[CDC News] CDC HIV/STD/TB Prevention News Update 03/12/04
prevention...@cdcnpin.org
Friday, March 12, 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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abstracted below for full texts of the articles.
HEADLINES
NATIONAL NEWS
UNITED STATES: "Bush Administration Weighs Condom Warning"
UNITED STATES: "New Test Finds HIV in Earlier Stages"
UNITED STATES: "Syphilis Shows Some Resistance to Antibiotic in
United States"
UNITED STATES: "HIV-Positive Moms, Healthy Babies"
UNITED STATES: "Just Saying No: Teens Wonder if Abstinence-Only
Sex Education Realistic"
INTERNATIONAL NEWS
GLOBAL: "Number of AIDS Orphans to Skyrocket in 6 Years, Study
Says"
MEDICAL NEWS
UNITED STATES: "First US TB Vaccine Trial in 60 Years Begins"
LOCAL AND COMMUNITY NEWS
WASHINGTON: "Safe Sex the 'Norm' Among Seattle Gays"
NEWS BRIEFS
TENNESSEE: "Salon Owners Help Make Blacks Aware of HIV/AIDS"
NIGERIA: "Nigeria Starts Local Production of Anti-Retroviral AIDS
Drugs"
QUEBEC: "Quebec Not Looking at Opening Injection Sites Despite
Drug User Support"
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NATIONAL NEWS
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UNITED STATES:
"Bush Administration Weighs Condom Warning"
Associated Press (03.12.04)::Lara Jakes Jordan
Following recent studies indicating that condoms do not
safeguard against HPV, a widespread STD that can cause genital
warts or cervical cancer, the Bush administration is considering
requiring warning labels on condom packages stating that the
condoms do not protect users from all STDs. Currently, packages
say that condoms, if used properly, reduce the risk of AIDS and
other STDs - but do not mention HPV.
The Food and Drug Administration "has developed a regulatory
plan to provide condom users with a consistent labeling message
and the protection they should expect from condom use," Dr.
Daniel G. Schultz, director of the agency's Office of Device
Evaluation, said Thursday. Schultz told members of a House
Government Reform subcommittee the FDA "is preparing new guidance
on condom labeling to address these issues."
The question is whether to provide any additional
information regarding protection against HPV - without
discouraging people from using condoms for HIV/AIDS protection.
The FDA has considered warning labels since President Clinton
directed the agency in 2000 to look into whether information
included in packages accurately reflected condom effectiveness in
preventing all STDs, including HPV.
"Are condoms perfect? Of course not. But reality requires us
not to make a public health strategy against protection, but
rather to ask a key question: compared to what?" responded Rep.
Henry Waxman (D-Calif.). Waxman added that lawmakers who offer
abstinence-only programs as the solution to STDs and teen
pregnancy overlook evidence indicating "abstinence-only education
works rarely, if at all."
But according to Rep. Jo Ann Davis (R-Va.), "This is not
about social ideology, or religious ideology. It's about
informing women. ...And truly, the only way to be protected is
abstinence. That's not ideology - it's fact."
More than 2 million American women are infected with HPV
each year, said Dr. Ed Thompson, deputy director for public
health services at CDC. Ten thousand women are diagnosed each
year with cervical cancer, claiming 4,000 lives, Thompson said.
UNITED STATES:
"New Test Finds HIV in Earlier Stages"
Atlanta Journal-Constitution (03.11.04)::David Wahlberg
North Carolina officials discovered an HIV outbreak among
black male college students using an RNA test for HIV, which can
detect fragments of the virus two weeks after infection, compared
to a routine test that finds antibodies to the virus a month or
more after infection. The new test could allow doctors to
identify patients days after infection, when they are
biologically most able to spread the virus and often continuing
to take risks.
"It could be an extremely effective method of finding people
very close to the time they are infected and allow us to notify
their partners very quickly," said Ida Onorato, deputy director
of science for CDC's division of HIV/AIDS prevention. "But it's
not so straightforward that this is something that we should be
doing."
The RNA method adds $2 to HIV tests - which now run about $4
per kit - not including lab and staff time or tracking down newly
infected people. If used on a mass scale, officials worry that a
potentially substantial number of false positives could create
undue fear.
The San Francisco Department of Public Health is conducting
an RNA testing pilot study, Onorato said, and CDC plans to offer
grants this spring for other areas to consider RNA testing.
Georgia health officials said they might apply for some of the
funds.
For years, blood banks have been using versions of the RNA
test to screen blood for HIV. North Carolina began to use the RNA
test for diagnosis and surveillance in November 2002, and has
since used it on all the roughly 125,000 specimens collected each
year at 110 public clinics.
Dr. Peter Leone of the North Carolina Department of Health
and Human Services said the testing program costs about $250,000
a year, roughly the cost of treating one HIV patient over a
lifetime. The state, he said, has discovered 28 newly infected
people through the test, whose cases might otherwise not have
been reported for week, months or years. The first 22,000 tests
led to two false positives.
CDC's Onorato said the test might be most appropriate in
places with a significant amount of HIV transmission.
UNITED STATES:
"Syphilis Shows Some Resistance to Antibiotic in United States"
Reuters (03.11.04):Paul Simao
A federal study released on Thursday found that syphilis may
be developing resistance to one of the antibiotics used to treat
it. San Francisco health officials documented eight cases in 2002
and 2003 in which single oral doses of azithromycin apparently
did not cure the infection, according to a report published by
CDC.
All the patients were gay males, five of whom had HIV. They
were later successfully treated with either doxycycline or
penicillin, the CDC's preferred antibiotic for treating syphilis.
Dr. Samuel Mitchell, a CDC epidemiologist and one of the
authors of the study, said the San Francisco City Clinic has
since dropped azithromycin for treating most cases of primary,
secondary or early-latent syphilis. Azithromycin's apparent
failure to cure syphilis is a disappointment to infectious
disease specialists, who had hoped a single 1- or 2-gram oral
dose would offer a more convenient, better treatment for many
syphilis infections. It is easier to administer than benzathine
penicillin, an antibiotic that is usually injected.
"The downside of azithromycin becoming less useful is that
it will probably limit our ability to do in-the-field
prophylactic treatment," said Mitchell. He urged doctors still
prescribing the drug for syphilis to follow patients closely.
Several studies have shown that azithromycin was effective in
patients who did not have HIV.
The new study came out three days after CDC reported that
the nation's syphilis rate appeared to have risen for the third
consecutive year, mostly due to rising infections among gay and
bisexual men. CDC estimated that 60 percent of cases last year
occurred among men who have sex with men, compared to 5 percent
in 1999.
UNITED STATES:
"HIV-Positive Moms, Healthy Babies"
Chicago Tribune (03.10.04)::Eun-Kyung Kim
About 6,000-7,000 HIV-positive women give birth each year in
the United States, resulting in more than 300 infected infants,
according to CDC estimates. Early detection of HIV is crucial.
With HIV drugs, infected people can suppress the virus, which is
essential to reducing mother-to-child transmission. Although
typically only federally funded clinics make HIV testing routine
for expectant women, CDC recommends that HIV screening be part of
the standard set of tests for all pregnant women.
"Women are feeling well. They're living longer with the
disease; they have confidence that they're going to be alive to
see this child grow," said Dr. Judy Aberg, director of HIV
services for Washington University's Department of Medicine in
St. Louis, Mo. Aberg said the risk of transmitting the virus from
mother to child can be as low as 1 percent if the mother is on
medication during pregnancy. Without prenatal treatment, the risk
increases from 25 to 40 percent. But research has shown that even
women who forgo treatment can receive intravenous medicine during
labor that can significantly reduce the chance of transmitting
the virus.
Catherine Williamson, a nurse practitioner at a St. Louis
private practice that sees many HIV/AIDS cases, calls it a
"wonderful trend" that women are living longer and having healthy
babies. She cautions, however, against HIV patients being
unrealistic about their condition. "The truth is," she said, "in
the real world, people are still getting advanced AIDS and still
dying."
UNITED STATES:
"Just Saying No: Teens Wonder if Abstinence-Only Sex Education
Realistic"
Associated Press (03.08.04)::Martha Irvine
At a time when new federal statistics show that half of new
STD cases are in young people ages 15 to 24, President Bush has
proposed doubling federal funding for abstinence-only sex
education. And while many teens agree it is generally best for
young people to wait to have sex, surveys have shown that about
half of them have sex before leaving high school.
In a national study released in January by the Kaiser Family
Foundation and done in conjunction with Harvard University's John
F. Kennedy School of Government and National Public Radio, 95
percent of surveyed 7th- to 12th-graders thought it was appropriate
to teach high school students to wait until they are older to
have sex; just under two-thirds agreed that abstinence was the
"expected standard" for all school-age children.
But 94 percent of students agreed that teaching high school
students about birth control was appropriate, and 87 percent
thought it was appropriate for teachers to explain how to use
contraceptives and where to get them.
The debate between advocates of abstinence-only and
comprehensive sex education was further stirred earlier this year
when Minnesota health officials released an independent
evaluation of an abstinence-only pilot program, titled "Education
Now and Babies Later" (ENABL), which found that sexual activity
had doubled among its junior-high student participants.
Still, many teens base their decisions about sex - as well
as alcohol and drugs - on what their peers think, said 16-year-
old Heather Santone. "I've chosen abstinence, but that's just
because I have high morals for myself," said the sophomore. "But
the fact is, a lot of kids aren't waiting, even if they check a
box that says they will" - a reference to the "yes" box on
virginity pledge cards that some abstinence speakers hand out to
students.
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INTERNATIONAL NEWS
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GLOBAL:
"Number of AIDS Orphans to Skyrocket in 6 Years, Study Says"
Washington Times (03.09.04)::Ken Stier
By 2010, 25 million children worldwide - roughly half the
number in US public schools - will become AIDS orphans, according
to a study to be published next month by the Washington-based
nonprofit International AIDS Trust (IAT). Currently, there are
about 14 million children around the world orphaned by AIDS, and
their number is growing by 800,000 each year, the study reports.
And as the number of women with HIV grows to 50 percent of those
infected, the effect on children worldwide will worsen.
"The numbers are just mind-boggling," said Sandra L.
Thurman, president of IAT and the first presidential envoy for
AIDS under President Clinton. "We can't even begin to get our
heads around the social and anthropological consequences of this,
because we are just at the beginning of this epidemic," said
Thurman on the sidelines of a weekend Caribbean health conference
that ended Sunday.
Besides social stigma and emotional stress, AIDS orphans
suffer loss of food, health care, education and security, and are
more vulnerable to exploitation.
Every day, more than 2,000 infants contract HIV at birth
through mother-to-child transmission (MTCT), and most die by the
age of five. IAT figures show that 580,000 infants died of AIDS
in 2001. MTCT risk can be greatly reduced with a one-time dose of
nevirapine, available for $8. Mother's milk is another primary
HIV transmission route. Researchers say study in this area is
urgently needed, as most women worldwide have no choice about how
to nourish their babies.
Mothers should not be overlooked in the AIDS orphan crisis,
said Thurman. "We have to try to keep these mothers alive,
because we know from decades of research that every day we can
keep a child with its mother, the more viable that child is -
physically and psychologically."
The IAT report, conducted in conjunction with the Children
Affected by AIDS Foundation, will be submitted to Congress on
April 7.
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MEDICAL NEWS
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UNITED STATES:
"First US TB Vaccine Trial in 60 Years Begins"
TB & Outbreaks Week (02.17.04)
A new TB vaccine candidate made with several proteins from
the TB bacterium will soon enter phase I of human safety testing.
The US National Institute of Allergy and Infectious Diseases
(NIAID) have supported research on the vaccine from its earliest
stages.
The trial, conducted by Seattle biotechnology firm Corixa
and Belgium-based GlaxoSmithKline Biologicals, will enroll 20
volunteers at a single US site. Researchers will examine blood
from volunteers to determine which dosage of vaccine promotes the
greatest immune response. Should the vaccine prove safe in the
initial testing, larger clinical trials will follow.
"This is the first recombinant tuberculosis vaccine to reach
human trials in the United States," said NIAID Director Anthony
Fauci, MD. "Indeed, this is the first new TB vaccine to be tested
in our country in more than 60 years. This candidate vaccine, as
well as other novel products emerging from the TB research and
development pipeline, offers hope for reducing the burden of a
disease that claims approximately 2 million lives each year."
The vaccine combines two TB proteins that stimulate strong
immune response in humans, initially identified by screening
blood from volunteers who never got TB despite long-term
infection with Mycobacterium tuberculosis bacteria. Using
recombinant DNA technology, scientists fused the proteins and
combined them with adjuvants, substances that further boost the
immune system's response to the vaccine.
The current TB vaccine, Bacille Calmette-Guérin (BCG),
offers some protection against the form of TB most often
contracted by young children, but it is not very effective
against the most contagious form of the disease, pulmonary TB.
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LOCAL AND COMMUNITY NEWS
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WASHINGTON:
"Safe Sex the 'Norm' Among Seattle Gays"
Seattle Post-Intelligencer (03.12.04)::Julie Davidow
Results of a study presented at the National STD Prevention
Conference in Philadelphia showed that most gay and bisexual men
in Seattle are taking steps to protect themselves and their
partners from STDs. The telephone survey of 400 men around the
city found that one in five gay men said they had unprotected
anal sex with partners whose HIV status they did not know or who
had a different status than theirs. The majority said they use
condoms during anal intercourse, avoid sex with partners whose
HIV status they do not know, and disclose their own HIV status
before having sex.
"That means [safe sex] is the community norm," said Dr.
Hunter Handsfield, director of King County STD Control Program
and co-author of the study. "Most gay men are in fact sexually
responsible."
Handsfield said a smaller group who practice unsafe sex
likely drives a recent surge in HIV and other STDs among gay and
bisexual men. Another study at the conference found that only
about one-third of 149 gay and bisexual men interviewed after
being tested for HIV at King County health clinics last year knew
their most recent anal sex partner's HIV status. Handsfield said
the telephone survey allowed health officials to gauge practices
of a wider gay/bisexual male community than those populations
that seek out county services and thus may be at higher risk for
contracting STDs.
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NEWS BRIEFS
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TENNESSEE:
"Salon Owners Help Make Blacks Aware of HIV/AIDS"
Tennessean (03.12.04)::Anita Wadhwani
Earlier this week, Nashville beauty and barbershop owners
joined forces with the Shears United HIV Prevention Project to
participate in the national Black Church Week of Prayer for the
Healing of AIDS. Hair salons provide a place for African
Americans to find out what is going on in their community and
lend well to prevention efforts, said Shears United Program
Coordinator Mary Owens. But the effort is a hard sell for many
beauticians, salon owners and pastors. With more than 200 black
churches in Nashville, and perhaps even more beauty and barber
shops, few are part of either the black church week or the Shears
Program. But Rev. Donald Smith of the First Response Center, an
HIV prevention program at the Metropolitan Interdenominational
Church - which is hosting the week of prayer - said that
hesitance is changing among pastors and barbers, "because of a
realization that their memberships can certainly be affected or
infected."
NIGERIA:
"Nigeria Starts Local Production of Anti-Retroviral AIDS Drugs"
Agence France Presse (03.12.04)
Nigerian health officials announced the nation has begun
local production of HIV/AIDS antiretroviral drugs, which it
introduced into the Nigerian market on Thursday. Figures show 5.4
percent of Nigeria's 126 million people have HIV, and there are
concerns that the rate is rising. Nigeria launched the first
trial of generic AIDS drugs imported from India in December 2001.
Health Minister Eyitayo Lambo said the launch of AVOLAM
(lamivudine), Azido (zidovudine) and NEVRAN (nevirapine) by
Ranbaxy Nigeria Limited will provide greater access to treatment
and that the government hopes to achieve more than 80 percent
local production of generic drugs within the next three years.
The drugs will be distributed to designated treatment centers at
subsidized rates, the minister said.
QUEBEC:
"Quebec Not Looking at Opening Injection Sites Despite Drug User
Support"
Canadian Press (03.09.04)::Ross Marowits
Although a study published Tuesday suggested Montreal's
intravenous drugs users (IDUs) want a supervised injection site
similar to the one in Vancouver, British Columbia, the Quebec
government said it has no immediate plans to open such sites. "I
don't think that in Quebec we will see that kind of site in the
very short term," said Cathy Rouleau, spokesperson for Health
Minister Philippe Couillard. "But if we do, it's going to be
because we will take a good lesson from what Vancouver is doing
and make sure that we're doing it properly." Vancouver's site has
had nearly 500 visits a day since opening last September as a
four-year pilot project. The study, conducted by McGill
University, questioned 251 Montreal IDUs. Most said they would
like a safer place to inject than in parks, alleys, cars or
stairwells.
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