[CDC News] CDC HIV/STD/TB Prevention News Update 03/16/04
prevention...@cdcnpin.org
Tuesday, March 16, 2004
The CDC National Center for HIV, STD and TB Prevention provides
the following information as a public service only. Providing
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HIV/AIDS, other sexually transmitted diseases and tuberculosis
does not constitute CDC endorsement. The following summaries were
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abstracted below for full texts of the articles.
HEADLINES
NATIONAL NEWS
UNITED STATES: "First the Free Test, Then the Free Tunes"
INTERNATIONAL NEWS
GLOBAL: "Around the Globe, Drug-Resistant TB Is Rampant"
INDIA: "Gates Gives $47 Million for AIDS in India"
RWANDA: "Senior US Treasury Official Visits Clinic for AIDS
Victims in Rwanda to Assess Projects Funded by Grants"
NIGERIA: "Nigeria's AIDS Program Said Back on Track"
CANADA: "More Than 1,100 People Need Blood Tests After Illegal
Acupuncture in Montreal"
BRAZIL: "AIDS Spreading Six Times Faster Among Teenage Girls"
MEDICAL NEWS
UNITED STATES: "Tuberculosis: CDC Provides Perspective on
Genotyping in TB Contact Investigations"
NEWS BRIEFS
ALABAMA: "25 More Co-Workers of TB Patient Test Positive, to Get
X-rays"
SOUTH DAKOTA: "Health Department Reports 20 Tuberculosis Cases in
2003"
WISCONSIN: "School Employee Diagnosed as Having Tuberculosis"
ZAMBIA: "Zambia Bans Distribution of Condoms in Schools to
Prevent 'Immorality'"
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NATIONAL NEWS
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UNITED STATES:
"First the Free Test, Then the Free Tunes"
New York Times (03.14.04)::Lynette Clemetson
As part of a national effort to bring HIV testing to places
where people might not otherwise be tested, a program called
Rhythms for Health gives fans willing to take an HIV test and
answer some questions about sex a chance to win free concert
tickets. By linking the testing to the Ladies First concerts
featuring Alicia Keys, Beyoncé and Missy Elliott, organizers hope
to reach the young, predominantly black fans considered to be at
risk.
"What this is about is integrating HIV awareness into the
fabric of our social, cultural and political lives," said Phill
Wilson, director of the Black AIDS Institute (BAI), a national
education group that is sponsoring Rhythms. In the last year, BAI
has offered HIV screenings at Six Flags amusement park in Dallas
and conducted testing at the annual conventions of the NAACP, the
Southern Christian Leadership Conference and the National Urban
League. "It's about reaching black people where they are, as
opposed to asking them to go somewhere else," noted Wilson.
At a recent Rhythms session in Fort Lauderdale, not all of
the roughly 50 people who underwent the 15-minute testing and
counseling session received tickets, as the winners were selected
by lottery. Those who tested on March 12 will be able to pick up
their results on April 2. When tested, they must provide their
names, addresses and phone numbers so they can be notified if the
result is positive. In some cities, tests that provide results in
20 minutes will be used.
"We're strongly encouraging people to think very creatively
about outreach," said Dr. Robert S. Janssen, director of CDC's
Division of HIV/AIDS Prevention. "It's a real opportunity to get
to people who may be at high risk and not know they are
infected."
Rhythms is modeled after a Los Angeles-based program started
in 2001 called Fighting HIV Through R&B: Its founder, Tony
Wafford, estimated it has helped some 12,000 blacks undergo
testing, of whom about 400 were HIV-positive. Wafford eventually
turned to BAI to help expand the program.
Rhythms will offer HIV testing in conjunction with the
Ladies First tour in 14 cities in the next month.
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INTERNATIONAL NEWS
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GLOBAL:
"Around the Globe, Drug-Resistant TB Is Rampant"
New York Times (03.16.04)::Donald G. McNeil Jr.
A new study from the World Health Organization reports there
are possibly as many as 300,000 new cases of drug-resistant
tuberculosis cases worldwide each year, and 79 percent of them
are "superstrains" resistant to any three of the four first-line
drugs. The survey found that patients in the former Soviet bloc
countries are 10 times as likely to have drug-resistant TB
strains as those elsewhere in the world.
According to WHO researchers, drug-resistant TB might be a
much larger problem than they could measure, especially in
countries like India and China, where just a few areas were
surveyed, and in Bangladesh, Indonesia, Nigeria and others, where
no surveying was done. "The true burden in unknown. The more we
survey, the more multi-drug resistant TB we find," said Dr.
Mohamed Abdel Aziz, WHO's TB expert and the study's lead
researcher.
In 10 years, WHO has examined only about one-fifth of
worldwide cases. Some countries have been reluctant to
participate in the effort, and setting up regional laboratories
is expensive and time-consuming.
Though TB is common in very poor countries with many AIDS
cases, drug-resistant strains are more common in moderately poor
countries where patients receive inadequate treatment. WHO
recommends all TB patients receive a cocktail of four drugs
comprising directly observed treatment, short-course (DOTS)
therapy: streptomycin, isoniazid, rifampicin and ethambutol.
Resistance develops when patients skip pills, but researchers
also suspect it is high in areas where first-line drugs are sold
over-the-counter, as in Southeast Asia. Second- or third-line
drugs can be hundreds of times more expensive, and some are
highly toxic and require hospitalization.
The report highlights the need for new TB drugs, said Gwynne
Oosterbaan, spokesperson for the Global Alliance for TB Drug
Development, who said the last new TB drug was introduced in
1963.
INDIA:
"Gates Gives $47 Million for AIDS in India"
Associated Press (03.15.04)::Rajesh Mahapatra
On Monday, the Bill and Melinda Gates Foundation donated $47
million to private agencies doing HIV-prevention work in India,
according to Rajat Gupta, head of Avahan, the foundation's India
AIDS initiative. Gupta said the money will fund a significant
expansion of AIDS prevention efforts among high-risk groups in
the states of Maharashtra, Tamil Nadu, Manipur and Nagaland.
The new money will go to five private agencies: three US-
based groups, one group from Australia, and one from India. The
five have delivered HIV-prevention services around the world. The
money will go mainly to promote condom use and treat STDs and
will complement Indian government prevention programs in the
states.
In Sanskrit, Avahan means "call to action." It was launched
as part of the foundation's $200 million pledge to fight AIDS in
India, where an estimated 4.6 million people are HIV-infected.
Microsoft chief Bill Gates made the initial pledge during a 2002
visit to India. Earlier this year, the foundation sanctioned
$67.5 million for HIV prevention in the states of Andhra Pradesh
and Karnataka. Monday's announcement brings the total of Gates
Foundation grants awarded to India to $114.5 million.
RWANDA:
"Senior US Treasury Official Visits Clinic for AIDS Victims in
Rwanda to Assess Projects Funded by Grants"
Associated Press (03.15.04)::Rodrique Ngowi
US Treasury Undersecretary for International Affairs John
Taylor visited a Rwandan HIV/AIDS clinic on Monday to see if
projects funded by grants - rather than loans - are helping
improve people's lives. Taylor visited projects financed by
grants from the International Development Association, the World
Bank and the African Development fund. "The shift from loans to
grants is really an increase in the total amount of support
because the grants don't have to be paid back," Taylor said.
President Bush's administration, Taylor said, has pushed for
an increase in the use of grants rather than loans and aims to
press for higher grant levels at future World Bank meetings. "Our
assistance through banks has been in the form of loans until now,
and right now 25 percent of the [US] funding through the World
Bank is going to be in the form of grants," he said.
Ten years after 500,000 people were killed in 100 days of
bloody genocide, Rwanda is still struggling to rebuild its
economy. The country has external debts of $1.4 billion, and 70
percent of Rwanda's people live on less than $1 a day. "For the
highly indebted poor country like Rwanda, it is extremely
important that as the program of debt alleviation is completed,
they don't fall back into the debt trap," said Donald Kaberuka,
Rwanda's finance minister.
NIGERIA:
"Nigeria's AIDS Program Said Back on Track"
Associated Press (03.12.04)::Dulue Mbachu
Nigeria's Health Ministry announced Friday that its AIDS
treatment program, recently beset with drug shortages, has had
its drug stocks resupplied and has local production underway. The
government placed a 500 million naira (US$3.7 million) emergency
antiretroviral drug order for the program, said Ministry
spokesperson Ayo Osinlu. "The drugs are here now and the 25
centers are now being resupplied," said Osinlu. An additional $11
million has been allocated in the 2004 budget to buy more drugs,
he said.
The program faltered when it ran out of drugs in September.
AIDS advocates criticized the government for its handling of the
program and said patients at some centers had been given expired
drugs.
Launched in 2002, the program intended to treat 10,000
adults and 5,000 children with HIV. In this nation with 5.4
percent of its 126 million people HIV-infected, though, more than
14,000 people signed up to receive treatment, which costs 1,000
naira (US$8.30) a month. At a pharmacy, patients would have to
pay 12,000 naira (US$100).
Health Minister Eyitayo Lambo said the program would be
expanded to treat more people and commended some Nigerian states
that have their own subsidized HIV drug programs.
CANADA:
"More Than 1,100 People Need Blood Tests After Illegal
Acupuncture in Montreal"
Canadian Press (03.15.04)::Peter Ray
On Monday, Quebec health officials said they are contacting
more than 1,100 patients of a woman who practiced acupuncture in
Montreal following the recent discovery that the needles she used
during treatment were not properly sterilized. The department is
asking them to have a blood test for HIV and hepatitis. Even
thought the risk of infection from HIV or hepatitis B and C
during acupuncture is "virtually nil," there are no guarantees,
said Dr. John Carsley, head of infectious diseases for the
Montreal Public Health Department.
Letters are being sent to 1,071 of the 1,144 patients who
went to Suzanne Sicotte for acupuncture between 1979 and last
January, and authorities are seeking addresses for the 73 other
patients.
Carsley said Sicotte was an osteopath by training but
offered acupuncture to some clients. Osteopaths work with their
hands to treat musculoskeletal and other physical problems
including repetitive strain injury. Sicotte has a Swiss diploma
in acupuncture, according to her attorney, Marc Plamdon, but was
not a member of the professional order that represents
acupuncturists in Quebec. "In the circumstances, our client
regrets the inconvenience suffered by her clients as they verify
the state of their health," said Plamdon.
Since April 2003, acupuncture needles can be used only once
by acupuncturists who are members of the province's professional
order. Previously, acupuncture needles had to be sterilized with
heat before they could be reused. But Sicotte only dipped the
needles into a chemical solution to sterilize them, said Carsley.
After a client questioned her sterilization procedures, she was
fined $7,000 and is no longer practicing, said Raymond Bourret,
head of Quebec's acupuncture association. Sicotte's illegal
practice had escaped detection because she neither joined the
professional order nor placed advertisements, said Bourret.
BRAZIL:
"AIDS Spreading Six Times Faster Among Teenage Girls"
Inter Press Service (03.10.04)::Mario Osava
Alexandre Granjeiro, head of the Brazilian Health Ministry's
division on sexually transmitted diseases and AIDS, said HIV/AIDS
is spreading at an alarming rate among teenage girls - the only
category in which the epidemic's growth shows "a huge gender
difference."
Although six girls ages 13-19 are infected for every boy in
that age group, women still represent a minority of people living
with HIV/AIDS in the country of nearly 180 million. Women account
for 35 percent of the 138,000 patients currently receiving
antiretroviral drugs provided free by the public health system,
and they represent 28 percent of the total 277,153 cases
registered in Brazil since 1983.
Several factors have contributed to the spread of HIV/AIDS
among adolescent girls in recent years. "Besides having less
bargaining power to convince their partners to use condoms, girls
tend to stop insisting on condom use once the relationship
evolves into a more stable one based on ties of affection,"
Granjeiro said. He noted that girls begin using other
contraceptive methods, putting a higher priority on pregnancy
prevention. Also, many girls get involved with older men, who
have a higher rate of HIV/AIDS and are less willing to use
condoms, Granjeiro noted.
Another factor is the increasingly young age at which
teenagers become sexually active. A study by UNESCO found that
sexual activity begins, on average, between ages 13.9-14.5 among
boys, and between ages 15.2-16 among girls. The survey questioned
16,422 students ages 10-24 in Brasilia and 13 state capitals.
The Health Ministry launched a controversial condom
distribution program last year in schools in five municipalities
as a pilot test. This year, the program will be extended to 205
municipalities that account for nearly half of all HIV/AIDS cases
in Brazil. Nearly 2.2 million condoms will be handed out in 900
public schools attended by 540,000 students.
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MEDICAL NEWS
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UNITED STATES:
"Tuberculosis: CDC Provides Perspective on Genotyping in TB
Contact Investigations"
TB & Outbreaks Week (02.03.04)
Recent research from CDC provides a perspective on
genotyping in TB contact investigations. "Genotyping of
Mycobacterium tuberculosis isolates has been widely used to
support investigations of outbreaks and as a tool for studying
transmission dynamics and other aspects of tuberculosis
epidemiology. Its applications to contact investigations are more
limited. Targeted typing can be used to confirm or disprove
suspected relationships among cases," according to the study.
"Universal typing of isolates can be used to identify
unsuspected transmission and broaden the scope of contact
investigations," said CDC's Jack T. Crawford. "In order to
properly use the results, one must understand the nature of the
changes in the M. tuberculosis genome that produce the
heterogeneity reflected in the genotypes, and understand the
discriminatory power of the various methods."
"IS6110 fingerprinting provides the highest discriminatory
power, but can be a slow process," Crawford explained. "Spoligo-
typing and MIRU-VNTR are PCR-based methods that provide faster
turnaround and produce digital results that facilitate
comparisons. Appropriately used, isolate genotyping can be a
useful adjunct to standard contact investigations."
The study, "Genotyping in Contact Investigations: A CDC
Perspective," appeared in the International Journal of
Tuberculosis and Lung Disease (2003;7(12Suppl.):S453-S457).
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NEWS BRIEFS
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ALABAMA:
"25 More Co-Workers of TB Patient Test Positive, to Get X-rays"
Associated Press (03.16.04)
In Bayou La Batre, 25 more co-workers of a man with TB have
tested positive for tuberculosis bacteria and will be X-rayed to
see if they have active cases. The 25, who were among 55 people
receiving skin tests on Friday, are in addition to 16 co-workers
who tested positive earlier, said Joseph Jablecki, Mobile
County's program manger for TB control. He noted that he and his
staff are having trouble communicating with the man, who is
Asian. Ten of the patient's 11 household contacts have tested
positive: Six had normal X-rays and are receiving medications,
and two will be X-rayed this week. Two children with abnormal X-
rays are on multiple drug therapy for active cases, although they
are not infectious, Jablecki said. Health officials are seeking
more people who may have been exposed, as they suspect the man
had contact with others beyond his home and workplace.
SOUTH DAKOTA:
"Health Department Reports 20 Tuberculosis Cases in 2003"
Associated Press (03.12.04)
Last year, South Dakota reported 20 cases of TB, up from 13
cases in each of the previous two years. However, the state's
overall number of cases is declining, state Health Department
officials said. "The number of TB cases fluctuates from year to
year, but the overall trend continues to decline," said Kristin
Rounds, TB control coordinator for the Health Department. Rounds
credited the decline to an aggressive control program that
screens those at risk and to active surveillance.
WISCONSIN:
"School Employee Diagnosed as Having Tuberculosis"
Associated Press (03.12.04)
An employee at the Indian Trail Academy was diagnosed with
active TB, and students and staff members there may have been
exposed, said Kenosha Unified School District Superintendent
Scott Pierce. The Kenosha County District of Health notified the
school district Tuesday of the possible exposure, and letters
were sent home to parents Thursday. "Anyone at this point who may
have been infected or come into contact with the germ is not an
active case. They cannot pass the infection to others," said
Cynthia Rafenstein, the division's assistant director of nursing.
Students and staff believed to have had close contact with the
infected employee were to be offered free skin tests on Monday.
ZAMBIA:
"Zambia Bans Distribution of Condoms in Schools to Prevent
'Immorality'"
Agence France Presse (03.15.04)
Zambia has banned the distribution of condoms in schools -
an effort begun to fight HIV/AIDS - saying the initiative was
promoting immorality and pre-marital sex. "The distribution of
condoms to young boys and girls could, instead of protecting them
from HIV/AIDS, encourage them to engage in premature sex,"
Education Minister Andrew Mulenga said in a statement. The
activists and non-governmental organizations that had been
distributing the condoms to pupils denounced the move. "We can't
continue living in denial," said Nkandu Luo, a former health
minister turned AIDS activist. "We need to protect the young from
this deadly disease." An estimated one in five adults in Zambia
is believed to be HIV-positive.
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