[CDC News] CDC HIV/STD/TB Prevention News Update 03/15/04
prevention...@cdcnpin.org
Monday, March 15, 2004
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
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HEADLINES
NATIONAL NEWS
ILLINOIS: "Bill Would Let HIV Patients Donate Organs"
GEORGIA: "HIV Study Is Chilling to Black College Campuses"
MICHIGAN: "Sex Disease Numbers Worry Officials"
INTERNATIONAL NEWS
CANADA: "AIDS Drug Bill Fatally Flawed, Activists Warn"
MEDICAL NEWS
SOUTH AFRICA: "Tuberculosis Epidemiology: Genetic Distance Useful
as Measure of Ongoing TB Transmission"
LOCAL AND COMMUNITY NEWS
MISSOURI: "St. Louis-Area AIDS Services Slashed"
MARYLAND: "Cummings Calls for Committee Hearing on HIV Tests at
Hospital"
MASSACHUSETTS: "Crystal Meth Eyed in Syphilis Uptick Among Hub
Gay Men"
NEWS BRIEFS
NEW YORK: "Program Tracks New Yorkers Exposed to HIV"
CARIBBEAN: "AT&T Donating Computers for Regional HIV/AIDS
Programs"
CARIBBEAN: "Clinton Foundation Has Plans for Region"
RWANDA: "Rwanda to Join African Trials for AIDS Vaccine"
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NATIONAL NEWS
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ILLINOIS:
"Bill Would Let HIV Patients Donate Organs"
Associated Press (03.12.04)::Ginny Skalski
Under a bill passed by the Illinois House 95-22, persons
with HIV would be allowed to donate their organs to other HIV-
infected persons. Some organ donor experts and physicians are
backing the bill, which if passed by the Senate would make
Illinois the first state to allow organ transplants between HIV
patients. The law could set off a movement in other states to
eliminate the prohibition on such procedures, experts say.
Opponents, however, worry that not enough controls are in place
to prevent the organs from being accidentally transplanted into
uninfected persons.
HIV-infected organs are currently discarded to prevent their
being used in transplants. But some doctors are saying that the
organs could be used to prolong the lives of HIV patients, who
are living longer thanks to medical advances.
So far, only the Illinois State Medical Society is opposing
the bill; that organization wants the measure to contain language
protecting doctors from being held liable if HIV is accidentally
transmitted during surgeries.
If the measure passes, Illinois will have to work with the
United Network for Organ Sharing, which coordinates the United
States' organ transplant system under contract with the
government, to change the rules that prohibit the procedures.
Rep. Larry McKeon (D-Chicago), who is HIV-positive,
developed the bill after a conversation during a routine doctor's
visit with Dr. Robert Murphy, a professor of infectious disease
at Northwestern University.
GEORGIA:
"HIV Study is Chilling to Black College Campuses"
Atlanta Journal-Constitution (03.11.04)::David Wahlberg
A study revealing an HIV outbreak among black male college
students in North Carolina has caused concern among Atlanta
educators and student leaders. A new testing method initiated in
North Carolina in 2002 led to the discovery of 84 newly infected
male college students, 73 of whom were black. Sixty-seven of the
black men had sex with men; 27 also had female partners.
Desmond Drummer, president of a student health association
at Atlanta's Morehouse College, said people at his school did not
want to "face the facts" about black males who have sex with men
"on the down low" because of anti-gay sentiment. Such men may put
their girlfriends at risk for HIV. At Atlanta's Spelman College,
a predominantly black women's school, HIV education is included
in first-year orientation, said Brenda Dalton, director of
student health services. Georgia State University sponsors
HIV/STD prevention efforts, but none targeted specifically to
black students, said Becky Laurens, director of the student
health clinic.
The National Association for Equal Opportunity in Higher
Education, which represents 120 historically black colleges and
universities, launched a "Stop the Silence" campaign a year and a
half ago to encourage HIV discussion, and added a Web site last
year.
Ronald Bass, executive director of Someone Cares, a Smyrna
AIDS awareness agency, said another issue is that men who do not
use condoms with their girlfriends early on may be reluctant to
start using them after they begin having sex with men or find out
they have HIV.
Dr. Lisa Fitzpatrick, director of CDC's HIV/AIDS Research
Initiative, who assisted with the North Carolina research, said
many black people still view HIV as a gay white man's issue.
Fitzpatrick said, "We're very concerned that this is not unique
to North Carolina. This needs to be addressed throughout the
South, and probably throughout the country."
Students and the presidents of North Carolina's 11
historically black colleges will gather at North Carolina Central
University in Durham March 19-21 to discuss the issue.
MICHIGAN:
"Sex Disease Numbers Worry Officials"
Detroit Free Press (03.11.04)::Megan Christensen
A study presented by the Michigan Department of Community
Health (MDCH) during the National STD Prevention Conference in
Philadelphia found that 14 percent of adolescents in a three-year
screening of Oakland County teens tested positive for chlamydia.
The study examined 3,350 young people in three school-based
clinics, two juvenile centers and two youth shelters. School-
based clinics had the most cases, with 17 percent of males and 21
percent of females testing positive. The research began in
December 2000.
Mark Miller, director of STD prevention for MDCH, said the
Oakland numbers are similar to figures in other US cities, and
that adolescents have generally higher STD rates than the general
population. Without the initiative, the study concluded, 80
percent of male cases and 55 percent of female cases would have
been missed because they had no symptoms. In schools, half of the
positive results occurred in students who had visited the clinics
for reasons unrelated to STDs.
MDCH statistics show chlamydia was the most commonly
reported STD in the state for all age groups in 2002, with 32,272
cases. Detroit had 11,374 cases, 34 percent of which were found
in teens ages 15-19, said city health officials. Miller noted
that chlamydia is still underreported, so rates will likely grow
as testing expands. Men are more likely to have noticeable
burning during urination, Miller said, and women may mistakenly
attribute vaginal discharge or burning to other infections.
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INTERNATIONAL NEWS
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CANADA:
"AIDS Drug Bill Fatally Flawed, Activists Warn"
Globe and Mail (03.12.04)::Steven Chase
Debt Aids Trade Africa (DATA), a relief group founded by
Bono, has written Prime Minister Paul Martin warning that
Canadian legislation to get cheap copies of patented medicines to
poor countries will set a bad precedent for the world unless key
provisions are removed. Last fall, Bill C-9 was drafted after a
worldwide agreement specifying that countries skirting patent
laws to copy brand-name HIV/AIDS, malaria and tuberculosis drugs
for distribution in poor countries would not be prosecuted. But
the Canadian law, as currently written, gives brand-name drug
firms the "right of first refusal" to fill contracts that generic
drug firms might arrange. Critics say that provision is a fatal
flaw removing the incentive for generic firms to arrange
humanitarian contracts.
DATA told the prime minister that Canada should not include
such rights in the bill and criticized the government's plan to
restrict which drugs can be copied and shipped to developing
nations. "Giving patent holders a 'right of first refusal' or
'equal opportunity' and restricting what products are eligible
sets a poor precedent for the world after so much promise from
Canada," the group said.
Brand-name companies have argued that since they hold
intellectual property rights on drug patents, they should have a
right to bid on contracts that generic companies might arrange.
They said they believed there would still be instances where a
generic company could fill a contract instead of the patent
holder.
An official in the prime minister's office said the
government is listening and willing to rework Bill C-9. "The
government's view is we should get this right because it's very
important," said the official, who asked not to be named.
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MEDICAL NEWS
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SOUTH AFRICA:
"Tuberculosis Epidemiology: Genetic Distance Useful as Measure of
Ongoing TB Transmission"
TB & Outbreaks Week (02.10.04)
Scientists at the University of Stellenbosch showed that
genetic distance is a valuable measure of ongoing TB
transmission. "The stability of the genotypic marker IS6110, used
to define the epidemiology of Mycobacterium tuberculosis, is one
of the most important factors influencing the interpretation of
DNA fingerprint data," G.D. van der Spuy and colleagues
explained. They proposed that "evolved strains should be
considered together with clustered strains to represent chains of
ongoing transmission." Their study "used a large set of
fingerprint data for strains collected between 1992 and 1998 from
residents of a community with a high incidence of tuberculosis in
Cape Town, South Africa."
"Interstrain genetic distances were calculated by counting
the banding pattern mismatches in the IS6110 DNA fingerprints of
different isolates," the report stated. "These data demonstrate
that the propensity to change by one or two bands is independent
of the IS6110 copy number. Hence, the genetic distance between
pairs of isolates can be simply expressed as the number of
differences in the banding patterns."
"From this foundation, a data set which identifies newly
evolved strains has been generated. Inclusion of these evolved
strains into various molecular epidemiological calculations
significantly increased the estimate of ongoing transmission in
this study setting," the scientists wrote.
"The indication is that nearly all cases of tuberculosis in
this community are due to ongoing transmission," the
investigators concluded. "This has important implications for
tuberculosis control, as it indicates that the control measures
used at present are unable to reduce the level of transmission.
This technique may also be applicable to the study of low-
incidence tuberculosis outbreaks as well as the analysis of
epidemiological data from other disease epidemics."
The report, "Use of Genetic Distance as a Measure of Ongoing
Transmission of Mycobacterium Tuberculosis," appeared in the
Journal of Clinical Microbiology (2003;41(12):5640-5644).
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LOCAL AND COMMUNITY NEWS
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MISSOURI:
"St. Louis-Area AIDS Services Slashed"
Associated Press (03.14.04)
A dramatic cut this year in federal Ryan White Title I
grants to the St. Louis area makes the region the biggest loser
among the 51 metropolitan areas vying for the awards, which were
announced March 4. The city's 14 percent cut from the previous
year's level means the St. Louis region will receive $4.3 million
in Ryan White money this year, the St. Louis Post-Dispatch
reported.
The funding reduction comes despite the region's increase in
new HIV cases, from 10-15 new HIV cases a month in 2002 to 35 per
month in 2003. Efforts to identify and test those most at risk
for the virus are uncovering more AIDS cases. It is troubling
that those who are newly diagnosed with HIV/AIDS will enter the
public health system, said David Salter, St. Louis' grants
administrator, only to be placed on a waiting list for services.
The Metro St. Louis HIV Health Services Planning Council had
to cut $700,000 for services including housing, food, drug cost
reimbursement, childcare, transportation and emergency financial
assistance. The council agreed to keep funds for primary care and
insurance reimbursements. About $1 million goes to drug cost
reimbursements. Other cuts hit transportation, mental health
services, food banks and case managers that help clients access
services.
To ensure that the HIV/AIDS patients with most need get
assistance, the council restricted eligibility criteria for
housing, food and mental health services. A family of four must
not earn above $18,850 a year to qualify.
MARYLAND:
"Cummings Calls for Committee Hearing on HIV Tests at Hospital"
Baltimore Sun (03.13.04)::Walter F. Roche Jr.
US Rep. Elijah E. Cummings (D-Md.) called Friday for a
public hearing on the release of questionable HIV and hepatitis
test results to patients at Maryland General Hospital. Inspectors
from Maryland's Office of Health Care Quality (OHCQ) concluded
that about 400 HIV and hepatitis C test results sent to hospital
patients over a 14-month period ending in August should not have
been issued. In the nine-page report, the inspectors stated that
Maryland General laboratory personnel manipulated and eliminated
data that showed the results were questionable.
"It's one thing not to know something. It's another to have
knowledge and fail to act," said Cummings about allegations that
the hospital was warned of malfunctions with the testing
equipment but failed to address the problems immediately. HIV
tests are "a life-and-death issue," and it would be unacceptable
"for there to be the slightest doubt" that the tests might be
inaccurate, he said. Cummings, chair of the Congressional Black
Caucus, said he was also concerned the disclosure could hamper
efforts to get high-risk groups tested.
A former laboratory worker, Kristin S. Turner, had sent a
letter to hospital officials detailing a long history of safety
and accuracy problems with the HIV testing machine. Turner has
filed a multimillion-dollar suit against the hospital and a test
machine manufacturer, charging that she became infected with HIV
and hepatitis C after the machine malfunctioned and splattered
her with infected blood.
On Friday, Maryland General submitted a formal plan of
corrective action to the state OHCQ, which included new
requirements for quality control and periodic retraining of
laboratory technicians. It also set new requirements to ensure
that personnel follow the operating instructions for testing
equipment - failure to follow those instructions was cited in the
state report.
Hospital officials also detailed their outreach plans to
locate patients possibly affected by the suspect results.
According to the submitted plan, Maryland General halted its HIV
testing operation in August and will continue to use an outside
contractor to conduct HIV tests.
MASSACHUSETTS:
"Crystal Meth Eyed in Syphilis Uptick Among Hub Gay Men"
Boston Herald (03.11.04)::Kay Lazar
On March 10, Boston Public Health Commissioner John Auerbach
said officials have seen a dramatic increase in the use of
crystal methamphetamine in the city's gay male community. Noting
that the drug first became fashionable several years ago among
gays on the West Coast and then gained wider popularity there,
Auerbach said officials are bracing for the same scenario in
Boston.
"On the West Coast, it crossed over to women who use it as a
way to lose weight," he said. "Addicts are often very thin and
paranoid."
The health commissioner said a task force, formed last year
by state and local health officials to study syphilis surges
among gay men, found that crystal meth was a key factor in that
rise. The task force will host a conference next month on the
crystal connection and will focus on "the dangers as it spreads
out into the general population."
Although the city does not yet have data to track the
suspected upswing in crystal use, Sophie Godley, director of
prevention and education at Boston-based nonprofit AIDS Action,
said plenty of anecdotal information from treatment centers
indicates an influx of crystal.
"We're going to see incredible demands on our treatment
facilities," Godley said. "We want to be ahead of the curve and
that's where we need to be investing prevention."
"We're hearing very disturbing stories about people with
strong addictions [to crystal meth] and its connections with
sexually transmitted diseases," Auerbach said.
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NEWS BRIEFS
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NEW YORK:
"Program Tracks New Yorkers Exposed to HIV"
Associated Press (03.14.04)
Under a partner notification program run by the New York
City Health Department, scores of people have been identified for
HIV testing. "One way we can stop the spread of HIV is to contact
partners of infected people who may be afraid or ashamed to do it
themselves," said Susan Blank, assistant commissioner of the
Health Department's STD control program, according to Sunday's
New York Post. The department diagnosed 485 people as HIV-
positive in 2002, and those patients gave the names of 241 sex
partners. Of the sex partners, 99 consented to testing, and 25
partners were HIV-positive, the department said. A department
survey last year reported that while some 80,000 city residents
have HIV/AIDS, as many as 20,000 others may be infected but not
know it.
CARIBBEAN:
"AT&T Donating Computers for Regional HIV/AIDS Programs"
Barbados Advocate (03.11.04)::David Hinkson
AT&T has launched a program to donate approximately 1,200
computers to private and public sector Caribbean organizations
involved in the fight against HIV/AIDS. Jordan Roderick,
president of AT&T International, said the company would
distribute the equipment with assistance from the William J.
Clinton Foundation, the US Peace Corps and USAID. The agencies
will liaise with the HIV/AIDS organization to determine their
needs so AT&T can send them the appropriate equipment. Marcia
Bernicat of the US Embassy in Barbados said the equipment would
be used to develop the Caribbean HIV/AIDS Regional Training
Initiative (CHART), which aims to increase regional capacity for
the care and treatment of HIV/AIDS. The Caribbean is second only
to sub-Saharan Africa in HIV/AIDS prevalence.
CARIBBEAN:
"Clinton Foundation Has Plans for Region"
Barbados Advocate (03.11.04)
Michael Goff of the William J. Clinton Foundation said that
an agreement reached with pharmaceutical companies manufacturing
generic HIV/AIDS drugs reduced the cost of treating HIV patients
in the Bahamas from US$3,900 per year to an average of US$300.
Goff said the agreement created economies of scale for smaller
nations when the foundation purchased drugs for all its member
nations across Africa and the Caribbean. Goff also said the
foundation had negotiated to reduce the cost of the CD4 test from
US$55 to US$3-7 per patient. Goff spoke at the launch of AT&T's
initiative to donate computers to HIV/AIDS organizations in the
Caribbean.
RWANDA:
"Rwanda to Join African Trials for AIDS Vaccine"
Reuters (03.10.04)
A government minister said on March 10 that Rwanda will join
Kenya, Uganda, Botswana and South Africa in medical trials for an
HIV/AIDS vaccine. The Rwandan trial, conducted in conjunction the
International AIDS Vaccine Initiative (IAVI), will occur in
Kigali over a 10-month period and involve 45 volunteers,
according to Innocent Nyaruhirira, minister in charge of HIV/AIDS
and related diseases. The minister said that rape as an
instrument of war during Rwanda's 1994 civil conflict accelerated
the HIV infection rate. Between 10-13 percent of the country's
population of 8 million are infected.
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