that the price of
HIV/AIDS drugs be reduced even more in Africa. "Today, the prices
have fallen by another 50 percent, but every time the price comes
down, more people can afford treatment," said Morton Rostrup,
international council president of MSF. Rostrup said the World
Health Organization has moved closer to its target to give 3
million people antiretrovirals by 2005, thus increasing tenfold
the number of people now getting the drugs. Currently, MSF treats
about 9,000 HIV/AIDS patients in 19 countries at a price of $140
per patient, a price it hopes to reduce to $70.
************************************************************
CORRECTION: Yesterday's PNU summary of the San Francisco
Chronicle's article "Bush Sends Blue-Chip Group to Four AIDS-Hit
African Nations" misidentified delegation member Don Nickles; he
is a US senator (R-Okla.).
************************************************************
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