National Coalition of STD Directors

CDC HIV/STD/TB Prevention News Update
Tuesday, April 13, 2004

CANADA:
"STD Rates Soaring"
Edmonton Sun (04.12.04)::Keith Bradford

Heterosexuals who regularly engage in casual sex are hampering efforts by Edmonton health officials to trace partners in the region's largest syphilis outbreak since the 1980s. Dr. Ameeta Singh, medical director of Capital Health's STD Centre and a consultant for Alberta Health, said many of those testing positive for syphilis cannot identify their partners, leading those unknowingly infected to continue spreading the disease. People with syphilis are up to five times more likely to contract and transmit HIV.

Over the last decade, between one and five new cases of syphilis were reported each year in the Capital Health region. In 2003, the region reported 32 confirmed cases. About five more cases have surfaced in the last three months. "We are exceedingly concerned about it," said HIV Edmonton Executive Director Sherry McKibben. "When people are diagnosed with syphilis... they are more at risk for HIV. It does mean we potentially face an increase in the number of people with HIV."

According to Singh, about half of those confirmed syphilis cases were gay men and half were heterosexuals. While outbreaks among heterosexuals are typically related to the sex industry, many Edmonton cases are related to casual sex. "The challenge has been that a number of people have said they don't know who they had sex with, so many of these individuals have been left untraced," Singh observed. Some of the people who tested positive for syphilis have also been found to have HIV.

The region has seen a huge increase in other STD cases. Gonorrhea rates have almost doubled from 260 in 1999 to 507 in 2003. Though 2003 statistics are incomplete, chlamydia cases, which reached 2,326 in 2002, are also expected to show increases. HIV cases in Edmonton dropped slightly from 92 in 2001 to 83 in 2002, but reporting delays - including fallout from the syphilis outbreak - could change that trend, McKibben said.

CANADA:
"Youth Awareness Program Scrapped"
Edmonton Sun (04.12.04)::Keith Bradford

Though Edmonton's youth are among those most at risk from the region's syphilis outbreak, nonprofit HIV Edmonton has scrapped its youth HIV and STD prevention programs due to a funding crisis. "We are not delivering programs for youth at this point" because HIV Edmonton is lacking the financial resources to do so, said the group's Executive Director Sherry McKibben.

HIV Edmonton's federal-provincial grant - its main source of funding - was cut very slightly this year to $450,000 (US$337,056). But increased costs associated with insurance, rent and other expenses are to blame for the funding crunch, McKibben said. "Over the past three years, we've lost four positions," she said, adding that the group now has 10 full-time staff. "We are working as hard and as fast as we can to get out the prevention message, but our capacity to address this is limited."
McKibben said her group has been working with Capital Health to heighten awareness to the syphilis outbreak. "We've been trying to do some outreach testing in the inner city" and continue partner tracing for those who test positive for syphilis, said Dr. Ameeta Singh of Capital Health's STD Centre. Investigations are ongoing, she said.

CDC HIV/STD/TB Prevention News Update
Monday, April 12, 2004

MEXICO:
"Human Papillomavirus: Data Demonstrate HPV Testing Catches More Serious Cervical Disease"
Women's Health Weekly (04.01.04)

Human papillomavirus (HPV) DNAwithPap test-maker Digene Corp. recently told attendees at the 21st Annual Papillomavirus Conference & Clinical Workshop in Mexico City that a growing body of data demonstrate the ability of its HPV test to identify women at high risk of cervical cancer more accurately than the most
advanced form of Pap test.

"The general principal is that screening should be performed as infrequently as possible using the best available test," professor Jack Cuzick, PhD, head of epidemiology for Cancer Research UK at Queen Mary's College in London, told the conference. "There is no doubt that the HPV DNA test is more sensitive than cytology [Pap testing]. This has been shown in every study conducted, using both conventional and liquid-based cytology." Available evidence supports the recommendation that the high-risk HPV DNA test be used as the primary tool for cervical cancer screening, Cuzick concluded, with the Pap performed only in those women who test positive for HPV, which causes virtually all cases of cervical cancer. Cuzick also announced he would further research this proposal by planning a European primary-screening study involving 1 million women.

A Netherlands study involving more than 44,000 women followed for two years to date showed that 5.2 percent of 574 women who were HPV-positive but had normal Pap results were found to have serious cervical disease (cervical intraepithelial neoplasia CIN grade 2 or 3), compared to 0.07 percent of 3,029 women who were HPV-negative and had normal Paps.

The use of a highly sensitive test is critical in the developing world, where it is unlikely that women can be screened more than once or twice in their lifetimes. Thomas Wright Jr., MD, associate professor of pathology at Columbia University Medical Center, reported the results of a 4-year study of approximately 4,000 women in Capetown, South Africa, in which women were screened and immediately treated - in the same office visit - if they were HPV-positive. Cervical disease in the study population was reduced by 78 percent, compared to those women who were monitored for an additional 6 months. "HPV plus treatment appears to be safe and clinically effective. Now we need data that extends beyond 6 months and that look at cost-effectiveness in these low-resource regions," Wright concluded.

Digene recently announced a partnership with the Program for Appropriate Technology to develop a version of DNAwithPap for developing countries.

ILLINOIS:
"Chatting It Up; City Health Surveyors Take to the Streets to Take Pulse of Community"
Chicago Free Press (04.07.04)::Gary Barlow

Project CHAT (Chicago Health Assessment project) aims to compile the most detailed and diverse survey ever on Chicago men who have sex with men (MSM) on matters related to sex, drugs, and HIV/AIDS. "We're looking at what kinds of behaviors are being sustained, what behaviors are being changed," as well as their awareness and use of local HIV services, said Nik Prachand, an epidemiologist with the Chicago Department of Public Health (CDPH) who is directing CHAT. By year's end, Project CHAT will have interviewed over 1,000 MSM.

Project CHAT is part of a survey effort to be conducted in over two-dozen US metropolitan areas. The CDC-funded studies will be central to the government's effort to reduce the national HIV infection rate by 50 percent. This year's focus is on gay and bisexual men. Next year, teams will target injection drug users; high-risk heterosexuals will be the focus the following year; and then the focus returns to gay and bisexual men. "This information is going to be fed directly back into the health planning process," said Jim Pickett of CDPH.

Chicago began Project CHAT last December after five months of planning and identifying MSM venues. About 50 sites were targeted for their geographic and cultural scope. Three-person teams count patrons entering venues, selecting participants to ensure the sample is random and comprehensive. At the conclusion of the 15- to 20-minute interview, each participant receives $25,
though this is not mentioned initially.

The overall response from venue owners has been very good, said CHAT members, and about 91 percent of people asked to take the survey agree to participate. "There's a big sense of giving back," said Jose Gonzalez, a CHAT member. "People want to feel like they're contributing to the overall wellness of the community."

CDC HIV/STD/TB Prevention News Update
Thursday, April 08, 2004

AUSTRALIA:
"Hepatitis May Lurk Unknown in Former Patients"
Sydney Morning Herald (04.07.04)::Gerard Ryle

Thousands of Australians may be unknowingly infected with hepatitis C (HCV) because the system designed to trace those potentially infected did not work, a Senate inquiry was told. "I have been horrified by the number of mothers who have acquired hepatitis C from contaminated blood... this is a medical emergency," Charles MacKenzie, of the Tainted Blood Product Action Group, told the Senate hearing Tuesday. "The Australian Red Cross and the relevant health departments have neglected to adequately warn the public. Letters have not been sent to all those who have received blood transfusions in the high-risk blood transfusion years prior to 1990." MacKenzie called on the government to rectify the situation and inform the public.

MacKenzie said the Red Cross blood service's failure to introduce an early screening test for HCV in the mid-1980s accelerated the danger. Blood was taken from prisoners for almost 12 years after other countries ceased the practice, deeming it too risky due to prisoners' high use of illegal drugs. The ALT test claimed to reduce the incidence of HCV infection by up to half and was used in the United States four years before any screening was implemented in Australia in 1990.

"In the last three decades thousands of Australian hospital patients have been infected with the deadly virus hepatitis C from contaminated blood transfusions and blood products," said MacKenzie. "While this is a medical disaster it is in essence first and foremost a human tragedy that has destroyed the lives of many women and children."

CHINA:
"Chinese Hepatitis B Carrier Wins Landmark Lawsuit Against Job Discrimination"
Agence France Presse (04.03.04)

Last Friday in Wuhu city in Anhui province, a district court handed a landmark victory to a non-infectious hepatitis B (HBV) carrier in a job discrimination lawsuit. The decision gives HBV patients a boost in their fight for equal work opportunities. Zhang Xianzhu had sued the Wuhu government's personnel affairs bureau after he was rejected for employment because he has HBV, according to the China Daily.

The lawsuit is a first in China, where people with HBV are barred from government jobs by many local administrations, despite the fact that the virus is not spread through casual contact. The court ruled that the Wuhu government had violated provincial guidelines because Zhang did not belong to the seven hepatitis groups prohibited from public service work by Anhui's health standards. The court ordered authorities to withdraw their decision denying Zhang's application; the government plans to appeal.

China has no national laws barring people with HBV from public service, but this is nevertheless the practice of many local and central government departments. As the number of appeals grows, however, some local governments are changing their policies. Central Hunan province lifted its ban last month. China has some 120 million chronic HBV patients - equivalent to about 10 percent of the population.

CDC HIV/STD/TB Prevention News Update
Wednesday, April 07, 2004

"Study: Nearly Half of People Don't Have Protected Sex"
Associated Press (04.06.04)

A new online study of 1,155 people ages 18-35 indicated about 84 percent believed they adequately protected themselves against STDs, but nearly half engage in unprotected sex. Approximately 47 percent of the respondents never used protection for vaginal sex, 82 percent never used protection for oral sex, and 64 percent never used protection for anal sex, according to the study conducted by the American Social Health Association (ASHA).

The survey - which has a margin of error of plus or minus 3 percent - showed that about 93 percent believed their current or most recent partner did not have an STD, yet around one of three people have never discussed STDs with their partner. More than two-thirds of respondents, or 68 percent, worried little about contracting an STD.

"What surprised us and distressed us is the fact that so many young adults believe that they are not at risk of a sexually transmitted disease and they don't believe that their sexual partner is at risk," noted Dr. James Allen, ASHA president and a former assistant US surgeon general. "They don't talk with their partner about whether they may or may not be at risk. So they're simply making assumptions."

The study also found that more than half of the people interviewed were unsure of their vaccination status or said they had not been vaccinated against hepatitis A and hepatitis B. "Those are the only two STDs - hepatitis A and hepatitis B - that are vaccine preventable and they need to talk to their doctor about that if they're at risk," said Allen. Around half of the respondents said they did not know those forms of hepatitis could be sexually transmitted. ASHA said more than 1.25 million Americans have hepatitis B.

AUSTRALIA:
"Safe Sex Message Being Ignored"
Sunday Age (04.04.04)::Lucy Beaumont

The latest data from the Department of Human Services show a continuing STD rate increase for Victoria. From 2002 to 2003, Victoria's chlamydia cases increased from 4,846 notifications to 6,485, occurring mainly among heterosexuals ages 20-24. Gonorrhea increased from 802 notifications in 2002 to 1,160 cases in 2003. Since 2000, when Victoria recorded eight syphilis cases, the notifications doubled each year to reach 55 in 2003. Syphilis and gonorrhea were being spread to both sexes predominantly by male partners.

Alcohol and drugs were often factors in unsafe sex, said professor Steve Wesselingh of Melbourne's Burnet Institute. Wesselingh is the chair of a new ministerial advisory committee on HIV, hepatitis C and other STDs that is meeting Wednesday for the first time.

Many youths did not perceive themselves to be at risk of acquiring STDs. "I think young people think about HIV in terms of very high risk behavior," said Wesselingh. "The problem with chlamydia is that it's probably being transmitted in groups that aren't particularly promiscuous but do have multiple partners."
More oral sex could explain a rise in gonorrhea and syphilis during a year when HIV infections declined slightly. Gay and bisexual men may be attempting to avoid HIV infection by engaging in more oral sex but then acquire other STDs, said professor Christopher Fairley, Melbourne Sexual Health Center Director and a member of the new committee. "A number of cases that we see at the center are attributable to oral sex alone," he said. Fairley suggested more intensive testing for STDs in men to further reduce HIV and gonorrhea transmission.

"Teens' STDs Often Not Treated Properly in ER"
Reuters Health (03.29.04)

A new report shows that a substantial number of teenagers diagnosed with STDs in emergency rooms may not receive appropriate treatment. Dr. Kathleen R. Beckmann and colleagues at Children's Hospital of Wisconsin studied data covering 1.2 million adolescent visits to ERs over a seven-year period. Of the 351 patients selected for the study, most (92 percent) were female and the most common diagnosis was pelvic inflammatory disease (PID) - (44 percent of cases).
The researchers found that only 80 percent of patients with any STD were treated with antibiotics or admitted to the hospital. The finding was true for 91 percent of PID patients and 71 percent of patients with other STDs.

Only 27 percent of female patients with PID received the full treatment recommended in public health guidelines. Less than half of female STD patients had a pregnancy test, and only one such patient was tested for HIV.

Male patients were more likely than female patients to receive treatment for STDs, but Hispanic patients were less likely than non-Hispanic whites to be treated.
"Further work is necessary to explain these disparities and optimize care for adolescents who have sexually transmitted infections and present to emergency departments," the authors concluded. "Most important, efforts should focus on better implementation of existing guidelines."

The report, "Emergency Department Management of Sexually Transmitted Infections in US Adolescents: Results from the National Hospital Ambulatory Medical Care Survey," appeared in Annals of Emergency Medicine (2004;43(3):333-338).

MISSOURI:
"Survey Seeks Input on Health of Gays and Lesbians"
Associated Press (04.03.04)

A recent survey conducted by the Kansas City Health Department and the Lesbian and Gay Community Center of Greater Kansas City assessed the health and habits of more than 1,000 gays, lesbians and bisexuals. Although most participants considered themselves healthy, the study revealed unhealthy practices like smoking, unprotected sex and missed medical tests.

More than 95 percent of participants considered themselves to be in good to excellent health. More than 40 percent got at least 30 minutes of exercise several days a week. And while 24 percent were obese, that was below the overall adult obesity level of 34 percent in Kansas City.

Most gays and lesbians were "out" to family and friends and many were in faithful, long-term relationships. Sixty-five percent of lesbians, 51 percent of gay men and 41 percent of bisexuals were in relationships.

Many lesbians did not get regular mammograms, although research suggests they may be at increased risk of breast cancer. Some sexually active men did not use condoms consistently, and 9 percent of gay men said they had HIV.

But 38.4 percent of study participants were smokers - significantly higher than the national adult smoking rate of 23.1 percent. About 34 percent of gays and 24 percent of lesbians reported they drank to get drunk at least once a month. About one-fifth said they experienced stress or depression almost always or very often.
Investigators distributed the survey from May to July 2003 at events that attract the gay community, such as the Heartland Pride Festival and AIDS Walk. A total of 1,143 people from Jackson, Clay, Platte and Cass counties in Missouri and Johnson, Wyandotte and Leavenworth counties in Kansas completed the survey.
"We didn't try to be statistically representative," said Gerald Hoff, a Health Department epidemiologist who helped analyze the data and compile the report. "But the survey accomplished its main objective: to create some baseline data."

CDC HIV/STD/TB Prevention News Update
Tuesday, April 06, 2004

IDAHO:
"Syphilis Outbreak Spreads Across Treasure Valley"
Associated Press (04.03.04)

Health officials announced Friday that the largest known outbreak of syphilis in state history is spreading across southwestern Idaho, especially among young Hispanics.

Southwest District Health, which serves the region, has confirmed 39 adult cases and four congenital cases in infants over the past year. An additional 38 cases are under investigation, and 13 have been referred to other districts, according to officials.

"Syphilis has gotten a foothold in Canyon County and it's rapidly spreading in the western Treasure Valley," according to Gene Gunderson, director of Southwest District Health.

The outbreak began with a single case in Homedale. Officials, however, have not been able to find the common partners who are spreading the disease, which is unusual, leading to suspicions that the infected persons may be involved in drugs, gang activity, or trading sex for drugs.

The epidemic shows signs of spreading eastward, Gunderson said. "The message we're trying to get out is that it's a deadly disease but that it's easily treatable."
The health district has upped the number of employees fighting syphilis, increased staff training, and assigned case managers to pregnant women who have tested positive for syphilis, according to Jennifer Tripp, health district epidemiologist.

"HIV/AIDS Public Health: Knowledge of HIV and STDs Limited in European Roma Women"
Women's Health Weekly (02.26.04)

J.A. Kelly and colleagues at the Medical College of Wisconsin studied Roma to understand the cultural and social context in which HIV sexual risk behavior among Roma occurs. "Roma, the largest ethnic minority group in Central and Eastern Europe, have cultures that are traditional, often closed, and autonomous of majority populations." "Roma communities are characterized by pervasive social health problems, widespread poverty, limited educational opportunities, and discrimination," the scientists explained.

In their study, "in-depth interviews were used to elicit detailed information about types of sexual partnerships and sexual risk behavior practices occurring in them, use and perception of protection, knowledge and beliefs about AIDS and STDs, and sexual communication patterns in a sample of 42 men and women aged 18-52 living in Roma community settlements in Bulgaria and Hungary."

According to study results, "Analysis of the interview data revealed that men have great sexual freedom before and during marriage, engage in a wide range of unprotected practices with primary and multiple outside partners, and have much more relationship power and control. In contrast, women are expected to maintain virginity before marriage and then sexual exclusivity to their husbands." The authors noted that condom use was not normative and was typically associated as a form of contraception. AIDS awareness was common, but AIDS was generally not perceived as a personal threat.

The researchers concluded, "Misconceptions about how HIV is transmitted are widespread, and women - in particular - had very little knowledge about STDs, HIV transmission, and protective steps. There is an urgent need for the development of HIV prevention programs culturally sensitive to Roma populations in Eastern Europe, where HIV rates are rapidly rising."

The study, "Gender Roles and HIV Sexual Risk Vulnerability of Roma (Gypsies) Men and Women in Bulgaria and Hungary: An Ethnographic Study," was published in AIDS Care (2004;16(2):231-246).

CDC HIV/STD/TB Prevention News Update
Monday, April 05, 2004

"Science Not Being Distorted, White House Aide Says"
Washington Post (04.03.04)::Rick Weiss

John H. Marburger III, director of the White House Office of Science and Technology Policy, responded Friday to a scientists' advocacy group that had accused the Bush administration of distorting facts to support a conservative political agenda. Marburger said his 17-page, point-by-point rebuttal aimed to "correct errors, distortions and misunderstandings" in the Feb. 18 report by the Union of Concerned Scientists (UCS). That report was accompanied by a supporting letter signed by 60 scientists, including 20 Nobel laureates.
"The accusations in the document are inaccurate," Marburger wrote. "In this administration, science strongly informs policy." The administration has been under fire over allegations that officials have ignored certain findings, altered Web sites, revised or eliminated wording in some reports, and changed the makeup of advisory committees in ways that bowed to political priorities.

The UCS report said CDC had removed from its Web site a fact sheet about condoms and replaced it with a document focused on condom failure rates and the effectiveness of abstinence. In response, Marburger said CDC "routinely takes information off its Web site and replaces it with more up to date information." This change, based on new data from the National Institutes of Health, was such an example, he said.

In addition, UCS alleged that the National Cancer Institute's (NCI) Web site posted information suggesting a link between abortion and breast cancer even after the science behind the link had been debunked, removing the page only after a public outcry. But Marburger said NCI removed the information "when it became clear that there was conflicting information in the published literature."

Marburger labeled as "preposterous" allegations that scientific advisory committee members must pass a political litmus test. "After all, President Bush sought me out to be his scientific adviser... and I am a lifelong Democrat," he wrote.

Kurt Gottfried, professor emeritus of physics at Cornell University and chair of UCS, said he had only read part of the rebuttal but was unconvinced so far.

"San Francisco's Homeless with HIV Plagued by Hepatitis C Virus - Few Treated"
San Francisco Chronicle (04.02.04)::Carl T. Hall

A new study by doctors at the University of California-San Francisco (UCSF) and San Francisco General Hospital is among the first to document how widespread hepatitis C (HCV) is among HIV-positive urban poor people. The report found that about three out of four HIV- positive homeless or "marginally housed" people in San Francisco are co-infected with hepatitis C and almost none is being treated for it.

The researchers tested and interviewed 249 HIV-positive people recruited from shelters, soup kitchens and single-room-occupancy hotels. Tests showed 69 percent were positive for HCV. After nearly three years of follow-up, the figure had risen to 74 percent. Yet only 4 percent of HCV patients were being treated for it.
Dr. Christopher Hall, a UCSF fellow in infectious diseases and lead author of the study, said the situation is doubtless worse in other big cities that lack San Francisco's public-health system and that may be paying even less attention to the hidden epidemic.

HCV, which can impair liver function, complicates the treatment of HIV/AIDS. Because of their serostatus, participants in the study qualified for free care through San Francisco's public-health system, but the system has yet to focus seriously on the growing problem of HIV/HCV co-infections, according to Hall.
According to CDC, chronic, sometimes life-threatening liver disease occurs in about 70 percent of chronic HCV infections. Treatment works only about half the time, somewhat less for those co-infected with HIV.

HCV is blood-borne and is usually contracted through sharing needles and other drug paraphernalia. The study found 64 percent of participants had used intravenous drugs at some point; roughly 21 percent had injected within the previous month.

The report, "Hepatitis C Infection in San Francisco's HIV-Infected Urban Poor. High Prevalence but Low Treatment Rates," appeared in the Journal of General Internal Medicine (2004;19(4):357-365).

CDC HIV/STD/TB Prevention News Update
Friday, April 02, 2004

"Condom Label Changes Spark Debate"
Associated Press (04.02.04)::Martha Irvine

The request by President Bush to have the Food and Drug Administration modify current warnings on condom packaging to include information about human papillomavirus - also called HPV or genital warts - has set off a fierce debate. On one side are scientists who say that condoms should be promoted as a critical line of defense against STDs. On the other are groups that advocate abstinence before marriage and see the dangers of HPV as a justification for their cause.
Linda Klepacki, manager of the abstinence policy department at Colorado-based Focus on the Family, said research demonstrates that condoms do not necessarily prevent the spread of HPV because the virus may be found on parts of the body they do not cover. "The lack of information getting to the American pubic regarding this disease is beyond comprehension," said Klepacki. She argues that abstinence is the best way to prevent HPV.

Adding the information to condom labels would be "truth in advertising," according to Libby Gray, director of Project Reality, an Illinois-based organization that promotes abstinence in public schools. Gray noted that most students she deals with have no idea what HPV is.

But abstinence groups may be overlooking important medical information to promote their own values, some scientists say. Tom Broker, professor of biochemistry and molecular genetics at University of Alabama-Birmingham and president of the International Papillomavirus Society, a coalition of experts who study HPV, said the focus should be on the fact that condoms have been shown to reduce the risk of cervical cancer, which is caused by HPV. In a recent report to Congress, CDC reached the same conclusion.

Dr. Ward Cates, former head of CDC's STD/HIV prevention group and current president of the family Health Institute of the nonprofit Family Health International, said that while teaching abstinence is a key to preventing the spread of HPV, "condoms are the best imperfect way we have" for those who are sexually active. FDA officials concede that condensing the extensive and complicated medical literature on HPV down to a few words on a condom label will not be easy.

NEW HAMPSHIRE:
"Sexual and Reproductive Health: Syphilis Increase Has Health
Officials Concerned in New Hampshire"
TB & Outbreaks Week (03.23.04)

Last year, New Hampshire reported 19 cases of syphilis. The outbreak followed nearly a decade of low rates of the infection. After reaching 19 cases in 1993, syphilis dropped dramatically, with five cases reported in 1994 and only eight more over the next seven years. In 2002, cases increased to eight, then more than doubled in 2003.

"That indicates we've got some real problems," said Dr. William Kassler, state medical director. Kassler noted most of the new cases involved gay men, but there was also a small outbreak among young heterosexuals. The doctor called syphilis "a marker for unsafe sex."

Since syphilis infection makes it easier to transmit HIV, the state expects a spike in HIV/AIDS in coming years. Four of the new syphilis cases were in people who have HIV. Though the total number of new HIV/AIDS cases has not fluctuated much in recent years, Kassler noted that last year, more people were diagnosed in later stages of the disease.

Given the stigma attached to STDs, Kassler said the actual number of cases was probably greater than that reported. "STDs are a hidden epidemic," he said. "Every year, across the nation, 15 million people become infected with an STD and half contract incurable, lifelong infections."

In 2003, New Hampshire recorded 1,610 cases of chlamydia and 123 cases of gonorrhea. Chlamydia cases represented a steady increase since 1999, while gonorrhea held steady. However, the number of teens infected with both diseases increased. A CDC report last month estimated that teens and young adults account for nearly half the cases of STDs in the United States even though they comprise just a quarter of the sexually active population.

CDC HIV/STD/TB Prevention News Update
Thursday, April 01, 2004

"Hepatitis C Conference in Vancouver Hears of Efforts Underway in Prisons"
Canadian Press (03.29.04)::Greg Joyce

On Monday, Francoise Bouchard, director general of Health Services for Corrections Canada, said that the federal prison system is making strides to combat hepatitis C among inmates, but the disease is still on the rise. Bouchard outlined the current state of hepatitis C infection in Canada's 52 federal correctional institutions at the 2nd Canadian Conference on Hepatitis C, telling delegates that while tracking and preventing hepatitis C's spread is a daunting task, programs are making progress.
In 2002, Canada released 1,856 inmates with hepatitis C, Bouchard said. There are no specific data on how many patients get infected while in prison, due to a lack of capacity to track inmates from admission through the course of the sentence. She said experts suspect the majority of hepatitis C patients have the disease when they enter they system. Of the more than 12,000 inmates in federal custody, most are male. Among the males, about 17 percent are members of native populations.

Bouchard said it is vital that the government track, study and try to stem the spread of infectious diseases because most inmates are eventually released into the community.

Seventy percent to 80 percent of Canadian inmates report drug use problems on admission to prison, Bouchard said. Corrections Canada has recently put in surveillance, prevention and treatment systems, and a harm reduction program, with $7.34 million (US$5.61 million) from the Treasury Board. Corrections has also started a methadone treatment program, provides condoms and bleach, and is in the process of starting a "safe tattooing" program.

The Canadian Viral Hepatitis Network sponsored the conference in conjunction with the federal, provincial and territorial governments.

UNITED KINGDOM:
"Sexually Transmitted Diseases in Young People Double in 10 Years"
The Independent (03.31.04)::Maxine Frith

According to a report released March 30 by the Office for National Statistics, STD cases among children and teenagers in the United Kingdom have doubled in the past 10 years. In 2001, more than 1.3 million people under age 20 were diagnosed with an STD, and young people were the most at risk, the report said.
Among all age groups, women under age 20 now have the highest rates of chlamydia, which can cause infertility. Reports of genital warts, the most common STD, increased by 15 percent among female teens during the past decade. One-third of women diagnosed with genital warts in 2001 were under age 20, compared with 10 percent of infected men.

"The sexual health of adolescents in the UK is poor," the report stated. "It is likely that an increase in risky sexual behavior has contributed to sexual health outcomes and unwanted pregnancy among young people."

Millions of pounds have been spent to reduce teenage pregnancies, but the report said the strategy is meeting with little success. For the past 10 years, pregnancies among 13- to 15-year-olds have remained the same: 10 per 1,000 girls.
The report, which included statistics on a range of other health problems for young people, noted that huge inequalities exist between the society's richest and poorest children.

"Chicago Syphilis Elimination Task Force Launches New Web Site"
Windy City Times (03.17.04)

The Syphilis Elimination Task Force, a private/public collaboration led by the Chicago Department of Public Health (CDPH), recently announced the debut of its new, improved Web site. The site features complete medical information on syphilis, frequently asked questions, current news, a list of all testing locations, and tips on how to inform one's partner about possible exposure to syphilis.
"The new site is a great resource for Chicago," said Christopher Brown, CDPH's assistant commissioner for STD/HIV/AIDS Public Policy and Programs. "The site has not only been significantly updated, but it's been streamlined and made more interactive as well. We hope everyone in the community - from individuals to healthcare providers to community-based organizations - clicks on www.GetTestedChicago.com and takes advantage of all it has to offer."
The second phase of the Task Force's social marketing campaign, first launched in October 2003, was recently unveiled with the message, "If you're sexually active, make syphilis testing part of your routine." It is being featured on the
Chicago Transit Authority Red and Blue lines and on buses serving the South and West sides of the city.

While syphilis rates are rising nationwide, Chicago's are going down. CDPH reported that 2003 saw a 25 percent decline in primary and secondary syphilis cases compared to 2002. A total of 264 cases were reported in 2003, the lowest numbers in 10 years. Men who have sex with men accounted for 169 of the 2003 cases, down from 211 in 2002.

The Syphilis Elimination Task Force, launched in August 2001, works to build awareness and encourage testing among at- risk populations. The group meets biweekly and comprises representatives from CDPH, social service organizations, faith- based groups, health-care providers, educational organizations, private businesses and community leaders.

CDC HIV/STD/TB Prevention News Update
Wednesday, March 31, 2004

NEW MEXICO:
"Adolescent Health: Sex Abstinence Program Languishing Because of Financial Troubles"
Women's Health Weekly (03.04.04)

The New Mexico Department of Health cannot account for more than $500,000 in federal funding for an abstinence education program. Health Secretary Patricia Montoya said the program fell through the cracks when she transferred it to the public health division's family planning activities program from the behavioral health division. "There's really no excuse for it," said Montoya of the loss. Rep. Heather Wilson (R-N.M.) has called on the department to account for the missing funds.

According to Health Department spokesperson Beth Velasquez, the state received $518,368 from a federal program for abstinence education in the fiscal year that ended Sept. 30, 2003. The state, which had the nation's third-highest teen pregnancy rate in 2002, spent $3,822 on administrative costs within the department, Velasquez said.

Laurel Edenburn, president of the New Mexico Abstinence Education Coalition, said that four programs previously received money from the state, but funds were unavailable after June 2003. Many of the abstinence programs involved classroom presentations discouraging sex before marriage, and some have trained teens as peer mentors to encourage abstinence among their schoolmates, she noted. A campaign of billboards and broadcast ads has also been funded. Edenburn said her group has tried for months to determine what happened to the money.
Montoya said that money released by the federal government in 2003 for the current year totals about $629,000 for the department to spend on abstinence education. Montoya said the department recently called on community programs to submit proposals and will try to disburse the money more quickly.

"Study: Summer Sun May Increase Women's Chance of Papilloma Virus"
Associated Press (03.31.04)::Daniel Q. Haney

Findings presented Tuesday at an Orlando, Fla., meeting of the American Association for Cancer Research said that sunshine could increase the risk of human papilloma virus (HPV) infection. The researchers, analyzing cancer-screening tests from Holland, found support for the theory that sunlight suppresses women's immune defenses so they are more likely to contract HPV, a sexually transmitted infection that is the most common cause of cervical cancer. The disease kills about 4,000 US women annually.

Dr. William Hrushesky of the WJB Dorn Veterans Administration Medical Center in Columbia, S.C., analyzed the results of more than 900,000 Pap tests done in southern Holland from 1983 to 1998. Although the Pap smear does not detect HPV, it reveals abnormal cells typically caused by the infection. Hrushesky found that the sunnier the year and the sunnier the month, the higher the rate of HPV. August, the sunniest month in southern Holland, showed twice as much evidence of HPV as the winter months. HPV fell off sharply in September. "Sexual intercourse did not appear to explain most of the variance," Hrushesky said.

Hrushesky theorized that even though women are exposed to HPV at roughly the same level year round, extra sunlight in summer weakens their defenses against it. He noted that sun can dampen the body's production of antibodies and the activation of protective T cells, the main branches of the natural defenses against infection. Other research has suggested a connection between sunlight and susceptibility to such infections as herpes and adenovirus, among others.
Dr. Bruce Armstrong of the University of Sydney-Australia said the sun's impact can occur far from the patches of skin sunlight hits, and an effect on cervix infection is plausible. "The relationship between sunlight and cancer is complex," he said.
Many studies have shown a link between incidence of cancer and how far north people live. Generally, the reports show that several kinds of cancer - including colon, prostate and breast - occur less frequently in southern regions, suggesting that sunlight may protect against them.

Armstrong's study, also presented Tuesday at the conference, found that the more sunlight people get, the less likely they are to develop non-Hodgkin's lymphoma. He studied 1,398 subjects and found that those who got the most sun had a one-third lower risk of the disease than those who got the least.

"Cervical Cancer: Publication Points to Increasing Use of HPV Testing in Cervical Cancer Screening"
Women's Health Weekly (03.04.04)

The first published consensus guidance on the most effective way to use human papillomavirus DNA testing for cervical cancer screening acknowledges that testing for high-risk types of HPV - the primary cause of cervical cancer - can identify more women with pre-cancerous cells than a single Pap test. The guidance also includes recommendation for how to manage women with conflicting test results - when HPV is present, but the Pap test is normal.

Developed by representatives from the National Cancer Institute, the American Cancer Society, and the American Society of Colposcopy and Cervical Pathology, the consensus document aims to provide "interim guidance for clinicians and patients on the use of HPV DNA testing, which has been recently approved by the Food and Drug Administration for use as an adjunct to cytology Pap testing for cervical cancer screening." The only FDA-approved HPV DNA test is marketed by Digene Corp. and is sold under the brand name DNAwithPap.

Guidance author Dr. J. Thomas Cox, a gynecologist at University of California-Santa Barbara, noted the use of HPV testing for routine screening represents the first significant expansion in cervical cancer prevention since the Pap test was first introduced in 1949. Studies show that there is greater than 95 percent sensitivity for detecting cervical disease (cervical intraepithelial neoplasia grades 2 and 3) or cancer when the HPV DNA and Pap tests are administered together.

"A potential advantage of using HPV testing as an adjunct to cervical cytology for screening is that it identifies not only women with cervical disease, but also those at risk of developing disease in the future," the guidance states. "In contrast, cervical cytology mainly identifies concurrent disease."

The guidance also concludes that if a woman has high-risk types of HPV but a negative Pap, the two tests should be repeated in 6 to 12 months. The authors also stress patient counseling, as only a small percentage of women who are infected with HPV are likely to have or to develop serious cervical disease or cancer.

"Interim Guidance for the Use of Human Papillomavirus DNA Testing as an Adjunct to Cervical Cytology for Screening" was published in Obstetrics & Gynecology (2004;103(2):304-309).

WYOMING:
"Hepatitis Spike Due to Needles"
Casper Star-Tribune (03.30.04)::Matthew Van Dusen

On Monday at a joint HIV/hepatitis conference in Cheyenne, Wyoming health officials said methamphetamine users who shared water to rinse their needles and dissolve the drug contributed to last year's hepatitis B (HBV) outbreak that sickened 57 people in Natrona County. State Department of Health Hepatitis Coordinator Clay Van Houten and High-Risk Population Specialist Rob Johnson presented a study conducted during the outbreak that found that those meth users who shared rinse water were 22 times more likely to get HBV than drug users who did not.

Van Houten first noticed a spike in HBV cases in February 2003. Reported cases in the county went from zero or two in the preceding months to around five a month in the winter and spring. The outbreak peaked in June with 10 new cases. State and county health officials determined that many of the cases were related to meth use.

In addition to local and state health officials tracking down infected cases and their contacts, CDC also sent a team to investigate the outbreak; it plans to release a report soon.

According to Johnson, 21 people in the 113-person study group had HBV, and 18 of those injected meth. Among the 92 people who did not get HBV, 45 were injection drug users. Most people in both groups shared needles. Though sharing accessories such as spoons and cotton to filter drug impurities was also common, sharing rinse water was the strongest indicator of HBV infection. Van Houten reported one user told him that rinse water - often shared by many users in a common glass at parties - "looks like pink Kool-Aid by the end of the night" from the blood dissolved in it.

An HBV vaccination campaign seems to have curbed the outbreak. Johnson said officials might need to consider other prevention approaches, such as signs warning users not to share rinse water.

"Maryland General Says 180 Patients Sought for Retesting"
Associated Press (03.30.04)

Maryland General Hospital announced Tuesday it is still seeking 180 patients who may have received questionable HIV and hepatitis C test results. According to hospital spokesperson Lee Kennedy, 460 people were originally identified as receiving suspect results during a 14-month period ending last August. "We are doing everything that we possibly can to find these individuals," said Kennedy of the patients still needing retesting. Of those already retested, 100 percent of the original HIV tests proved accurate, Kennedy reported. He said all but three of the HCV cases matched the original results. In those three cases, negative HCV tests were found to be positive upon retesting. The hospital said possible reasons for the change in results may include testing equipment error and infection after the original test.

CDC HIV/STD/TB Prevention News Update
Monday, March 29, 2004

SOUTH CAROLINA:
"Team Trying to Slow Syphilis Outbreak"
Anderson Independent-Mail (03.23.04)::Emily Huigens

Over the past three years, Anderson County has seen an increase in the number of reported syphilis cases. But with 25 people already diagnosed so far this year - compared to 35 cases for all of 2003 - public health officials have brought in a team to help control the outbreak. Though it is uncertain as to what is driving the outbreak, Susie Makison, district disease response surveillance coordinator at the county Health Department, said an increase in sex being traded for drugs began to show up in STD rates over the past few years.

A high number of cases among inmates at the Anderson County Detention Center prompted a recent visit by the Syphilis Outbreak Response Team, although the outbreak is not confined to the jail, said the South Carolina Health Department's District Public Information Officer Rachelle Shirley. "We're being proactive with this; we called in the [syphilis response team] and had them do some education out in the field, try to do some interviews, follow-ups with contacts," said Shirley.
According to Makison, hard-to-detect symptoms associated with the infection could present a challenge to controlling the outbreak. "Syphilis is known as the great imitator, because a lot of times these symptoms are symptoms of other things too," Makison noted.

Because syphilis can be transmitted from mother-to-child, testing is routinely done on pregnant women; otherwise, anyone else must ask for a test from his or her doctor. Testing is also available at the Anderson County Health Department, Makison said. For more information, telephone 864-260-5659.

"VA's Hepatitis C Web Site Aimed at Veterans, Medical Practitioners"
Providence Journal (03.22.04)

A comprehensive Web site on hepatitis C, www.hepatitis.va.gov, was launched in February through a collaboration between the Department of Veterans Affairs and University of California-San Francisco's Center for HIV Information. "This Web site will help both veterans and medical practitioners to understand this complex, long-term illness," said Secretary of Veterans Affairs Anthony J. Principi. VA records indicate that the department cares for more HCV patients than any other medical system, treating more than 200,000 patients since 1996, including screening, testing and care programs. The site has general information about HCV, which affects about 2 percent of the US population. It also offers HCV information for health-care providers, including best practices, guidelines and slides.

CDC HIV/STD/TB Prevention News Update
Friday, March 26, 2004

FLORIDA:
"Methamphetamine Taking a Toll on Gays"
Miami Herald (03.22.04)::Andrea Robinson

At the recent National STD Prevention Conference in Philadelphia, government health experts presented findings indicating that crystal methamphetamine use is contributing to the continuing spike in STDs, including HIV and syphilis, among gay and bisexual men. Studies have shown that crystal meth use leads to greater likelihood of being HIV-positive and having syphilis; users also tend to have more sex partners than nonusers.

Last year, Marc Cohen - president of the United Foundation for AIDS - and health and law enforcement officers formed the South Florida Crystal Meth Task Force to track the drug's usage and manufacture in the region. In November, the task force held a workshop in Fort Lauderdale to alert residents to the drug's dangers; it drew more than 500 people. The group will hold a similar event in Miami Beach on April 21.

Cohen started a campaign last year called Meth Equals Death to spread the word. Campaign strategies include logging into popular gay Internet chat rooms, offering support groups for users in Miami-Dade and Broward counties, and maintaining two Web sites that attract people from as far away as Australia. Cohen
spends as much as five hours a day chatting online, counseling men to be tested and/or seek drug abuse treatment. Cohen said that after two years of gaining chat room users' trust and counseling them, most have appreciated his efforts.
Crystal costs between $80-$100 per gram in South Florida. "The price of cocaine and meth are similar in terms of quantity," said Jim Hall, executive director of Up Front Drug Information Center in South Miami-Dade, "but meth has longer duration of action. That's part of its appeal."

CDC HIV/STD/TB Prevention News Update
Monday, March 22, 2004

NORTH CAROLINA:
"Forum Educates Black Colleges on HIV"
Atlanta Journal-Constitution (03.22.04)::David Wahlberg

North Carolina's 11 predominantly African-American colleges gathered over the weekend at North Carolina Central University (NCCU) for "Stomp Out HIV/STDs," a forum that drew more than 400 people to address the increase in HIV cases among black male college students. Last month, a study by North Carolina officials found a disproportionate HIV incidence among black male college students, most of whom had sex with men and many of whom also had sex with women. Their female partners at risk of infection may be unaware of it.

Officials said the same trend is likely occurring in Georgia and throughout the South, though some states do not have long- term HIV data to verify it.
While many of North Carolina's new HIV infections occurred on mainstream campuses, school officials said the state's black colleges are now tackling issues generally ignored: HIV and homosexuality. The topics can be uncomfortable for the black church, whose influence touches campus life.

"We need to make all college campuses safer for young men who have sex with men, so they... feel more like their lives are worth protecting," said David Jolly, an NCCU health education teacher. Reggie Lowery, counseling center director at Shaw University, a Baptist school, said his campus has HIV education efforts but not programs for gay men. "They don't come out [as gay] because they don't have a support system," said Lowery. Six staff members and 38 students from Shaw were in attendance.

The forum focused on heterosexuality, as well. In a men-only session, some students said their fathers encouraged them to be promiscuous, and others said they were encouraged to trash women in locker room chats. "You are considered a square if you do the right thing," such as not demanding sex, said one man.
Clark Atlanta University held a similar, smaller, forum last week, the first such event sponsored by CDC.

COLORADO:
"Sex Education Bill Undergoes More Revision"
Associated Press (03.22.04)

On Friday, Rep. Shawn Mitchell (R-Broomfield) responded to increasing opposition to his sex-education bill by toning down its proposed restrictions on Colorado schools. The measure would have required parental permission for children to receive sex education. An earlier version would have banned teaching about homosexuality except when talking about STDs.

The revised bill, Mitchell said, maintains the status quo by allowing parents to pull their children out of sex-education classes, but it adds requirements that schools notify parents of their ability to remove their kids from the classes and tell them about the topics discussed and materials used. "I'm trying to make it easy for parents to know what's in their children's sex- ed classes. They shouldn't have to go looking it up," Mitchell said.

Previous incarnations of the bill were opposed by schools, teachers and lawmakers, Mitchell said Friday. However, during a recent hearing, some parents spoke in favor of the earlier versions. Parents complained about discussions whose topics included oral sex and homosexuality, and they said schools did not make it clear that parents could remove their children from the classes.
But Rep. Jack Pommer (D-Boulder), who said he had received hundreds of e-mails criticizing the measure, commented, "The way to protect kids is not the hide facts from them but to educate them and help them make good decisions."

"Hundreds of Syphilis Patients in Los Angeles Got the Wrong Drug"
Los Angeles Times (03.20.04)::Lisa Richardson

On Friday, the Los Angeles Gay & Lesbian Center notified county health officials that it has given the wrong medication to about 300 syphilis patients seeking treatment since 1999. Center clients were administered the penicillin formula Bicillin C-R instead of the higher-dose penicillin formula Bicillin L-A (benzathine penicillin G). The formula given to center clients contains only half the dose of benzathine penicillin G that CDC recommends for treatment of syphilis.
The Gay & Lesbian Center is asking any syphilis patient treated there from 1999 to this month to make an appointment for another assessment and further treatment, if necessary. It is not clear whether patients dispensed the wrong formula would still have syphilis, and people with syphilis can be asymptomatic, said Darrel Cummings, COO of the center.

"This drug looks identical and has the same name, with the exception of the two letters, so in some ways one can understand how this mistake can be made," said Cummings. "After we disclosed the problem, we began identifying the pool of people who might be affected, and we're trying to contact those folks personally."
A county survey has found no similar errors at its 13 syphilis treatment sites, said Dr. Peter Kerndt. "We know in fact it hasn't occurred in any of our public settings," he said.

MISSOURI:
"City Clinic that Treats Sexually Transmitted Diseases Will Stay Open"
St. Louis Post-Dispatch (03.20.04)::Doug Moore

A St. Louis Health Department STD clinic that treats about 90 people a day will not close after all. Closing the clinic had been under consideration for several weeks as the department sought to cut more than $1.5 million from its budget for the fiscal year beginning July 1.

The Health Board learned recently that it no longer has to pay $422,000 for nine employees who work in lead poisoning prevention; that expense has been transferred to the Building Division. Armed with this information, the Health Board met Friday to formalize a budget that is being presented to Budget Director Frank Jackson on Monday. However, the budget is still $500,000 over the $8 million the office was allocated. "You come to a point where you say, this is all we can do," said Patrick Cacchione, a board member. "It's a minimalist budget as is." Earlier, Jackson said he would have to see the budget before changing the allocation amount.

The board decided to keep the clinic open out of concerns that shifting its services to community clinics before educating the public about the change could lead to fewer people in treatment and more STD infections. To save about $400,000, however, the board does plan to close the department's immunization clinic; other community health centers will offer childhood vaccinations and immunizations for hepatitis A and B.

CDC HIV/STD/TB Prevention News Update
Thursday, March 18, 2004

NEW YORK:
"Hepatitis C Treatment Rules Continue to Draw Criticism"
Associated Press (03.15.04)::Joel Stashenko

New York state's refusal to treat hepatitis C-infected inmates serving short sentences does not jeopardize their chances of ultimately beating the virus, the prison system's top doctor told skeptical state Assembly committee chairs Tuesday. "We just don't feel it's wise to start something we can't finish," said Dr. Lester Wright, chief medical officer for the state Department of Correctional Services, adding that hepatitis C is unlike other diseases in state prisons - such as HIV or TB - that compel immediate treatment upon detection.

The Assembly's health committee chair, Richard Gottfried (D- Manhattan), and Jeffrion Aubry (D-Queens), chair of the Assembly's corrections committee, remained critical of the prison's policy of treating HCV-infected inmates only if they are incarcerated for the year needed to complete the drug regimen. Consequently, just a few hundred of the estimated 9,200 inmates who show signs of HCV infection are treated while incarcerated.

According to Wright, released inmates do not have particularly good histories of follow-up with doctors and sticking to health care routines. Prison officials have also had difficulty in lining up HCV-treatment programs outside of prisons for inmates released unexpectedly, prior to treatment conclusion. "Treatment ends up with large gaps in it, which is not good health care," said Wright. Discontinuing the treatment schedule could make later attempts to treat HCV impossible, added Wright.

Gottfried said treatment for inmates is often delayed because they cannot become immediately eligible for Medicaid upon their release, and he urged for a plan allowing the paperwork for Medicaid to be started well in advance of the end of inmates' sentences. Dr. Guthrie Birkhead, director of New York's AIDS Institute, said social service officials are hesitant to accept Medicaid applications for people who do not apply in person and who are not currently living in the local district.

CDC HIV/STD/TB Prevention News Update
Monday, March 15, 2004

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, with17 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.

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.

CDC HIV/STD/TB Prevention News Update
Friday, March 12, 2004

"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.

"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.

"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.

"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.

CDC HIV/STD/TB Prevention News Update
Thursday, March 11, 2004

"Gays' Use of Viagra and Methamphetamine Is Linked to Diseases"
New York Times (03.11.04)::Lawrence K. Altma

Expanding recreational use of Viagra and crystal methamphetamine is apparently behind a rise in HIV, syphilis, and other STDs among gay and bisexual men in the United States, according to new studies reported Wednesday at the National STD Prevention Conference in Philadelphia.

Dr. Samuel J. Mitchell of the San Francisco Health Department (SFHD) said a study found that 17.4 percent of 1,263 gay men who had gone to the city's STD clinic reported using crystal in the four weeks prior to their visit. Crystal users were more than twice as likely as nonusers to have HIV, 4.9 times as likely to receive a diagnosis of syphilis, and 1.7 times as likely to test positive for gonorrhea.
In a study of 388 gay men, Dr. Gordon Mansergh reported his CDC team and the SFHD found that 16 percent had used crystal the last time they had anal sex. The study found that crystal users were twice as likely as nonusers to have engaged in unprotected receptive anal intercourse. In the men's last anal sex encounter, 6 percent had used Viagra, and the Viagra users were 6.5 times more likely to report having had unprotected insertive anal sex during that encounter. Viagra was not linked to receptive anal risk behavior.

Another study found that gay men who used both Viagra and crystal together were 6.1 times as likely to be diagnosed with syphilis as those who did not use either drug, reported SFHD's Dr. William Wong.

For three consecutive years through 2003, syphilis rates fell by 50 percent among women, but increased by 65 percent among men. "We are very, very concerned" about the trend, said Dr. Ronald O. Valdiserri, deputy director of CDC's National Center for HIV, STD and TB Prevention, at a news conference at the meeting.
Seattle health officials also reported a sharp spike among gay men in cases of gonorrhea resistant to the commonly prescribed antibiotic ciprofloxacin. From October-December 2003, ciprofloxacin-resistant gonorrhea accounted for 22 of 133 cases (16.5 percent) compared with 6 of 159 cases (3.8 percent) from July-September 2003; the overwhelming majority of cases were among gay men. Such drug-resistant gonorrhea has also been reported in New York and Boston.

"Protest Condemns Bush on Sex Ed"
Associated Press (03.11.04)::Jason Straziuso

Yesterday at the National STD Prevention Conference in Philadelphia, about 200 people attended a rally to criticize President Bush's plan to expand abstinence-only education. Instead, they advocated for an approach that would teach youths about condoms and STD prevention.

In his State of the Union address, Bush proposed doubling funding for abstinence programs to $270 million. Independent researchers, in their first report two years ago, said there is no reliable evidence that abstinence programs work. A study released Tuesday at the Philadelphia conference found STD rates were the same among teens who pledged to remain virgins until marriage and those who did not.
The advocates at the rally also criticized Rep. Mark Souder's (R-Ind.) Washington hearing, planned for today, on whether condoms should carry warning labels saying they do not protect against human papillomavirus (HPV). HPV, which can be transmitted even when condoms are used, will affect more than 50 percent of sexually active Americans at some point in their lifetimes.

Souder said he wants Food and Drug Administration to uphold a 2000 law to ensure that condom labels are "medically accurate." His spokesperson, Martin Green, said people need labeling to protect against HPV, which can cause cervical cancer in a small number of cases. "Any time certain liberal elements disagree with scientific facts they label them as politicized, but we point to the CDC's report," Green said.

In January, CDC issued a report saying it could not recommend condoms as a primary prevention strategy against HPV. Other public health advocates say an HPV warning label would lead to confusion, decreased condom use and increased exposure to HIV/AIDS and other STDs. The American Cancer Society said it does not support an HPV warning label for condoms because it would have little effect on transmission rates and users might confuse HPV with HIV.

"Casual Sex, Serious Health Consequences"
Los Angeles Times (03.08.04)::Ridgely Ochs

CDC says human papillomavirus (HPV) is "likely the most common STD among young, sexually active people," affecting 20 million in the United States at any one time. According to CDC, every year about 5.5 million people contract an HPV infection.

HPV is a major health concern for sexually active women in their 20s and 30s. "HPV is the epidemic right now," said Dr. Margaret Polaneczky, an obstetrician-gynecologistat New York- Presbyterian Hospital in Manhattan. Polaneczky and other doctors said they are seeing more young women having more and more sexual partners over time. Such behavior increases the risk of contracting viruses such as HPV, herpes and HIV.

Of the 30 strains of HPV, a few types can lead to cervical cancer. The virus is undetectable in about 90 percent of women after two years, but studies have found that in some women, HPV strains that lead to cervical cancer can persist. Constant re-infection from multiple partners greatly increases that risk.
Herpes is another major health concern. CDC says about 45 million Americans have genital herpes, which produces genital blisters that usually disappear within two to three weeks. The herpes simplex virus remains in the body for life and sores may recur. Dr. Judith Morris de Celis of New York University Medical Center in Manhattan said that both HPV and herpes could be transmitted via the scrotum, which is not covered by a condom.

In 2002, according to CDC, more than 56,000 US women had HIV/AIDS, which they had acquired through heterosexual sex. Aside from abstinence, doctors said that condoms remain the best way to reduce transmission of STDs and they suggested women have frank conversations with their doctors and their sexual partners.

CAMEROON:
"Sexually Active Cameroon Youths Shun Condoms - Study"
Reuters (03.02.04)::Tansa Musa

A study by the German Agency for Technical Cooperation (GTZ) recently revealed that two-thirds of teenagers in Cameroon have sex by age 16 and more than half of them shun condoms. The figures shed new light on sexual behavior in a nation where HIV/AIDS adult infection rates have risen more than twenty-fold in slightly more than a decade.

Albert Mbanfu, assistant coordinator of the survey, blamed the situation on an "inappropriate environment", including a lack of sex education in families and schools, the negative influence of peers, the media, video clubs, and poor knowledge of modern contraceptives.

The HIV/AIDS infection rate among people ages 15-45 in Cameroon was 0.5 percent in 1989 compared to 11.8 percent by the end of 2001, according to UN figures. The two year-study of 5,000 youths ages 12-18 found 51 percent of sexually active adolescents had unprotected sex. Of those who used condoms, 63 percent said they did not always do so.

Sixty percent of girls surveyed had sexual intercourse by age 16. This resulted in unwanted pregnancies in one in five cases and abortion rates as high as 51 percent in some regions. One in three girls and two out of three boys said they had sex with more than one partner a year. Eleven percent said they had contracted at least one STD during the past 12 months.

"More Sex Partners Mean More Trouble for Teenage Girls"
Women's Health Weekly (02.26.04)

A recent study of more than 3,000 female students found that teenage girls who have sex with more than one partner over a short period of time are likely engage in other risk behaviors such as fighting, binge drinking, smoking cigarettes, using cocaine or sniffing glue.

Donna E. Howard, DrPH, and Min Qi Wang, PhD, of the University of Maryland, based their study on information from the 1999 National Youth Risk Behavior Survey, focusing on the 3,288 girls who reported ever having sexual intercourse. Among those adolescents, 24 percent reported no sexual partners in the past three months, about 63 percent had one partner, and 13 percent had two or more recent sexual partners.

Besides fighting, drinking and substance abuse, girls with multiple sexual partners were also likely to have had unprotected sex the last time they had intercourse, the study found. Other studies have shown that girls are starting to have sex at younger ages, and earlier sexual intercourse often leads to having multiple sexual partners.

The researchers found that sexually active girls increasingly limited themselves to just one recent partner as they progressed through high school. Ninth graders reported more recent multiple sexual-partner behavior, but the odds of having more than one partner declined for girls in the 11th and 12th grades. Howard said one possible explanation was that younger adolescents may be experimenting with their sexuality and intimacy, while by late high school, girls may be involved in stable, longer-term dating relationships.

Howard said educating girls before ninth grade may pay off in reduced sexual activity and its negative health consequences. She said ninth grade marks an important transition for girls who must deal with a new school and may also meet and date older boys and be exposed to changing sexual pressures and norms. Howard noted that since risky behavior is more common among dropouts or teens frequently absent fromschool, the findings may actually underestimate the problem.

The study, "Multiple Sexual-Partner Behavior Among Sexually Active US Adolescent Girls," appeared in the American Journal of Health Behavior (2004;28(1):3-12).

CDC HIV/STD/TB Prevention News Update
Wednesday, March 10, 2004

"Study Finds That Teenage Virginity Pledges Are Rarely Kept"
New York Times (03.10.04)::Lawrence K. Altman

The majority of teenagers who pledged not to have sex before marriage did not keep their vows, and those teens also developed STDs at about the same rate as youngpeople who had not made such pledges, according to a study reported Tuesday at the National STD Prevention Conference in Philadelphia. But the study found that a pledge to refrain from sex did tend to delay the start of sexual intercourse by 18 months. Those who took virginity pledges also married earlier and had fewer sex partners than the other teens surveyed, said lead author Dr. Peter Bearman, chair of the sociology department at Columbia University.
Of the 12,000 teenagers included in the study, 88 percent of those who made a virginity pledge reported having had sexual intercourse before they married, Bearman and co-author Hannah Bruckner of Yale University reported. The researchers tested the participants for three common STDs - chlamydia, trichomoniasis and gonorrhea - and found the rates were nearly identical for the teens who took pledges and those who did not.

According to Bearman, telling young people "to 'just say no,' without understanding risk or how to protect oneself from risk, turns out to create greater risk" of STDs. And those teens who had taken abstinence pledges were less likely to know they had an infection.

Also, the teenagers who had made abstinence pledges were less likely to get tested for STDs. Among the girls, 14 percent of pledgers had been tested, compared with 28 percent of girls who had not pledged. Among the boys, 5.2 percent of pledgers were tested, compared with 9.1 percent of boys who did not pledge. Just 40 percent of teens who had taken pledges reported condom use in the most recent year of the study, compared with 60 percent of teens who did not pledge.

The study, financed by the National Institutes of Health, CDC and the National Science Foundation, is part of the National Longitudinal Study of Adolescent Health and is based on a six- year follow-up of participants who began the study when they were 12 to 18 years old.

MASSACHUSETTS:
"Resistant Form of Gonorrhea Gains Foothold"
Boston Globe (03.10.04)::Stephen Smith

In Massachusetts, disease trackers have reported a strain of gonorrhea that cannot be treated with standard antibiotics. First discovered in the state in 2002, the drug-resistant bacteria affected one of every seven gonorrhea patients in the state last year. Maine reported its first case in January, and although other New England health departments do not routinely test for the new strain, health officials suspect its presence.

Infectious disease specialists fear cases of drug-resistant gonorrhea will spread exponentially as patients are unwittingly prescribed drugs that do not work. Thinking they are cured, patients may resume unsafe sex practices and pass on the infection. Federal health officials are monitoring the spread of the drug-resistant bacteria, first discovered on the West Coast about four years ago. CDC investigators said the Massachusetts outbreak appears more severe than clusters recently reported in Seattle, Las Vegas, Chicago, Dallas and Philadelphia.
CDC investigators predict the new gonorrhea strain could increase HIV infections, because people with gonorrhea's open sores can more easily contract and spread HIV.

The resistant gonorrhea strain is emerging as STDs have begun to rebound, and state funding cuts have reduced the number of Massachusetts STD clinics. Gonorrhea cases had declined slightly in Massachusetts over the past two years. However, the 3,010 diagnoses reported in 2003 represent a 45 percent increase since 1997, when cases were at a historic low. Nationally, gonorrhea cases grew by 7 percent from 1997-2002.

Drug resistance has long been a problem with gonorrhea, and infectious disease doctors fear that eventually gonorrhea may become resistant to all the antibiotics available to treat it. "We're burning through antibiotics," said Dr. Jeffrey Klausner, director of STD prevention and control services for the San Francisco Department of Public Health. "What happens when we burn through them all?" he asked.

"Syphilis Falls Here as US Rates Rise; 25% Decline Tied to City's Ad Push"
Chicago Tribune (03.09.04)::Nikki Usher

Data released Monday reveal that new syphilis cases in Chicago have dropped 25 percent three years after the city led the nation in syphilis cases. The decline came as syphilis numbers rose across the rest of the nation.

In 2001, reacting to a strong spike in the number of syphilis cases, city officials launched an extensive public awareness campaign which many believe was successful because it was not aimed at changing sexual behavior but at encouraging people to be tested. The campaign advertised at venues ranging from the elevated train to urinals in gay bars.

Chicago's efforts are being touted as a model for fighting STDs this week at the National STD Prevention Conference in Philadelphia - especially the city's success in reducing syphilis rates among gay men by 20 percent in the past year.
"We were really aggressive about putting the word out there," said Chris Brown, assistant commissioner for STD/HIV/AIDS at the Chicago Department of Public Health. "Syphilis is a pretty serious disease, and we tried to jump really quickly on this when we saw how much of it we had."

A recent survey conducted by the Syphilis Elimination Task Force, an organization of public and private advocacy groups, found that 50 percent of Chicago men who got tested did so because of the ad campaign. The number of people tested at Howard Brown Health Center, a private nonprofit clinic for gays and lesbians, rose from 644 in 2000 to 3,165 in 2003.

Despite Chicago's success, officials remain concerned about syphilis, especially since prevalence seems to be shifting from the North Side to the South Side. Next week, the Chicago Public Health department will launch a widespread campaign to reach more South Siders.

CDC HIV/STD/TB Prevention News Update
Tuesday, March 09, 2004

"Herpes Rate on the Decline"
Atlanta Journal-Constitution (03.09.04)::David Wahlberg

After increases throughout the 1970s and 1980s, the herpes infection rate in the United States has declined significantly - especially among young people, CDC officials reported Monday. But the rate of syphilis, which had been on the decline and targeted for elimination by 2005, was up last year for the third consecutive year. The two diverging trends underscore the challenges in the fight against STDs being highlighted out of this week's National STD Prevention Conference in Philadelphia, co-sponsored by CDC.

The conference comes amidst a backdrop of what organizers call flat funding for STD prevention as more resources are channeled to bioterrorism and emerging diseases - and to abstinence-only education programs, which some say hinder efforts to fight STDs.

A national survey found herpes infections decreased by 17 percent from 1988-1994 to 1999-2000, the latest data available. Despite the recent decline, more than one in six people age 14 to 49 have herpes. The new figures show herpes dropped 48 percent among people in their 20s since 1988-1994, and 74 percent among teens. The reduction may be explained by studies showing a decline in sex among high school students and an increased use of condoms, said Dr. John Douglas, director of CDC's Division of STD Prevention.

After steady declines in the 1990s, syphilis rates increased in 2003 for the third year in a row. Syphilis continues to drop among African-Americans and women, but rates soared among men who have sex with men - who accounted for about 60 percent of the nation's 7,082 cases last year, said Dr. Hillard Weinstock, of CDC's National Center for HIV, STD and TB Prevention. The increase among gay men is partly attributed to AIDS prevention fatigue and new HIV drugs; it also may be fueled by methamphetamine use and using the Internet to meet sex partners, said Douglas.

Douglas said the goal of eliminating syphilis will not be achieved by 2005, at least among gay men. He added that new strategies must be developed to target gay men who perceive themselves at less risk for HIV and therefore lower their guard about safe sex.

CDC HIV/STD/TB Prevention News Update
Friday, March 05, 2004

"Don't Let Me Down"
Southern Voice (02.27.04)::Christopher Seely

Since its introduction in 1998, Viagra has been popular with gay men who want to stay sexually potent for long periods of time and attendees at gay circuit parties who want to counteract the side effects of drugs like crystal meth.
Some men with HIV are prescribed the erectile dysfunction drugs, which now include Levitra and Cialis, to counteract HIV drugs' side effects. But others, said Dr. Charlotte Kent, chief of epidemiology in the STD prevention and control division of the San Francisco Department of Public Health, obtain them without a prescription to combat the impotence that results from using crystal meth.

A 2001 study, "Drug Use and Sexual Risk Behavior Among Gay and Bisexual Men Who Attend Circuit Parties: A Venue-Based Comparison," published in the Journal of Acquired Immune Deficiency Syndromes (2001;28;(4):373-379) found that gay men use erectile dysfunction drugs in combination with common party drugs such as crystal meth, amyl nitrates (poppers), ketamine, gamma-hydroxybutyrate or gamma-butyrolactone (GHB-GBL), and ecstasy. The study examined the sex and drug habits of 295 gay and bisexual men who attended circuit parties. During one weekend of drug use, the report found, 80 percent of participants used ecstasy, 66 percent used ketamine, 43 percent used crystal meth, 29 percent used GHB/GBL, 14 percent used Viagra and 14 percent used poppers. More than half of the circuit partiers used four or more drugs during the course of the weekend, according to the study, which concluded that drug use increased the likelihood of high-risk behavior such as unprotected anal sex. The study said Viagra is "specifically associated with high-risk sexual behavior."

But doctors cannot name Viagra as the problem itself, said Dr. Jason Schneider, a member of the board of directors of the Gay & Lesbian Medical Association. "It depends on the individual person and the setting in which it is used," he said. "A single guy at a circuit party using crystal meth... is at a higher risk. It's not because of Viagra, but of other drugs he's doing and the setting he's in."

WEST VIRGINIA:
"STD Rates Higher Among the Young"
Wheeling News-Register (03.01.04)::Betheny Holstein

In 2002, West Virginia Public Health District 6, comprising Hancock, Brooke, Ohio, Wetzel and Marshall counties, reported 158 chlamydia cases, 119 (76 percent) of which occurred among 15- to 24- year-olds. Of 63 reported cases of gonorrhea, 46 (73 percent) were diagnosed among youths ages 15-24. The Alan Guttmacher Institute recently reported that nearly half of all reported STDs in America during 2000 occurred among youths ages 15-24. Its report was based on CDC data.
The Jefferson County Health Department (JCHD) reported that of 106 positive tests for either gonorrhea or chlamydia, 88 cases (83 percent) were in youths ages 14-25. Harrison and Monroe counties reported only 29 and nine cases, respectively, of either chlamydia or gonorrhea in 2002, and no syphilis cases.
The state reported two of its five syphilis cases were youth cases; and Ohio reported 60 youth cases (17 percent) out of 353 total. This reflects the national trend, with 3,399 cases out of 15,449 total cases of syphilis reported among 15- to 24-year-olds (22 percent).

Cindy Deavers, a JCHD nurse working with infectious disease, said part of the difficulty is that younger people may be more promiscuous than older people. Youths may also be less knowledgeable about STDs and how to prevent them.
An important role for local health departments is to provide STD education and awareness, said Charles McConnell, an STD field consultant for the West Virginia Bureau of Public Health. "Information is out there and available. Every local health department has information," he said. "That effort is there every day."

WISCONSIN:
"Monroe Committee Votes Against Distributing Condoms to Students" Associated Press (03.04.04)

On Wednesday, the Monroe School Board policy committee unanimously rejected a proposal to distribute condoms to high school students. "I feel the responsibility for the purchase, distribution and use of condoms by high school-age children should be a choice made by parents and not the school district," said Mark Mayer, the board president and a policy committee member. "This is not an appropriate role for our public schools," said Mayer.

In January, high school students Daniel Flynn and Garrett Wartenweiler asked the school advisory committee to allow the free distribution of condoms to high school students with no questions asked. The advisory committee sent the proposal to the policy committee with a recommendation to deny the request.

Superintendent Ed Van Ravenstein said while he did not agree with the proposal, "[it] is the right of students to express themselves in support or in opposition to various issues within our society." The issue drew community interest from both those favoring and opposing the idea, said Van Ravenstein.

Although disappointed with the outcome, Wartenweiler and Flynn were happy to have had the chance to meet with the committee to explain their proposal.

CDC HIV/STD/TB Prevention News Update
Wednesday, March 03, 2004

NEW HAMPSHIRE:
"Health Officials Concerned About Syphilis Increase"
Associated Press (03.02.04)::Holly Ramer

New Hampshire, which saw only sporadic syphilis cases for almost a decade, last year reported 19 cases. The state's caseload fell from 19 in 1993 to five in 1994. Over the next seven years combined, it saw just eight cases. Then cases jumped to eight in 2002 before more than doubling in 2003.

State Medical Director Dr. William Kassler likened the upturn to "the canary in the coal mine. That indicates we've got some real problems," he said, calling syphilis "a marker for unsafe sex." Most of the new cases involved gay men, but there is also a small outbreak among young heterosexuals.

Kassler blamed the syphilis rise on complacency among gay men, who are no longer as fearful of contracting HIV as they were at the height of the AIDS crisis. He said the most disturbing aspect of the syphilis increase is that it indicates New Hampshire will likely see a rise in HIV/AIDS in the next few years, because syphilis infection aids in the transmission of HIV. Four of the new syphilis cases were also HIV-infected. While the number of HIV/AIDS cases has not fluctuated much in recent years, more people are being diagnosed in the later stages of the illness.
Chlamydia has steadily increased in New Hampshire from 1999 to 2003, when 1,610 cases were reported. While gonorrhea cases held steady at 123, both diseases infected an increased number of teenagers.

"STDs are among the most under-recognized health problems in the country," Kassler said. "Teens are more biologically susceptible to STDs and behaviorally they're at a stage of their life when they take risks."

"Patients Take Fight Against Hepatitis C into Their Own Hands"
Associated Press (03.01.04)

According to health officials, as many as 23,000 Maine residents are infected with hepatitis C (HCV), the most common blood-borne infection in the United States and the number-one reason for liver transplants. Yet, resources to fight the virus are scarce: Last year, Maine used $32,000 in federal block grants and $15,000 in private funds to provide free HCV testing at 22 sites statewide. CDC provided around $110,000 to fund the state's viral hepatitis coordinator.

In contrast, Maine last year allocated $1.9 million in federal and state funds for HIV prevention programs and about $350,000 for STD control and prevention.
To raise awareness about HCV, some patients are taking matters into their own hands. "It's time for someone to come out and for people to understand that over 4 million Americans are infected with this virus and it's a big epidemic," said Norm Burnell, who thinks he was exposed to HCV as a medic in the Vietnam War. Burnell has created a Web site, www.hepatitiscnme.org, to advocate for patients.

Joelle Leeks, 36, was shocked when she was diagnosed with HCV in May. She eventually traced her transmission to a blood transfusion after a 1987 car accident. Leeks and members of her support group are beginning a grassroots HCV education campaign aimed at the public and health care practitioners.
"The knowledge about hepatitis C has expanded," said Geoff Beckett, assistant state epidemiologist. "Nobody knew what to do about it early on, and that's changed very dramatically in the last five or six years."

CDC HIV/STD/TB Prevention News Update
Monday, March 01, 2004

"Action Urged on Diseases with Dangers for Women"
New York Times (02.28.04)::Lawrence K. Altman

Compared with men, women are disproportionately affected by STDs and other common infections, and these can be particularly dangerous in pregnancy, CDC Director Dr. Julie Gerberding told a conference Friday in Atlanta. "Women disproportionately suffer the burden of poverty, are victims of widespread and persistent discrimination in all areas of life and put their lives at risk every time they become pregnant,"

Gerberding said at the opening of the two-day International Conference on Women and Infectious Diseases, sponsored by CDC, the World Health Organization and the American Society for Microbiology.
While the problem of women and infection is more complex than gender alone, it offers "some unique aspects," said Gerberding. For instance, women are at least four times more susceptible to HIV infection and other STDs. Some 60-70 percent of women infected with gonorrhea or chlamydia may not be aware of it. Late diagnosis or treatment can lead to chronic pain, stillbirth, infertility and in some cases death.

"Nearly every sexually transmitted pathogen can also be passed on to the fetus or infant, sometimes with fatal consequences," Gerberding said. A lack of scientific knowledge and the failure to apply what is known increase the burden of illness on women, she said. And though women are often the family brokers for health care, they are also "last in line to address their own health problems for lack of time."

A UNAIDS official, Dr. Paul DeLay, said the latest information shows women comprised 58 percent of HIV infections in sub-Saharan Africa in 2002. And infection rates among teenage girls in Africa are 5-16 times higher than among teenage boys. Women in their early 20's are infected at three times the rate of male teenagers.

New HIV infections are also increasing among US women. In New York City, 35 percent of new HIV diagnoses in 2001 were in women, compared to 28 percent before 2001.

CDC HIV/STD/TB Prevention News Update
Friday, February 27, 2004

"Methamphetamine Spread in South Florida Causes Alarm"
South Florida Sun-Sentinel (02.22.04)::Noaki Schwartz

Methamphetamine, a growing problem nationwide, has begun to surface in South Florida during the past few years. In 2003, Miami-Dade and Broward County health experts and law enforcement officials set up South Florida's first meth task force. Five months later, authorities seized 10 pounds of crystal meth in Coral Gables. By the end of fiscal 2003, authorities had dismantled 299 meth labs statewide. In the first quarter of fiscal 2004, law enforcement officials dismantled 88 labs.

White-collar users in the gay party circuit call the drug "Tina" and claim it keeps their abs tight, allows them to dance all night, and loosens their inhibitions. Health officials say meth use in south Florida has contributed to the recent spike in HIV/AIDS and syphilis rates. Studies in California have shown that meth users, both gay and straight, are likely to have more sexual partners and riskier sex than other types of drug users.

In 2002, Marc Cohen, president of the United Foundation for AIDS in Miami, helped organize the area's first Crystal Meth Anonymous meeting. An estimated 200 former users attend daily meetings in Miami Beach and Fort Lauderdale, he said, and plans are underway to start meetings in Palm Beach County. Almost all who attend are gay men, and more than half are HIV-positive or have had syphilis.
The Broward County Commission on Substance Abuse organized a community forum in Fort Lauderdale in November to address the emerging drug epidemic and its correlation with the spread of STDs. Cohen said the drug's attraction for some gay men is especially powerful. Escaping through meth is seductive for those who have struggled with issues of sexual identity, acceptance and insecurity. "Crystal becomes a very strong veneer for someone facing depression," Cohen said.

ZIMBABWE:
"Saying No to 'Sugar Daddies'"
Wall Street Journal (02.25.04)::Marilyn Chase

The National Institutes of Health is granting $5 million to California researchers to test a new AIDS prevention tool in Zimbabwe - a financial prophylactic intended to shield young girls from sexual liaisons that leave them vulnerable to HIV. The program, Shaping the Health of Adolescents in Zimbabwe (SHAZ), offers girls the potential of economic security through training, jobs and loans.

In impoverished southern Africa, many orphaned adolescents wind up becoming heads of households. In turn, young women among them often fall into relationships with older men - "sugar daddies," or "dharas" in the Shona language - who ply them with gifts and cash in return for sex. Dr. Nancy Padian, SHAZ's lead researcher and a professor of obstetrics, gynecology and reproductive sciences at University of California-San Francisco, said these relationships are a factor in the spread of HIV across the region. Studies show that the HIV infection rate in African girls ages 16-19 is six times higher than in boys. Researchers note that teenage girls are powerless to negotiate safe sex, and the use of condoms is rare.
All 200 girls in the pilot study will receive training in life skills, reproductive health, HIV prevention and negotiating condom use. Next, vocational training will stress entrepreneurship and developing a business plan. Each girl will be paired with a local businesswoman mentor. Those with a business plan backed by a market feasibility study will receive a loan of up to $100 from a microcredit firm.
After the pilot study concludes, a larger study of 1,000 girls will begin in July in which half of the volunteers will receive the entire training package plus the loan, while the other half will receive just the life-skills class.

Researchers will assess whether the microcredit group had less HIV, herpes and pregnancy. They will also see whether being on a career track delayed the onset of sexual activity, and they will examine the girls' business viability and loan repayment - both major hurdles in underdeveloped nations.

TANZANIA; UGANDA:
"Higher Risk Behavior and Rates of Sexually Transmitted Diseases in Mwanza Compared to Uganda May Help Explain HIV Prevention Trial Outcomes"
AIDS (12.05.03); Vol. 17; No. 18: P. 2653-2660::Kate K. Orroth; Eline
L. Korenromp; Richard G. White; Awene Gavyole; Ron H. Gray; Lawrence
Muhangi; Nelson K. Sewankambo; Maria Quigley; Maria J. Wawer; James
A.G. Whitworth; Heiner Grosskurth; J. Dik F. Habbema; Richard J. Hayes

Three large-scale community randomized trials in East Africa found different results regarding STD treatment as an intervention to prevent HIV transmission. In Mwanza, Tanzania, syndromic STD case management reduced HIV incidence by 38 percent in the general population, suggesting that the treatment of genital ulcer and discharge syndromes could be an effective HIV control strategy in African populations. However, STD mass treatment trials in Rakai, Uganda, and trials of a behavioral intervention in conjunction with syndromic STD treatment in Masaka, Uganda, showed little or no effect on HIV incidence.

The authors undertook the current study to determine to what extent differences in the trial outcomes might be explained by differing STD epidemiology, sexual risk behavior and demographic risk factors in the three populations. The researchers compared baseline data from the Mwanza, Rakai and Masaka trial populations using standardized indicators and definitions after adjusting for differences in data collection methods.

The researchers found that demographic patterns were similar across populations. Mwanza had higher sexual risk behaviors, including younger age of sexual debut, higher number of recent partners and lower frequency of condom use than either Rakai or Masaka.

HIV epidemiology at the start of the three trials showed major differences among the sites. HIV prevalence was highest in Rakai (16.5 percent), lower in Masaka (12.1 percent) and lowest in Mwanza (3.8 percent). The Ugandan sites have a more mature HIV/AIDS epidemic than Mwanza.
Age and sex patterns of HIV prevalence were similar across sites except for differences in overall levels. Prevalences were higher for females than males, peaking between 25-29 years for women and 30-34 years for men. Age peaks were somewhat younger in Mwanza than in the Ugandan sites, consistent with the relatively young epidemic in Mwanza, where the majority of prevalent cases have been contracted recently.

The authors noted the higher prevalence of short-duration, curable STDs in Mwanzaand higher rates of risky sexual behavior reported at that site. Most differences among the sites related to markers of recent risk rather than past risk, suggesting that risky behavior may have decreased in the recent past in Uganda.For instance, high-titer serological syphilis, reflecting recent risk behavior, was more prevalent in Mwanza than in Uganda. However, all titer serological syphilis was more prevalent among older participants in Rakai and Masaka than Mwanza, suggesting past rather than current risk behavior. Gonorrhea, chlamydia and trichomoniasis were all more prevalent in Mwanza. Seroprevalence of Herpes simplex virus type-2 differed little among sites.

"Our findings of higher risk sexual behavior and STD prevalences in Mwanza than in Rakai and Masaka may help to explain why STD reductions reduced HIV incidence in Mwanza, but had little effect in Rakai or Masaka," the researchers concluded. "We would theoretically expect a larger impact of STD treatment interventions and behavioral interventions in populations in which reductions in risky sexual behavior have not yet taken place and in which prevalences of curable STDs are high. For generalized epidemics in which behavioral change may have already occurred, interventions to prevent HIV transmission in stable relationships become much more important. Such interventions might include voluntary counseling and testing with disclosure to partners, vaginal microbicides, consistent condom use by HIV-discordant couples, male circumcision, HSV-2 suppression, vaccines and antiretroviral therapy."

NEW YORK:
"'Condom Fatigue' Shock in Epidemic"
New York Post (02.22.04)::Susan Edelman

A New York City Health Department study presented in San Francisco at the 11th Conference on Retroviruses and Opportunistic Infections showed that more than 100,000 New Yorkers are infected with HIV/AIDS and that HIV infection among gay men has held steady at 2.5 percent. It also found new cases growing among women, black, Hispanics and heterosexuals in general.

Warning of a "new epidemic," AIDS experts cited several reasons why HIV continues to spread, among them:

• Condom fatigue. Dr. Marjorie Hill, assistant commissioner for the city's bureau of HIV and AIDS, said laziness, impatience and pleasure- seeking put many people at risk, including the 45 percent of men who have sex with men without condoms.
  
• A lack of women taking protection into their own hands. Wider use of female condoms and the development of microbicides (vaginal creams to kill HIV) would help empower women to take more control of HIV prevention.
  
• Lower fear of AIDS due to the success of antiretroviral therapy. *Sex parties where young people use alcohol and other substances - including crystal meth - and lose inhibitions.
  
• Poverty and homelessness, which cause some young people to trade sex for housing, drugs and money.

Hill said the health department, which recently ran a "Bring Your Own Condom" poster campaign targeted to women, gave out more than 2.6 million male condoms and 114,000 female condoms to community groups last year. Ana Oliveira, executive director of Gay Men's Health Crisis, said the city giveaway "just scratches the surface" of what is needed.

Oliveira said GMHC developed a poster showing Manhattan covered in a condom to promote National Condom Week, but the transit authority rejected the ads for subways, saying they "violated our standards of appropriateness."

CDC HIV/STD/TB Prevention News Update
Thursday, February 26, 2004

MINNESOTA:
"Lawmakers Seek to Revamp Sex Education Standards in Minnesota" Associated Press (02.26.04)::Craig Gustafson

A bipartisan group of lawmakers plans to introduce today an all- encompassing sex education bill to retool Minnesota's 15-year-old curriculum. The Comprehensive Family Life and Sexuality Education Act expands the definition of what constitutes comprehensive sexual education and is intended to give clear direction to school districts. The bill applies the mandate for sexual education only to grades 7-12, making sex education an option for lower grades.

Sen. Sandy Pappas, (Democratic-Farmer-Labor, St. Paul), the bill's lead author in the Senate, said a state-sponsored abstinence-only program confused school districts about the requirements for sex education. "We want to look at what will protect kids and what parents want for their kids," he said.
Under the law, the sex education curriculum would include abstinence, values, relationships, and the use of contraceptives to prevent pregnancy and STDs. It requires notification of parents, who have the option of removing their children from classes.

A recent study commissioned by the Minnesota Department of Health found that the abstinence-only program, Education Now and Babies Later (ENABL), did not help decrease sexual activity at three schools where it was taught. Sexual activity for those students doubled between 2001- 2002. The study showed that most Minnesota parents wanted both kinds of information provided to their children. A survey of 2,500 parents found that only one-fifth wanted abstinence-only education and that 77 percent wanted their children to know about contraception as well.

Bob Tracy, a spokesperson for the Minnesota AIDS Project, said a key element of the bill is re-establishing regional training sites - eliminated by budget cuts last year - to help school districts implement the sex curriculum and services. Bill supporters include 35 House members and 10 members of the Senate.

"Vaccine Testing Short of Subjects"
Cincinnati Enquirer (02.25.04)::Matt Leingang

A multi-site herpes vaccine trial for women is progressing slowly because researchers at medical centers cannot find enough women without the virus. The National Institutes of Health, which announced the trial in late 2002, seeks to enroll 7,500 women in at least 20 sites to determine whether the vaccine can prevent genital herpes. But with the enrollment period scheduled to end this summer, just 950 US women are signed up.

"This trial is a huge undertaking, one of the biggest NIH studies ever, and I knew it would be hard. But it's much harder than I thought," said Dr. David Bernstein, director of the division of infectious diseases at Cincinnati Children's Hospital Medical Center. The center, which has a goal of enrolling 500 participants, to date has 84.

Early studies show the vaccine, made by GlaxoSmithKline Biologicals, reduces a woman's risk of contracting genital herpes by about 70 percent. Should the vaccine prove effective, it would have major public health benefits because herpes can be transmitted from mother-to-child and is a risk factor for the spread of HIV/AIDS.

The trial requires a rare population of women ages 18-30 who have never been infected with either genital herpes (HSV-2) or oral herpes (HSV-1), both of which are extremely common. Symptoms can be so mild or non-existent that many people are unaware they have herpes, causing the disease to spread. The rate of genital herpes has increased 30 percent over the past three decades.
Officials will extend the trial's enrollment period another year and more testing sites will be added. Men are excluded from the study because the vaccine is ineffective for them.

If it is approved by the Food and Drug Administration, the vaccine's target population could be girls ages 10-12, said Bernstein. "Not because we want them to have sex, but they would be reaching an age when they might - and it's our obligation to do everything we can to prevent the transmission of [STDs]," he said.

FRANCE:
"Oral Sex Shown to Be Linked to Mouth Cancer"
Reuters (02.26.04)

On Wednesday, New Scientist magazine reported that oral sex can cause oral cancer, although the risk is small. Citing a study by researchers working for the International Agency for Research on Cancer (IARC) in Lyon, the article said that patients with oral cancer containing a strain of human papillomavirus (HPV) known as HPV 16 were three times more likely to report having oral sex than those without HPV 16.

The IARC scientists studied more than 1,600 patients from Europe, Canada, Australia, Cuba and the Sudan who had oral cancer and more than 1,700 people without oral cancer. They found that while the risk is small and oral cancer is more likely to result from heavy drinking and smoking, HPV, which is also linked to cervical cancer, can be associated with tumors in the mouth. Heavy use of alcohol and cigarettes is estimated to cause 75-90 percent of oral cancer, and the combination of tobacco smoke and alcohol is thought to produce high levels of cancer-causing agents.

"The researchers think both cunnilingus and fellatio can infect people's mouths," the magazine reported. Raphael Viscidi, a virologist who worked on the study, said, "This is a major study in terms of size. I think this will convince people."
Scientists are currently working on vaccines to prevent cervical cancer, which also might be effective against oral cancer, the magazine reported. The article, "Oral Sex Linked to Mouth Cancer," appeared in New Scientist (02.28.04: P.10). The initial report, "Human Papillomavirus and Oral Cancer: The International Agency for Research on Cancer Multicenter Study," appeared in the Journal of the National Cancer Institute (2003;95:1772-1783).

CALIFORNIA:
"Students Fail to Use Barrier Protection During Oral Sex"
Stanford Daily (02.12.04)::Lisa Diver

Although young people may be knowledgeable about how to protect themselves from sexually transmitted diseases when engaging in intercourse, many are unaware they should take similar precautions with oral sex. The Alan Guttmacher Institute reports that more teenagers and college students are engaging in oral sex than penetrative sex - often without protection.

According to Stanford University's Sexual Health Peer Resource Center (SHPRC), the three most common STDs on campus are herpes, chlamydia and HPV. All three diseases can be transmitted via oral sex and can manifest themselves in the mouth and throat. And because infected persons may not show any symptoms, they may unknowingly spread the infections to their partners.

Barrier methods such as dental dams or condoms decrease the risk of transmission during oral sex. But prevention efforts that stress safe oral sex often go unheeded among students. "Everybody knows about [barrier methods for oral sex], but I've never heard of anyone who used it," said one student, who asked to remain anonymous. "People don't think there's a risk of anything remotely serious," offered senior Kelly Parker, as to why students engage in unsafe oral sex.

Some students claim barrier methods are inconvenient or "don't feel as good." "Using a dental dam is like an extra measure that would make it seem extra dirty. They're too exotic," said Elaine Liu, a senior. Students also claim dental dams are difficult to find.

Various online retailers as well as the SHPRC in Vanden Student Health Center carry dental dams. Condoms or non-microwavable plastic wrap can also be used as barrier methods.

CDC HIV/STD/TB Prevention News Update
Wednesday, February 25, 2004

"Young Americans Account for Nearly Half of Sexually Transmitted Diseases, New Report Says"
Associated Press (02.24.04)::Mark Sherman

In the first extensive national estimate of STD occurrence among young Americans, CDC researchers found that of the 18.9 million new cases of eight STDs in 2000, 9.1 million were in people ages 15-24. Human papillomavirus, trichomoniasis and chlamydia comprised 88 percent of the new cases among 15- to 24-year-olds. The report appeared Tuesday in Perspectives on Sexual and Reproductive Health, a journal published by the non-profit Alan Guttmacher Institute. The other diseases studied were gonorrhea, syphilis, genital herpes, hepatitis B and HIV.

In the same journal, another article by CDC researchers estimates the lifetime medical cost of those 9.1 million cases at $6.5 billion. "The overall cost burden of STDs is so great that even small reductions in incidence could lead to considerable reductions in treatment costs," the article said.

The lack of STD symptoms is a major obstacle to diagnosis and treatment, according to both studies, which call for increased screening and other preventive measures, including partner notification.

A separate report on STDs, also released Tuesday, said that only comprehensive sex education - that teaches both abstinence and birth control - will reduce their spread. Calling abstinence "the surest way to avoid STDs," the report said improved sex education, including instruction on proper condom use, is essential. The report, conducted by the School of Journalism and Mass Communication at the University of North Carolina, was based on a working group of health experts and a separate youth panel.

CDC acknowledges that condoms are effective against the spread of HIV, and in reducing the risk of gonorrhea, chlamydia and trichomoniasis. But since 2002, CDC has toned down its emphasis on condom use in favor of abstinence. The Bush administration has proposed to double funding for abstinence-only programs for teens.

The full reports, "Sexually Transmitted Diseases Among American Youth: Incidence and Prevalence Estimates, 2000," and "The Estimated Direct Medical Cost of Sexually Transmitted Diseases Among American Youth, 2000," appear in Perspectives on Sexual and Reproductive Health, (2004;36(1):6-10) and (2004;36(1):11-19), respectively; visi twww.agi- usa.org. The full UNC report, "Our Voice, Our Lives, Our Futures: Youth and STDs," can be found at http://www.jomc.unc.edu/youthandSTDs/ourvoices.html.

CANADA:
"'Safe Sex' Fatigue Cited for Increased Disease Rate"
Toronto Star (02.23.04)::Karen Palmer

Fatigue over safe sex messages is contributing to an aggressive comeback of STDs in Toronto. Health officials report a spike in syphilis rates in the past year, particularly among men who have sex with men, as well as smaller increases of chlamydia and gonorrhea rates. "It's something that we're seeing, particularly in the gay and bisexual community, with having all these messages for the past 20 years about using condoms and reducing risk, I think people get tired of that at times. It's a hard behavior to sustain," said Dr. Rita Shahin, acting director of communicable diseases for Toronto Public Health.

Last year, Toronto's board of health reported 279 people infected with syphilis, the highest number of cases in more than 12 years. In 2002, that number was 195 and in 2001, only 31 people were diagnosed with syphilis.
More than a third of people newly infected are coinfected with HIV, making the blood test to diagnose syphilis harder to read and allowing the disease to progress more rapidly. Symptoms of the disease, such as damage to the eyes or brain, that typically show up in untreated patients 30 years later are showing up within a few months in HIV patients, said Shahin.

About 85 percent of those who got syphilis last year believe they contracted it through sex without a condom. An AIDS Committee of Toronto (ACT) survey found that some men decline to use condoms because of substance abuse problems, relationship breakdowns, or feeling as though they cannot demand safe sex from partners. Public health, along with ACT and Hassle Free Clinic, continue an education campaign - modeled after a UK program - urging people at risk to get tested for syphilis. Montreal, Calgary and Ottawa are also using a similar campaign to reduce infection rates.

CDC HIV/STD/TB Prevention News Update
Tuesday, February 24, 2004

"University of Alberta Alarm; Stats Say 1 in 4 Students Have Sexually Transmitted Disease"
Edmonton Sun (02.22.04)::Shane Holladay

"Dreadful" is how University of Alberta infectious disease specialist Dr. Barbara Romanowski characterized the news that one in four students at the university currently has an STD. "It's very significant, and it goes far beyond the medical bumps and lumps and bit of discharge you might have," said Romanowski. Among post-secondary students, the big STDs are genital warts, herpes, chlamydia and gonorrhea, she said.

"The difficulty is that other STDs often mark an increase in HIV, and that's the really frightening part of that," said HIV Edmonton Executive Director Sherry McKibben. While the HIV rate within that population is very low, the 25 percent STD rate, she said, "tells you you've got a sexually active population that is not exactly engaging in safe sex." Making matters worse: Because many people do not learn they have an STD until in their 30s, "We have no idea when they actually got the disease," she said.

Provincial health reports suggest that roughly 10 percent of Albertans have an STD. Judy Hancock, health education coordinator at the University Health Center, said a particularly disturbing trend is condom fatigue: Young people seem to be growing indifferent to safe-sex messages. Hancock is trying to reach students with a three-part message: regular STD testing, using condoms, and delaying intercourse. But another issue is students who think they are abstinent, but really are not. "You've got kids who are having oral sex, consider themselves abstinent, and they're getting STDs. But they don't get checked for it because [they believe] they're not having sex," Hancock said.

NEW YORK:
"Fight Against Crystal Demanded"
Gay City News (02.19.04)::Duncan Osborne

At the Feb. 8 town meeting in New York City on crystal methamphetamine, HIV and gay men, Eric Altman, a staffer at the Gay Men's Health Crisis (GMHC), registered a complaint. Altman told moderator Harvey Fierstein he felt people came away from the recent forums without a sense of "next steps." Altman was speaking for himself, not GMHC, an agency spokesperson said.

Fierstein said the town meetings sparked discussions, then commented, "The organizations that are in place and have been in place for 20 years have not ended this crisis."

Peter Staley, an AIDS activist who, with Vincent Gagliostro, funded anti-crystal ads on Chelsea phone booths, said community groups had blown it. "All I know is that [crystal] is a major issue for gay health these days and they should have been out in front of it," Staley said.

Staley and town-meeting organizers Dan Carlson and Bruce Kellerhouse are forming a crystal meth working group to create awareness/outreach campaigns. Kellerhouse is organizing a one-day prevention and treatment conference for health care providers, tentatively scheduled for late March.

The Lesbian, Gay, Bisexual and Transgender Community Center placed anti-crystal ads that promote its counseling services on five Chelsea phone booths on Feb. 10, and plan five more elsewhere. GMHC is organizing a task force on crystal and HIV prevention. Staley, GMHC Executive Director Ana Oliveira and Dr. Mathilde Krim, board chair of the American Foundation for AIDS Research, met with city health department officials on Feb. 2 to discuss the issue.

In a Feb. 6 letter to Staley, Dr. Thomas Frieden, the city's health commissioner, wrote that the Office of Gay and Lesbian Health would "assume the lead for coordinating an ongoing response to this issue within [the health department] and collaborating with community partners."

At the town-hall meeting, City Councilmember Margarita Lopez, chair of the council's mental health committee, was critical of the health department and the Bloomberg administration. The department repeated its commitment to tackling the problem. The City Council health and mental health committees will hold joint hearings on crystal meth April 22 at 1 p.m.

CDC HIV/STD/TB Prevention News Update
Friday, February 20, 2004

CALIFORNIA:
"Health Officials Use E-Mail to Notify Sex Partners of Possible STD Exposure"
Associated Press (02.19.04)::Daniel Yee

Los Angeles County public health officials are using e-mail to stop the spread of STDs among people who meet sex partners through Internet chat rooms and Web sites. In a pilot program, the county is notifying by e-mail the sex partners of people diagnosed with STDs so they can be tested. The only other agency to use e-mail in this way is San Francisco's Health Department, said Dr. Pragna Patel of CDC, which released a case study Thursday on the LA County project.
"Using e-mail has been a helpful and good alternative when you have otherwise anonymous sex partners," Patel said. "More and more the Internet is serving as a place to meet sex partners and engage in risky behavior," said Patel.

Tracking STD cases among people who meet in chat rooms is difficult because people often take part anonymously. Health officials often do not have full names, addresses or other information to use for partner notification. During 2001-2003, LA County reported that nearly a quarter of 759 gay and bisexual men with syphilis had used the Internet to meet sex partners. And preliminary figures showed the county's new AIDS cases rose by a half-percent between 2001 and 2002. The increase occurred entirely among men; new cases among women declined.

In the case study, health officials described one man diagnosed with syphilis in 2002 who said he had 134 male sex partners in a six-month period. Using e-mail addresses to contact 111 of the partners, county officials alerted them that they may have been exposed to an STD. A quarter of those people contacted the health department.

In a second case, a 31-year-old man tested positive for syphilis last March and provided the county with 16 e-mail addresses of recent partners. Nearly half of the partners made arrangements with health officials to be tested.
The full report, "Using the Internet for Partner Notification of Sexually Transmitted Diseases - Los Angeles County, California, 2003," is published in Morbidity and Mortality Weekly Report (2004;53(06):129-131).

CDC HIV/STD/TB Prevention News Update
Thursday, February 19, 2004

INDIANA:
"The Day at the Statehouse"
Associated Press (02.18.04)

On Wednesday, a state Senate committee approved a bill requiring high school students to receive a hepatitis B vaccination. Currently, Indiana students have to get the vaccine before entering elementary school, but the first class of students under that ruling are now in sixth grade; older students may not have been vaccinated. The bill requires vaccinations for students in ninth and 12th grades. After two years of shots for students moving through those grades, all students would have been vaccinated. The bill, which requires mandatory vaccinations for all students except those with medical or religious exemptions, passed the committee 9-1 and now moves to the full Senate.

CDC HIV/STD/TB Prevention News Update
Tuesday, February 17, 2004

NORTH DAKOTA:
"Health Officials Say Chlamydia Cases Set Record Last Year"
Associated Press (02.13.04)

Chlamydia in North Dakota climbed last year by more than 400 cases from 2002, according to preliminary figures cited by state Health Department officials. The preliminary total of 1,663 cases for 2003 is up by more than 600 cases from the five-year average. Ninety percent of chlamydia cases are people ages 15-29. "Even though we are testing more people and we have better tests, we also think we have more prevalence of the disease," said Kirby Kruger, manager of the department's STD program. Previously, the highest number of chlamydia cases in a year was 1,541 in 1990. Gonorrhea cases were also up last year, to 101 from 72 in 2002; this is the highest number of gonorrhea cases in North Dakota since 1999.

 

CDC HIV/STD/TB Prevention News Update
Friday, February 13, 2004

"Bush Advocates Abstinence-Only Education"
Associated Press (02.13.04)::Mark Sherman

The Bush administration proposes to double spending on sexual abstinence programs that prohibit discussion of birth control or condom use to prevent pregnancy or HIV/AIDS, despite a lack of evidence that such programs work.
A CDC study of declining birth and pregnancy rates among teens concluded that prevention programs should emphasize abstinence and contraception. "Both are important," said Dr. John Santelli, lead author of the unpublished study.
An independent study commissioned by the Minnesota Health Department found sexual activity doubled among junior high school students in an abstinence-only program. The report recommended broadening the program to include more information about contraception.

In their first report two years ago, independent researchers studying abstinence-only programs for the federal government said that no reliable evidence exists as to whether the programs work. They are expected to issue an update soon.
In his State of the Union address, President Bush proposed to spend $270 million on abstinence-only education, compared to $100 million annually when he took office. Bush would also move abstinence programs into the same Health and Human Services agency that oversees religious-based programs and the president's proposal to promote marriage.

James Wagoner of Advocates for Youth (AFY) said abstinence- only programsdeprive teens of information about condoms' effectiveness in preventing the spread of HIV/AIDS and other STDs. Yet Robert Rector, the Heritage Foundation senior researcher who helped write the administration's abstinence- education program, said the comprehensive sex education AFY promotes focuses on safe sex instead of abstinence. Wagoner noted that AFY's Web site states, "Abstinence is the only 100 percent effective method for avoiding unwanted pregnancy and sexually transmitted infections, including HIV."

"Teens Promote Abstinence by Wearing White Before Valentine's Day"
Associated Press (02.13.04)::Mike Schneider

In what's being called a "Day of Purity," thousands of students around the United States planned to wear white T-shirts to school today, the day before Valentine's Day, to show their commitment to not having sex outside marriage.

The grassroots effort - supported by Christian groups across the country and organized by the Orlando, Fla.-based conservative religious rights group Liberty Counsel - comes as President Bush is pushing his budget proposal to double federal funding for abstinence programs.

But the effort is being watched warily by groups like the Gay, Lesbian and Straight Education Network and Parents, Families and Friends of Lesbians and Gays. The Day of Purity's Web site accuses these groups of "a concerted effort in the schools and media to turn our youth away from traditional values."

A recent report by the Alan Guttmacher Institute notes that teen pregnancies declined by 21 percent in the 1990s. Institute researchers attributed three-quarters ofthe decrease in 1988- 1995 to more effective contraceptive use by sexually active teens, and one-quarter of the decline to teens' being abstinent.
It is especially appropriate to have the event before Valentine's Day, participants said, since teenagers often feel pressure to have sex with their boyfriend or girlfriend on the holiday.

"Cervical Cancer: Group Urges Women to Learn More about Their STD
Risks and to Get Screened"
Women's Health Weekly (12.25.03)

The National Women's Health Resource Center (NWHRC) is urging women to become educated about their risk of contracting STDs and to be screened for cancers that can result from untreated STDs. One in five people in the United States currently has an STD, and women are particularly vulnerable to complications because they are less likely to experience STD symptoms.
The human papillomavirus (HPV), the most common STD in the country, is often asymptomatic and may be the leading cause of cervical cancer. Amy Niles, president and CEO of NWHRC, said, "I would encourage all women to take control of their sexual health - sit down with their partners, honestly assess their risk factors, and get screened for cervical cancer."

Mary Hunt, MD, assistant professor of obstetrics and gynecology at the New York University School of Medicine, said even women in long-term monogamous relationships could be at risk for STDs. "Couples shouldn't forget that even if they both tested negative before beginning a relationship with each other they may be putting each other at risk unknowingly," Hunt said, adding that condoms cannot fully protect against HPV, which is transmitted through skin-to-skin contact rather than the exchange of fluids.

The American Cancer Society projects some 12,200 new cervical cancer cases this year, with one-third of those cases fatal. Cervical cancer screening can be done with a Pap smear, including new liquid-based cytology; HPV DNA testing; and speculoscopy (visual examination of the cervix) using a chemiluminescent light for vaginal illumination. Screening reduces the risk of developing invasive cervical cancer because abnormalities are generally detected while treatment is still a possibility.

"Cervical cancer is a serious disease, but if it's caught early, it's one of the most successfully treated cancers," Hunt said.

"Unsafe Sex Sets UK HIV Infection Rate Soaring"
Reuters (02.12.04)

On Thursday, Britain's Health Protection Agency (HPA) announced that increases in unsafe sex underlie the advance of HIV infection rates to what are expected to be the highest levels ever. "The year-on-year increase we are observing... is a cause of considerable concern," said Dr. Berry Evans of HPA, which monitors infectious diseases.

New HIV infections jumped 20 percent from 2002 to 2003 and are expected to rise to more than 7,000 - the highest-ever yearly total, according to HPA. New diagnoses among gay men are expected to rise to more than 2,000 when all the reports are in, which would make it the highest annual figure since testing became available in the 1980s. HPA also reported a 27 percent increase in HIV infections among heterosexuals, but added that 80 percent of the infections originated in countries with high HIV prevalence. Heterosexual infections in Britain are also increasing, said Evans.

"With almost a third of the 49,500 people currently living with HIV in the UK still unaware they are infected, the rising trend in new diagnoses is liable to get worse before it gets better," said Evans.

The advocacy group Terrence Higgins Trust urged the government to make HIV a national priority and to develop a sexual health strategy. "Modernizing sexual health services to make it easier for people to test for HIV and other STIs [sexually transmitted infections] would be a major step forward in helping to tackle this crisis," said trust CEO Nick Partridge. "We must also make a concerted and focused effort to educate young people about the risks of unprotected sex," he said.
HPA believes the rise in HIV cases is related to other STDs and to more people being tested for the virus. "Changing people's sexual behavior so they use a condom with all new and casual partners is one of the most effective ways of reversing the trend," Evans said.

"Roche Trial Shows Pair of Drugs Can Treat Both HIV, Hepatitis C"
Wall Street Journal (02.13.04)::Gautam Naik

In San Francisco at the 11th Conference on Retroviruses and Opportunistic Infections, Roche Holding AG said a trial of a two- drug combination for patients infected with HIV and hepatitis C (HCV) showed a marked benefit against viral levels.

Roche said the combination of its hepatitis C drug Pegasys and the antiviral Copegus produced a sustained 40 percent virological response in a trial of 868 patients with both infections. Similar viral reductions were achieved in only 20 percent of patients receiving only Pegasys, and in only 12 percent of participants receiving conventional interferon/ribavirin treatment.

In the trial, patients were treated for one year and followed for six months. At that point, 40 percent of Pegasys- Copegus patients showed no discernible sign of the hepatitis virus, showing "that you can eradicate the virus," said Francesca Torriani, lead investigator and an associate professor of medicine at the University of California-San Diego.

Improving treatments for co-infected HIV/HCV patients is vital. In the United States and Western Europe, some 30 percent of HIV-infected people are also HCV-infected. Elsewhere, co- infection rates range from as low as 13 percent in some developing countries to 50 percent or more among male patients in Thailand. HIV transmission is more linked to intravenous drug use in Spain; there, the co-infection rate is believed to be greater than 60 percent.

HIV exacerbates liver disease in patients with HCV. Now that antiretroviral drugs are prolonging the lives of many people with HIV, liver disease is emerging as one of the main causes of morbidity and mortality among such patients.

CALIFORNIA:
"Parents Preview Sex-Ed Play"
The Argus (02.11.04)::Sandhya Somashekhar

This week, parents of Fremont high school freshmen previewed a controversial Kaiser Permanente play, "Secrets," that may be presented in sex-education classes this spring. The play depicts five teens grappling with their sexuality, focusing on Eddie, who had two random sexual encounters and learns he has HIV.
Using music, language and situations familiar to most teens, the play follows Eddie as he decides to be tested and breaks the news to his friends, family and girlfriend. The show includes frank discussions of sex, condoms and STDs.
Parents who oppose the play say the story encourages young people to have sex because it discusses condoms. Supporters, however, say the play also includes abstinence messages, and that it is important for teens to learn about safe sex from a reliable source.

A five-member cast of 18- to 30-year-olds travels to high schools across Northern California to perform the award-winning "Secrets" free and take questions from students afterwards. Parents may bar their children from seeing "Secrets," and school districts can ask for certain scenes - such as one showing how to put on a condom using a banana - to be deleted from the program, according to Katrina Lashea, coordinator for Kaiser's educational theater programs. About 40 percent of schools, including those in Fremont, requested the banana scene be deleted. Fremont school officials also banned the question-and-answer period; it is the only district to do that.

Lashea said each actor received 120 hours of HIV training from physicians, psychologists, community organizations, public agencies and HIV counselors.
According to CDC, 50 percent of all high school students have had sex, and roughly half of them reported condom use during their most recent encounter. Estimates say some 25 percent of new US HIV infections occur in young adults and teens.

 

CDC HIV/STD/TB Prevention News Update
Thursday, February 12, 2004

PENNSYLVANIA:
"Syphilis Outbreak Triggers Detective Work"
Pittsburgh Post-Gazette (02.08.04)::Christopher Snowbeck

For year, syphilis had been nonexistent in Westmoreland County, and the annual number of cases in Allegheney County ran in the single digits during the late 1990s. But since 2001, 62 people in the two counties have been infected with cases traced to an outbreak in New Kensington, a Westmoreland town of 15,000.
When the outbreak first appeared in October 2001, Alan McNamara of the Pennsylvania Department of Health went to interview a man supposedly at his home address - a crack bar. The man was so indifferent to the women who had traded him sex for drugs that he refused to provide names. To learn who might be at risk, McNamara, a 52-year-old white man, had to instead become an insider in the man's network.

At the same time, Dr. Jonathan Han started seeing syphilis cases at the New Kensington Family Health Center. When Han reported the cases to the state, he got a return call from McNamara. Their partnership was crucial because most of those caught up in the outbreak did not have a place where they could get care. As McNamara identified people at risk, he sent them for testing and penicillin treatment to the health center, run by University of Pennsylvania Medical Center St. Margaret, and to two other area clinics.

McNamara walks around city streets to see who is coming and going and to hear from the old ladies who know everything about a block. If the conversation suggests he is talking to someone at risk for syphilis infection, he then talks about the outbreak, trying to instill a sense of urgency about testing and treatment.
By January 2002, 12 people had tested positive, and McNamara focused on several pregnant prostitutes and crack cocaine users. But he was discreet: If people hear that a Health Department worker is looking for Jane Doe, they will assume Jane has AIDS, he said. During the outbreak, McNamara's efforts have prevented four congenital syphilis cases.

"EU Drugs Agency Warns of 'Hidden Epidemic' of Hepatitis C Infections"
Agence France Presse (02.04.04)

The 15-member European Union is facing a "hidden epidemic" of liver-destroying hepatitis C, according to the EU's Lisbon- based drug monitoring agency. In a report released Feb. 4, the European Monitoring Centre for Drugs and Drug Addiction said more than a million people, "possibly up to several million," already have the virus. Although hepatitis C can spread through sex or transfusion with infected blood, needle sharing by intravenous drug users accounts for 60-90 percent of new infections, according to the report. Some experts believe hepatitis C can spread ten times more easily through needle sharing than HIV can. The report recommended that governments initiate programs to prevent needle sharing and improve hepatitis C monitoring.

NORTHERN IRELAND:
"Doctors Worry at Rise in Sex Diseases"
Belfast Telegraph (02.02.04)::Nigel Gould

According to data gathered from Genitourinary Medicine (GUM) clinics, the incidence of STDs across Northern Ireland has soared in recent years. In the 15 years up to 2001, only one or two new cases of infectious syphilis were recorded annually in Northern Ireland. Three years ago, a syphilis outbreak began, with more than 60 cases of infectious syphilis diagnosed since July 2001. Figures show that cases of chlamydia have nearly doubled to 1,170 in four years, and 117 gonorrhea cases were reported. Since the figures only represent cases diagnosed at GUM clinics, actual numbers may be higher. During 2002, from which the latest figures are taken, GUM clinics detected 20 cases of syphilis, compared to no cases in 1998 and only one from 1998-2000.

CDC HIV/STD/TB Prevention News Update
Wednesday, February 11, 2004

"No HIV Spike to Mirror Syphilis Rise"
San Francisco Chronicle (02.11.04)::Sabin Russell

A sharp rise in syphilis cases among gay men in San Francisco has not produced a corresponding increase in HIV infections, researchers reported yesterday at the 11th Conference on Retroviruses and Opportunistic Infections in San Francisco. The findings, combined with other data pointing to decreases in unsafe sexual practices, could mean that an increase in the city's rate of HIV infections, which began in 1998, might be waning.

Four years ago, Dr. Willi McFarland, chief AIDS epidemiologist for the San Francisco Department of Public Health, said the city's declining HIV infection rate had reversed and that the estimated number of newly infected was growing to 900 per year from 500 throughout much of the 1990s. Of the many factors driving the increase in HIV infections, syphilis was of particular concern because the genital ulcers it causes become portals for HIV to enter the bloodstream. From 1998 to 2003, reported syphilis cases in the city rose from 40 to more than 600 annually.
CDC's Kate Buchacz presented the study showing that HIV infection rates at two clinics where gay men are treated for syphilis were holding steady or even declining. A team of CDC and San Francisco Department of Public Health researchers conducted the study.

However, Dr. Jeffrey Klausner, director of STD Prevention and Control Services for the Health Department, remains cautious. Klausner said the lesson of the surprising syphilis report may be that it takes a greater number of syphilis cases - not just an increase in the trend - to affect HIV rates. San Francisco sexual practices favoring oral sex may also be a factor, since syphilis is readily spread by oral sex while HIV is not.

Also playing a role is "sero-sorting," the trend toward men picking partners of their same HIV serostatus. In a separate presentation yesterday, McFarland said the percentage of gay men surveyed who reported unprotected anal sex with an HIV-positive partner had declined from 11 percent in 2000 to 8 percent in 2002. The percentage of HIV-positive men surveyed who had unprotected sex with partners of an unknown serostatus had declined from 31 percent in 2001 to 21 percent in 2003.

UNITED KINGDOM:
"Explicit Ads Target Sex Diseases Among Young"
The Guardian (02.07.04)::James Meikle

Britain's Department of Health is launching an explicit government advertisement campaign as part of a drive to reduce STD rates. Radio advertisements warn of the risk of developing genital warts, and spoof Valentine cards will be distributed in clubs, student unions and other young people's social venues.

Advertisements will also appear in tabloid newspapers, and radio advertisements, run after 9 p.m. on independent stations, will test the boundaries of taste, despite being passed by the radio advertising clearance center. The campaign is also supported by a sexual health hotline and a Web site.

The latest stage of the £4 million (US $7 million) "sex lottery" campaign aimed at sexually active 18- to 30-year-olds is the brainchild of Melanie Johnson, the public health minister. She said the campaign was "targeting those most at risk by using thought-provoking language and direct language."

In the last 10 years, new sexually transmitted infections have more than doubled to nearly 1.5 million a year. And chlamydia incidence in England increased by 139 percent in six years, to more than 78,000 new cases, Johnson said.
CDC HIV/STD/TB Prevention News Update
Friday, February 06, 2004

"Drug Effective for Resistant Hepatitis B"
Reuters Health (01.29.04)::Will Boggs, MD

When chronic hepatitis B virus (HBV) becomes resistant to the standard lamivudine (Epivir) treatment, the antiviral adefovir (Preveon), alone or in combination with ongoing lamivudine therapy, appears to be effective, according to a study in the medical journal Gastroenterology. The rate of lamivudine resistance can reach 69 percent after five years of treatment, Dr. Marion G. Peters and colleagues from the University of California-San Francisco explained in their report. Adefovir has been shown in lab experiments to suppress lamivudine-resistant HBV.

The researchers assessed the safety and effectiveness of adefovir in 59 lamivudine-resistant patients. They found that levels of the virus in blood specimens declined significantly in patients given adefovir alone or in combination with lamivudine, but not in patients taking lamivudine alone.

Sixteen percent of patients taking adefovir alone and 11 percent of patients taking adefovir and lamivudine cleared the virus within 48 weeks. None on lamivudine alone did so.

Peters said there appears to be no reason to continue lamivudine after beginning adefovir therapy in most cases. However, combination therapy should be continued in patients with cirrhosis. The article, "Adefovir Dipivoxil Alone or in Combination with Lamivudine in Patients with Lamivudine-Resistant Chronic Hepatitis B," appeared in Gastroenterology (2004;126(1):91-101).

NEW YORK:
"City Schoolbooks Badly Outdated on Sex Education"
New York Sun (02.06.04)::Kathleen Lucadamo

Yesterday at a state Assembly hearing, school officials said sex education lessons in New York City schools have not been updated in twenty years, and material for teens on HIV/AIDS are nearly ten years old. Teachers are either following an outdated curriculum or skipping sex education altogether.

Officials are working on the curriculum but have offered no timeline on its availability to students. According to Roger Platt, director of the Office of School Health, in 2002, nearly 10,000 city women under age 18 were pregnant, and 3,000 became mothers. Teenagers accounted for 114 new HIV cases.
State law requires schools to teach HIV/AIDS education to all students. High school health courses, though required, are often haphazard. Platt said a shortage of health teachers - 196 for 1,200 schools - makes it hard to offer quality classes. It is also difficult to get elementary teachers to sign up for the required 30 hours of training for sex education. "It's pretty hard to justify people investing 30 hours of their time to learn a 20-year-old curriculum," Platt said.

At least 75 percent of school districts violate government mandates for health education, including sex education and HIV/AIDS instruction, according to Assembly member Scott Stringer, whose report, "Failing Grade: Health Education in New York City Schools," examined the issue.

Assembly member Steven Sanders said, "For too long people have relegated health education courses as the stepchild of the academic programs. It should be approached with a sense of urgency."

Planned Parenthood representatives said the primary focus of sex education had been abstinence. "We support abstinence," said spokesperson Carla Goldstein. "But should it be only abstinence?"

In 1993, Schools Chancellor Joseph Fernandez suggested the Rainbow Curriculum, which promoted tolerance for homosexuality and condom distribution in the schools. Mayor Rudolph Giuliani and the Christian Coalition objected strongly.

TENNESSEE:
"Downtown STD Rates Puzzle Health Officials"
Chattanooga Times Free Press (02.01.04)::Ashley M. Heher

New Health Department data show STDs up to five times higher in downtown Chattanooga's 37403 ZIP code than in any other area of Hamilton County. The county ranks fourth-highest in the state for chlamydia, fifth for gonorrhea and 17th for syphilis, according to Tennessee Department of Health figures. Health officials do not understand why the 37403 postal zone has rates as high as 28.5 percent for chlamydia alone. Chlamydia infections in the neighborhood are 104 times the state rate; gonorrhea rates are about 87 times higher. Nearly 46 percent of 34703's chlamydia infections occurred in 19- to 24-year-olds, 68 percent of whom were African Americans.

The 37403 area has most of the city's homeless shelters and a mix of inner-city poverty and urban revitalization. It is home to the University of Tennessee-Chattanooga, the Health Department, and the Chattanooga Times Free Press. The county's highest syphilis rate is just to the south, in the 37408 zone, where nearly half the population lives below the federal poverty level and median household income is less than $10,000 a year.

Local shelter workers refer homeless persons to the Health Department-run Homeless Health Care Clinic in the 34703 area. Many homeless people use shelters as their mailing address, which may be reflected in the data. Ron Berryman, a chaplain at the Chattanooga Rescue Mission, said the numbers may also reflect high prostitution rates downtown.

Pam Pitts, STD/HIV field services director for the state Health Department, said Hamilton County disease rates are not surprising. The challenge to health officials is how to reach out to those most at risk. Pitts said African Americans and gay white men are most at risk for syphilis and that people ages 15-19 are most likely to contract gonorrhea and chlamydia.

 

CDC HIV/STD/TB Prevention News Update
Thursday, February 05, 2004

"Study: Investing in Sexual Health Pays Benefits"
Reuters (02.03.04)

On Tuesday, Dr. Sharon Camp, president of the New York-based Alan Guttmacher Institute (AGI), said providing sexual and reproductive health services for the 200 million women who need them worldwide would cost about $3.9 billion but could prevent 1.5 million maternal and infant deaths each year. It would also avert 52 million unintended pregnancies and prevent 505,000 children from losing their mothers, according to a new report.

However, rich countries, especially the United States, have failed to live up to financial commitments they made at a 1994 Cairo conference on population and development. Developed countries are committing only about half of what they promised at that meeting, while demand is growing for services including contraceptives, maternal and infant health care, and HIV and STD prevention.
Sexual and reproductive health accounts for one-third of the global burden of disease among women, while HIV/AIDS accounts for 6 percent. Keeping women healthy and providing contraceptives to delay childbirth contributes to equality and economic growth, the report states. "Money invested in sexual and reproductive health services will be repaid many times over," said Dr. Thoraya Obaid, executive director of the UN Population Fund (UNFPA).

When President Bush took office in 2000, he withdrew funding for New York-based UNFPA; the administration argued that UNFPA was sustaining Beijing's policy of forced abortion in pursuit of its one-child-per-family program. But UNFPA said its programs are run in Chinese counties where the policy is not pursued.

"We hope it [the report] will reach the Bush administration and also members of the US Congress who appropriate funds," Camp said. The study, "Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care," was jointly published by AGI and UNFPA.

CDC HIV/STD/TB Prevention News Update
Wednesday, February 04, 2004

"STD Risk Rises After Teens Have a Baby"
Reuters Health (01.26.04)

A recent study found that teenage girls appear to be at high risk of getting a sexually transmitted disease in the year after having a baby. Researchers said the findings suggest more needs to be done during routine post-delivery care to promote STD prevention among new teen moms.

The Yale University team found that among 203 pregnant girls ages 14-19 seen at community health clinics in Connecticut, 7 percent contracted either chlamydia or gonorrhea roughly three months after giving birth. The rate rose to 14 percent six months later - nearly double that of a control group of non-pregnant teens. The pregnant teens, all of whom were unmarried, were predominantly African-American or Hispanic.

The researchers found that the risk of the two STDs increased with the number of lifetime sex partners that study subjects reported. Those who had new partners after having their babies also faced relatively higher risk.

The authors noted that the high STD rates in the study are of serious concern and point to the need for health care professionals to target new teen mothers for STD prevention. "Routine prenatal and postpartum care provide unique opportunities to promote condom use and risk reduction interventions among adolescents," the study stated.

The report noted that many teens are encouraged to use hormonal forms of contraception after delivery, yet these methods offer no STD protection. Doctors must stress both pregnancy prevention and STD prevention, the study said.
The article, "High Postpartum Rates of Sexually Transmitted Infections Among Teens: Pregnancy as a Window of Opportunity for Prevention," appeared in the journal Sexually Transmitted Infections (2003;79(6):469-473).

CALIFORNIA:
"LA County to Intensify Fight Against HIV, STDs in Gay Bathhouses" Associated Press (02.04.04)

Yesterday, the Los Angeles County Board of Supervisors ordered local health officials to review HIV/AIDS and STD prevention efforts in gay bathhouses and sex clubs. The board unanimously backed a motion instructing the Department of Health Services and other county workers to recommend improvements in a report within 90 days. The order also requires officials to look for ways cities and the county can coordinate licensing and permitting for the clubs.

The motion, authored by County Supervisor Zev Yaroslavsky, cited a study showing 11 percent of patrons at two bathhouses in 2002 were HIV- infected despite counseling and testing efforts. This rate "suggests that our HIV/AIDS and STD prevention and treatment efforts must be strengthened to address the environment in which high risk sexual behaviors occur," the motion stated. It also noted the risky behavior occurs at such venues as sex clubs frequented by gay men, with the potential for higher rates of HIV and other STDs at these sites as well.

According to John Schunhoff, chief of operations for the public health division of Los Angeles County's health department, an estimated 50,000-60,000 people are infected with HIV in the county. Schunhoff said the motion was also prompted by a syphilis outbreak in 2000 among men going to bathhouses. CDC reports syphilis cases throughout the West soared 64.3 percent between 2001 and 2002.
"We are glad that the county has taken these crucial first steps toward safeguarding public health and well-being by regulating these establishments," said AIDS Healthcare Foundation President Michael Weinstein.

CDC HIV/STD/TB Prevention News Update
Friday, January 30, 2004

"Studies Shed Light on Youth Sex and Drinking: Parents and Teens
Don't See Eye to Eye"
AIDS Alert (01.01.04)

Researchers looking into early sexual behavior and attitudes about sex among youths found that alcohol use does play a role in sexual initiation. They also found that children as young as preteens have different attitudes about sexual behavior than their parents.

"The bottom line is we don't think parents are doing a very good job of explaining their expectations to kids," said Nicholas Long, PhD, of the University of Arkansas for Medical Sciences- Little Rock. Long studied fourth- and fifth-graders and found they had different ideas about acceptable sexual behavior than their parents. He also found preteens are less concerned about AIDS and teen pregnancy than their parents.

Long's preteens and parents' attitude study focused on children ages 9-12 and their parents. All the families were African-American. Investigators and staff worked with preteens' parents in interventions designed to make them feel more comfortable talking about sex with their children and teaching them strategies to become sex educators, Long said.

Researchers found that 79 percent of preteen boys thought it was OK to have a girlfriend at their age, and 17 percent of parents thought it was OK. Fifty-five percent of preteen girls thought it was appropriate to have a boyfriend, while 3 percent of their parents agreed, according to the study.
"The other issue was the seriousness of AIDS and the difference between kids and parents and perception," Long said. "For example, 97 percent of the parents of boys thought AIDS was a serious problem, and 94 percent of the boys thought so."

Among families with preteen girls, 99 percent of the parents thought AIDS was a serious problem, while 93 percent of the girls thought so.
In another study, Rick Zimmerman, PhD, of the University of Kentucky-Lexington, found that alcohol use was more consistently related to early sexual initiation and the number of partners than it was to condom use among three high-risk groups: females in inner-city housing developments, males in detention facilities, and men who have sex with men in Midwestern gay and bisexual youth groups. The study found the least alcohol use among inner-city females, and that marijuana use was at least as prevalent as alcohol in all three groups.

The study offered clues to interventions for young people. One potential intervention, according to Zimmerman, would be to target younger adolescents, ages 10-14, for education that might help delay alcohol use.

MISSISSIPPI:
"Hepatitis Investigation Ongoing at Neshoba Nursing Home"
Associated Press (01.29.04)

The investigation into a hepatitis B outbreak at the Neshoba County Nursing Home could take as long as two months, according to Mississippi health officials. Since November, 16 patients at the facility have been treated for the virus. While epidemiologists are seeking to determine the cause of the outbreak, the Health Department's Office of Licensure is reviewing procedures at the nursing home, which is publicly owned but privately managed.

State health officials were notified after a patient was diagnosed with hepatitis B in November, said Lonnie Graeber, the home's administrator. That patient died; the Health Department has not determined if the death was related to the infection. After a second patient was found to be infected, all 160 residents were tested.

Under federal regulations, the nursing home was cited for a deficiency related to infection control, said Liz Sharlot, Department of Health spokesperson. The determination of a possible penalty will not be made until the investigation is completed, she said.

Board of Supervisors President James Young said board members were notified of the outbreak but had not met with nursing home officials.

WASHINGTON:
"Hepatitis Vaccination Promoted for Gay Men"
The Columbian (01.29.04)

The Clark County Health Department is taking part in the first regional effort to promote hepatitis vaccination for men who have sex with men (MSM) in Oregon and Washington. According to a 2003 survey by the Gay and Lesbian Medical Association, 67 percent of MSM have not been vaccinated against hepatitis A; 60 percent have not been vaccinated against hepatitis B. CDC reports the rate of hepatitis B among adults has risen since 1999. "Hepatitis A and B are both preventable by vaccine, and both shots can be given at the same time," said Ryan Lutz of the Clark County Health Department. The effort is taking a regional approach because MSM "in the metro area travel across county and state lines," said Lutz. "So, it's important that all the health departments of these counties are involved and work together."

CDC HIV/STD/TB Prevention News Update
Thursday, January 29, 2004

WEST VIRGINIA:
"Abstinence Not Enough, Nurse Says"
Charleston Daily Mail (01.26.04)::Jan Boyles

Brenda Isaac, lead school nurse for Kanawha County schools, said President Bush's promise to double funding for school abstinence programs is not enough. "Sex education is not sufficient alone," Isaac said. "Our philosophy is to give our kids the knowledge base that they need to make healthy decisions."
Statewide, teen pregnancy statistics have dropped, as they have in Kanawha County, Isaac said. Anecdotal reports from school nurses show a trend toward student abstinence - with exceptions.

"We have to be realistic that some students are sexually active," Isaac said. To help youth make good decisions, sex education in Kanawha County schools begins in the fifth grade with lessons about puberty and its accompanying physical and emotional changes. In the sixth grade, students discuss sexual abuse, STDs and decision-making skills. High school freshmen learn about various contraceptives, and AIDS education is incorporated into the curriculum. Beyond formal instruction, Isaac said, students often speak with school nurses.

Isaac said school programs should not single out pregnancy as the only issue to discuss. Risky behaviors such as teen sex, underage alcohol use and drug use are often related, she explained.

Rather than increase funds for abstinence education, Isaac would like to see additional spending on the school system's expectant mothers program. "After they have made a decision to keep a baby, it's our responsibility to make them good parents," Isaac noted. "We want to keep them in school."

"I wish abstinence only would work, but we have to be prepared," Isaac added.

CALIFORNIA:
"Cases of Chlamydia Increased in 2003"
Record Searchlight (01.20.04)::Andi Winters

2003 saw a steep rise in the number of reported chlamydia cases in Shasta County. But that is not necessarily a negative trend, according to Dr. Patti Culross, deputy health officer for Shasta County Public Health. Last year, 643 new cases of the STD were reported, compared to 449 cases in 2002. From 1997-2002, average annual cases numbered 360.

Culross said the increase is largely attributable to improved screening kits, medical providers' improved compliance with reporting guidelines and an increase in screening people without symptoms. Chlamydia is asymptomatic for 75 percent of women and 50 percent of men. Screening requires only a urine sample. Transmitted through vaginal, oral or anal sex and during childbirth, chlamydia is easily treatable. It usually requires only one dose of antibiotics, medicine that is inexpensive and covered by most insurance policies, including Medi-Cal.

"Young people who have unprotected sex - and those of any age with multiple partners - are at the greatest risk of this and a host of other sexually transmitted diseases," Culross said. She added that three of every four reported cases occur in people under age 25. She recommends all pregnant women be screened.
Health care providers offer chlamydia tests and include them in general STD screenings. Shasta County Public Health offers testing Tuesdays and Fridays, 2-4 p.m. No appointment is necessary and payment is on a sliding scale.

CALIFORNIA:
"Board OKs Free Hepatitis C Tests"
Santa Cruz Sentinel (01.28.04)::Shanna McCord

On Tuesday, the Santa Cruz County Board of Supervisors announced that free laboratory testing will be offered to uninsured hepatitis C patients. An estimated 70 percent of the 610 hepatitis C patients treated by the county are uninsured.
With free tests available, about 30-40 additional patients can be treated annually, according to Rama Khalsa, director of the county Health Services Agency. The tests, which are part of ongoing treatment, measure enzymes in the liver and normally cost $1,600 for each patient.

Officials estimate as many as 8,000 people in Santa Cruz County have the virus, which can go undetected for two decades while slowly eroding the liver. About 1,300 county residents know they have it.

While there is no vaccine or cure for hepatitis C, early detection allows patients the possibility of slowing the virus with medication. The virus, spread from blood-to-blood contact, most often occurs among intravenous drug users and people who received blood transfusions before 1992. It can also be contracted through body piercings and tattoos, and people who have had multiple sex partners may also face an increased risk.

The county Health Services Agency was directed to update the board of supervisors on the progress of the free tests at their meeting on March 23.

 

CDC HIV/STD/TB Prevention News Update
Wednesday, January 28, 2004

"NIH: Sex Research, Including Questioned Kinsey Work, Is Valid"
Associated Press (01.28.04)

National Institutes of Health Director Dr. Elias Zerhouni told his advisory committee earlier this month that an internal review of about 190 NIH-funded grants concluded that all of them - including work at Indiana University's Kinsey Institute - are valid and in the public's interest. "When we looked at the public-health relevance, there was no question that these projects should have been funded and should continue to be funded," Zerhouni said, according to the Chronicle of Higher Education.

Some conservatives have questioned the value of the sexual studies. Rep. Mark Souder (R-Ind.) objected to a Kinsey Institute-sponsored conference on sex research methods, as well as grants to other groups to investigate women's reaction to pornography, older men's sexual fantasies, and HIV among prostitutes. Later, the US House fell two votes short of amending a Department of Health and Human Services funding measure to cut money for the Kinsey study and other projects. In October, a Congressional staffer sent Zerhouni the list, furnished by the Traditional Values Coalition, of 190 projects deemed objectionable.

John Bancroft, director of the Kinsey Institute for the Study of Sex, Gender and Reproduction, credited Zerhouni's position to an organized effort by scientists to backthe peer- review system that funded the research. "The tendency has been for the religious right to be very well-organized and everyone else to be somewhat in disarray," Bancroft said. "Here we're seeing a well-organized, coordinated response from the scientific community."

Martin Green, Souder's press secretary, said the representative "supports research into HIV, sexually transmitted diseases and drug abuse if the intention is to cure, treat, or prevent them." In a statement, Souder said, "It is upsetting that tax dollars are misused like this, but it is infuriating that the agency defends the continued funding of such dubious research...."

"Reported Hepatitis Cases on the Rise in Parts of Pennsylvania"
Associated Press (01.27.04)::Joann Loviglio

CDC figures show that reported acute cases and new infections of hepatitis C dropped more than 50 percent nationwide from 1980 to 2002. But the Pennsylvania Department of Health's (PDH) statistics show the total number of hepatitis cases in Luzerne County rose from 32 in 1993 to 67 in 2001.

PDH's annual County Health Profiles list only hepatitis A and B, two of five recognized strains of the disease. But Wilkes- Barre physician Robert Czwalina went from treating one patient with hepatitis C to treating 30 within a year. He said changing demographics, notably people with drug and alcohol problems who acquire hepatitis C elsewhere and move to rural Pennsylvania, account for the rise.

State regulations that took effect last year require health professionals to report all cases of hepatitis including the three most common US strains: A, B and C. Reported cases of hepatitis A and B increased only moderately in Pennsylvania from 1994-2001: 903 to 1,097 for hepatitis A and 829 to 864 for hepatitis B.
In York, hepatitis C cases jumped from 10 in 1999 to 105 in 2003. Health officials believe the rise comes from improvements in health care rather than changing demographics.

Dr. David L. Hawk, director of the York City Bureau of Health, said greater awareness of hepatitis in the medical community, more testing and better reporting account for the rise in cases, and that the increase in hepatitis B and C represents people who have had the virus for years.

Whether the numbers come from a changing population or more vigilant doctors, health professionals agree that there is too little money for drug and alcohol treatment and medication.

"Study Finds Men Unlikely to Use Condoms Despite Disease"
Associated Press (01.23.04)::Jay Reeves

A new study highlights the problems health officials have in reducing the spread of HIV/AIDS and other STDs among low-income black patients. Researchers interviewed 224 males seeking treatment at a Birmingham STD clinic for low-income patients from 1997-1999. Of the men, 87 percent were black and 13 percent were white. The number of whites in the study (29) was so small that it was impossible to determine whether their attitudes were different from the 195 blacks, according to Diane Grimley, a University of Alabama-Birmingham professor and the study's lead author.

Grimley said the people most at risk for STDs live in a world of poverty, violence, drugs, alcohol and sex that few others see or understand. "There's something about the social context I don't think we've grabbed hold of yet," she said.
Despite knowing or suspecting they had a disease and understanding that not using condoms increased their likelihood of contracting another one, 66 percent of the men with a primary partner said they did not plan future condom use. One-third of the men without a primary partner said they would not use condoms.
Men mainly said they eschewed condoms because they did not want to have to rely on a partner's cooperation and that condoms made sex feel unnatural. According to Grimley, men in more intimate relationships were the least likely to use condoms, wanting their partners to feel they were committed to the relationship. Rather than use condoms, many men preferred to take their chances and seek treatment if they became infected.

In Alabama, blacks made up roughly 60 percent of AIDS patients over the past two decades while representing only one- quarter of the population. Forty-six percent of the state's AIDS patients are black men; 14 percent, black women; 34 percent, white men and 4 percent, white women.

The study, "Condom Use Among Low-Income African American Males Attending an STD Clinic," appeared in the American Journal of Health Behavior (2004;28(1)).

"Cervical Cancer: Study Finds American Women Need More Education About HPV"
Women's Health Weekly (12.18.03)

Researchers have found that US women have wide gaps in knowledge about human papillomavirus (HPV) and that news stories frequently offer incomplete information about it. Incomplete knowledge makes it harder for women to cope with a positive test for HPV.

A few types of HPV cause virtually all cervical cancer cases. The American Cancer Society estimates that 12,200 women were diagnosed with cervical cancer in 2003, and 4,100 died from it. A new FDA-approved test on the market can be used along with Pap smears to screen for cervical cancer in women 30 years of age and older.

Harvard School of Public Health and Columbia University researchers conducted focus groups with ethnically and economically diverse women to assess what women know about the virus and what questions and concerns they have.
The investigators found that women had questions about transmission, prevention, treatment and progression of HPV. The women asked how worried they should be if they tested positive for HPV and about the difference between HPV test and Pap smear results. Younger women were more concerned about the consequences of HPV as an STD; older women were concerned about the risk of cancer.

In a media review, the researchers found that articles about HPV tests tended to focus on screening guidelines, while stories about HPV as an STD usually emphasized symptoms, transmission and prevention. Few stories presented all the basic information about transmission, prevention, screening, the different types of HPV and their associated symptoms or cancer risks.

An editorial, "Human Papillomavirus Infection: Truth or Consequences" accompanied the studies in the journal Cancer (2004;100(2):225-227). It called for "the collaboration of advocacy groups, of payors, and providers, with journalists to enhance their understanding and subsequently, of the public's, so as to enhance decision-making as it relates to HPV infection prevention, screening, and treatment."

The studies in Cancer were "Women's Desired Information About Human Papillomavirus"(2004;100(2):315-320) and "News Media Coverage of Human Papillomavirus" (2004;100(2):308-314).

CDC HIV/STD/TB Prevention News Update
Wednesday, January 21, 2004

"President's State of the Union Message to Congress and the Nation"
New York Times (01.21.04)::President George W. Bush

Following is an excerpt from President Bush's State of the Union address, as transcribed by the New York Times:

"To encourage right choices, we must be willing to confront the dangers young people face - even when they are difficult to talk about.

"Each year, about 3 million teenagers contract sexually transmitted diseases that can harm them, or kill them, or prevent them from ever becoming parents. In my budget, I propose a grass-roots campaign to help inform families about these medical risks.

"We will double federal funding for abstinence programs, so schools can teach this fact of life: Abstinence for young people is the only certain way to avoid sexually transmitted diseases. Decisions children make now can affect their health and character for the rest of their lives. All of us - parents and schools and government - must work together to counter the negative influence of the culture, and to send the right messages to our children."

TEXAS:
"Syphilis Cases Fall; Concerns Remain"
Dallas Morning News (01.19.04)::Sherry Jacobson

Dallas County health officials are debating whether syphilis is being brought under control or is getting worse. In each of the last seven years, fewer than 200 new syphilis cases were detected in the county. Reported cases of primary or secondary syphilis in 2003 (161) were down 16 percent from 2002 (191). However, the county ranked 14th in the nation in syphilis rates in 2002, which concerns the Dallas County Medical Society. CDC statistics show the county had 8.6 new syphilis cases per 100,000 people, compared to the national average of 2.4 per 100,000. Nationally, cases rose by 9.1 percent from 2001 to 2002.
Dr. Robert Haley, the medical society's past president, said the numbers suggest a syphilis epidemic, and doctors are concerned that a relatively high number of women have the disease. The county said 35-40 percent of new cases in the past three years occurred among women.

Dr. Jeanne Sheffield of Parkland Memorial Hospital said she has noticed "a definite increase in women with syphilis in the last few months." However, state and federal officials involved in CDC's national Syphilis Elimination Effort said the percentage of syphilis among Dallas County women has been declining.
"At this point, we're not concerned about the percentage of syphilis cases in females in Dallas County," said Caeli Paradise, syphilis elimination program coordinator for the Texas Department of Health. "It's probably a pretty normal ratio."

CDC launched its national syphilis elimination strategy more than four years ago at a cost in excess of $100 million. In Dallas County, the strategy includes a mobile unit that offers testing to prostitutes, alcoholics and drug addicts on the street. Unit personnel have administered more than 8,000 syphilis tests over the past two years, identifying 150 cases.

CDC HIV/STD/TB Prevention News Update
Thursday, January 15, 2004

"Herpes Vaccine for Women Being Tested"
Courier-Journal (Louisville, Ky.) (01.15.04)::Darla Carter

About 7,500 women are being recruited at sites across the country to participate in the Herpevac Trial for Women. "It is an important area because one out of four women in the [United States] develop genital herpes," as do one out of five males, said Dr. Stanley A. Gall, principal investigator at University of Louisville, which hopes to begin recruiting participants after Feb. 1. According to CDC, as many as 1 million people nationwide become infected with genital herpes each year.
Because there is no foolproof way to prevent genital herpes and infected people harbor the virus forever, the ability to prevent infection with a vaccine would be significant, said Gall. If a women has herpes, her baby can suffer severe neurological damage or death if sores are present at delivery. A vaccine "could be a really important thing for the health care of women," Gall noted.

Study participants will receive three shots over a six-month period to protect against herpes and then will be tracked for several more months, said Dr. Kenneth Fife, principal investigator for the trial at the Indiana University Infectious Disease Research Group.

To participate in the study, women cannot have been exposed to herpes simplex virus (HSV) type 1 or 2. Genital herpes is typically caused by HSV-2. HSV-1 can also cause genital herpes but more commonly results in cold sores. Men are excluded from the trial because the vaccine was previously found to be ineffective in men, Fife said.

Finding the right people for the study - co-sponsored by National Institute of Allergy and Infectious Diseases and GlaxoSmithKline Biologicals - presents a considerable challenge because herpes is so common. Nationwide, about 3,000 people have been screened for the trial, but only 800 have been enrolled, said Gall. For more information about the trial, visit: www.herpesvaccine.nih.gov.

"Houston Steps Up Syphilis Prevention"
Houston Voice (01.09.04)::Josef Molnar

As in other large metropolises, health officials in Houston - the nation's fourth-largest city - have recently detected an alarming rise in syphilis among gay men. Eric Roland, director of education at the Montrose Clinic (MC), said Houston has taken steps to educate gay men about syphilis and to encourage them to take precautions.

From January through November 2003, the Houston Health and Human Services Department received reports of 307 syphilis cases, 100 of them at MC. For every reported case, there may be numerous undetected cases. Roland said he fears the clinic will see an increase in cases this winter and spring.
Of the new cases at MC, Roland said roughly 25 percent were among African Americans, 25 percent among Hispanics, and half among Caucasian clients. A small percentage of Asians have tested positive for syphilis.

Experts believe the increased availability of Internet chat rooms and sex services that cater to anonymous sex contributes to increasing rates of syphilis. Roland said the rise in syphilis over the past few years accompanied an increase in HIV rates in Houston and across the country.

MC offers free HIV and syphilis testing. For those who test positive and cannot afford the antibiotics that cure syphilis, it provides them free or at a reduced rate. Houston encourages health care providers to actively screen people for syphilis now that cases are on the rise.

Roland said he urges all people in the gay and lesbian community who have had unprotected sex to test for syphilis and follow safe sex practices. Those who have unsafe sex should be tested every six months, he noted. "We need to move the gay culture and community to one that promotes health and a long life," he said.