NEWS ARCHIVE: July 2003 - January, 2004
07/01/2004
CDC HIV/STD/TB Prevention News Update
"Increase in Syphilis Prompts Call for Testing"
(01.07.04)::Tom Majeski
In an effort to control the steadily increasing spread of syphilis in Minnesota, state Health Department officials on Tuesday called for more screening and testing for the highly infectious STD. Preliminary data show there were 74 early syphilis cases in the first nine months of 2003, up from 60 cases over the same period in 2002, health officials said. Of the 74 cases, 69 occurred in males, of whom 54 were men who have sex with men. Some of the males contracted syphilis from female prostitutes.
Most of the syphilis cases in 2002 and 2003 were concentrated in the Minneapolis-St. Paul area. Minneapolis had the 12th highest syphilis rate among major US cities in 2002, according to CDC.
Health Department officials are asking for health care providers to increase their screenings, and for people who have had unprotected sex to get tested. "Doctors need to be taking sexual histories of their patients and testing those who are involved in high-risk sexual practices," said state epidemiologist Dr. Harry Hull.
"It's a totally preventable disease. If you practice safe sex, you shouldn't get it. If you do, it can be treated and you shouldn't be spreading it to anyone else," Hull said. Latex condoms, when used consistently and correctly, can reduce the risk of spreading syphilis if infected areas are fully covered by the condom, said health officials.
A major concern is that a person with syphilis who has sex with someone with HIV is far more likely to be infected with the deadly virus. "Some people are not taking the safe-sex warning seriously," said Hull. "Part of the problem that we are seeing here is that, with all the effective treatments we now have, HIV doesn't seem as threatening as it once was," he said.
Reuters Health
"Herpes Infections Common Among Lesbians"
(01.02.04)::Will Boggs, MD
A new study shows that herpes simplex virus infections are common among women who have sex with women. Nearly half the women (46 percent) in the study tested positive for HSV-1, the usual cause of cold sores, and 7.9 percent tested positive for HSV-2, which causes genital infections. The study is the first to report HSV prevalence in this group specifically, according to Dr. Jeanne M. Marrazzo of Harborview Medical Center, Seattle.
Marrazzo and colleagues took medical and sexual histories from 392 women, including both members of 71 couples, who reported having sex with a woman during the preceding year, and tested for HSV-1 and HSV-2 antibodies in their blood. Most of the women (80 percent) had also had sex with a man at some time; 28 percent had sex with a man during the previous year. Of 257 participants who identified themselves as lesbians, the figures were 73 percent for HSV-1 and 8.6 percent for HSV-2.
"This means that routine acquisition of chronic viral sexually transmitted diseases like herpes, human papillomavirus (HPV), HIV and hepatitis B can occur at the same rate as in strictly heterosexual women," Marrazzo said. "Providers should really assume nothing when a woman says, 'I'm a lesbian' - at least in terms of prior viral sexually transmitted disease acquisition - until a more complete history is taken."
Nearly all women reported giving and receiving oral-vaginal and digital-vaginal sex with female partners during the past year; 34 percent reported oral-anal sex; and 63 percent reported digital-anal sex. Only 9 percent of 31 HSV-2-positive subjects reported a history of genital herpes, and only 30 percent of HSV-1-positive women reported a history of cold sores. HSV-2 was linked to having a male sex partner with genital herpes, while HSV-1 was directly related to the number of prior female partners, according to the study.
"This suggests, but does not prove, that lesbians might be at increased risk for sexual acquisition of HSV-1 from their female partners, likely through oral sex," Marrazzo said. The
study, "Prevalence and Risk Factors for Infection with Herpes Simplex Virus Type-1 and -2 Among Lesbians," appeared in Sexually Transmitted Diseases (2003;30(12):890-895).
News & Observer
"Wake Revises Sex-Ed Policy"
(01.07.04)::T. Keung Hui
Thirteen months after the Wake school board expanded the county's sex education curriculum, a 5-3 vote Tuesday eliminated parts of that policy. The new policy requires Wake to strictly follow North Carolina's curriculum, which stresses abstinence.
The new policy will drop comprehensive sex education taught as part of new high school health electives, instead requiring all school employees to promote abstinence until marriage as the expected standard for all grades. Lessons about diversity and tolerance for other groups will also be eliminated.
Critics said the vote went too far in overriding a board compromise reached in late 2002 between those in favor of comprehensive sex education and those supporting an abstinence-only program. In that compromise, the board voted to keep abstinence-until-marriage as the standard for grades seven through nine. It also voted 5-4 to include more lessons about STDs, contraceptives and tolerance for gays and lesbians. Including comprehensive sex education in the high school elective also passed 5-4 in the 2002 vote.
At the public hearing Tuesday, most of the 23 speakers argued against the new policy. Robin Allen, who works with gay, bisexual and transgender teens, said she was in favor of a comprehensive elective. "This is a public school system. People who want to opt in can."
Those in favor of the new policy said the comprehensive elective's curriculum overstated the effectiveness of contraceptives. Sarah Harden, co-president of Citizens for Excellence in Education, called that "a betrayal of the public trust."
Administrators said the tolerance sections were dropped because they are not included in the state's sex-ed material. However, officials said they will try to teach tolerance elsewhere in the health curriculum. A measure to prevent Wake from teaching tolerance anywhere in health lessons was defeated 5-4 on Tuesday.
The new abstinence policy will include information on STDs and the effectiveness and failure rates of contraceptives. It also drops wording that critics said would have required teachers of other subjects to discuss abstinence whenever sexual subjects were discussed.
The Union
"Sex-Ed Grant Splits Board"
(01.07.04)::Millete Birhanemaskel
On Tuesday, Nevada County leaders discussed issues of appropriate sex education for teens as they debated seeking a $285,000 state grant aiming to prevent high-risk behavior, such
as unsafe sex. The Community Health Department (CHD) asked the Board of Supervisors to support the department's application for the grant, which would fund a three-year TeenSMART Outreach Program. The board voted 3-2 in favor of requesting money for the program.
While the program promotes abstinence first, sexually active high school and middle school students would have access to the TeenSMART Clinics, which would provide birth control and other services.
Nevada County Supervisor Sue Horne said the program fails to provide enough abstinence-based teaching, and she voted against supporting the application. "I have a philosophical issue with what I see as a program that tries to connect our children with clinics," she said.
Lisa Stern, program manager for CHD, said TeenSMART does not promote sexual activity. Prior to dispensing birth control, counselors at the clinics work with youth to pursue alternatives
to sex, Stern said. The department has a moral responsibility to teach sexually active youth about STDs and pregnancy prevention, she argued.
According to health reports released in 2002, teenagers in Nevada County accounted for 40 percent of pregnancy exams, 30 percent of chlamydia cases, 66 percent of gonorrhea cases, and 50 percent of herpes cases.
Deputy Health Director Henry Foley said the goal is to educate youth about the risks involved in premature sexual activity. "What's ironic about it [is] here we are trying to prevent unwanted pregnancies and STDs and the money to do that was at stake," noted Foley.
Associated Press
"Public Aid Starts New Program to Prevent Unplanned Pregnancies in Poor"
(01.05.04)
On Monday, the state Department of Public Aid said the Illinois Healthy Women program will soon offer reproductive health care services for 120,000 women who leave the state Medicaid program each year. The program, which covers women ages 19-44, will provide annual physicals, Pap smears, mammograms, contraceptives and STD treatment. Illinois expects to save more than $9 million by preventing an estimated 6,600 unplanned pregnancies in the program's first five years. Unplanned pregnancies often disrupt women's efforts to move from welfare to work. The program will also likely increase the chances that babies will be born healthy because of proper planning and spacing between births. The federal government will pay for 90 percent of the state's cost of the family planning services.
CDC HIV/STD/TB Prevention News Update
Tuesday, January 06, 2004
The Guardian (Charlottetown, Prince Edward Island)
"Overall TB Case Rate Falling but Experts See Pockets of Illness"
(01.03.04)::Canadian Press
Preliminary data from a new study show that while tuberculosis rates fell in Canada in 2002, that is no reason for complacency. The rate of new TB cases in 2002 fell to 5.0 cases per 100,000 people, down from 5.5 for 2001 and 7.4 a decade earlier, according to Health Canada.
However, a rising percentage of foreign-born individuals are infected with drug-resistant forms of TB, said Dr. Kevin Kain, director of the center for travel and tropical medicine at Toronto General Hospital. "Because we're seeing a huge explosion of cases worldwide, with our interconnected world we're going to anticipate seeing more and more of those [drug-resistant cases] come in," he said.
"The challenge is really with the foreign-born," said Dr. Edward Ellis, director of Health Canada's TB prevention and control program, adding that Quebec, Ontario, British Columbia and Alberta are dealing with the bulk of Canada's TB problems because of immigration patterns.
In 2002, 66 percent of all new Canadian TB cases were among foreign-born individuals. Health Canada data show Canada's northern territories are hardest-hit by TB, with 31.4 cases per 100,000 people. Atlantic Canada has the lowest TB rate, with 1.1 cases per 100,000.
Nearly half the Canadian-born TB cases were among aboriginal people. In 2001, 10 percent of new cases were resistant to a single drug; in 2002, 12.7 percent were single-drug-resistant.
The proportion of multi-drug-resistant cases rose to 1.6 percent over 1 percent for the same time period. The report, "Tuberculosis in Canada: 2002 Pre-Release," appears in the Canada
Communicable Disease Report, (2004;30-01), an online journal published by Health Canada.
Townsville Bulletin/Townsville Sun
"Students Get STD Message"
(01.03.04)::Roberta Mancuso
This month, Townsville high school students will receive information on how and where to be tested for Chlamydia and other STDs in response to concern about the North's growing STD rate.
"It's just a recognition that Chlamydia is a fairly common infection," said Dr. John Scott of Queensland Health Services.
"All we're trying to do at this stage is to provide information that will allow people to be aware of the problem, which will allow them to assess their own level of risk. After that we would offer advice in terms of where people could go to access services."
Chlamydia is the most common bacterial STD in Australia, especially among people ages 15-29. Tropical Public Health Unit figures show northern Queensland - which includes the towns of
Cairns, Cape York, Townsville and Mount Isa - has the highest Chlamydia prevalence in the state and an infection rate three times higher than the national average. Chlamydia testing is done with a urine sample.
The campaign, part of the Healthy Cities Plan, is being carried out with partner agencies such as Sexual Health Services and Townsville Division of General Practice. Wanda Lambert, state president of Council of Parents and Citizens Association, said the group supported more sex information for students.
The plan will also provide more condom vending machines in Townsville places such as hotels and nightclubs, put safe-sex promotional messages on movie and concert tickets, and urge businesses to attach leaflets about Chlamydia to their products. Under the plan, Chlamydia screenings may also take place in entertainment venues, shopping centers and sporting clubs. Last year, Townsville promoted a range of sexual health programs such as testing clubgoers at the Sovereign Hotel and students on Magnetic Island.
CDC HIV/STD/TB Prevention News Update
Monday, January 05, 2004
Star Tribune
"State's Abstinence-Only Sex Education Doesn't Work Any Better,
Report Says"
(01.04.04)::Josephine Marcotty
An independent study commissioned by the Minnesota Department of Health (MDH) found the state's $5 million abstinence-only sex education program is not working. At three schools with the ENABL (Education Now and Babies Later) program, of 413 junior high students surveyed, the rate of sexual activity increased from 5.8 percent to 12.4 percent in 2001-2002 – a pattern similar to that of kids statewide. The rate of students reporting they would likely have sex before high school graduation increased from 9.5 percent to 17 percent.
Critics of ENABL questioned why MDH waited six months after the report's completion to post it, with little fanfare, on its Web site last week. The 91-page report recommends including more information about contraception in the program. Of 2,500 Minnesota parents surveyed, only one-fifth wanted abstinence-only education and 77 percent wanted their kids to know about contraception.
"We take it very seriously," said Carol Woolverton, assistant commissioner of MDH. But it is too early to say whether the department will find ways to reach sexually active kids with information about contraceptives, she said. ENABL - paid for with state and, mostly, federal money - would lose federal funding if it changes from abstinence-only.
The five-year-old ENABL program is coordinated by schools, local organizations and parents. It primarily consists of a five-hour curriculum including statistics, reasons why kids should wait until they are adults or married to have sex, and suggestions on how to avoid sex and risky situations where sex might occur. It also encourages them to talk to their parents about sex. The program includes information about condom failure rates but nothing on their efficacy for preventing pregnancy and disease.
The findings raise the question of whether sexually active kids are getting the information they need to avoid pregnancy and STDs, said Connie Schmitz, the Professional Evaluation Services consultant who headed the study. However, Minnesota Family Council President Tom Prichard said ENABL is not working because its abstinence message does not go far enough: Kids should wait until marriage to have sex - not just until adulthood - and should abstain from any physical or sexual contact.
On a happy note, researchers said that between 1998 and 2001, kids surveyed showed a greater willingness to talk to their parents about sex.
Independent
"Doctors Warn of Death Toll from Silent Epidemic of Hepatitis C"
(01.01.04):: Jeremy Laurance
Hospital specialists criticized the British government on Dec. 31 for not acting to curb the spread of hepatitis C, which officials estimate has infected 200,000 people in the United
Kingdom - four times as many as HIV - and infects more than 100 additional people each week. It is the main cause of liver transplants and is predicted to kill more people than AIDS by
2020. However, only a fourth of patients know they are infected, and only 1 percent receive treatment.
The Department of Health published a strategy for dealing with hepatitis C 18 months ago and promised an action plan by the end of 2002. Graham Foster, professor of hepatology at the Royal London Hospital, said, "There is much disappointment at the lack of an action plan. Absolutely nothing is happening."
Last month, the Health Protection Agency announced that 5,901 cases of hepatitis C were diagnosed in 2002, up from fewer than 1,000 in 1994. Foster said over the next 10 to 15 years liver disease and cancer rates would soar if no action is taken.
New drug cocktails have increased the proportion of patients who can be cured to 60 percent, but since the virus is symptomless in its early stages, efforts must be made to test and identify people who are infected.
William Irving, professor of virology at Nottingham University, said, "There are a lot of people out there with hepatitis C and there is a window of opportunity to treat them now before they develop liver disease."
The bloodborne virus can be spread through sharing needles, razor blades, toothbrushes and cocaine straws; tattooing; body piercing; and sex. It is 10 times more infectious than HIV via
blood-to-blood contact, but less infectious than HIV via sexual contact.
CDC HIV/STD/TB Prevention News Update
Friday, January 02, 2004
Southern Voice (Atlanta)
"STD Prevention Efforts Turn to Web Hook-Ups"
(12.26.03)::Ryan Lee
On Dec. 19, CDC highlighted the Web-based approaches the San Francisco Department of Public Health (SFDPH) uses to deliver safe-sex messages in response to a four-year syphilis outbreak among gay men. "Because a majority of new syphilis cases are from men who have met online, we had to bring our staff up to speed on how to use the Internet to reach people," said Jeffrey Klausner, director of the STD Prevention & Control division of the health department.
In 2002 in San Francisco, men who have sex with men (MSM) accounted for 88 percent of the 495 reported cases of early syphilis; MSM accounted for 22 percent of the 41 cases reported in 1998. Researchers collected information from 415 MSM with the disease. The men reported a combined total of 6,482 sex partners during the time period in which they might have contracted syphilis. The Internet was the most common way to meet sex partners: almost 33 percent of hook-ups occurred online, followed by bars, bathhouses and sex clubs.
Among syphilis-infected MSM in San Francisco, 37 percent met partners online in the last half of 2002, compared with 12 percent in the first six months of 2000. From January through
April 2003, 44 percent met sex partners online.
The SFDPH created guidelines to help health agencies use the Internet to contact potential sex partners. The guidelines ensure that prevention messages protect confidentiality and are not discarded as spam.
Also on Dec. 19, the National Coalition of STD Directors (NCSD) called on Internet service providers to help curb the spread of STDs through online hook-ups. "The Internet has the potential to increase the spread of HIV and STDs, but also has unique characteristics which, if we take advantage of them, can reduce transmission," Theresa Raphael, executive director of
NCSD, said in a statement.
Associated Press
"Seattle Researchers Say Pill Thwarts Spread of Genital Herpes"
(01.02.04)
People with genital herpes who took once-daily valacyclovir were able to reduce by almost half the chances of transmitting the STD to their partners, according to new research. This is the first time an antiviral drug has been shown to impede the spread of an STD, said lead study author Dr. Lawrence Corey.
In the study of 1,500 heterosexual, monogamous couples, one partner had genital herpes and the other did not. Half of the infected people were given a daily dose of valacyclovir and the other half received a placebo. Both groups were counseled to use condoms, but few did so consistently. During the eight-month study, those with herpes who took valacyclovir - sold under the brand name Valtrex - cut genital herpes transmission by 48 percent.
The participants' overall chance of spreading herpes to their partner was low, even among the placebo group, perhaps because they were established partners who had already managed to avoid passing the virus. The likelihood of transmitting herpes to a partner was 1.9 percent with Valtrex and 3.6 percent with a placebo.
Preliminary study results helped GlaxoSmithKline win federal approval for valacyclovir to prevent the sexual transmission of genital herpes.
Using a condom can help reduce transmission by as much as 50 percent in some studies, said Dr. Anna Wald, medical director of the University of Washington Virology Research Clinic and study co-author. Avoiding intercourse during an outbreak reduces the chance of passing the virus as well, she said. The drug is not 100 percent effective, so people should still tell potential partners about their infection, said Wald.
Valtrex can cause headaches, nausea and kidney problems. GlaxoSmithKline, which wholesales the pill for about $3.50 per day, sponsored the study.
Genital herpes infects an estimated one in five Americans over age 12, according to CDC. Because most people with the virus have mild or no symptoms, up to 90 percent of those who have herpes are unaware of their infection. Dr. Connie Celum, a UW professor of medicine, said more than 30 studies have linked genital herpes infection with HIV acquisition and transmission.
In some parts of sub-Saharan Africa, up to 80 percent of people with HIV also have herpes, she said.
The full study, "Once-Daily Valacyclovir to Reduce the Risk of Transmission of Genital Herpes," appeared in the New England Journal of Medicine (2004;350(1):11-20).
Associated Press
"Hepatitis B Rates on the Decline in the United States"
(12.31.03)::Daniel Yee
On Wednesday, federal officials said hepatitis B has declined in the United States during the last decade, reflecting the effects of vaccinating children. CDC said cases have dropped 67 percent overall from 1990 to 2002. The greatest decrease - 89 percent - was among newborns to 19-year-olds.
However, cases are still rising among adults, CDC said.
Since 1999, hepatitis B has risen by 5 percent among males ages 20-39 and by 20 percent and 31 percent, respectively, for men and women age 40 or older.
"There have been overall declines - that is good," said Dr. Beth Bell, chief of the epidemiology branch of CDC's viral hepatitis division. "But the recent rise among adults is concerning and highlights the need to improve our ability to vaccinate adults at high risk."
High-risk adults include those with multiple sex partners, men who have sex with men and injection drug users. Hepatitis B is bloodborne or sexually transmitted. CDC noted that high-risk persons could be vaccinated during health-care visits.
Hepatitis B can - along with hepatitis C - cause both acute and chronic infection, which can lead to chronic liver disease, liver scarring and liver cancer. The report, "Incidence of Acute
Hepatitis B - United States, 1990-2002," appears in Morbidity and Mortality Weekly Report (2004;52(51):1252-1254).
San Antonio Express-News
"Teens Wish They'd Waited"
(12.26.03)::Rosemary Barnes
A recent survey conducted for the nonprofit coalition National Campaign to Prevent Teen Pregnancy found two-thirds of teens who had sexual relations expressed regret at not having waited longer. Another finding was that teens' parents, rather than friends, have more influence on their decisions about sex, although adults do not believe they are influential in such matters.
Although teen pregnancy rates in Bexar County, Texas, are in decline, they remain higher than the national average. According to San Antonio Metropolitan Health District statistics, the county's birth rate per 1,000 girls ages 15-17 fell from its 1994 peak of 58.9 to 44.5 in 2001. This was still higher, however, than the national rate of 24.7 and the statewide rate of 39.3 for that year. County teens had 1,573 babies in 2001.
"One of the major problems here is that kids don't understand the risks of sexuality," said Kelly Welsh, director of education for Planned Parenthood of San Antonio and South Central
Texas. "Parents must have an ongoing communication with their kids about sex and other issues. But so many of the parents didn't have good communication with their parents. So, it's difficult for many of today's parents to stress sexual responsibility to their teens."
Project WORTH (Working on Real Teen Health), San Antonio's teen pregnancy prevention program, and Planned Parenthood stress abstinence but provide contraception information to sexually active teens.
The survey, conducted by telephone on 1,000 people ages 12-19 and 1,000 adults 20 or older, found that 77 percent of sexually experienced teenage girls and 60 percent of sexually experienced teenage boys wished they had postponed sexual activity. The survey took place in August and September 2003.
Associated Press
"Moberly Inmate Diagnosed with Tuberculosis"
(12.31.03)
The Missouri Department of Corrections said Wednesday that inmates at the Moberly Correctional Center in Moberly will be tested for TB, following one inmate's diagnosis with the disease.
Testing is to begin Friday and is also being made available to prison staff. The inmate is in respiratory isolation.
CDC HIV/STD/TB Prevention News Update
Wednesday, December 31, 2003
Associated Press
"Louisiana Worst Gonorrhea Rate; Top 10 in Two Other STDs"
(12.30.03)::Janet McConnaughey
Louisiana had the highest gonorrhea rate in the nation for the second year in a row in 2002, according to CDC. Louisiana has been among the five worst states for both gonorrhea and chlamydia for the past five years. The state ranked seventh-worst in 2002 for syphilis.
"We definitely need to get the word out that the safest sex is no sex, and if you're going to have sex, use protection," said Dr. Jimmy Guidry, the state health officer.
In 2002, chlamydia - the nation's most common STD - affected 834,555 Americans, or 296.5 out of every 100,000, compared to 412.7 of every 100,000 in Louisiana. One reason for chlamydia's prevalence is that the infection often shows no symptoms or only mild ones.
Louisiana had 12,253 cases of gonorrhea in 2001 and 11,387 in 2002: 274.2 cases and 254.8 cases per 100,000 respectively.
Mississippi, which led the nation in gonorrhea rates in 2000, was second in 2001 and 2002, with rates of 272.8 and 241.7 per 100,000.
In Louisiana, the syphilis rate was the only STD rate that has lowered substantially since 1998. That year, the state had the nation's third-highest rate at 37.8 cases per 100,000. Louisiana's falling syphilis rates may be attributable to three factors, said Guidry.
Syphilis more commonly shows symptoms that would prompt a person to be tested. The Department of Health and Hospitals has aggressively tracked sex partners of syphilis patients. Finally, the lower volume of patients - 775 in 2002 - makes it possible to locate all contacts.
Age
"Take Condoms to Party, Doctor Warns"
(12.31.03)::Lucy Beaumont
As rates of STDs in Australia's Victoria state continue to climb, sexual health experts are warning about the dangers of New Year's Eve liaisons.
Partying fueled by alcohol and drugs makes the New Year's period a busy one for sexual health medical staff, according to Dr. Darren Russell of the Melbourne Sexual Health Centre, a senior lecturer in the department of public health at Melbourne University. Many people, when drunk, forget to carry condoms or do not use them, Russell said.
Russell said increased requests for STD treatment and the morning-after pill are indications that safer-sex messages from previous HIV prevention campaigns are being forgotten. Because HIV has been largely confined to the gay community, "a lot of people think they have nothing to worry about," he said.
Of particular concern: rises in syphilis, gonorrhea and chlamydia - the most common bacterial infection in Australia. So far this year, the Department of Human Services has recorded 6,244 Victorian chlamydia infections, up from 4,808 at the same time last year. Many infected persons, however, are unaware they have the disease.
"There is evidence that high school kids and [university] students know about HIV but they don't know about anything else," Russell said.
"It's conceivable that we could get back to the very high levels [of STDs] of the 1970s and earlier."
Beginning Jan. 1, the morning-after pill will be available without prescription in pharmacies. Russell praised the increased availability of the emergency contraceptive and said he hopes pharmacists will counsel patients on safer-sex practices in the absence of a consultation with a physician.
Daily Yomiuri
"Blood Donors' IDs to Be Checked"
(12.31.03)
Following the announcement Monday that a person in Japan had been infected with HIV through a blood transfusion, the Japanese Red Cross has decided to require that donors provide ID including a driver's license or passport before donating their blood. For those who do not possess any identifying documents, such as some homemakers and elderly people, the system would confirm their identity through other means.
The ID system will be implemented on an experimental basis in Tokyo by the summer and nationwide by the end of fiscal 2005, sources said.
The Japanese Red Cross has been asking people not to donate blood if it learns in pre-donation interviews that they have had unprotected sex with many people or engaged in other risky acts. However, in a number of reported cases donated blood tested HIV-positive and the donors could not be contacted, as they had given false names and contact numbers. One HIV-positive person had repeatedly donated blood using different aliases.
According to the Health, Labor and Welfare Ministry, 11 donors were found to be HIV-positive in 1987. The number of such cases jumped to 54 in 1997 and 82 last year. A senior ministry official said, "It's obvious that the number of these people using donation for the purposes of testing [their blood] is rising."
"Blood donors must be aware that serious consequences could occur if people who might have been infected with [HIV] donate their blood just to get it tested," said Jugo Hanai, who attended a ministry panel on blood affairs that was held Monday.
"Blood samples should be individually checked," rather than having 50 samples together screened for diseases, "even if it costs much more to do so," said former House of Representatives member Satoru Ienishi, who was infected with HIV through a tainted blood product. "The ministry's responsibility is heavy as it has largely left safety measures to be dealt with by the Japanese Red Cross Society," he added.
Reuters Health
"Chlamydia Linked to Cervical Cancer Risk"
(12.18.03)::Megan Rauscher
New research suggests that women with persistent chlamydial infection are at increased risk for developing cervical cancer. The latest findings, along with other emerging evidence, indicate that "cervical cancer should be listed as one of the potential long-term [consequences] of genital chlamydia infection," according to lead investigator Dr. Jorma Paavonen from the University of Helsinki-Finland.
Paavonen and co-authors studied 178 women with invasive cervical cancer, matching each one to three cancer-free controls. The researchers measured antibodies to a component of the chlamydia organism in blood samples from both groups and studied the earliest blood samples before the onset of cancer for the cervical cancer group.
The presence of antibodies to chlamydia increased the odds of cervical cancer, according to the report, "Serum Antibody Response to the Heat Shock Protein 60 of Chlamydia trachomatis in Women with Developing Cervical Cancer" published in the American Journal of Obstetrics and
Gynecology (2003;189(5):1287-1292).
Although chlamydia likely does not directly trigger cervical cancer - it is most often caused by infection with one or more high-risk strains of human papillomavirus - evidence suggests chlamydia is an important co-factor.
"Chlamydia trachomatis is an immunomodulator, which causes chronic inflammation and may alter the host immune response, and ultimately inhibit spontaneous clearance of HPV," Paavonen said.
The study findings "further emphasize the importance of sexual health education in primary prevention, and chlamydia screening programs in the secondary prevention of chlamydial infections," Paavonen added, "particularly since the vast majority of genital chlamydial infections are asymptomatic."
Oakland Tribune
"Berkeley Scientists Create Tuberculosis 'Superbug'"
(12.27.03)::Ian Hoffman
Infectious disease professor Lee W. Riley and his post-doctoral students set out to solve a problem that has been vexing researchers for decades: Why does tuberculosis lie dormant in some humans for decades before triggering disease? Trying to render TB harmless, they disabled a collection of genes associated with the bacteria's invasion of healthy cells. Instead, they created a synthetic "superbug" of tuberculosis, a "hypervirulent" organism so lethal to its host population that it leaves itself nowhere to run, endangering its own survival.
"We thought that by disrupting that gene we would make the bacteria less virulent and what happened was the opposite," Riley said.
"It all made sense. This is a bacteria where it's more important for it to become latent."
TB infects almost a third of the world's population, primarily in developing countries. Scientists have struggled for decades to decipher details of its life cycle in order to make progress on the path toward a vaccine.
Riley said the Berkeley mutant TB strain killed all the lab mice within 10 months because their immune systems did not perceive it as a threat, so did not mount much defense. Meanwhile, the mutant kept copying itself. Riley plans to bombard the germ with antigens in hopes of finding one that could be promising for a vaccine.
Former Berkeley post-doctoral students Nobuyuki Shimono of Kyushu University and Lisa Morici of Tulane University reported the experiment in "Hypervirulent Mutant of Mycobacterium Tuberculosis Resulting from Disruption of the mce1 Operon" in the Proceedings of the National Academy of Sciences (2003;100:15918-15923; online 0.1073/pnas.2433882100).
CDC HIV/STD/TB Prevention News Update
Wednesday, December 24, 2003
Associated Press
"State Reports More Chlamydia Cases"
(12.23.03)
During the first nine months of 2003, chlamydia cases in North Dakota increased by 37 percent. "Although some of the increase can be attributed to more screening and improved
testing, some of the increase is likely due to unprotected sex and other high-risk activities," said Kirby Kruger, manager of the state health department's STD program. From January through
September, 1,178 chlamydia cases were reported. During the same period in 2002, 860 cases were reported. The state's worst year for chlamydia was 1990, when 1,541 cases were reported.
CDC HIV/STD/TB Prevention News Update
Tuesday, December 23, 2003
New York Times
"More Teenagers Say No to Sex, and Experts Aren't Sure Why"
(12.23.03)::Linda Villarosa
Last week, CDC's annual tally of birth statistics showed that the teen birthrate has declined 30 percent over 10 years to a historic low of 43 per 1,000. African-American teenagers showed
the sharpest drop, down more than 40 percent since 1991. For black teens ages 15-17, the rate dropped by half - 40 births per 1,000 in 2002 versus 83.6 per 1,000 in 1991.
According to the Alan Guttmacher Institute, the pregnancy rate dropped from 11.5 per 1,000 to 8.5 per 1,000 in 1999 among women ages 15-19. It estimates that the abortion rate declined in women 15-19 from 40 per 1,000 in 1990 to 24 per 1,000 in 1999.
"Since 1991, when teen birthrates peaked, there's been a tremendous amount of attention focused on preventing teen pregnancy, and it has paid off," said Stephanie Ventura, chief of the reproductive statistics branch of the National Center for Health Statistics and a co-author of the new report.
AIDS awareness campaigns have also helped reduce teen pregnancy, especially in the black community. "Our community has had to become more forthright and willing to discuss sexual issues, because we have been so hard hit by AIDS," said Bronwyn Mayden, executive director of Campaign for Our Children in Baltimore.
Experts in the field point to statistics that show teenagers are having less sex and using contraception more effectively when they do. CDC's Youth Risk Behavior Survey shows that the percentage of high school students who ever had sexual intercourse dropped among girls from 51 percent in 1991 to 43 percent in 2001, and among boys from 57 percent to 48 percent.
Among high school students, condom use during the same 10-year period rose from 46 percent to 57 percent.
Washington Times
"Agencies Rapped for Shirking HPV Law"
(12.23.03)::Cheryl Wetzstein
Rep. Mark Souder (R-Ind.) has charged two health agencies with failing to comply with federal mandates concerning the development of prevention strategies for human papillomavirus.
CDC and Food and Drug Administration officials have been asked to appear at a Jan. 28 hearing of the House Government Reform subcommittee on criminal justice, drug policy and human resources, which Souder chairs, to discuss issues pertaining to HPV.
Under federal mandates signed by President Clinton in 2000, CDC was to have issued a report on the best HPV prevention strategies by Dec. 21. Separately, FDA was to re-evaluate condom labels to ensure that they are "medically accurate" concerning their efficacy in preventing disease, including HPV. Neither agency has complied, said Souder.
CDC spokesperson Kathy Harben said that the agency was finishing its HPV report and would issue it in January. CDC has posted HPV information on its Web site and given HPV presentations to health care workers, she said.
"The FDA has also undertaken enormous review of the literature related to prevention of [sexually transmitted diseases], and we are evaluating the issue," said an FDA spokesperson.
The Eagle Forum and other groups have urged Health and Human Services Secretary Tommy Thompson to highlight HPV education, "including the fact that condoms do not provide effective protection against infection."
"I don't think we, in any way, want to do anything that will frighten people from using condoms or going to the doctor and getting tested," said Tamara Kreinin, president of the Sexuality Information and Education Council of the United States. "The bottom-line message always needs to be that most STDs are treatable and it's important to get tested... early."
"Married Women in China's Capital to Be Equipped with 'Condom Cards'"
(12.20.03)
On Saturday, the Beijing Times reported that authorities will soon issue cards to married women allowing them to get free condoms from vending machines placed throughout the city. One hundred machines will initially be placed in the city of 13 million and should begin operating in January. At the outset of the pilot project, 60,000 married women will be issued the cards, which entitle them to 12 packs of condoms per year. The machines are seen as less embarrassing than buying condoms from a salesperson, the paper said. Urban Chinese couples are usually restricted to having one child and face severe penalties if they decide to have a second.
CDC HIV/STD/TB Prevention News Update
Friday, December 19, 2003
Reuters Health
"Rise in Syphilis in San Francisco Tied to Internet"
(12.18.03)
The Internet is a major factor in San Francisco's increase in early syphilis infections among men who have sex with men (MSM), according to a new CDC report. However, the Internet can also be used to track and treat the STD, the authors wrote.
A summer 1999 outbreak of early syphilis among MSM who met their partners on the Internet "presaged a rapidly expanding syphilis epidemic in San Francisco." By 2002, the city reported the highest rates of first- and second-stage syphilis of any metropolitan area in the nation.
Between 1998-2002, early syphilis cases rapidly increased from 41 to 495. Officials noted at the time the proportion of cases among MSM had jumped, from 22 percent in 1998 to 88 percent in 2002.
A focus on data for 415 MSM diagnosed with early syphilis in 2002 found that Internet chat rooms were the most common venues for meeting partners. Chat rooms were used more often for this purpose than bars, bathhouses or sex clubs. Among 151 MSM interviewed, nearly 45 percent reported meeting sex partners online, and about one-fifth had no other contact information for the partner except for an e-mail address.
"As the association between syphilis among MSM and the use of the Internet as a means for meeting sex partners grows, health departments must adopt new strategies for partner notification," said CDC and San Francisco Department of Public Health officials. They have evidence that Internet-based partner notification can be an effective tool for finding and treating early syphilis infections.
"Local health departments in other cities that have had large increases in early syphilis cases among MSM should consider using the Internet for partner notification and management," the authors of the report wrote. San Francisco's DPH developed interim online notification guidelines that address "concerns about protecting confidentiality and ensuring that messages are not discarded as junk e-mail, two common barriers to online partner notification."
The full article, "Internet Use and Early Syphilis Infection Among Men Who Have Sex with Men - San Francisco, California, 1999-2003," appeared in Friday's Morbidity and Mortality Weekly Report (2003;52(50):1229-1232).
Associated Press
"Novartis Signs Deal to Provide TB Drugs"
(12.19.03)
Swiss pharmaceuticals manufacturer Novartis signed an agreement today with the World Health Organization to provide free drugs to half a million tuberculosis patients over the next five years. The donation will cost the company $7 million, and it ties in with a campaign by the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has committed $400 million over he past two years to fight TB.
Novartis is one of the world's largest drug companies. It reported a full-year profit of $5.3 billion last year. TB drugs are well-established and relatively inexpensive. Many people miss out on them, however, due to lack of access to good treatment, according to WHO. The organization calls TB the world's leading curable infectious killer. Almost 2 million people die from TB each year, mainly in Asia, Africa and the former communist bloc.
Novartis plans to buy the drugs from a manufacturer in Bangalore, India, for the Global Drug Facility, a group that organizes bulk procurement of drugs for programs in developing countries. The treatment will be offered as a fixed dose of four drugs in blister packs. This will ensure that more patients take the drugs correctly, thereby reducing the risk of patients developing drug-resistant strains of the disease.
Novartis CEO Daniel Vasella, who had TB as a child, said the donation is designed "to help some of the poorest patients in the world."
Star Phoenix
"Young Adults, Teens Urged to Adopt Safe Sex Policy"
(12.16.03)::Shannon Boklaschuk
With the hope of reducing high rates of sexually transmitted disease among local youth, the Saskatoon Health Region has launched a new public awareness campaign urging people who have had unprotected sex to get tested. Until March 14, posters with the slogan, "Unsafe Sex Can Mess Up More Than Just Your Bed" will appear in 100 city buses and on two bus tailboards.
"With the rates of chlamydia in Saskatchewan being double the national average, it was important to us to launch an awareness campaign" targeted at the 15- to 24-year-old population, said Pamela de Bruin, healthy lifestyle supervisor with the region's sexual health program. "The main message we wanted to send out is, 'You had unprotected sex. Get tested, because [sexually transmitted infections] are happening to people like you, right here in Saskatchewan.'"
Chlamydia rates in Saskatchewan are nearly double the Canadian average, 309.2 per 100,000 compared to 161 per 100,000, respectively. De Bruin said it is unclear why Saskatchewan has a
high chlamydia rate.
Launched by the Sexual Health-Public Health Services, the posters "are part of a comprehensive strategy to reduce rates of chlamydia among young people living in Saskatoon Health Region," said Dr. Stephen Whitehead, deputy medical health officer.
More than 500 Saskatoon youth, the majority ages 15-19, helped develop the poster campaign. "We asked them, 'Where would you most likely see it?' And they told us buses," said de Bruin. She added that a bus campaign was effective in terms of cost "because buses go everywhere."
Reuters Health
"Human Papillomavirus Tied to Oral Cancer"
(12.10.03)::David Douglas
Human papillomavirus, a virus associated with cervical cancer, appears to be involved in cancer of the mouth and oropharynx (the part of the throat that includes the lower part
of the tongue and the tonsils), according to a recent study. Lead author Dr. Rolando Herrero of the Costa Rican Foundation for Health Sciences-San Jose, said it is possible that "HPV vaccines currently under development could be effective at preventing HPV-related oral cancer."
The study included 1,415 patients with cancer of the mouth, 255 with cancer of the oropharynx, and 1,732 cancer-free control subjects. The researchers found HPV DNA in nearly 4 percent of cancers of the mouth and in 18 percent of cancers of the oropharynx. Such findings were more common in subjects who reported having more than one sexual partner or who practiced oral sex. HPV can be sexually transmitted.
DNA for HPV 16, the most common HPV in genital tumors, was found in roughly 94 percent of HPV DNA-positive patients. A significantly increased risk of mouth and oropharynx cancers was associated with the presence of antibodies against HPV 16 L1, E6 or E7. The findings suggest to the researchers that HPV seems to play a role in the development of cancers of the oropharynx and possibly a small subgroup of cancers of the mouth. The study, "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(23):1772-1783).
TB & Outbreaks Week
"Tuberculosis Screening: TB Not Always Evident at Arrival in New Country"
(10.07.03)
Researchers from the UK Health Protection Agency, the British Thoracic Society, and the Department of Health Collaborative Group recently looked at changes in the number of cases of tuberculosis in children between 1988-1998. They found that the overall number of cases in children under 15 had changed only slightly, with cases increasing from 308 in 1988 to 408 in
1993, then falling to 364 in 1998.
The figures are small compared to the 1960s when just under 2,000 TB cases were diagnosed in children under 15 each year. Cases in children born abroad increased from 41 in 1988 to 42 in
1993 to 97 in 1998. The most recent data comparable to the study show there were 469 total cases in children in 2001, with less than one-third of cases in children known to have been born abroad.
"These figures may reflect recent patterns that have been observed in other developed countries of a rise in cases of TB in people who are born in areas of the world where the disease is now epidemic," said an HPA spokesperson.
"Current guidelines for the control and prevention of TB in the UK recommend screening of new immigrants as part of a coordinated local control policy," the spokesperson continued.
"Screening should consist of a health interview and a Heaf test to measure people's immunity to TB and in some instances a chest X-ray. Screening in this way can identify people with active TB disease who require treatment, people who are infected with TB who can be prevented from developing the disease using prophylactic antibiotics, and people who have no immunity to the disease and can be protected by immunization. This is particularly important for children.
"However," the spokesperson noted, "many individuals develop their TB after being in the UK for some time and the disease is not evident at the time of arrival. Raising the awareness of the symptoms of TB in foreign-born people and those who work with them, and good access to health care for prompt diagnosis and treatment are crucial."
WHO estimates that one-third of the world's population are infected with TB, but only a small proportion of those infected will go on to develop active TB. Although it is a leading killer
worldwide, with proper treatment almost all TB cases can be cured.
The study, "A Decade of Change: Tuberculosis in England and Wales 1988-98," appeared in the Archives of Disease in Childhood (2003;88:772-777).
Boston Globe
"A School's Lesson: TB"
(12.14.03)::Christine MacDonald
On Dec. 1, a 7th grader at Umana-Barnes Middle School in East Boston was diagnosed with tuberculosis. Students reacted fearfully to the news. "There was a very heightened sense of anxiety," said Principal Edward Cook. "They asked things like, 'Will this boy die? Will I die?'"
Public health doctors and nurses were at the school the next day and have spent several days briefing students and faculty about TB. School officials have sent out letters in English, Spanish, and Portuguese to inform parents of the situation. The case and screening efforts were on the agenda at the Dec. 11 parent council meeting.
Dr. Anita Barry, director of communicable disease control at the Boston Public Health Commission, and her staff were in East Boston last week to perform free TB skin tests on about 150 students and faculty at the school and an after-school program the sick boy attended. Officials will return in three months to conduct another round of tests.
Although most TB cases never become active, the 7th grader's TB had entered the active stage. Boston provides free medication for TB and assigns a nurse to each patient. The city assigned a Vietnamese-speaking nurse to the 7th grader, who is of Vietnamese extraction. None of his family members tested positive.
Barry said 67 people were diagnosed with TB in Boston in 2002, mostly immigrants from countries where it is widespread. City data show Boston had a TB incidence rate of 11.4 people per 100,000 last year, down from 15.8 people in 1998. But Boston residents have more than twice the statewide and national incidence rates, data show.
"On average, we may get a case in the schools every year or every other year," Barry said.
CDC HIV/STD/TB Prevention News Update
Tuesday, December 16, 2003
New York Times
"Teenagers Want More Advice from Parents on Sex, Study Says"
(12.16.03)::Kate Zernike
Adults and youths have diverging views about the role of parents in offering advice and guidance to their kids about sex, how many teens are having sex, and whether being a teen virgin is embarrassing or not, a study released today shows. The study, conducted by the Washington-based nonprofit group National Campaign to Prevent Teen Pregnancy, surveyed 1,008 adults (79 percent were parents) and 1,000 teenagers.
In general, "teens express more cautious attitudes and values toward sex than is perhaps generally believed," the report concludes. And parents are the biggest influence on teenagers' decisions about whether to have sex, according to the survey, but they do not realize it. Among the report's findings:
*48 percent of adults said it was embarrassing for teens to admit being virgins, but only 26 percent of teenagers believed so.
*85 percent of teenagers said sex should occur only in a long-term committed relationship, up from 82 percent surveyed last year.
*Three in 10 teenagers said they have become more opposed over the past few years to having sex.
*45 percent of teens said their parents were the biggest influence on deciding whether to have sex, while only 31 percent said their friends were.
*32 percent of parents surveyed said that parents were the biggest influence on a teen's decision to have sex, while 48 percent thought friends filled that role.
"Adults continue to underestimate their influence," said Sarah Brown, the director of the campaign. "They may be so concerned about being friends or pseudo-peers that they forget that the primary job of parents is to be parental," she said. "They didn't come of age in the full-blown understanding of AIDS and with quite as much attention to teen pregnancy and how it derails young lives."
St. John's Telegram
"Visits Up at Planned Parenthood: Concerns Being Raised at Clinics About Lack of Sexual Health Education in Schools"
(12.11.03)::Deana Stokes Sullivan
Patient visits to the sexual health clinics of Planned Parenthood Newfoundland and Labrador in St. John's increased by 47 percent this year. PPNL Executive Director Annette Johns said
1,647 people visited between January and November at the Merrymeeting Road center. Doctors reported that the higher-than-usual volume for the part-time clinics peaked at 220 visits and
222 visits for September and October, respectively, Johns said.
About 78 percent of PPNL's clients are ages 15-24. Through November, the center recorded 1,000 pregnancy tests, and 1,626 prescriptions, including 1,415 for oral contraceptives, 122 for emergency contraceptive pills, and 89 for Depo contraceptive injections. Patients generally go to the clinics for information, STD testing, cervical screening and birth control counseling.
In youth focus groups, a lack of sexual health education in provincial schools and a lack of access to health services emerged as common themes. Many were concerned about the lack of education about decision-making and STDs, Johns said, in addition to where youths could go for testing or counseling.
Johns said the trend of youths initiating sex at an earlier age raises the concern that adolescents may not be aware of the non-pregnancy related risks of having sex, such as contracting STDs. The rate of STDs including chlamydia, genital warts and genital herpes is on the rise in Newfoundland and Labrador, and there are also new HIV cases, said Johns.
Associated Press
"Tanzanian Rats, Who Already Sniff Out Landmines, Now Poised to Detect TB"
(12.15.03)::George Mwangi
A grant from the World Bank will help train giant pouched rats, who have been trained to sniff out land mines in Africa, to detect tuberculosis bacteria in human saliva. The $163,780 grant is one of several awarded by the World Bank for proposals with creative responses to the challenges of development.
Bart Weetjens, director of the rat project, said he was challenged by the potential social impact the project could have if successful. "TB is a growing problem... people are feeling like
we are losing the battle," said Weetjens.
According to World Health Organization estimates, deaths from TB will rise from 2 million this year to 8 million by 2015. Weetjens said about 40 percent of the estimated 60,000 Tanzanians suffering from TB are also HIV-positive. TB can be treated if detected early enough.
In his proposal, Weetjens said the rat, whose Latin name is Cricetomys gambianus, can sniff 120-150 human saliva samples in lab dishes in 30 minutes, in contrast to the day's work it takes
for a human technician to analyze 20 samples. The rat is trained to stop in front of samples that smell like TB and wait for a reward, while it walks past samples where TB is not present.
When the project gets underway in July, a training hospital in Dares Salaam will provide the human saliva samples to be tested. "There may be not only a greater advantage in terms of
cost but also in processing more samples," said Weetjens.
Some of the grant funds will be used to construct a new lab to test for TB at the research station at Sokoine University of Agriculture in Morogoro, 100 miles west of Dar es Salaam. The
station is run by Apopo, the Belgian-funded, Antwerp-based research group that is also running the project that has trained the rats to sniff out land mines.
CDC HIV/STD/TB Prevention News Update
Monday, December 15, 2003
Province
"Syphilis on the Rise Among Downtown Eastside Prostitutes and Johns"
(12.09.03)
According to the British Columbia Centre for Disease Control, syphilis is on the rise. More than 200 cases have been reported this year, up from 177 in 2002 and 18 in 1996. The center's Dr. Michael Reckhart warns the numbers have the potential to skyrocket.
"We are going to have about 250 cases of syphilis this year, mostly from the Downtown Eastside," of Vancouver, said Reckhart, director of STD and HIV/AIDS control for the center. "At least 50 percent are sex workers and their customers. And given the small population down there, that is a very big problem."
Reckhart noted there is also a smaller outbreak among Vancouver's gay community. "We are not sure why exactly it hasn't caused a larger outbreak of syphilis in the gay community, but it could and there is a large potential for rapid spread in the gay community."
A recent study of women's health found syphilis incidence increased by 62 percent among males and 22 percent among females between 1991 and 2000. Syphilis in the United States is on the rise, mainly due to outbreaks among gay and bisexual men in several large cities. "[To reduce syphilis risk] I would say use a condom and reduce your number of sex partners...," said Reckhart.
New York Times
"Free Tuberculosis Tests Offered After Case Is Found"
(12.14.03)::Barbara Whitaker
Following the discovery of an active TB case at Claremont School in Ossining, the Westchester County Department of Health is to offer free TB tests to students and faculty Monday. The case was diagnosed Dec. 1. Fifty to 60 of the school's 580 students and 100 staff members are to be tested. Officials said they have no reason to believe any other active cases will be found.
CDC HIV/STD/TB Prevention News Update
Monday, November 24, 2003
Associated Press
"US Syphilis Rate Increases; Mississippi Decreases"
(11.21.03)::Sheila Hardwell Byrd
State Epidemiologist Mary Currier said Mississippi's syphilis rate continues to decline due to measures taken in the 1990s to reduce the number of cases. While the nation's syphilis rate has climbed for the second year in a row, Mississippi's cases dropped from 140 in 2001 to 48 in 2002. Currier said the state had more than 2,000 cases in 1994.
"What we started doing in the mid-90s, when we had such an increase of syphilis cases, was we put more people in the field to look for syphilis cases, to find their contacts and to provide preventative therapy to those contacts so that we can try and stop the spread of the disease," Currier said.
Currier said the state Health Department cooperates with community organizations, hospitals and clinics to keep them informed of syphilis outbreaks and to help them identify syphilis symptoms.
According to CDC, national syphilis rates rose 9.1 percent between 2001 and 2002 after having dropped every year between 1990 and 2000. The actual increase was small - 759 new cases for a total of 6,862 - but the rise among gay and bisexual men has caused concern over the erosion of the public health safeguards and safe-sex practices adopted over the last twenty years.
"We're seeing syphilis rise primarily in groups of gay and bisexual men," said Dr. John Douglas, director of CDC's division of sexually transmitted diseases.
In Mississippi, however, two-thirds of last year's syphilis cases were female. "That spread was likely heterosexual in that case," Currier said. "Certainly, when any high-risk group is identified in the nation, it's another reason for us to be sure that we're providing prevention education to the groups."
Los Angeles Times
"San Francisco Has Nation's Highest Rate of Syphilis"
(11.22.03)::Lisa Richardson
San Francisco has the nation's highest rate of syphilis cases, according to new CDC data. San Francisco's highest syphilis rate since 1999 - 40.6 cases per 100,000 in 2002 - was apparently driven by infections among gay and bisexual men. The city's rate compares to a national syphilis rate of 2.4 cases per 100,000 people in 2002, itself a 9.1 percent increase from 2.2 cases per 100,000 in 2001.
The city's increase in syphilis cases may be attributable in part to improved screening and outreach efforts, health officials said. The city, in conjunction with community groups, has opened three testing sites and Web page-initiated testing, and testing increased 33 percent from 1999 to 2002.
However, increased screening is not solely responsible for the rise. "We know that the increased number of cases is definitely related to increased transmission," said Dr. Jeffrey
Klausner, San Francisco's director of STD control. "People are coming in with lesions; people have sores, and there is an increased number of syphilis cases of the brain. That's real disease and real transmission," Klausner said.
California's syphilis cases almost doubled from 2001 to 2002, rising to 1,046, according to state health officials.
Preliminary 2003 estimates indicate the infection rate is slowing.
While releasing the CDC data, officials cited a New York study comparing the behavior of gay and bisexual men with syphilis and without syphilis. Men with syphilis were more likely
to report engaging in unprotected anal intercourse, attending private sex parties to meet partners, and using methamphetamine and Viagra or other drugs before having sex. They were also more likely to have HIV. According to Lee Klosinski of AIDS Project Los Angeles, "Most people are finding sex partners on the Internet, and the Internet has emerged as a more problematic area in terms of syphilis transmission."
Associated Press
"Baltimore's Rate of New Cases of Syphilis Falls to Behind Georgia's Rate"
(11.22.03)
Baltimore's syphilis rate has declined from the worst in the nation in 1997 for new cases to the number five spot, despite the fact that rates are rising nationally. City Health Commissioner
Dr. Peter Beilenson attributes the improvement to a campaign to stem the disease's spread among drug users, including those who trade sex for crack cocaine.
Beilenson said the city had hired more clinicians at its STD clinics and tested and treated people taken to the Central Booking and Intake Center. "It was an 82 percent drop from [1997] to 2002, which we think is the biggest [five]-year drop in any American city ever," he said. Cases went from roughly 662 in 1997 to 121 last year.
San Francisco had the highest rate of new syphilis cases in 2002, with 40.6 cases per 100,000 people, or 315 new cases. Detroit, Atlanta and Newark also had higher rates than Baltimore's 18.6 per 100,000. In 2001, Baltimore ranked third, behind Detroit and Atlanta, in rate of new syphilis cases.
However, Beilenson voiced concern that an increasing number of teenage girls reported contracting syphilis from older male partners. He also said syphilis is on the rise among men who have sex with men. About 22 percent of Baltimore's cases last year involved men having sex with men, according to Beilenson, and approximately 10 percent involved females ages 15-29.
Indianapolis Star
"Study Shows Drop in City's Syphilis Rate"
(11.22.03)::Diana Penner
Indianapolis dropped from seventh place in 2001 to 24th place in 2002 in the national rankings of syphilis cases per 100,000 in major cities, according to new CDC data. Indianapolis reported 36 new cases of syphilis in 2002, compared with 128 in 2001. The figures represent a 71.8 percent drop in the city's syphilis cases - from 14.9 cases per 100,000 residents to 4.2 per 100,000.
In 1999, the city ranked number one for new syphilis cases, with the infections largely occurring among heterosexuals. When the number of Marion County cases soared, CDC awarded the county health department a grant to combat the problem. The grant paid off, said Dr. Virginia Caine, director of the department, by allowing the county to concentrate people and programs to fight the disease.
But nationally, syphilis is increasing among men in their 30s, and that could be the next problem for the city, local officials said. The new surge is being seen among men who have
sex with men but do not necessarily consider themselves to be gay. "So we're trying to plan for that," said Caine.
Marion County was one of three metropolitan areas involved in demonstration projects, in which CDC helped mount "a full-court press, in terms of responding to syphilis," said Dr. John Douglas, director of CDC's Division of STD Prevention. "And we have, in fact, in those three counties seen among the largest decreases," he said in a telephone news conference.
For three years beginning in 2000, the county has received $600,000 to $800,000 to battle syphilis, Caine said. The grants will likely be reduced by 25-50 percent because of Indianapolis' improvements and the needs of other cities. However, anti-syphilis efforts will continue, including 24-hour testing at Wishard Memorial Hospital's emergency room, and outreach targeting MSM. Community groups can help organize that response in meetings to be held in the coming months, said Caine.
Florida Today
"Teens Broach Subject of Sex"
(11.19.03)::James Dean
First Defense, a Melbourne, Fla.-based sex education group presented a three-day workshop to eighth-grade boys, and then to girls, at Southwest Middle School in Palm Bay recently. Steve
Smith, the group's director, gave statistics on STDs and teen pregnancy and cautioned that condoms are not foolproof protection against either.
First Defense promotes sexual abstinence until marriage, in accord with Brevard School District standards. Its 12 volunteers have presented five-day workshops to many South Brevard high schools over the past six years. Southwest is the first and only middle school to invite the group to work with eighth graders, although Principal Robin Novelli thinks the group's effective communication about the risks of sex may attract more schools.
"You can bet all the students were listening very carefully," Novelli said. "It's a subject we need to address because kids are getting involved in sexual activity younger without information to make good decisions."
A survey by the Kaiser Family Foundation showed half of all high school students report being sexually active. The report also noted that one in ten high school girls ages 15-19 becomes pregnant.
Debra Hauser, vice president of Washington-based Advocates for Youth, said teaching kids about sex as early as possible is a good idea, but questioned whether Brevard's abstinence-only approach, which does not allow discussion of contraception, was a successful method.
"Clearly in middle school, an age appropriate message is to delay [having sex]," she said. "However, many young people in middle school are sexually active, and an abstinence only until marriage lesson is completely irrelevant and leads them to high risk."
Associated Press
"TB Testing Continues for Sebewaing-Area Students"
(11.21.03)
Sebewaing-area students and teachers continue to be tested for tuberculosis, and two more cases have been identified, in the wake of 34 people testing positive for TB late last month. A senior and a staff member at Unionville-Sebewaing Area High School had positive skin tests for the disease, the Huron Daily Tribune of Bad Axe reported. TB skin tests were administered at the high school after 30 teachers and four middle school students in the Thumb district tested positive last month. More than 400 students were tested earlier after a fifth-grade teacher and an eighth-grade student were found to have active TB in October. Health officials said it is likely the teacher had active TB during the previous school year, but did not know what it was until she was tested. None of the 36 positive skin tests in the Sebewaing area has been diagnosed as active cases.
CDC HIV/STD/TB Prevention News Update
Friday, November 21, 2003
Atlanta Journal-Constitution
"Georgia Leads Nation as Syphilis Increases"
(11.21.03)::Patricia Guthrie
Georgia's rate of syphilis cases led the nation last year as the disease re-emerged among gay and bisexual men, CDC announced yesterday. The STD's increase is likely linked to rising numbers of HIV/AIDS cases among men who have sex with men.
Atlanta recorded the third-highest urban rate of syphilis, behind San Francisco and Detroit. Although the South is an area traditionally rife with STDs, Georgia and the rest of the country witnessed a decline in the 1990s.
Since 1999, CDC has targeted syphilis elimination, especially in the South and among minority populations. But given the new statistics, CDC said Thursday that it must redouble education and prevention efforts targeted to gay and bisexual men.
"This campaign against syphilis is now being waged on two fronts," said Dr. Ronald Valdiserri, deputy director of CDC's National Center for HIV, STD and TB Prevention. "We are working on one front to sustain the progress made among populations formerly hit by syphilis, including African Americans. On the second front, we're combating new challenges among gay and bisexual men."
A recent 25-state study shows a nearly 18 percent increase in HIV in the last four years among MSM. In New York City, syphilis cases tripled from 2000 to 2002, with half of the new cases in the gay community, according to Dr. Susan Blank, a New York City health official. Veronica Hartwell of the Georgia Division of Public Health said public and private health clinics should emphasize the importance of STD screening. The state so far has partnered with faith-based groups and targeted venues frequented by men to get the message out, she said.
Rankings for primary and secondary syphilis cases per 100,000 people for 2002 are as follows: Georgia - 439 cases/5.4 rate; Michigan - 486/4.9; Florida - 617/3.9; Illinois - 479/3.9; Arizona - 200/3.9. US total cases in 2002 were 6,862/2.4.
Agence France Presse
"Thai Teenagers Shunning Condoms, Health Ministry Warns"
(11.16.03)
On Sunday, the Health Ministry warned of an alarming trend of Thai teenagers shunning condoms, and it called for more campaigns to encourage their use as protection against HIV/AIDS. A survey of 350 teenage boys in Kalasin province found that only
24 percent regularly used condoms, believing it was safe to have sex with someone they knew.
"Sexual relations among teenagers now are happening between people who have known each other for a while, so they believe that they can trust one another more than a condom," said ministry spokesperson Nittaya Chanreung. "That's a worrying problem."
In the 1990s, Thailand mounted a national publicity drive encouraging condom use, which slashed HIV/AIDS infection rates. But the recently released three-year survey found that most teenage boys only use condoms when they have sex with sex workers, which Nittaya said happens relatively rarely.
"Campaigns aimed at preventing sexually transmitted diseases have worked well among sex workers and clients, who use condoms," Nittaya said. "But for teenagers we need to carry out more campaigns to promote their knowledge of this."
The survey found that the average age for boys to have sex for the first time had dropped from 16 years in 1998 to 14 years at the time of the study.
More than 700,000 Thais have HIV/AIDS, and 300,000 have died of the disease. The epidemic's impact is expected to grow as people who contracted HIV a decade ago begin to sicken and die, and the lack of access to antiretrovirals worsens the death rate.
Life expectancy in Thailand has dropped 1.4 years, to 68.9, due to the high number of young people dying of AIDS, the UN reported in July.
Fayetteville Observer
"Robeson Task Force Targets Syphilis"
(11.20.03)::Venita Jenkins
Robeson County health officials hope a new task force that targets prostitutes will help achieve the goal of eliminating syphilis in the county by 2005.
In 2001, the county ranked first in the nation for its syphilis rate - 73 cases per 100,000 people - with health officials identifying 144 new or existing cases. Last year, the rate was 53.2 cases per 100,000 people. Between Jan. 1 and Sept. 30 of 2003, 30 new cases have been reported.
A recent survey by state and county health officials indicated that 49 percent of Robeson County women with syphilis said they had exchanged sex for drugs or money. Health officials say the task force - which met Wednesday, and whose program should be in place by January - will encourage prostitutes to take classes, develop job skills, and get off the streets.
"We have a lot of young ladies and men walking the streets in Robeson County. Some of them want to make a change," said April Oxendine, an outreach specialist with the county Health Department.
The task force also plans to provide a one-stop location for prostitutes to access substance abuse and mental health services, said Pete Moore, senior public health adviser with the North Carolina Department of Health and Human Services.
The county Health Department and the state have spent nearly $750,000 in the past three years toward syphilis elimination, outreach programs and screenings, said Health Director Bill Smith. The county is one of eight in the state to receive CDC funds to begin an initiative to eliminate syphilis by 2005.
Although Robeson County has seen a decline in syphilis rates, the county's HIV cases have doubled in recent years, said Oxendine. In 2002, 17 new cases were reported, compared with 46 this year. "It is a known fact that if you have an outbreak of syphilis, a couple of years later you will see a rise in HIV," explained Moore.
CDC HIV/STD/TB Prevention News Update
Wednesday, November 19, 2003
Stamford Advocate
"Chlamydia Most Common STD Among State's 15- to 19-Year-Olds"
(11.15.03)::Alison Damast
Chlamydia is the most common sexually transmitted disease among Connecticut 15- to 19-year-olds, affecting about 10,000 people in 2002, according to the Connecticut Sexually Transmitted Diseases Control Program (CSTDCP). There are likely more cases than the 8,000 females and 2,000 males reported last year, but many people do not get tested, skewing the data, said Heidi Jenkins, CSTDCP director.
Last year, chlamydia levels peaked in Stamford and Norwalk, with about 300 and 244 cases reported respectively, according to CSTDCP. In 2003, Norwalk's cases have leveled off, with only 190 cases reported so far, said Jenkins.
At a recent conference on adolescent health hosted by the Norwalk-based social services agency Human Services Council, Mary Barrett, chief clinician with the Norwalk High School-based Health Centers, reported, "The pervasive attitude is it won't happen to me." The council's health clinics at Brien McMahon, Norwalk and Briggs public high schools reported 10 chlamydia cases this fall.
According to Jenkins, many adolescents are having unprotected sex, and they are often dishonest about their sexual activity with medical practitioners. "You can have an adolescent
tell you 'I'm a virgin,' while they continue to have oral sex and reckless sex," said Jenkins.
Carla Gisolfi, director of the Dr. Robert E. Appleby School-based Health Centers, noted that a major hurdle many of her colleagues face is that they are not allowed to give out condoms
or dispense birth control to students.
Other STD rates have also risen recently in Connecticut. Over the past year, there has been a slight increase in gonorrhea cases reported, and the number of reported syphilis cases increased sharply among men having sex with men. Jenkins noted that gonorrhea has become most prevalent among the 15- to 19-year-old age group and the 20- to 24-year-old age group.
Edmonton Journal
"861 Men Given Unsterilized Biopsy Probes: Ontario Reports Second Hygiene Breach in 3 Weeks"
(11.18.03)::National Post
Toronto's Sunnybrook Hospital is urging other hospitals across the country to review infection-control procedures after an internal audit revealed that 861 men with prostate cancer had been exposed to an unsterilized biopsy probe since 1999.
Hospital officials blamed the men's potential exposure to HIV and hepatitis B and C on complex manufacturer's instructions for a tool used to take prostate tissue samples. The long, thin probe is covered in a rubber sheath and inserted in the rectum. A small needle is inserted into the prostate to collect a tissue sample that can be tested for cancer cells. The potential exposure occurred where the needle pierces the rubber sheath, said Dr. Bob Lester, Sunnybrook's vice president of medical and academic affairs. The hospital sent letters to men who underwent the procedure, offering blood testing at home, at work or at the hospital.
The incident is the second involving unsterilized medical equipment in Ontario hospitals in the last three weeks. A hospital in Oshawa is facing two lawsuits worth $81 million (US $62.1 million) after throat and colon scopes were cleaned but not disinfected.
A lawyer working on the Oshawa hospital lawsuits said a class-action claim by some or all of the 861 men treated at Sunnybrook is likely. Sunnybrook admitted it had not been sterilizing the half-dozen biopsy tools since it first began using them in December 1999.
"The people using the equipment did not understand [the instructions] and even I, looking at it now, can see why it would be easy to misinterpret," said Dr. Andrew Simor, head of microbiology.
BK Medical of Wilmington, Mass., the manufacturer of the probe, did not return calls to answer allegations that the equipment's instructions were too complex.
Leo Steven, president and CEO of Sunnybrook, emphasized that the risk of infection is low: one in 100,000. Ontario Health Minister George Smitherman has ordered every hospital in the province to conduct an infection-control audit and report the results by January.
Women's Health Weekly
"Human Papillomavirus: Scientists Announce Vaccine Hope"
(10.02.03)
Scientists at Cancer Research UK's Paterson Institute, in collaboration with doctors at St. Mary's Hospital, tested a vaccine, TA-HPV, and found that it shrank lesions in almost half
of women with a precancerous disease of the vulva. The scientists believe the results of their study will help in the search for vaccines against vulval and cervical cancer, both strongly associated with HPV infection, although they caution that it is too early to know how effective TA-HPV will be.
Eighteen women with vulval intraepithelial neoplasia (VIN), a condition in which recancerous lesions appear on the lining of the vulva and are difficult to treat, took TA-HPV, a modified version of the smallpox vaccine. The researchers monitored the vaccine's effect on the size of the women's lesions and conducted tests to assess whether the vaccine was stimulating an immune response.
Thirteen of the 18 women developed a specific immune reaction to HPV following vaccination. In eight of the patients, the diameter of the lesions shrank by at least 50 percent.
Another four patients experienced significant symptom relief. The study marks the first time scientists have used vaccines to produce clinical and immunological responses in women with VIN.
Professor Peter Stern, lead researcher, said, "Our results were encouraging, with more than half the women in the trial gaining some clinical benefit, although I think vaccines will prove most useful as part of a combination of treatments. The big advantage vaccines have is that they are relatively free of side effects and have far less impact on a woman's quality of life than surgery, which is currently one of the mainstays of treatment for this condition."
Scientists believe vaccines may be particularly useful in women whose bodies have already begun to generate an immune response against HPV. In this study, women with high levels of immune cells within their lesions before vaccination were significantly more likely to respond to treatment than women with low levels.
"The suggestion is that vaccines work better in some patients than others because there is a need for active immune cells or their products in the vicinity of a lesion. It could be that we'll need to test women beforehand, to identify a group who are most likely to benefit from vaccination," said Stern.
"It's also possible that repeated vaccination may build up the immune response against cancer, in which case it might be necessary to give women a number of shots of vaccine during a course of treatment," Stern explained.
Stern and colleagues are currently testing the effect of repeat vaccination in ongoing clinical trials.
Dr. John Toy, medical director of Cancer Research UK, said, "There are two kinds of cancer vaccines being investigated at the moment: prevention vaccines, to try to stop the disease from developing in the first place, and treatment vaccines, like this one. In the future it's likely that vaccines will play an important role in helping us control certain cancers, particularly those like vulval and cervical cancer which are associated with persistent HPV infection," Toy said.
The study, "Immunological and Clinical Responses in Women with Vulval Intraepithelial Neoplasia Vaccinated with a Vaccinia Virus Encoding Human Papillomavirus 16/18 coproteins," appeared in Cancer Research (2003;63:6032-6041).
Advocate (Baton Rouge)
"Risky-Sex Study OKs Antibiotic Use"
(11.12.03)::Joe Gyan Jr.
The prophylactic use of antibiotics can be a safe and effective way to prevent the spread of syphilis, a Tulane researcher said recently. Participants who were given antibiotics in a Baton Rouge pilot study reported no increase in unprotected sexual activity, according to Tom Farley, chair of the community health sciences department at Tulane School of Public health and Tropical Medicine.
"Until now, public health experts have been reluctant to treat people with antibiotics to prevent them from getting infected because of concerns that they may get a false sense of security and adopt even riskier behavior," said Farley. "Our results indicate this is not the case. It didn't get worse."
Farley said Baton Rouge was mapped to identify syphilis "hot spots." A mobile laboratory went into the areas and offered free STD testing. Those tested were asked to fill out a questionnaire concerning the number of sex partners they had in the past year. Respondents were considered at risk for syphilis exposure if they reported three or more sex partners in the past year or felt certain that one of their partners had other sex partners at the same time, Farley said.
Of 186 heterosexual black male and female volunteers who agreed to take part in the study during 1997-1999, 174 were treated and 125 were located for follow-ups, said Farley.
Volunteers could choose a one-time injection of the antibiotic or pills that would require additional visits for more treatment. Most chose injection. Nearly all participants said they would be willing to take antibiotics again to prevent syphilis and other STDs, he said.
At one- and four-month follow-ups, participants given antibiotics reported reductions in the number of sex partners, Farley said. At four months, 1 percent of participants had acquired gonorrhea, 5 percent had contracted chlamydia, and none had acquired syphilis, he said. "Condom use stayed about the same," said Farley. "Controlling syphilis is really key to controlling HIV," he said, since HIV is less likely to spread in the absence of syphilis sores.
The CDC-funded study, "The Acceptability and Behavioral Effects of Antibiotic Prophylaxis for Syphilis Prevention," appeared in the November issue of Sexually Transmitted Diseases
(2003;30(11):844-849).
San Luis Obispo Tribune
"Volume Rising in Needle Exchange Debate"
(11.16.03)::Julie Lynem
San Luis Obispo County does not have a syringe exchange program, but the idea of offering clean needles to drug users is circulating among some community groups and public health officials. In 2002-2003, 78 of 99 people testing positive for hepatitis C in the county reported IV drug use as their primary risk factor. Of the county's 250 AIDS cases as of June 2003, 39 percent reported IV drug use as their only risk factor.
Officials with the HIV Consortium, Economic Opportunity Commission, San Luis Obispo Hepatitis C Project, county Drug and Alcohol Service and other agencies plan to meet soon to discuss ways to educate the public and county authorities about syringe exchange with the goal of getting the Board of Supervisors to support a program.
To permit such a program, state law requires the county public health officer to declare a health emergency, and the Board of Supervisors would have to approve the state of emergency every two weeks. The unauthorized possession and distribution of needles is illegal statewide.
Some supervisors said they would need more information before taking a stand on the issue. "Hopefully, studies will educate us enough to come to a decision," said Supervisor Katcho
Achadijian. Supervisor Shirley Bianchi said she would favor it.
"It assists individuals in illegal drug use," County Sheriff Pat Hedges said of an exchange program. "It purports to decrease the spread of certain types of illnesses and diseases. But I've not been made aware of anything that necessarily supports that. Providing someone with a new needle does not guarantee they would not share that needle with someone else."
A 1999 Johns Hopkins study found that syringe exchange did not generate more crime, increase drug use among IV drug users or encourage youths to use drugs. Seven government-funded reports on syringe exchange programs found that they reduce HIV transmission without increasing drug use, according to a Human Rights Watch case study.
Associated Press
"Organization Started by University of Georgia Alums Aims to Help Children"
(11.14.03)
Two recent graduates of the University of Georgia (UGA) have founded Hearts Everywhere Reaching Out (HERO) for Children with the aim of improving the quality of life and emotional health of Georgia children who have HIV/AIDS or whose parents have died of the disease.
The founders, Garrett Gravesen and Ryan Gembala, plan to offer children sustainable programs and unforgettable experiences, Gravesen said: "These children may not live long lives but they still live important ones."
Saturday was HERO Day at Sanford Stadium in Athens. UGA Coach Mark Richt made an announcement to promote the organization, and the group sold red-and-black bumper stickers reading, "Always a Dawg. Support HERO for Children." People who bought the stickers each got a ticket to win a prize including dinners with Richt and Athletic Director Vince Dooley, cash, and a trip to Las Vegas.
"They're devoted, idealistic young people who really want to make a difference," said Dooley, who serves on HERO's board of advisers.
HERO's goal is to raise $50,000 to implement its programs. Initially, Gravesen said HERO hopes to reach 500 children in the Atlanta area. Headquartered in Norcross, HERO plans to partner with health care providers such as Grady Memorial Hospital on a mentoring initiative, a HERO for a Day carnival for children and an international pen pal program. Eventually, the group plans to expand to other cities and countries. About 4,000 UGA students and faculty helped the organization in its first fundraiser.
Philadelphia Business Journal
"FDA Fast Tracks Biosyn Gel Product"
(11.17.03)
Biosyn Inc. of Huntingdon Valley, Pa., announced Monday that the Food and Drug Administration had granted "fast track" designation to its C31G vaginal gel designed to reduce HIV transmission. "We have worked closely with the FDA on the clinical path for this candidate since it is an important product for the prevention of sexual transmission of HIV," said Anne-
Marie Corner, president and CEO. Fast track programs facilitate the development and expedite the review of new drug candidates intended to prevent or treat serious or life-threatening conditions and that demonstrate the potential to address unmet medical needs. Biosyn's gel is entering phase III clinical trials for prevention of HIV transmission, prevention of chlamydia and contraception.
CDC HIV/STD/TB Prevention News Update
Tuesday, November 18, 2003
St. Louis Post-Dispatch
"St. Louis University Will Test Hepatitis C Vaccine"
(11.17.03)::Eli Kintisch
The Center for Vaccine Development at St. Louis University is launching the first US trial of a vaccine that aims to defeat the most common type of hepatitis C, a liver infection whose chronic form affects around 2.7 million Americans.
To be done in conjunction with the Emeryville, Calif.-based pharmaceutical firm Chiron, the SLU trial marks the first attempt to test a preventative vaccine against HCV in people. An ongoing therapeutic vaccine trial by a Belgium firm is focused on curing patients with HCV. "This is the first step on that road towards preventing pain and suffering and death from hepatitis C," said Dr. Adrian Di Bisceglie, a study investigator at the SLU School of Medicine.
The trial is an initial study, mandated by the Food and Drug Administration to test safety and biologic response to the vaccine. Investigators expect to test the vaccine on 45 healthy people, whose blood will be examined for signs of an immune system response. At no stage will patients be purposefully infected with HCV.
Vaccines work by training the body's immune system to recognize and defeat viruses or bacteria. But round, spiky HCV has eluded vaccine developers for decades because it has been so hard to grow. In addition, HCV mutates quickly - sometimes causing the disturbing phenomenon of reinfection by a second strain of the virus. "That made us despondent about the prospect of developing a vaccine," Di Bisceglie noted.
But Chiron's scientists made a breakthrough this year when a new vaccine showed promise: A trial in chimpanzees showed those vaccinated could eventually fight off HCV infection. "In chimpanzees, the vaccine may not prevent infection, though it may prevent the virus from taking hold," said Di Bisceglie.
There are six main HCV types, with dozens of variants of each type. Though the vaccine is designed to attack the most common type, it is unclear how it will perform against other strains. "This is not likely to be the final vaccine for all hepatitis C viruses, though it is an important step," noted SLU Vaccine Center Director Dr. Robert Belshe.
Daily Herald
"Syphilis Cases Climbing; Lake County Sees Jump"
(11.16.03)::Tona Kunz
Significant jumps in the number of syphilis cases reported in Chicago-area counties in the first three months of 2003 have put health officials on alert, especially since the sores associated with the disease increase by up to five times the likelihood of contracting HIV and hepatitis.
In the Chicago area, "it is starting to look like one of every four cases is co-infected with HIV," said Colette Petit, STD clinic charge nurse for the DuPage County Health Department.
Officials do not yet know how the outbreak will affect suburban HIV rates.
Chicago led the nation in new syphilis cases in 2001; more recently, it has ranked second nationally in the number of cases. Although city numbers have stabilized, the disease has spread to outlying areas. Suburban Cook County saw an 80 percent increase in new cases - from 50 in 2001 to 90 in 2002. This year, only 28 cases have been reported through September in suburban Cook County, but the area is still considered by CDC to be in the midst of an outbreak.
DuPage County numbers increased from 10 total in 2002 to 16 for the first nine months of 2003. During the first three months of 2002 and 2003, Lake County cases jumped from zero to four but have since leveled off.
Double-digit percentage increases have yet to hit nearby counties like Will and Kane, although health officials say it may just be a matter of time. "Pathogens and human behavior don't respect boundaries on a map," said Thad Zajdowicz, Chicago Public Health Department medical director for the HIV/STD program.
Right now, syphilis increases are showing up primarily among white men - and to a lesser extent Latino men - having sex with other men. Illinois health officials are split on whether enough bisexual men are functioning as crossover carriers to spread the disease to the heterosexual community, as is occurring in Detroit.
According to Dr. Ronald Valdiserri, deputy director for CDC's HIV, STD and TB prevention programs, "Our challenge - and the challenge for gay and bisexual communities across America -
is to underscore the connections between syphilis and HIV, and renew the kind of commitment these communities brought to HIV prevention in the early years of the epidemic."
Associated Press
"Nigerian Tests Show Polio Vaccines Do Not Contain Harmful Hormones"
(11.17.03)::Gilbert Da Costa
Nigeria's National Hospital in Abuja said tests showed that polio vaccines used recently in a nationwide vaccination campaign do not contain hormones linked to infertility and sterility,
despite persistent fears to the contrary among Nigerian Muslim fundamentalists. Hospital administrators did not say whether the vaccines were also being checked for HIV, about which Islamic radicals had also expressed concern. Nigerian Vice President Atiku Abubakar ordered the tests after UN officials said an international drive to eradicate polio was being hampered in Nigeria by the assertion of Islamic fundamentalists that the vaccine drive was part of a US plan to decimate the Muslim population by spreading AIDS and infertility.
Daily News
"Give Cons Condoms, Pols Urge"
(11.15.03)::Joe Mahoney
On Thursday, New York Assembly Correction Committee Chair Jeff Aubry (D-Queens) and Health Committee Chair Dick Gottfried (D-Manhattan) introduced a law requiring that state prisoners get free condoms, even though sex behind bars is prohibited. The lawmakers criticized the state's "ostrich-like" approach to prison health care. "They have taken the attitude that the public won't stand for it [giving out condoms] even though they understand it would save lives," said Aubry. Of the state's 65,800 inmates, some 5,500, or about 8 percent, have HIV. Pataki administration officials quickly nixed the idea. "Do the Assembly Democrats also propose that we give inmates needles and syringes so they can shoot up drugs like they did on the outside, too?" asked James Flateau, spokesperson for the state Department of Corrections.
Milwaukee Journal-Sentinel
"16 Test Positive for TB Contact"
(11.18.03)::Marilynn Marchione
Tuberculosis skin tests were offered to about 100 students and faculty at Marquette University who had been in contact with a professor who developed an active case of the disease. Of the
16 who had positive skin tests, none has developed symptoms, and all are being given follow-up tests and chest X-rays. A physician notified Milwaukee and Shorewood public health officials in late October that the professor had TB. The professor is now being treated and is recovering at home.
CDC HIV/STD/TB Prevention News Update
Friday, November 14, 2003
Macon Telegraph
"Teen Pregnancy Clinic Could Stop Handing Out Condoms if State Budget Plans Approved"
(11.13.03)::Andy Peters; Gray Beverley
A state effort to replace safe sex counseling with an abstinence-only approach could bring changes at a teen health clinic in Bibb County.
Last month, the Georgia Department of Human Resources board approved a budget that cuts $4.7 million from adolescent health and development programs. If approved by Gov. Sonny Perdue and the Georgia Legislature, the cuts would affect 39 teen centers statewide. The money, which funds different programs in different counties, pays to staff a teen health clinic in Bibb. The new DHR proposal includes a plan to reopen five of those 39 centers as part of a pilot program to explore new ways of reducing teen pregnancy.
Those advocating safe sex counseling as a means to lower teen pregnancy rates and prevent the spread of STDs are worried that the cuts will mean that state-funded health clinics in Bibb and other counties may soon stop handing out condoms.
Ann Mintz, policy director for the Georgia Campaign for Adolescent Pregnancy Prevention, said a combination of safe sex and abstinence counseling is the best way to prevent teen pregnancy and lower STD rates. But she and other advocates worry that the new leadership of the DHR wants to abandon that method. Bruce Cook, the new DHR board chair, is the founder of Atlanta-based Choosing the Best Publishing, which sells abstinence-only curricula to schools. Perdue's aides stress that no final decisions have been made. Responding to a $1 billion shortfall,
Perdue ordered all state agencies to cut 7.5 percent out of their budgets for 2003 and 2004.
Should the cuts go through, the Macon-Bibb County Health Department likely will provide those services now offered by the Bibb Teen Parent Center - including providing physicals, condoms and birth control pills - at three other locations where they are currently offered, said Ecleamus Ricks, administrator of the Macon-Bibb County Health Department.
SWEDEN
"Chlamydia: Outbreaks Can Be Caught in the Net"
A study at Umea University in Sweden shows that the Internet and the mail are useful in tracing chlamydia among young men. The study, run by research general practitioner Daniel Novak, his thesis director Roger Karlsson and Monica Jonsson at the Unit for General Medicine, covered all 22-year-old males in Umea, Sweden, during 2002. Researchers sent participants an information sheet, a questionnaire and a coded plastic capsule. Men who wanted to be tested submitted a urine sample in the coded capsule. The samples were tested for chlamydia and results entered into a database. Participants could go online to check their results on a Web page that contained detailed information about chlamydia and other STDs and urged those who tested positive to come in for free treatment. This method of obtaining results yielded a 39 percent response rate (396 of 1,016 interviewees), the highest published participation rate ever in a chlamydia screening of young men.
Four of the men tested positive. Three received their results via Internet and sought treatment on their own. Researchers contacted the fourth man, in accordance with the Act on Contagious Diseases, and found that he did not understand Swedish well enough to get his result.
The two most common reasons men did not want to participate in the study were that they did not believe they were infected (50 percent) and they were in a stable relationship (55 percent).
The full report, "The Internet, a Simple and Convenient Tool in Chlamydia trachomatis Screening of Young People," was published in Eurosurveillance (2003;8(9):171-176).
CDC HIV/STD/TB Prevention News Update
Tuesday, November 11, 2003
Rutland Herald
"STDs Are Up in Vermont, Health Department Says"
(11.07.03)::Darren M. Allen
Last year, Vermont saw a nearly 50 percent jump in chlamydia cases and an almost 30 percent spike in gonorrhea, according to the state health department. Some of the rise could be attributed to more accurate testing and diagnosis, said Marilyn Richards, STD coordinator.
There were 954 chlamydia cases in Vermont in 2002, affecting 161 out of every 100,000 people, a rate 49.5 percent higher than in 2001. The rate is significantly lower than the US average of about 278 cases per 100,000 people but up 131 percent from Vermont's 1998 rate.
Gonorrhea cases totaled 98 in 2002, a rate of 17 infections per 100,000 Vermonters, up 29 percent over 2001 but still lower than the US average of approximately 129 cases per 100,000 people. While the numbers are low, the state said last year represented the highest incidence rate in 10 years.
Infection rates varied among age groups. The chlamydia infection rate for 20- to 24-year-olds equaled 1,084 for every 100,000 people. Sixty percent of gonorrhea cases were in people ages 15-24.
Syphilis, considered eradicated in Vermont since 1998, appeared again. Two cases were reported in 2002, with each patient identifying the source of infection as out-of-state sexual partners. Syphilis "continues to enter Vermont sporadically through the mobility of our population," the department said.
"Abstinence is your best protection," said Richards, while noting that using condoms and limiting sexual partners are also crucial to avoiding STDs.
Barrie Silver, marketing director for Planned Parenthood of northern New England, said the organization has an STD outreach program aimed at young men. "Teenagers lack a basic knowledge of birth control and sexually transmitted infections," she said. "The mission of Planned Parenthood is to make sure that young people get all of the information they need to protect themselves."
American Journal of Health Behavior
"Integrating Behavioral Theory to Understand Hepatitis B Vaccination Among Men Who Have Sex with Men"
(07.-08.03) Vol. 27; No. 4; P. 291-300::Scott D. Rhodes, PhD, MPH, CHES; Diane M. Grimley,
PhD; Kenneth C. Hergenrather, PhD, MRC, MSEd
Annually, 6,000 deaths occur from complications of HBV infection, according to the current study, even though the disease is preventable and a vaccine has been licensed in the United States for 20 years. Although CDC recommends HBV vaccination for all men who have sex with men, US epidemiologic data and results from community-based HBV vaccination programs indicate the majority of MSM are not vaccinated.
The authors used a theoretically integrated framework to identify beliefs and attitudes associated with motivational readiness for HBV vaccination among at-risk MSM. Theories and models for the study included the transtheoretical stage of change model (which describes behavior change on a continuum from precontemplation to contemplation to preparation to action to maintenance); the health belief model (which predicts participation in programs to prevent or detect disease based on factors such as perceived threat of infection and perceived benefits of and barriers to treatment); and social cognitive theory (which measures perceived self-efficacy as one of its central concepts). The researchers investigated the applicability of the constructs to issues of HBV vaccination "in order to provide information that can be used to design, deliver, and evaluate stage-appropriate intervention strategies to increase HBV vaccination among MSM," they wrote.
The authors gathered information from patrons who filled out questionnaires at two predominantly gay bars in Birmingham, Ala., during August and September 2001. The mean age of the 358 MSM participants was 27.6 years, with a range from 18 to 56. African Americans accounted for 47.8 percent of the sample; whites made up 43.3 percent; 5.3 percent were Native American; and 3.7 were Hispanic/Latino, Asian, or Native Hawaiian/Pacific Islander. Most participants reported some college or above, yearly incomes of more than $20,000, and having private health insurance. Over half the participants reported 10 or more lifetime male partners and two or more sexual partners within the past 30 days. Nearly a third reported having had sex with females as well as with males during the past five years; and nearly 20 percent of the subjects reported a lifetime history of STD diagnoses. Almost 8 percent reportedly had been diagnosed with HIV; about 10 percent had received blood or blood products before 1992; 8.9 percent reported injection drug or steroid use; and 4.9 percent reported ever having shared injecting drug equipment.
Using a variety of analytical methods, the authors found that MSM with increased readiness to complete the 3-dose vaccination series perceived lower practical barriers and greater benefits to vaccination, perceived higher severity of infection, and had higher self-efficacy to complete the vaccine series.
"Relationships between stages of change and theory-based constructs from the health belief model and the social learning theory follow predicted patterns suggesting that these theories may provide useful frameworks for understanding vaccination readiness and intervention strategy development among MSM," the researchers concluded.
South Florida Sun-Sentinel
"Three-Year Syphilis Outbreak Brings New Clinic to Wilton Manors"
(11.07.03)::Bob LaMendola
In response to a three-year increase in syphilis cases, the Broward County Health Department is opening a new STD clinic in Wilton Manors. The syphilis outbreak is occurring mainly among
gay men and others engaging in unprotected sex and is especially affecting the gay communities in Wilton Manors and Miami Beach, health officials said.
The new clinic at 1402 NE 26th St. will be open from 4:30 p.m. to 7 p.m. on Wednesdays and Thursdays to test people for the disease and spread prevention information, said Theresa Lowery of the Health Department's STD unit. The clinic will be in a shopping center storefront donated by Holy Cross Hospital. Services will be free, and treatment can be arranged through the clinic.
Broward health officials thought syphilis had all but faded away when they counted only 13 cases in 1998, but the number of infections began increasing in 2000. In 2002, 133 cases were diagnosed, and this year's total of 108 cases as of Aug. 3 is up 46 percent over the same period last year. Federal health officials have visited the area to help plan strategies to combat the outbreak.
In addition, a Broward and Miami-Dade task force nicknamed "SoBe Syph" is directing a campaign at gay men, focusing on bars, nightclubs and gay community groups.
CDC HIV/STD/TB Prevention News Update
Monday, November 10, 2003
Associated Press
"Newspaper: Federal Government Fails to Warn Public About Hepatitis C"
(11.09.03)
On Sunday, the Kansas City Star reported that nearly every public education campaign about hepatitis C, a virus that infects millions and kills thousands every year, has sputtered, with the government often citing lack of funds as the reason. In addition, the government did not follow through on a plan to notify tens of thousands of patients they might have been infected by HCV from blood transfusions before 1992.
"They [federal officials] basically failed to do what they needed to do to stay on top of the challenge of hepatitis," said Arthur Caplan, a bioethicist and former chair of a federal blood-safety committee.
CDC says 8,000 to 10,000 people die of HCV each year. A 2002 National Institutes of Health conference put the death toll at 10,000 to 12,000 but said that might be low. The total number of HCV infections, according to CDC, is 3.9 million.
"CDC has been working with numerous partners to better understand the extent of the infection in the United States as well as educating the public about how HCV is transmitted, what they can do to protect themselves, and the need for testing and counseling for those at risk," CDC Director Dr. Julie Gerberding said in a statement.
HCV, which attacks the liver, can lie dormant for 10 to 30 years. CDC officials believe that most Americans with HCV do not know they have it.
Hal Margolis, director of CDC's viral hepatitis division, acknowledges that much more public education needs to be done, but cites a lack of money. "We're putting out as much as we can," he said.
In 2000, Surgeon General Dr. David Satcher wanted to send a letter to every American household warning of the epidemic, but his office did not have $30 million to $40 million for postage, and Congress had legal problems mailing a letter from another branch of government.
In 1999, FDA officials pledged to look for at least 188,000 people who may have had tainted transfusions, but the effort quietly faltered. Officials, however, say there has been no foot-dragging. The search for patients simply takes a long time, according to Jay Epstein, director of FDA's Office of Blood Research and Review.
Associated Press
"Blood Banks Pass Up Test that Might Have Prevented Thousands of Infections"
(11.10.03)
US blood banks in the early 1980s failed to use a screening test for hepatitis C that could have prevented thousands of infections, the Kansas City Star reported. The Star used data from studies at the time and estimated that if screening that detected an enzyme indicating liver damage had been implemented, more than 300,000 HCV infections might have been prevented.
A group of blood industry experts - including representatives from the American Red Cross, the American Association of Blood Banks and the Council of Community Blood Centers - met in Washington in 1981 and decided ALT [alanine aminotransferase serum] testing for HCV would decrease the number of patients infected by transfusion.
For the next five years, however, the industry left ALT testing on hold, citing a lack of scientific evidence that it would reduce HCV cases in practice. It also worried about the difficulty in setting up the testing - a working group that was appointed at the January 1981 meeting to draft guidelines never met.
In addition, blood industry leaders argued that they would lose many donors. Of those who tested positive in the ALT test, they pointed out; only a third might have HCV. However, two extensive studies had estimated that only 1.5-3 percent of all donors would be excluded.
"In hindsight, maybe we could have done differently, but that's hindsight," said Paul Holland, who chaired the blood industry committee on hepatitis testing in 1981.
Just how many infections the ALT test could have prevented is impossible to estimate. And there is no way to determine how many people among the approximately 450,000 HCV patients infected by transfusion are alive today.
"Certainly if I had seen this information I would have had the test in place in 1981," said Ron Gilcher, head of the Oklahoma Blood Institute, who nonetheless broke ranks and began testing in 1983.
Johanna Pindyck, a participant at the 1981 meeting, also began using the test at her blood bank. "This was a serious disease, and it was a preventable disease," said Pindyck, who was director of the Greater New York Blood program.
In 1986, the Red Cross and other blood associations asked blood banks to use the ALT and hepatitis B core antibody tests. By 1987, most did. In 1992, new tests screened almost all hepatitis C from the blood supply.
Associated Press
"Clinton, in China: World Must Collaborate to Fight Diseases Like SARS, AIDS"
(11.10.03)::Stephanie Hoo
Former President Bill Clinton praised the Chinese government today for its decision to help 5,000 poor AIDS patients receive treatment through next year, and he said the SARS epidemic demonstrated how countries and companies must collaborate to fight disease.
"We cannot escape each other's fate," he told a symposium convened at Tsinghua University to explore ways to fight AIDS and SARS. "This medicine issue is an international scandal," he said, referring to the need for more affordable AIDS drugs. "Money shouldn't determine who lives and dies from AIDS." The one-day session brought together AIDS and SARS experts and others to explore strategies for fighting the diseases.
Last week, Chinese Executive Vice Health Minister Gao Qiang announced the treatment plan for patients with "financial difficulties" and said central and local governments have committed $820 million for AIDS units. Clinton said such initiatives would help foster Chinese economic progress.
"China has come too far to see the future of millions of people derailed," Clinton said, noting that the central government in Beijing, because of its recent experience fighting SARS, is in a unique position to effect change. "The Chinese are famous for good planning," Clinton said. "AIDS kills more people in two hours than SARS killed in total."
Dr. David Ho, executive director of the Aaron Diamond AIDS Research Center in New York, said China's government must act immediately. "A large and comprehensive societal response is in order," Ho said. "If there is no health, there is no prosperity."
Ho said local governments were "waiting for a clear directive from the top" before launching AIDS efforts. New HIV infections in China grow annually by about 30 percent.
Huang Jiefu, China's deputy minister of health, said, "We have learned from the SARS crisis that in today's world, there is no distinction between domestic disease and international diseases. There is no island in the world today."
San Jose Mercury News
"Event to Focus on Liver Ailment"
(11.08.03)::Nicole C. Wong
Over the weekend, the Youth Leadership Conference on Asian & Pacific Islander Health at Stanford University drew 105 students from 33 high schools throughout California to discuss hepatitis B. The idea was for students to go back to their communities and spread the word about HBV, which disproportionately affects Asian Americans. HBV is "the greatest health disparity between Asian Americans and Caucasian Americans," said Dr. Samuel So, director of Stanford's Asian Liver Center, sponsor of the conference. It is unclear why Asian Americans have a higher rate of HBV, "a disease that is totally avoidable," said So. According to the center, one in 1,000 US Latinos is infected with HBV each year. The rate is the same for whites and a bit higher for blacks - five in 1,000 annually. But for American-born Asians, the rate is 16 in 1,000.
CDC HIV/STD/TB Prevention News Update
Friday, November 07, 2003
Associated Press
"Survey Finds Support for Showing Students How to Use Condoms"
(11.07.03)
Most Indiana residents surveyed believed public high schools should teach teens how to use condoms properly to prevent HIV/AIDS, but they oppose distributing free condoms in school, according to research presented Thursday by Indiana University professor William L. Yarber at the meeting of the Society for Scientific Study of Sexuality in San Antonio.
Of those surveyed:
*82 percent agreed that teenagers who use condoms are being responsible.
*80 percent disagreed with the statement that a person who carries a condom has a lot of casual sex.
*77 percent favored teaching high school students how to use condoms properly.
*71 percent favored letting students see and touch condoms as part of classroom instruction.
*71 percent said local parents should determine what is taught about condom use.
*68 percent disagreed with the statement that promoting condom use is the same as promoting sex.
*54 percent favored explicit instruction on how to use condoms - for example, by showing how to put one on a banana or other object.
*46 percent favored distributing free condoms in schools.
However, only 39 percent thought condoms were "very effective" at preventing the spread of HIV and STDs, despite scientific consensus that they can reduce risk, Yarber said.
"Overall, the study shows that Hoosiers are adamant that medically accurate instruction of how to use condoms - not just that condoms exist - should be present in our high schools, said
Yarber, a senior research fellow in the Kinsey Institute for Sex, Gender and Reproduction.
The random telephone poll of 500 adults statewide, conducted by IU's Center for Survey Research between July and October has a ±4.4 percent margin of error. A similar 1993 study found 79 percent supported teaching teenagers proper condom use.
Gay City News
"Town Hall Forum Responds to Unsafe Sex"
(10.30.03)::Duncan Osborne
In response to the increase in unsafe sex, a panel discussion including playwright and actor Harvey Fierstein will take place at the Lesbian, Gay, Bisexual and Transgender Community Center in New York City on Thursday, Nov. 16. Fierstein was enlisted for the forum after he published "The Culture of Disease," a New York Times editorial arguing that having HIV had been made to appear manageable, even sexy. Fierstein called upon the gay community to "resist the normalization of disease and once again embrace health."
Friends Dan Carlson and Bruce Kellerhouse were talking about organizing an HIV awareness and prevention event when the editorial appeared. "Certainly, I was seeing people in my practice who were seroconverting. I was also aware of increasing rates of seroconversion among gay men," said Kellerhouse, a psychologist in private practice and panel member.
"I talked about my own personal experience in meeting people who wanted to have unsafe sex with me and becoming, at times, rather persistent about that," said Dan Carlson, referring to discussions he had had with Kellerhouse.
Panel members for "Challenging the Culture of Disease: A Panel Discussion with Harvey Fierstein" include Dennis deLeon, president of the Latino Commission on AIDS; Dr. David Kim, a physician in private practice; and Jeffrey Jones from San Francisco's Stop AIDS Project.
"My feeling about [Stop AIDS] is they are on the cutting edge,' Kellerhouse said."I want to hear how they do what they do and I think it's important for other people to know that is possible."
"We feel that the structure that's in place, the organizations, the agencies who have been conducting the prevention dialogue in New York City, that whatever it is they are doing isn't working," said Kellerhouse. "The event in some ways is a deliberate attempt to create a new dialogue and discourse about what's going on."
Mail Tribune
"County to Halve the Number of Condom-Use TV Spots"
(11.06.03)::Jonel Aleccia
Southern Oregon TV stations will continue airing only one of two controversial ads aimed at encouraging teenagers to use condoms. The other ad, which features two teens in the throes of passion, will not resume, said Jackson County Health and Human Services Director Hank Collins.
Jackson said the move was not a response to community criticism of the two 30-second spots, which have aired for six weeks on commercial and cable stations. When he spoke to a handful of critics, Collins said he found out they had not seen the ads. "There was clearly an organized movement out there where people were told to call this number and complain," he said.
The ad campaign will end after November, pending the launch of a similar, statewide media effort next year by Planned Parenthood, and an assessment of the campaign's effectiveness.
Co-sponsored by the Jackson County Health Department and the local Planned Parenthood affiliate, the ads were purchased with about $10,000 in state family planning funds. About $2,000 of the money remains, Collins said, and will be used to run the ad several more times, though less frequently than before.
Kellie Shoemaker, Planned Parenthood's community outreach coordinator, said response has been overwhelmingly positive. "We haven't received anything negative. People say they like the parent piece a lot." The ad that continues to run urges teens to "Protect yourself. Love, Mom and Dad."
The ads are based on the theme, "Love, Mom and Dad," replacing the "O's" in the message with unwrapped condoms. The second ad featured a teen couple who paused in their activities to find a condom left by the girl's parents.
In January, Oregon Planned Parenthood will hold a strategy session to discuss its "Rights, Respect and Responsibility" campaign.
Times Journal
"HIV, Hepatitis Testing Could Take Months"
(11.05.03)::Canadian Press
It could take up to six months to determine the health of 146 patients who received throat or colon examinations with cleaned but unsterilized equipment last week at Lakeridge Hospital in Oshawa near Toronto, a hospital official said Tuesday. However, Dr. Michael Silverman, an infectious disease specialist, said after days of poring through patient records, the hospital believed no one with known hepatitis A or B, or HIV, had contact with the instruments. But the hospital had not yet ruled out hepatitis C, he added. Testing for HIV and hepatitis, and hepatitis vaccinations continued Tuesday. Patients will have to be monitored over the next six months to rule out any infection, said Janice Dusek, the hospital's chief administrator. Scoping equipment is cleaned and disinfected after each use. Last week, the equipment was cleaned with detergent twice, instead of once with a detergent and once with a disinfectant. The cleaning and disinfecting process is automated. Dusek said the risk of anyone getting a blood-borne or other infection from the equipment is "extremely low."
Southern Voice (Atlanta)
"Health Summit Readies in Florida"
(11.07.03)::Van Gower
A wide range of health issues - including HIV, STDs, nutrition, substance abuse and spiritual and mental wellness - will be on the agenda during the annual Southeast Regional Gay Men's Health Summit next week in Sandestin, Fla. About 150 people are expected to attend and take part in more than 40 workshops. The event runs Nov. 13-16; telephone 404-870-7822 for registration information.
CDC HIV/STD/TB Prevention News Update
Thursday, November 06, 2003
Portland Press Herald
"State Broadens Its TB Search"
(11.06.03)::Josie Huang
The fight against a tuberculosis outbreak among homeless people in Portland has spread beyond city limits. Public health workers are searching the state for people who had close, extended contact with six men diagnosed with active TB between August 2002 and Spring 2003. The state has lent staff to the city, and CDC consultants have been assisting in the search.
Nearly $100,000 from CDC has allowed Portland to hire a full-time public health nurse and certified nurse assistants and to extend the hours of its staff medical officer.
So far, about 120 of 300 people on the "high priority" list have been found. Preliminary tests show 28 with latent TB. Health workers are querying shelters, jails and treatment centers where members of the high-risk pool may have been. Nate Nickerson, public health director for Portland's Department of Health and Human Services, said health workers are also contacting homeless advocates and trying to match names with addresses on general assistance rolls.
Dr. Kathleen Gensheimer, state epidemiologist, said by year's end Maine hopes to set up an information network among homeless shelters, methadone centers and county jails to help control TB transmission.
The last TB outbreak in Maine was in 1989, when 700 people associated with Bath Iron Works were infected, and 24 developed active TB. Cases were traced back to one employee who had the disease for nine months before he was diagnosed.
In the current outbreak, three of the six cases are linked to one man who made 42 trips to the emergency room and was given several X-rays before he was diagnosed with TB last March. He may have been infectious for two years or more.
Dr. Stephen Sears, infectious disease specialist at Maine General Medical Center in Augusta, urged health care workers at a recent conference to be vigilant about symptoms. "You have to raise your suspicions higher or you're going to miss it or not think of it when someone comes in," Sears said.
Detroit News
"Hidden Cases in Michigan Lead to New Worries About Hepatitis"
(11.03.03)::Shawn D. Lewis
The number of reported hepatitis C virus cases in Michigan has risen from 2,385 in 2001 to 4,500 cases currently because those who contracted it 10 to 30 years ago are just now discovering they have the virus. But there are thousands more cases in the state that are undiagnosed and unreported.
"The new cases have actually leveled off. But we're very worried about all those people infected years ago now finding out, because many will need liver transplants," said Kim Kirkey, hepatitis coordinator for the Michigan Department of Community Health.
Hepatologists - doctors who specialize in liver diseases - expect the number of chronic HCV cases to rise, as more people harboring the virus for 20 years or more are identified and reported. "This represents the way hepatitis C is exploding across the medical landscape, causing 8,000 deaths a year and that number is expected to triple in the next 20 years," said Dr. Dilip Moonka, transplant hepatologist and director of the viral hepatitis clinic at Henry Ford Hospital.
Hepatitis C is the number-one chronic blood-borne disease in the nation, with over 4 million infections, and is the leading cause of US liver transplants. A blood transfusion before 1992, when testing of the nation's blood supply began, is one of the primary factors for HCV infection.
HCV attacks the liver, and in some cases, causes liver failure, cirrhosis, and eventually, death. About 20 percent of people who contract HCV will clear it from their body, but the other 80 percent develop chronic infection. There is no vaccine for HCV.
"The treatments we have are not so great because they are very expensive, and many people can't tolerate them because of severe side effects," said Matthew Boulton, state epidemiologist.
"And if they do tolerate the drugs, many relapse and the disease returns later." Forty-eight weeks of treatment can cost between $10,000 and $12,000, and the success rate is only 30-50 percent.
Journal of Infectious Diseases
"Prevalence of Chronic Hepatitis B and Incidence of Acute Hepatitis B Infection in Human Immunodeficiency Virus-Infected Subjects"
(08.15.03) Vol. 188; No. 4:P.571-577::Scott E. Kellerman; Debra L. Hanson; A.D. McNaghten;
Patricia L. Fleming
The current study determined incidence and risk factors for acute and chronic hepatitis B virus (HBV) infection and vaccination rates among HIV-infected subjects from the Adult/Adolescent Spectrum of HIV Disease Project during 1998-2001. ASD is a longitudinal, medical-record-review study conducted by CDC in collaboration with researchers and state and local health departments in 11 geographical areas.
To study risk for acute HBV, the investigators restricted their analysis to 16,248 HIV-infected subjects with no known documented clinical or laboratory history of acute or chronic HBV who had been clinically observed some time during July 1998-June 2001. They found 316 cases of acute HBV (12.2 cases/1000 person-years). In this group of subjects, 2,479 received = 1 doses of the hepatitis B vaccine before or during the study period. Multivariate analysis showed higher rates of acute HBV infection among black subjects and those with a recent history (i.e., in the six months before an observation) of alcohol abuse and/or injection drug use.
"During the study period," the authors noted, "=1 doses of hepatitis B vaccination and prescription of ART or HAART with and without lamivudine were associated with a decreased risk for acute HBV infection; however, the estimated rate ratios of the association between ART or HAART regimens with and without lamivudine and a lower incidence density of acute HBV infection were approximately equal to those of regimens without ART. Low CD4 counts were not significantly associated with acute HBV; however, a previous diagnosis of an AIDS opportunistic infection was associated with a higher incidence density of acute HBV infection."
Among the 19,904 unvaccinated subjects eligible for analysis of the presence of chronic HBV infection followed up during the study period, the researchers identified 1,506 cases of chronic
HBV infection, for a three-year 7.6 percent prevalence. "The prevalence of chronic HBV infection was higher among men than among women and was lowest among Hispanics," the investigators found. "The highest prevalence, by risk group, was among MSM who were IDUs."
"Specifically, we applied our estimates of acute and chronic HBV infections to the prevalence of HIV in the United States (850,000-950,000 persons, as of 2000), including persons who know their HIV status and those who do not, while excluding the ~14% who were vaccinated against HBV," the study reported. "We determined that, in the United States, 55,600-62,100 persons may be coinfected with chronic HIV/HBV coinfection."
The researchers estimated the approximate range of incident cases of acute HBV infection in HIV-positive people - excluding those with prevalent chronic HBV infection, those vaccinated against HBV, and those with a previous, resolved acute HBV infection - may be as high as 5,100-5,700 cases per year. "Despite reported decreases in HBV seroincidence among high-risk groups - decreases associated with the adoption of safer sex practices and the availability of an effective HBV vaccine - the results of this study confirm that HIV-infected persons remain at risk for HBV infection," the researchers wrote.
"Because HBV and HIV are transmitted via the same routes, new cases of acute HBV infections, in persons known to have HIV infection, suggest that some HIV-infected persons do not adhere to traditional risk-reduction messages - that is, safe sex and/or safe injection practices. This finding suggests that prevention messages designed to decrease HIV transmission may not be effective or may be less effective, in the prevention of new comorbid infections such as HBV," the authors concluded. "Prevention programs specific for HIV-infected persons, such as
the Serostatus Approach to Fighting the HIV Epidemic (SAFE) Initiative being developed by the CDC, will focus prevention efforts on HIV-infected persons, as well as on HIV-negative persons at high risk."
Barre Montpelier Times Argus
"Vermont's 'Operation Hairspray' Enlists Hairdressers to Spread Health Information"
(11.04.03)::Peter Crabtree
A dozen Bennington County social service workers, health care providers and hairstylists gathered Monday for an "Operation Hairspray" workshop at the West Mountain Inn in Arlington, invited by the Vermont Department of Health. The goal of the meeting was to discuss the health resources available to local women and ways of getting the message out, said Christine
Bongartz, a public health nurse. From breast self-exams and smoking cessation to HIV testing, few people are as well positioned as hairdressers to spread the word.
Between raffle drawings and receiving goody bags, the hairdressers heard suggestions about ways to present information and improve public health.
Hairdressers should look as well as listen, said Cynthia Himmel of the AIDS Project of Southern Vermont. She suggested that they be sensitive to evidence of risky behaviors by their clients. If a client suggests she has been partying so hard that she cannot remember the details - opening the possibility of unprotected sex - a hairstylist can intervene. "It's really a fragile moment, a chance to say, 'Are you really taking care of yourself?... Are you putting yourself at risk?'" If a customer has new piercings or tattoos, the stylist has the opportunity to ask if they were done professionally.
Bridget Andrews of Hair 'n' Now asked how to handle questions from customers who object to condoms being distributed in a salon restroom. "We're not promoting sex," said Sharon Morrissey, owner of Sharon's Style Shoppe. "We're just promoting healthy lives."
Mary McVean, a family nurse practitioner, acknowledged the role Morrissey and her colleagues played in the lives of their customers. "Women come and tell you their deepest, darkest problems or complaints," she said.
Associated Press
"Thumb Schools Report 34 Tuberculosis Infections"
(11.04.03)
Thirty children and four teachers in Michigan's Thumb region have tested positive for tuberculosis. "A positive TB skin test means you've acquired the germ in your body, but it does not necessarily mean you have the active disease," said Gretchen M. Tenbusch, health officer for the Tuscola and Huron county health departments. Health department workers offered TB tests to staff members and students after a fifth-grade teacher and eighth-grade student came down with the disease. During the past week, health workers have tested 407 students and employees in the school district. The teacher and student are recovering at home. The 34 students and staff who tested positive for TB will begin taking the TB drug isoniazid. Of those who tested positive, results of chest X-rays have been received for about 11, Tenbusch said. So far, none of the X-rays has shown an active case of TB.
Lexington Herald Leader
"Lafayette Students to Get TB Tests"
(11.06.03)::Lisa Deffendall
About 150 Lafayette High School students will be tested for tuberculosis after a 16-year-old classmate began treatment Friday for suspected TB, Fayette school and health officials said Tuesday. The school system was notified late Tuesday afternoon, and letters were sent home to all families at the school. Students suspected of having had contact with the infected teen will get letters today seeking permission to test for TB. The teen is the 11th person in Fayette County to contract the disease this year. Two rounds of testing will be done - one next week and another in two or three months for follow up. "We intend to monitor the situation carefully along with our public health experts to prevent any further potential exposure and to ensure any affected students and staff receive medical attention," Fayette School Superintendent Ken James said. The infected teen is expected to make a full recovery and will likely return to school after two or three weeks when he is no longer contagious.
CDC HIV/STD/TB Prevention News Update
Wednesday, November 05, 2003
Associated Press
"South Dakota Sees New Cases of Syphilis"
(11.04.03)
After a 10-year lull, South Dakota is seeing a rise in new syphilis cases. Since June, five cases have been reported in the southeastern portion of the state. Previously, the state had just three cases in the last five years.
The state Department of Health is trying to contain the disease by monitoring syphilis patients and following up with their sex partners. But the department does not have a clear explanation for the rise.
"We've been in a phase of having syphilis eradicated from South Dakota in the last decade," said state epidemiologist Lon Kightlinger. "When you have such low numbers for such a long period of time, people just don't think about it." According to Kightlinger, that could lead to complacency and an increase in unprotected sex or sex with multiple partners.
"One of the scary things about syphilis is having syphilis lesions makes you more susceptible to HIV, because the syphilis lesion provides an easy entry point," noted Kightlinger.
Though the outbreak has not reached a point where a public education campaign is necessary, the state has alerted physicians to be on the lookout, said Kightlinger, adding that there had been local transmission in the southeast, not just infections brought in from outside the state.
Kate Looby, state director of Planned Parenthood, said she is alarmed by the new cases. Planned Parenthood has been placing signs with syphilis information in men's restrooms in Sioux Falls bars and casinos since September. Looby said young men are the group most at risk for contracting syphilis.
Looby believes more STD information is needed statewide. "It would be hard for me to say that we're doing enough, because we're continuing to see so many patients that have [STDs]," she said.
In South Dakota, chlamydia is the most common STD with 2,215 cases last year. There were 263 cases of gonorrhea and 21 new HIV infections in 2002.
Reuters Health
"Many Teen Girls Date More Than One Person at a Time"
(10.22.03)::Alison McCook
About half of teenage girls have been in a "non-exclusive" relationship, in which they and their partners could date other people, according to a survey of 12- to 15-year-old girls. And while having more partners can increase the risk of sexually transmitted diseases, less than half of the girls who date more than one person at a time said they had sex in the outside elationships, say the authors of the report.
Study author Dr. Mary Short, of the University of Texas Medical Branch Children's Hospital-Galveston, and colleagues surveyed 160 girls about their romantic relationships once every six months for three years. A total of 72 girls (45 percent) said they had been in a relationship in which they and their partner could date other people. Twenty-three girls said they had had sex in that outside relationship.
The investigators found that girls who were younger and believed their boyfriends were dating other people were more likely to have an outside relationship. Furthermore, girls who said their parents did not always know their whereabouts were more likely to be in a non-exclusive relationship, while girls who spent a lot of time without adult supervision were more likely to have sex in their outside relationships.
These results suggest that parental monitoring of kids' activities - through communication and supervision - "is just a good thing," said Short. "Parents need to talk to their children, set developmentally appropriate limits, and know their children's - and teens' - friends, activities, reading materials, and TV and movie watching habits," added Short.
Being in a non-exclusive relationship may not necessarily be a bad thing, Short noted. Relationships help people learn about themselves and how to relate to others, and the more relationships one has, the more one may learn, wrote the authors. However, Short cautioned, "We are not encouraging adolescents to cheat, even if it happens. It is better to have one boyfriend at a time or to be dating than to be having outside relationships."
The study, "Non-Exclusivity in Adolescent Girls' Romantic Relationships," was published in the journal Sexually Transmitted Diseases (2003;30(10):752-755).
Milwaukee Journal Sentinel
"Students, Faculty Offered TB Tests"
(11.04.03)::Scott Williams
Students and faculty at Waukesha County Technical College are being offered free TB tests following the news that a female student was diagnosed with the disease. The student is recuperating at home and doing well. Health officials said there is no reason to believe anyone has been infected through casual contact with the student. Officials said they found no connection between the student and a Marquette University professor reported last week to have contracted tuberculosis. Wisconsin reported 78 TB cases last year.
Plain Dealer
"20 New TB Cases Routine, School Safe, Officials Say"
(11.05.03)::Amanda Garrett
Cuyahoga County health officials said Tuesday that 11 of 142 adults and nine of 471 students tested positive for tuberculosis at Marion-Sterling Elementary School in Cleveland, but that the building is safe and that children should be in school. Of those testing positive, four had been previously diagnosed with TB, while the test results of four others are in dispute. Having a positive skin test does not mean that a person has active TB. Those testing positive have the option of being treated with oral antibiotics. Officials discovered the school cases last month while investigating how someone connected with the school contracted TB. In a separate TB investigation underway following the death of a chaplain at St. Michael Hospital, tests of more than 300 workers and 15 patients have revealed no additional cases. Cuyahoga County has seen no surge in TB, said Dr. Richard J. Blinkhorn Jr., director of the county Tuberculosis Clinic.
There were 71 TB cases last year, 67 in 2001 and 86 in 2000. The county estimates there will be 60 cases this year, said Blinkhorn.
CDC HIV/STD/TB Prevention News Update
Monday, November 03, 2003
Birmingham News
"Jail Contractor to Treat Hepatitis C"
(11.02.03)::Carla Crowder
Medical costs in Alabama prisons are expected to rise as the new medical contractor begins treating hepatitis C. On Monday, the state's three-year, $142 million contract with Brentwood,
Tenn.-based Prison Health Services takes effect, assuming care previously provided by Birmingham-based Naphcare for about $29.5 million a year.
According to Ronald Cavanaugh, director of treatment for the Alabama Department of Corrections, it will be the first time state prisons will offer HCV treatment and have a protocol for prevention and education. The new HCV treatment and prevention program alone will cost the department $3 million to $8 million.
In addition, the new contract will include greater accountability, better staffing and improved treatment for hepatitis as well as HIV. Currently, Alabama prisons are facing at least four class-action lawsuits relating to adequacy of care, with allegations that Naphcare and other providers failed to provide adequate care for prisoners with chronic conditions such as HIV and diabetes.
Many inmates contract HCV through high-risk lifestyles prior to incarceration. Cavanaugh said he has seen national estimates as high as 40 percent for the rate of HCV-infected prisoners.
Most reports put the number at 17-30 percent nationwide. The exact rate in Alabama is unknown. In the general US population, HCV infection rates are about 1.8 percent, according to CDC.
A window for HCV treatment often comes while prisoners are incarcerated. If care is not provided, the disease can progress and lead to a need for costly care once they are released, or it can become fatal, experts say. State prison health workers will begin identifying patients who would be appropriate candidates for treatment. Cavanaugh estimated a couple hundred prisoners initially may be identified.
Charles Edwards, community resource officer for Pardons and Paroles, said he welcomes the improved care. Parolees with HCV regularly report to his office; because the disease creates a greater susceptibility to illness, they "have a hard time holding jobs." HCV-infected parolees often need extra medical care, but most have no insurance.
USA Today
"When 'Friends' Talk, Teens Listen"
(11.03.03)::Marilyn Elias
A "Friends" episode that aired Oct. 11, 2001, might have taught teenagers more about safe sex than hours of adult preaching, a survey suggests. Rebecca Collins, a RAND senior behavioral scientist, surveyed 506 frequent viewers ages 12-17 within a few weeks of the episode, then six months later. Her report shows that many got the safe sex facts. The article,
"Entertainment Television as a Healthy Sex Educator: The Impact of Condom-Efficacy Information in an Episode of Friends," appeared in Pediatrics (2003;112:1115-1121).
On "Friends," Rachel told Ross she was pregnant even though they had used a condom. The show twice mentioned that condoms are 97 percent effective. According to Nielsen Media Research, about 1.7 million children ages 12-17 saw the episode.
About two-thirds of the viewers in Collins' study recalled that condom failure had resulted in pregnancy. Roughly a third even remembered the success rate for condoms.
Approximately two out of five children surveyed had watched with an adult. Collins found that watching with an adult helped teens have clearer recall about condom effectiveness and talking to an adult about the show increased their knowledge.
Vicky Rideout of the Kaiser Family Foundation said prime time TV is "saturated with sex." According to Kaiser's 2003 report, about seven out of 10 shows have sexual content, averaging six sexual references an hour. But she added that one out of four shows that talk about or depict sex also mention safer sex, waiting or consequences, up from about 14 percent in the foundation's survey four years ago. In the 20 top shows watched by teens, almost half the episodes about sex mention safer sex.
A recent Kaiser study showed 70 percent of teens said television sex influenced the behavior of kids their age. Tamara Kreinin, president of the Sexuality Information and Education Council of the United States, said parents should try to watch television with their teens so they can help interpret and even magnify positive messages.
Boston Globe
"Teaching Safe Sex, Ugandan-Style"
(10.28.03)::Rachel Scheier
Traditionally in Uganda, a senga, or paternal aunt, trained a young girl in all matters of love and marriage prior to her wedding night, said Phoebe Nakibuule Mukasa, a retired schoolteacher and local talk show expert in traditional romantic etiquette on Radio Simba. The "aunties" have become so popular recently that health officials and cultural leaders are trying to harness the old tradition as an AIDS awareness vehicle.
The idea is that if young adults will listen to sengas talk about erotic techniques and relationships, they may also listen to them teach HIV prevention and sex education.
Robert Ssebunnya, a Kampala businessman, won government funding for a plan to train a number of working sengas in the basics of AIDS prevention - abstinence, fidelity and condom use - who would pass on the lessons to youths in villages and schools. His plan also includes a "senga manual," which would offer guidelines on such topics as how boys and girls should behave at parties and guarding against premarital sex.
However, when Ssebunnya presented the idea recently at Makerere, Kampala's largest university, he was booed. AIDS education in Africa needs a more contemporary approach, the students argued.
There is a widespread belief among Ugandans that modernity and moral decadence are to blame for social maladies such as AIDS, said Carolyn Nakazibwe, a 28-year-old journalist for the Monitor newspaper. "A lot of men believe we have a lot of HIV because women dress indecently, which is, of course, ridiculous." Still, reviving old cultural practices like virginity testing for young girls has become fashionable elsewhere in Africa in the age of AIDS.
But the Medical Research Council, an AIDS research organization in Uganda, recently found that using sengas to teach sex education to adolescent girls showed promising results. Brent
Wolff, a behavioral scientist, said researchers deliberately did not tinker with any of the senga's traditional teachings.
Associated Press
"Hospital to Test All Employees for Tuberculosis"
(11.01.03)
Cuyahoga County health officials plan to test all employees at Cleveland's St. Michael Hospital for tuberculosis following the death of its newly appointed chaplain. The Rev. Norbert
Atimnedi, 36, died Oct. 24 at a hospital in Canton after showing symptoms of the disease. Lab tests confirmed the infection.
Infectious disease experts do not consider this a public health emergency or believe the case is connected to an earlier TB infection at Marion-Sterling School in Cleveland. There, after the discovery of one TB case, seven people tested positive while 424 tested negative. The seven at the school and any St. Michael employees who have positive skin tests will need follow-up tests.
Active cases can be treated effectively with oral antibiotics, which in some cases must be taken for up to a year.
Atimnedi, a native Ugandan who arrived in Cleveland in August, had only been rotating through the hospital's workforce for about one month. His visits there were confined to one shift.
St. Michael has an average of 60 patients per day, health officials said.
St. Michael is scheduled to close on Dec. 19; this complicates the matter, since the skin test needs to be repeated in 12 weeks.
News-Journal
"Health Care Worker Has Tuberculosis"
(11.03.03)::Mike Chalmers
Delaware public health officials are monitoring a trainee at two Brandywine Hundred assisted-living facilities who has tested positive for tuberculosis. The employee, whose identity was not released, worked at Shipley Manor on Shipley Road and Foulk Manor South on Foulk Road, said Heidi Truschel-Light, spokesperson for the state Division of Public Health. Truschel-Light said it is unlikely the trainee infected patients and co-workers at the facilities because the trainee had limited duties and no close contact with others. The patient showed no coughing or other symptoms, officials said. The worker was diagnosed by a positive culture on Oct. 9 after an abnormal X-ray in July. The trainee is receiving treatment and last worked on Oct. 3. The division helped both facilities test their employees and residents, as well as the trainee's close contacts.
CDC HIV/STD/TB Prevention News Update
Friday, October 31, 2003
Washington Post
"NIH Faces Criticism on Grants; Coalition Assails 'Smarmy Projects'"
(10.30.03)::Rick Weiss
The Traditional Values Coalition, a public policy organization that says it represents more than 43,000 member churches, yesterday said it will ask the Justice Department to investigate how scores of health and sexuality studies received federal funding through the National Institutes of Health.
An official at NIH, which is internationally renowned in part for its peer-review system of evaluating proposals, said the studies are an important part of devising better public health and education strategies. But TVC called them "smarmy projects" representing at least $100 million in wasted federal funds. TVC's call is the latest volley in its escalating conflict with NIH and the agency's congressional and institutional supporters, who see the attack as part of a larger effort to foist conservative religious values on the federal scientific enterprise.
"We have nameless, faceless bureaucrats doling out money like a federal ATM to do things like study the sex habits of Mexicans before and after they cross over the border. This doesn't pass the straight-face test," said TVC Executive Director Andrea Lafferty.
Calling TVC's tactics "scientific McCarthyism," Rep. Henry Waxman (D-Calif.) has in the past four days sent two angry letters to Health and Human Services Secretary Tommy Thompson asking him to stand up to TVC and support NIH.
Lafferty yesterday took sole responsibility for compiling and sending to Congress a list of about 200 NIH projects related to sexuality, AIDS and risk-taking. Waxman had expressed suspicion that HHS officials or others in the Bush administration helped compile or release the list. Yesterday, in a letter to Waxman, Thompson denied any HHS involvement but did not address Waxman's request for information on any meetings or communications between HHS and TVC.
"We can't have moralizing and ideology trump science when it comes to protecting the public health," warned Alan Leshner, CEO of the American Association for the Advancement of Science, the nation's largest general science organization. "It's vitally important that we understand the processes by which public health problems spread if we're ever going to get a handle on issues as important as HIV/AIDS and drug abuse."
Associated Press
"Focus Is on Prevention as STDs Continue to Increase"
(10.28.03)::Michael Koryta
Reported cases of STDs are on the rise in Indiana. According to state statistics, numbers for chlamydia and gonorrhea have been rising steadily in recent years, while syphilis is finally on a decline. Cases of HIV/AIDS are evaluated separately.
In Jackson County, reported STD cases have increased 93 percent since 2000. They have doubled in Monroe County in that same period, and nearly tripled in Greene and Washington counties. According to Michael Butler, director of the division of HIV/STD for the Indiana Department of Health, the rise can be attributed to two major factors: spread of the diseases and improved case-finding.
Butler points to successful prevention and treatment campaigns launched during a syphilis epidemic in 1999 when 443 cases were reported statewide. Last year, that number dropped to
66. "We received a federal grant, and thanks to a very involved effort on a state, local and federal level, we were able to have incredible success. The focus of that effort was community input and action," said Butler. He believes lessons learned then will help STD prevention as a whole.
Disease Intervention Specialist Penny Caudill, of the Monroe County Health Department, said STDs are a concern in south-central Indiana, especially in rural areas where there are few doctors. "Just getting health care is difficult, and it is more time-consuming for us," said Caudill, whose department oversees STD prevention and testing for a 12-county area. "I think people are becoming more lax regarding prevention," she added.
The presence of Indiana University makes Monroe County even more difficult for STD management due to the transient lifestyle of students, Caudill noted.
Anne Reese, director of health and wellness education for the IU Health Center, said the numbers for herpes and human papillomavirus - not considered reportable by the state - are much higher than those for chlamydia and gonorrhea. Reese said she believes the best way to manage the spread of STDs is by increasing awareness.
Los Angeles Times
"Implementation of Rapid HIV Test Off to Slow Start"
(10.29.03)::Daniel Costello
Despite Food and Drug Administration approval of a 20-minute finger-prick HIV test nearly a year ago, fewer than a dozen California sites offer it. Health officials say strict state testing guidelines and confusion about how to implement the test have limited its introduction in California.
In several instances, officials are not advertising what sites are conducting the new test for fear of being overrun with patients. But the heart of the problem, state health officials say, is the fact that California has some of the most stringent regulatory testing guidelines in the country.
Federal regulations require that any site offering blood tests outside of traditional laboratory settings apply for a waiver. In addition, California requires test givers to have at least a high school diploma and go through more extensive training than the federal government requires.
Many of those expected to give the test are HIV counselors who often have little or no experience administering blood tests. Most of them have worked with tests that use an oral swab, and have not had to deal with many of these state and federal rules before.
"It's been a little confusing figuring out how this test fits in with our current system and all the rules that surround it," said Deanna Sykes, who has overseen implementation for California's Office of AIDS.
An 11-site pilot testing program scheduled for late May began in only four locations because many lacked measures guaranteeing the test's safety and accuracy, officials said. A recent Los Angeles proposal for 26 testing sites was held up for several weeks because state health officials were unsure a group application was technically valid. After checking with federal officials, the state decided it was all right; however, it could still be months before counselors are trained.
By processing waivers more quickly and offering training, state health officials hope there could be as many as 700 rapid testing sites statewide by next summer. The Legislature is also expected to consider a bill early next year that would condense some of the training into one session.
Gay City News
"ACT UP Calls for Prison Condoms"
(New York City) (10.23.03)::Aaron Parsley
On Oct. 21, members of ACT UP-NY assembled at the Lincoln State Correctional Facility in Harlem and demanded that the New York State Department of Health take over health care inside state prisons because, they claimed, the Department of Corrections is not fighting a crisis of HIV and hepatitis C infections among inmates. The activists said the crisis is the result of inadequate health care, a lack of testing, and a ban on condoms in state prisons.
The protest precedes a Nov. 14 hearing of the state Assembly Committee of Health in which three related bills are to be discussed. Assemblymember Richard N. Gottfried (D-Manhattan) is sponsoring two bills that together would define the health care systems of state and local correctional facilities as hospitals, bringing them under the oversight of NYSDOH, and require that they implement HIV/STD education and prevention programs, including condom distribution.
"These are not earth-shattering proposals," said Ronald Johnson, associate executive director of Gay Men's Health Crisis. "It would just bring prison hospitals into line with the rest of the state."
Emmaia Gelman from ACT UP-NY said that while state and federal health officials promote condom use to protect against HIV and hepatitis C, condoms are contraband in state prisons.
"The CDC insists that people use condoms, but 60,000 inmates do not have access," Gelman said, adding that sex between inmates, while illegal, does take place. Group member Melvyn Stevens said he believes a lack of education, confidentiality and access to medication are all part of the problem.
Chino Hardin, who has spent time at Rikers Island correctional facility, said she tested HIV-positive while incarcerated, but all her tests since she was released have come back negative. Hardin believes she was told she was HIV-positive because she is lesbian. "The same thing happened to a friend," Hardin said. "I think it's happening on purpose. It's a form of punishment."
Canadian Press
"Faulty Machine Means Thousands in British Columbia Got Wrong Results in STD Test"
(10.29.03)::Terri Theodore
A technical problem with a diagnostic machine in Cranbrook, British Columbia, switched thousands of test results for chlamydia and gonorrhea to their opposites, said Alison Paine, spokesperson for the Interior Health Authority. "In other words, if you were a positive, you would have received a negative reading. If you were a negative, you would have received a positive reading," said Paine. About 3,000 people are believed to have taken the tests between Nov. 1, 2000 and May 24, 2002.
Paine said the company that manufactures the machine notified the authority in July of the defect. "We immediately stopped using the machine," said Paine. Becton, Dickenson and
Co., based in New Jersey, manufactures the BD ProbeTec. A spokesperson was unavailable for comment. Only two machines out of 1,000 tested worldwide have shown the defect – incorrectly installed optical bundles - according to the company's Web site product notice. The company said it is working with Health Canada to ensure the machine is recalled.
About 83 of those tested during the time were given a clean bill of health when they had one of the diseases. The rest were told they were infected and were given treatment when they did not have the diseases, said Paine. The number affected multiplies when considering that each of those tested had at least one sex partner to whom the results also mattered. Most of the 83 have been contacted, Paine said, but not all. She urged them to telephone 1-888-887-8811 for treatment.
CDC HIV/STD/TB Prevention News Update
Wednesday, October 29, 2003
Reuters Health
"Many Teenage Girls Underestimate STD Risk: Study"
(10.15.03)::Merritt McKinney
Teenage girls who have unprotected sex and engage in other risky sexual behavior may underestimate their odds of contracting an STD, a recent study shows.
"Most young women in this study, who were all sexually active and who demonstrated risk for STDs, did not perceive that they were at risk for infection," said Dr. Kathleen A. Ethier of
CDC.
Researchers tracked 209 young women, mostly African-American or Latina, over the course of 18 months. During that time, almost one out of four adolescent girls in the study were diagnosed with chlamydia or gonorrhea, even though "most of those had predicted that there was little or no chance of that happening," investigators reported.
About 89 percent of the girls felt they were at little to no risk of contracting an STD. However, 74 percent reported engaging in risky sex, having symptoms of an STD or having had an STD in the past. Each girl's risk factors for STDs, including unprotected sex and multiple partners, had little effect on her perception of risk, according to the study, "Adolescent Women
Underestimate Their Susceptibility to Sexually Transmitted Infections," published in Sexually Transmitted Infections (2003; 79:408-411).
"Adolescents may either be uninformed about or ignoring their risk for sexually transmitted diseases," according to study leader Ethier. She said young people may know about risk factors
for STDs but not connect those facts with their own behavior. Even when they engage in risky behavior, "many adolescents still feel that it can't happen to them," she noted. "That is clearly a dangerous assumption."
Why the young women in the study did not think they were at risk remains unclear, according to Ethier. Possible explanations include their relationships with male partners and the attitudes of people in their communities, she said, although she noted that the study did not examine those factors.
"We need to know more about why adolescents are not accurately assessing their risk for infection," Ethier stated. Without a clear understanding of the problem, it will be difficult to design programs to tackle it, she said.
Journal of Acquired Immune Deficiency Syndromes
"The Value of Screening for Sexually Transmitted Diseases in an HIV Clinic"
(08.15.03) Vol. 33; No. 5:P.642-648::Thomas A. Farley; Deborah A. Cohen; Shin-Yi Wu; Ceryl Lynn Besch
CDC recommends STD screening among HIV-positive patients. STDs facilitate the spread of HIV, so the diagnosis and treatment of curable STDs in HIV-infected persons can help prevent the spread of HIV to partners even when infected persons continue unprotected sex. However, according to the authors, such screening is not widely practiced in US HIV clinics.
To examine the potential benefits of an STD screening program in a public HIV clinic in New Orleans, the researchers analyzed the results of a urine-based screening for gonorrhea and chlamydia among HIV-positive patients and compared the positivity rates to the prevalence in the local community's general population. To project the potential value of the screening, the investigators estimated the number of potential HIV infections among sex partners that treatment of gonorrhea and chlamydia infections prevented.
For the study period from October 1998-June 2001, researchers found 1.7 percent of those tested for gonorrhea (46/2,629) to have it, and 2.1 percent (56/2,629) of those tested had chlamydia. Test positivity did not vary greatly by race or sex, although African-American women had higher rates of chlamydia (3.5 percent) than white women (1.9 percent), African-American men (1.2 percent) or white men (1.2 percent). But test positivity declined sharply with age: the percentage of patients with gonorrhea fell from 4.8 percent among 15- to 19-year-olds to
1.2 percent among those older than 35. Chlamydia rates fell from 9.5 percent among 15- to 19-year-olds to 0.9 percent among persons older than 35. Still, all age groups tested showed some infections.
Among 18- to 29-year-olds, test positivity for gonorrhea was similar in the HIV clinic to positivity for members of the sociodemographically similar community (3.1 percent versus 2.4 percent). Test positivity for chlamydia in that age cohort was lower among HIV patients (5.4 percent versus 10.5 percent). Based on a previously developed mathematical model, the authors estimated that treatment of all 46 gonorrhea and 56 chlamydia infections in the HIV clinic may have averted 9 HIV infections among sex partners and saved a great deal more in future medical costs than the cost of the screening.
The authors pointed out that implementation of the STD screening program demonstrates the feasibility of routine screening in HIV clinics. That positivity rates approximated those of a sociodemographically matched general population "suggests that HIV-infected persons in care continue to practice high-risk sexual behavior, perhaps at about the same level as the general population," the investigators speculated. The study notes that the mathematical model suggests the even with a relatively low prevalence of gonorrhea and chlamydia among the HIV-infected, screening and treatment of such infections in HIV clinics may prevent a large enough number of HIV infections to be worthwhile.
"In conclusion," the authors noted, "this study supports the CDC recommendation that screening for gonorrhea and chlamydia infection should be established in HIV clinics as part of routine care, at least in geographic areas with higher rates of these STDs. Patients in these clinics found to have these or other STDs can be intensively counseled to reduce risky sexual behavior, their curable STDs can be easily treated, and confidential partner notification procedures initiated. Thus STD screening can initiate a series of actions with the potential to prevent HIV transmission to others."
Reuters
"New Drug Hope for Millions of Hepatitis C Victims"
(10.26.03)
A new drug that prevents a contagious virus from duplicating in the body could be a new weapon against hepatitis C, researchers working for the German pharmaceutical firm Boehringer
Ingelheim said Sunday.
More than 170 million people worldwide are infected with the hepatitis C virus, which can cause permanent liver damage and in many cases death. There is no vaccine against HCV, and current interferon treatments - including Pegasys produced by Roche Holding AG, and PeginTron made by Schering-Plough Corp., which are given in combination with the antiviral drug ribavirin - can cause side effects.
The new drug, called BILN 2061, targets an enzyme to block the replication of HCV, and is the first of a class of drugs called NS3 protease inhibitors to be tested in humans. In eight people given four doses of the treatment, viral loads dropped by 100- to 1,000-fold after 48 hours without producing any unpleasant reactions in the patients.
"The antiviral results of protease inhibitor BILN 2061 in a proof-of-concept human trial clearly demonstrate the great potential of selective and anti-HCV agents," said Daniel Lamarre,
of the company research center in Laval, Canada. The report, "An NS3 Protease Inhibitor with Antiviral Effects in Humans Infected with Hepatitis C Virus," was published online by the journal Nature (doi:10.1038/nature02099 (2003)).
Although additional, longer trials are needed to see if BILN 2061 keeps the viral load down and if resistance develops, the researchers believe "it holds great promise to markedly improve treatments of chronic HCV infection."
Former US Surgeon General Dr. C. Everett Koop has described HCV as a graver threat to public health than AIDS. "Hepatitis C already infects three times more people than does AIDS. It is responsible for more than one-third of all liver transplants," said Koop, adding that the disease could kill more people than AIDS each year.
Associated Press
"Punxsutawney Teen Wins MTV Sex Education Essay Contest"
(10.25.03)
In the Pennsylvania town usually associated with groundhogs, 17-year-old Amanda Story has won an MTV essay contest on the topic of whether her town needs more sex education. Story, whose essay was selected from 14,000 entries among viewers ages 15-24, wrote about her five-month-old daughter Ryley and the challenges of being a teenage mother. Because her essay won, juniors and seniors at her school can attend a health forum that includes a concert by the band Good Charlotte. The Sexuality Information and Education Council of the United States said information about relationships, communication skills and preventing sexually transmitted diseases will be offered at the forum, which takes place on Tuesday. "I think the mystery of sex sometimes glorifies it," Story said. "If they had a better understanding of it, there wouldn't be such intrigue to it."
CDC HIV/STD/TB Prevention News Update
Friday, October 24, 2003
Associated Press
"HIV, TB Concern European Health Officials"
(10.23.03)::Doug Mellgren
Leading European health officials will gather in Oslo next week to address the severe health problems facing Russia and the Baltic states, including HIV and TB.
Vast differences in income, health care and cases of infectious diseases remain between wealthy northwestern Europe and the former Soviet Bloc. Per capita earnings in the Nordic countries can be 10 to 15 times those of Russia, Latvia, Estonia or Lithuania, said Joergen Kaurin of Norway's health ministry.
In 2001, Norwegians had a life expectancy of 79 years, compared to 65.3 years in neighboring Russia, according to the World Health Organization. In the same year, Estonia reported 1,470 new HIV/AIDS cases - more than nearby Finland has reported in its history, even though Finland has more than three times as many residents. In 2000, Norway reported 4.9 cases of TB per 100,000 people, compared to 94.6 cases in Russia, according to WHO.
The meeting's final declaration, which Kaurin said will likely be accepted without change, identifies two key project areas: prevention of major public health problems and promotion of social well-being. The meeting is not expected to pledge funding, but to start programs designed to help eastern countries reform their health systems, import expertise and deal with the causes of disease.
Korea Times (South Korea)
"Nine Percent of Sexually Active Students Had STD"
(10.24.03)
A Catholic University of Korea College of Medicine survey of 622 college students in three Seoul-area universities found that more than 9 percent of the 243 sexually experienced participants had an STD. Premarital sex and STDs were also more widespread among those teenagers who ran away from home. A survey of 175 male and female teen runaways revealed more than 54 percent (96) were sexually active, while 43.7 percent (42 males and 21 females) had an STD.
CDC HIV/STD/TB Prevention News Update
Wednesday, October 22, 2003
Associated Press
"New Mexico Inmates to Get Hepatitis Treatment"
(10.21.03)
For the first time, New Mexico will begin treating prisoners for hepatitis C, which infects roughly one-third of the state's 6,200 inmates.
Dr. Frank Pullara, medical director for the state Corrections Department, said a new generation of drugs to effectively treat the virus was developed only about two years ago, and treatment can range from $15,000 to $30,000 per patient. However, Pullara noted, that is only a fraction of the $500,000 cost of a liver transplant the state would likely have to pay for should an inmate need one.
Pullara, a University of New Mexico School of Medicine liver disease specialist, consulted with other health experts to develop a protocol for treating inmates. Although many people with the virus do not know they have it, 20-25 percent can develop liver cancer, cirrhosis, or lose liver function. At diagnosis, Pullara noted, there is no way to tell who might develop complications.
Inmates with the virus now have their blood tested periodically to gauge liver deterioration. Those likely to suffer liver damage are referred to a treatment review committee that monitors their liver functions more closely. The committee decides for which inmates medication is appropriate.
Prisoners have a right to refuse medication, which Pullara noted has "horrendous" side effects including nausea, vomiting and possibly severe depression. "This is a fairly brutal treatment," he said, adding that for every 100 people with the virus, he could probably only convince 10 to take the treatment.
Hepatitis Weekly
"Hepatitis C Virus: Duke, Johns Hopkins to Lead First Comparative Trial of Therapies"
(10.13.03)
In hopes of refining treatment practices for hepatitis C, researchers at Duke University Medical Center and the Johns Hopkins University School of Medicine will lead the first ever direct comparison of two leading treatments for the infection.Hepatitis C infects nearly 3.9 million Americans, according to CDC. Approximately 70 percent of patients have chronic hepatitis C, which can cause cirrhosis and liver cancer and is the leading indication for liver transplantation in the United States.
A combination of interferon and ribavirin is the most common hepatitis C treatment. A recent advance has been pegylated interferon, which improves pharmacokinetic characteristics compared to standard interferon, allowing more convenient weekly dosing instead of three times a week.
The study - led by John McHutchinson, MD, director of gastroenterology and hepatology research at the Duke Clinical Research Institute, and Mark Sulkowski, MD, assistant professor of medicine at Johns Hopkins - will compare three treatment regimens in 2,880 hepatitis C patients. The trial, IDEAL (Individualized Dosing Efficacy vs. flat dosing to Assess optimaL pegylated interferon therapy) is sponsored by the Schering-Plough Research Institute. Patients will be given one of two available pegylated interferon treatments - pegylated interferon alfa-2b (PEG-INTRON, by Schering-Plough Corp.) and pegylated interferon alfa-2a (PEGASYS, by Hoffman-LaRoche Inc.) - combined with ribavirin.
"The beginning of this trial is truly a milestone in research for treatments of hepatitis C virus," said McHutchinson. "This is the first time we have directly compared these two treatments in a head-to-head manner. We hope to learn important information that will directly impact the treatment of our hepatitis C patients."
The trial will enroll patients from 100 different sites nationwide. Dosing is one of the primary differences between the two treatments, scientists said. Alfa-2a is given in the same dosage to all patients, while Alfa-2b is given based on the individual patient's weight. The trial's goal is to determine which treatment results in a sustained viral response (an undetectable level of virus in the patient's blood 24 weeks after the end of therapy) in the largest proportion of patients.
"By eradicating the virus during and after therapy, we are able to forestall, and in many cases, prevent further damage to the liver. This has a huge impact on patient health and quality of life and translates into prolonged survival, a lower incidence of liver cancer and may prevent the need for liver transplantation," said McHutchinson, who has served as a paid consultant to Schering and has received research support and lectured on behalf of both Schering-Plough and Hoffman-LaRoche.
Journal-Standard (Freeport, Ill.)
"Health Officials Report Rise in Hepatitis C"
(10.22.03)::Travis Morse
Illinois' Stephenson County Health Department is watching hepatitis C rates after noting a rise in cases in 2002.
A county health department annual report showed 17 hepatitis C cases in 2002, a 40 percent increase over the 12 cases reported in 2001. But the Illinois Department of Public Health reported 22 cases of hepatitis C in Stephenson County for 2002. County Health Administrator
Jeff Todd said the discrepancy reflects the inclusion of later test results and that the IPDH figure is probably accurate, which means an 80 percent increase in the number of hepatitis C cases.
The case count represents disease carriers - individuals who are infected but not symptomatic. From April 2001 - when the federal government made hepatitis C a reportable disease - to the present, the state reported 818 infected persons.
Pam Kirkpatrick, communicable disease coordinator for the Health Department, said doctors are doing a better job of screening for hepatitis C and advising patients about risk factors, including having received a blood transfusion or solid organ transplant before July 1992, having received clotting factors made before 1987, and having ever been on long-term kidney dialysis. CDC estimates that injection drug use accounts for 60 percent of all new cases of the ailment, although body piercing or tattooing with unsterilized needles, sharing personal care items, sharing drug paraphernalia and sexual activity resulting in blood-to-blood contact can also lead to infection. Antiviral therapy is effective about half the time.
Former "Baywatch" star Pamela Anderson has hepatitis C. According to news reports today, she told US magazine in an upcoming issue, "I think I've got a good 10 years left in me, which is sad, too. Maybe 15, if I'm lucky." Anderson, who was diagnosed with the disease in 2001, is currently using homeopathic treatments, according to reports.
Todd said there are currently about 2 million to 4 million undiagnosed cases of hepatitis C nationwide.
CDC HIV/STD/TB Prevention News Update
Tuesday, October 14, 2003
Associated Press
"Workers Say State Should Have Done More to Prevent Infection"
(10.12.03)
Three retired prison employees infected with hepatitis C maintain the Michigan Department of Corrections has long known that HCV has spread among inmates, but has not warned workers of infection risks.
The retired workers - Dee Reeder, a captain at Riverside Correctional Facility in Ionia; Carol Lee Williford-Hoy, a guard at Carson City Correctional Facility; and Jan Major, a teacher's aide in the former Michigan Reformatory and a purchasing agent at Riverside Correctional Facility, both in Ionia - all say their only risk factor for HCV is having worked in prisons. "We aren't IV drug users. We aren't prostitutes. We did nothing to bring this on ourselves other than do our jobs," Reeder told the Lansing State Journal.
Between 12,000 and 18,000 of Michigan's nearly 49,000 prisoners are believed to be infected with hepatitis C. Prison officials say they do not know how many guards may be infected.
But the corrections department tests employees if they have been exposed to inmate blood and trains staff on the prevention of blood-borne disease transmission, said spokesperson Leo LaLonde.
Williford-Hoy believes she was infected 10 years ago during a routine search of an inmate's cell, when a tattoo needle pierced her latex glove and pricked her finger. She was diagnosed with HCV in 1995.
"I don't want anyone to go through what I've been through," said Major, who is unsure of how she was infected. "I'm afraid to even touch my grandchildren because I don't want to infect them."
Reeder said she settled a lawsuit against the state in 1999 for $100,000. She is the only one of the three for whom drug treatment did not work. Reeder is in the final stages of cirrhosis, and doctors are waiting for liver failure before considering a transplant.
Associated Press
"State Fears Malpractice Insurer Won't Stick with Hepatitis Lawsuits"
(10.09.03)::Kevin O'Hanlon
Nebraska Department of Insurance officials are worried that a medical malpractice insurance company might try to get out of paying claims that could arise from the Fremont hepatitis C outbreak. The department has asked a judge to rule that Medical Protective Co. (MPC) must defend Dr. Tahir Javed, who is accused of using unsanitary practices that caused 99 people - including one who died - to contract hepatitis C at his Fremont Cancer Clinic in 2000-2001. Scores of lawsuits have been filed against Javed.
In documents filed in Lancaster County District Court, the department says Javed's malpractice insurance policy set limits of $200,000 per claim and annual aggregate of $600,000. Nebraska is worried that MPC will settle a few lawsuits to meet the $600,000 limit, leaving the state's malpractice fund liable for the rest - potentially millions of dollars.
Nebraska contends that MPC must defend all the hepatitis cases collectively. If that is the case, the state contends that Javed's policy contained a provision that would increase the total amount the company must pay collectively to $7 million. Company officials declined to immediately comment.
The lawsuits against Javed are threatening to wipe out Nebraska's Excess Liability Fund, which pays claims in excess of a doctor's individual private malpractice insurance. About 3,100 doctors pay annually into the fund to defray the costs of malpractice insurance. The fund now has $55 million, but is expected to pay an estimated $46 million to settle pending claims - not including any filed against Javed. Department of Insurance Director Tim Wagner has said that if the Javed case exhausts the fund, the doctors would be required to pay the remaining claims - possibly tens of millions of dollars.
Earlier this month, the state revoked Javed's medical license under a settlement in which he admitted to using unsanitary practices at his clinic. Javed returned to his native Pakistan a year ago, around the time when the first hepatitis cases were detected.
Newsday (New York, N.Y.)
"The TB Fight Gets Harder"
(10.14.03)::Laurie Garrett
As the sixth child of 13 born to a Lusaka, Zambia, family, Winstone Zulu has witnessed firsthand the grip HIV and tuberculosis have on his country: Only he and five siblings remain alive today, and his parents are raising 18 orphaned grandchildren. Crippled by a childhood bout with polio, Zulu himself contracted HIV in 1990, and nearly died of TB seven years later.
In New York last week, Zulu decried the shortage of antibiotics to treat TB, which he said cost about $10 for a course of treatment. The costs of the drugs - and the medical support system needed to deliver them - are generally out of reach for Zambians in need.
Three years ago, the World Health Organization and private groups mounted the global Stop TB Partnership. A key element of the campaign is the Global Drug Facility, which purchases antibiotics in bulk and distributes them to needy countries. Since March 2001, the GDF has sent $20 million worth of drugs to 46 nations, its manager Gini Arnold said in an interview.
But a funding shortfall aggravated by the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria two years ago could stymie that success. As the Global Fund collected hundreds of millions of dollars in donations, the much smaller GDF saw its donations fall.
With the support of the Washington, D.C.-based charity Results, Zulu is rolling his heelchair through US cities to draw attention to the plight of GDF, which could disappear in six months without an infusion of $25 million to $30 million. "We cannot afford to have a GDF that collapses simply because of competing elements in the atmosphere," said Dr. Mario Raviglione, head of WHO's TB program. As Congress debates its contribution to the Global Fund, the very existence of GDR seems to be off the radar screens of politicians, said Raviglione.
New York Times
"AIDS Patients in Zambia Face Stark Choices"
(10.11.03)::Sharon LaFraniere
After two decades of HIV/AIDS, Zambia's government is taking urgent steps, under new President Levy Mwanawasa, to address what health officials call the sixth-worst AIDS epidemic on earth. Nearly one in five Zambian adults has HIV, and 570,000 children are orphans. The latest UN estimate says 120,000 Zambians die of AIDS each year.
According to the UN, less than one percent of the estimated 200,000 or more Zambians who need antiretrovirals receive them. The government treats 600 patients for a minimal fee. A handful of other patients buy drugs at market rates through local pharmacies. Some, like Kasango Kabaso, allocate scarce funds toward drugs so he can keep himself alive to earn money to feed his HIV-positive wife and children. If he becomes sick, there will be no drugs and no food for anyone.
The government plans to expand treatment to at least 20,000-30,000 people through enlarging its own program and by using $135 million in five-year grants from the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria. But officials cannot say when treatment will be truly widespread.
Until recently, many people blamed the government for lack of political will as well as money, because it limited its efforts to an awareness campaign and testing for Zambia's 10.6 million citizens.
"We were asleep," said Health Minister Brian Chituwo. "We had a leadership in the past 10 years where there was total denial from the highest office. It's like we are just waking up now and saying: 'Hey! What has happened?'"
The answer is obvious, even in downtown Lusaka, where roadside hawkers peddle tombstones; the two cemeteries are nearly full; and AIDS patients occupy as many as 80 percent of beds in the nation's largest hospital.
American Journal of Public Health
"Student Leadership in Public Health Advocacy: Lessons Learned from the Hepatitis B Initiative"
(08.03) Vol. 93; No. 8:P. 1250-1252::Leslie D. Hsu, MS; William DeJong, PhD; Renee Hsia, AB; Michael Chang, BS; Marvin Ryou, BA; Ellen Yeh, BA
Although Asian Americans/Pacific Islanders represent only 4 percent of the US population, they account for 50 percent of the 1.25 million chronic hepatitis B cases, according to the current study. Pacific Islanders are up to 13 times more likely to die from liver cancer than whites; Chinese Americans have a six-times greater risk; the risk is 8 times higher for Korean Americans and 13 times higher for Vietnamese Americans. Eighty percent of liver cancer among Asian Americans/Pacific Islanders is caused by hepatitis B infection.
"Increasing hepatitis B vaccination rates for Asian Americans and Pacific Islanders is a priority," the researchers wrote. "Laws requiring vaccination prior to school enrollment have helped, yet many youths remain unvaccinated."
Students from the Harvard School of Public Health and the Harvard Medical School launched the Hepatitis B Initiative (HBI) in 1997. The project provides free screenings and vaccinations to
Boston's Asian American/Pacific Islander community, focusing on youths. Before opening its doors to patients, HBI conducted an awareness campaign in Boston's Chinatown that included storefront posters and pamphlets in Chinese, Vietnamese and English; information kits for local newspapers and high schools; talks at neighborhood council meetings; skits performed at health fairs; appearances on local radio talk shows; information tables at community festivals; youth workshops; sponsoring a raffle; and a "guerrilla media" event at which youths made sidewalk drawings to raise HBV awareness.
HBI's services are organized to meet Chinatown's residents' needs: Clinic walk-in times accommodate restaurant workers with evening and weekend hours, minimum paperwork is required, and bilingual services and forms are offered.
By October 2002, 997 HBI patients from Boston's Chinatown had been screened for hepatitis B free of charge. Of those, 384 patients were deemed susceptible to the virus and offered free vaccinations. Patients most often cited word of mouth as the way they had learned about HBI, but the outreach campaign in newspapers and referrals from health centers were also key sources.
In 1998, HBI received funding from the Centers for Medicare and Medicaid Services as an Asian American/Pacific Islander initiative of the US Department of Health and Human Services. CDC gave HBI the Adult Immunization Achievement Award in 1999, and in 2000, the surgeon general's Web site featured HBI as a model program for eliminating health disparities.
"With dedicated leadership in place," the authors concluded, "a student-run program can create an opportunity to bring together institutional partners who might not otherwise coordinate their efforts. Through its efforts, the HBI created a screening and vaccination service for Boston's Chinatown that otherwise would not have been available."
New York Times
"FDA Approves Schering Drug for Hepatitis C"
(10.14.03)
Yesterday, Schering-Plough Corporation said it had received Food and Drug Administration approval for a prefilled penlike syringe that administers a drug for chronic hepatitis C. The device, the PEG-Intron Redipen, was designed to be simpler to use than a traditional vial and syringe. Schering-Plough, based in Kenilworth, N.J., said it expected to make the product available in the United States in early 2004. It is already available in Europe and other international markets.
CDC HIV/STD/TB Prevention News Update
Thursday, October 09, 2003
Hepatitis Weekly
"Viral Hepatitis: Chronic Hepatitis B Therapy Flare Fails Due to Hepatitis D Coinfection"
(09.08.03)
Researchers in Japan recommended that physicians should consider coinfection with hepatitis delta virus a possibility in cases of hepatitis B in which lamivudine therapy does not improve liver injury.
"In 1997, a 27-year-old homosexual man contracted acute hepatitis B that developed into chronic hepatitis," R. Joh and colleagues at Tokyo Women's Medical University, Institute of
Gastroenterology, wrote. "Because of repeated flares, administration of lamivudine was started in March 2002. Hepatitis B virus (HBV) DNA immediately decreased, but the serum level of
alanine aminotransferase gradually increased."
The scientists excluded the possibility of drug-induced hepatitis from lamivudine, and suspected that the progression of liver damage was caused by HDV, "because the patient was positive for both anti-HDV antibody and HDV RNA," the investigators found. Their study, "Chronic Hepatitis B with Flare Due to Co-Infection of Hepatitis Delta Virus during Lamivudine Therapy" appeared in Internal Medicine (2003;42(7):581-586).
Fort Worth Star-Telegram
"Tuberculosis Concerns Are Exaggerated, Night Shelter and Health Officials Maintain"
(10.09.03)::Peyton D. Woodson
Presbyterian Night Shelter volunteers, tour groups and at least one vendor have become hesitant to visit the facility after learning the results of yearlong mandatory tuberculosis testing
for shelter residents. Shelter employees and county health officials said the fears are exaggerated and that positive TB cases remain constant in the community.
"You don't get TB from casual contact," said Gerry Burgess, division manager for TB elimination at the Tarrant County health department. "The risk isn't any greater now than it has been for the past 15 years. For a healthy individual to acquire TB, you have to have an eight-to-10-hour-a-day exposure."
County officials began mandatory TB screening for shelter residents in 2002. In the past year, 17 active cases were identified among residents, in addition to the eight cases on record before the testing started.
Burgess said healthy visitors should not be concerned about contracting the disease. Transients are at greater risk because of their poor health and compromised immune systems. In Tarrant County, she said, TB cases have remained stable since 1996, at about 100 per year.
Shelter Director John Suggs said shelter employees are vaccinated regularly for TB. Suggs has worked at the shelter for 12 years and never contracted the disease.
Suggs worries about losing volunteers and the support of tour groups. "Volunteers are really important," he said. "Tour groups like to come out and see where they're spending their dollars. It's an important part of how we do fundraising and getting people involved in helping the homeless."
Irish Examiner
"Sexually Transmitted Diseases Up by 10 Percent"
(10.07.03)
According to figures released by Ireland's National Disease Surveillance Centre, the number of people who contracted an STD jumped by 9.4 percent in 2001. This included increases in
hepatitis B, genital herpes, chlamydia and gonorrhea, and a significant increase in syphilis. NDSC's Dr. Mary Cronin is appealing to sexually active people to engage in safe sex.
CDC HIV/STD/TB Prevention News Update
Wednesday, October 08, 2003
Associated Press
"Group Seeks Injunction Over Requiring Reports of Minors' Sex"
(10.07.03)
In a class-action lawsuit filed Monday in US District Court in Wichita, health care workers and other youth counselors asked a judge to bar enforcement of a Kansas law requiring them to report the sexual activity of persons under age 16 as evidence of child abuse. A June opinion by Kansas Attorney General Phill Kline left many people, including county prosecutors, confused, the suit said.
The New York-based Center for Reproductive Rights filed the suit, which seeks to prevent the reporting law from being applied to consensual sex between teenagers, on behalf of 13 Kansans. The suit claims fewer youths will seek medical treatment, psychological counseling and other services if they fear their sexual activity will be reported to authorities.
Kansas law makes sex involving someone under 16 illegal, no matter what the context. Another law requires prompt reporting to government authorities when youth workers suspect a child has been abused. Kline's opinion said that under the law, any illegal sexual activity is inherently injurious and must be reported. A 1992 opinion by Attorney General Robert Stephan had said such activity may be injurious but was not inherently so, allowing for case-by-case discretion. Because of Kline's opinion, the lawsuit said, the plaintiffs - who include doctors, nurses, psychologists, social workers and a sex education teacher - have received conflicting advice about the law and are confused about how to avoid criminal prosecution.
While Kline's opinion dealt primarily with abortion, saying the pregnancy of a girl under 16 is evidence of child abuse, Kline has acknowledged it might require health professionals to report cases where a teenager seeks treatment for an STD or where a teenage girl seeks birth control and reveals she is sexually active. On Monday, Kline said his opinion broke no new ground, and he expressed concern that the plaintiffs are challenging the mandatory reporting law.
Bay Area Reporter
"Shanti Hopes Layoffs Will Avoid Budget Crisis"
(10.02.03)::Matthew S. Bajko
Shanti, a San Francisco AIDS agency, is laying off nearly a dozen employees and instituting a restructuring plan in an effort to head off a budget crisis. The two-year restructuring plan, according the agency, will consolidate parallel functions and modernize fiscal and administrative systems to create sustaining operating reserves.
"It makes us more responsive to the needs of the people we serve," said Shanti Executive Director Hywel Sims. "It's been difficult but we hope it works." Sims and four top managers have taken a one-month pay cut this year that equals $35,000. Other staff have not been asked to do the same. Shanti expects the staff cutbacks and salary reductions to save it $900,000 during
the next two years. Sims noted the staff have not had raises "in four years, at least." Sims was hired to head Shanti nine months ago at a salary of $130,000 annually.
Sims said the measures will not result in a loss of services to clients. Most of the laid-off employees work in finance, administration and development. One director, two administrative personnel and three drivers are being laid off. Two other positions, one each in finance and development, are having their hours reduced. The 18 percent staff cut leaves Shanti with 46 employees. The agency is still recruiting a new director of development and communication.
Shanti, which has an annual budget of $4.1 million, has seen individual and corporate donations fall over the past year, and the agency did not meet any of its fundraising goals for the fiscal year that ended June 30. The agency receives 43 percent of its budget from government funding and 57 percent from donations. Upcoming fundraising events include Shanti's seventh annual Ride for Life motorcycle ride on Oct. 11 and its 29th annual awards gala on Oct. 23. The Consul General of Russia, Victor N. Lizun, and his wife, Irina, will chair the gala. For more information, telephone 415-674-4764.
Fort Worth Star-Telegram
"Shelter Had 25 Active TB Cases in Past Year"
(10.06.03)::Peyton D. Woodson
Twenty-five cases of tuberculosis have been diagnosed among residents at the Presbyterian Night Shelter since Fort Worth County health officials began screening for the disease in 2002, the first time mandatory tests were given at a county shelter. More than 1,700 chest X-rays have been taken since September 2002, according to Gerry Burgess, the county health division's manager for TB elimination.
Some cases were found at other facilities, but only Presbyterian regularly tests its residents. The frequency of Presbyterian's testing might result in its higher number of cases. The facility, often a place of last resort, receives the greatest volume of transient traffic. "These are individuals that can't pay for a bed," Burgess said. "Those are the people at the highest risk." In Tarrant County, TB cases have remained stable since 1996 at about 100 cases per year.
John Suggs, director of the Presbyterian Night Shelter, said TB, hepatitis C and HIV are the top illnesses that threaten his residents. TB poses a more immediate threat because the disease
is airborne. Shelter residents sleep on floor mats in often-cramped spaces.
"Homeless people, because of their lifestyles and poverty, their health is in bad shape," said Suggs. "We have lots of incidents of seizure, weakened immune systems and serious diseases. It's just a sicker population from bad feet to bad teeth," he said.
Test nights are held at the shelter at least once a month, and residents can gain entrance to the shelter only with a card that proves county health officials have screened them. Those without cards are given chest X-rays to test for the disease.
Suggs said he initially had reservations about the mandatory screening program, but the residents' willingness to be tested helped change his mind.
Associated Press
"Meharry Receives $27 Million in Federal Grants"
(10.03.03)
The National Institutes of Health recently awarded $27 million in grants to Meharry Medical College of Nashville, Tenn., to foster research of racial health disparities, the college announced on Oct. 2. Among the grants, $7.7 million goes to create a center and recruit scientists to study HIV/AIDS health disparities. The funding also covers the cost to renovate an existing site to house the new center.
Ledger (Lakeland, Fla.)
"Radio Program to Spread Message on STDs"
(10.06.03)::Margarita Martin-Hidalgo
Spanish-speaking residents of Polk County, Fla., tuning in to local radio station WSIR this Thursday evening will get an earful about HIV and other STDs. County Health Department officials hope to reach as many people as possible - particularly Polk's farm workers - by taking their prevention messages to the airwaves in Spanish. The department's HIV and STD prevention unit will conduct a live radio broadcast from the Winter Haven-based WSIR, 1490 AM, from 8-9:30 p.m. Airing one week before Hispanic HIV/AIDS Awareness Day on October 15, the program will feature HIV outreach worker Catalina Mondragon and STD Program Manager
Frances Pinero answering questions. Mondragon, a former farm worker who works closely with migrant communities, said reaching farm workers is critical because many of them come from countries where information about STDs is scant at best.
CDC HIV/STD/TB Prevention News Update
Tuesday, October 07, 2003
New York Times
"Those with Hepatitis C Still Face Long Odds"
(10.07.03)::Jane E. Brody
There is finally some good news to report about hepatitis C, the debilitating liver disease that has infected 4 million Americans and 170 million people worldwide. New cases of HCV have declined 80 percent since the virus was identified in 1988 and blood banks began screening for contaminated donations four years later.
But, the annual death toll from the long-term consequences of HCV is 10,000 a year in the United States, and scientists project it will triple by 2010 unless new treatments are developed to eliminate the virus or postpone its complications indefinitely.
HCV's primary route to a new bloodstream has been through contaminated needles shared by drug users and by blood transfusions. Unlike HIV, HCV is rarely transmitted through sexual contact - although people who engage in high-risk sex with multiple partners and people with STDs face increased risk of transmission. Low rates of transmission also affect health care workers through needle-stick accidents, men who have sex with men, and babies born to infected women.
Not everyone infected with HCV becomes ill. In most cases, however, the virus can linger in the body for years - even decades - before liver damage appears. Severe cirrhosis, liver failure and liver cancer make HCV the leading reason for liver transplants.
With at least six major genetic types and more than 50 subtypes of HCV, prospects for a vaccine are not promising. And a vaccine for HCV, which changes rapidly, depends on finding an exposed part of the virus that remains stable even as its protein coat mutates.
The two main HCV therapies are lengthy, expensive and can cause devastating side effects. They are most effective in patients with Genotypes 2 and 3, which represent about 25 percent
of US patients. The most common ones, Genotypes 1a and 1b, are the most difficult to treat and affect about 75 percent of patients.
Therapy is most successful when the treatments - weekly injections of interferon, usually long-acting pegylated interferon, and the oral antiviral drug ribavirin - are used simultaneously. The combination therapy is effective in slightly more than half the cases - in 42 percent of those with Type 1 and 80 percent for those with Types 2 or 3.
CDC HIV/STD/TB Prevention News Update
Monday, October 06, 2003
San Francisco Chronicle
"Former Health Official Freed Without Bail"
(10.03.03)::Jaxon Van Derbeken
On Thursday, San Francisco Judge Kay Tsenin freed former city Health Commissioner Ronald Hill from jail without bail on a supervised release program on the condition that he not use sex personal sites on the Internet. Hill was arrested last month after a grand jury indicted him for allegedly engaging in a pattern of soliciting men for sex, then lying to them about his HIV infection. Hill, who could face up to eight years in prison, has pleaded not guilty. At least two men with HIV testified before the grand jury about having relationships with Hill, who they said repeatedly, assured them he did not have the virus. Hill's attorney, Patrick Fitzgerald, asked that Hill be freed so he could continue medical treatment at home. Prosecutors objected, saying Hill's earlier alleged conduct showed he was a clear threat to others.
CDC HIV/STD/TB Prevention News Update
Friday, October 03, 2003
Hartford Courant (Connecticut)
"Women Urged to Take Papillomavirus Test; Procedure Helps Detect Cervical Cancer Risk"
(10.01.03)::John A. McDonald
A new DNA test for human papillomavirus (HPV) gives doctors an earlier warning than the Pap test that their patients may harbor the virus that causes most cervical cancer. On Tuesday, the American Cancer Society, the American College of Obstetricians and Gynecologists and the Association of Reproductive Health Professionals included the DNA HPV test as part of their regular screening recommendations.
The DNA HPV test, recommended for women over age 30, won Food and Drug Administration approval in March. It should not be given more than every three years, according to Debbie Saslow of the American Cancer Society.
"The ability to test for the virus that causes cervical cancer marks the beginning of a new era in cervical cancer screening - and in fighting all women's cancers," said Phyllis Greenberger, president of the Society for Women's Health Research, at a briefing on Capitol Hill.
While endorsing use of the new test, Saslow said, "There is much to be done to develop counseling and other tools to help women and [health care] providers understand the implications of knowing one's HPV status."
The incidence of cervical cancer has decreased significantly in the last 40 years, largely due to screening. However, an estimated 12,200 new cases will be diagnosed this year and roughly 4,100 women will die of the disease. Researchers are exploring an HPV vaccine, said Dr. Diane Solomon of the National Cancer Institute, but approval of such a vaccine is five to ten years in the future.
Women's Health Weekly
"Bacterial Vaginosis May Heighten the Risk for Acquiring Herpes Simplex Virus-2"
(09.18.03)
A study conducted by T.L. Cherpes and colleagues at the University of Pittsburgh, Medical Center, discovered that bacterial vaginosis may heighten the risk of acquiring herpes simplex virus-2. The researchers conducted a longitudinal cohort study of sexually active women ages 18-30 to identify variables associated with HSV-2 infections, following up 670 HSV-2-seronegative women at four-month intervals for one year. They detected acquisition of HSV-2 antibodies in 32 of those women.
"Black race, less than or equal to 12 years of education, having a new sex partner, and bacterial vaginosis (BV) were associated with HSV-2 seroconversion on univariate analysis," the investigators wrote. "Antecedent HSV-1 infection was not protective against HSV-2 cquisition."
After controlling for other risk factors in multivariable models, the scientists found that the diagnosis of BV remained associated with an increased risk of HSV-2 infection. "In this study, the population attributable risk of BV for HSV-2 seroconversion was 21 percent," according to the report.
The authors recommended further research to determine whether screening and treatment of BV could reduce women's susceptibility to HSV-2 infection. The report, "Association Between Acquisition of Herpes Simplex Virus Type 2 in Women and Bacterial Vaginosis," appeared in Clinical Infectious Diseases (2003;37(3):319-325).
CDC HIV/STD/TB Prevention News Update
Thursday, October 02, 2003
Edmonton Journal
"Sex Begins at Younger Age and Spreads More Disease"
(10.02.03)::Canadian Press
The Women's Health Surveillance Report, a new study described as the most comprehensive report on women's health in Canada, says the average age of first intercourse for Canadian girls is 16.8 years. The average age for boys is 16.7 years. Girls used to wait considerably longer than boys to become sexually active, but the gap has virtually disappeared, said co-author Donna Stewart of the University of Toronto, chair of women's health at the University Health Network.
Thirty years ago, the average age of first intercourse was 20 for girls and 18 for boys. Stewart noted that girls are reaching puberty earlier, possibly because of improved nutrition, although some attribute the change to chemicals such as estrogen in the food supply and environment.
Social climate is also a factor. "One could speculate that it's [due to] the normalizing of early sexual behavior in the media, the glamorization of sexual behavior on television, women's magazines, what have you," Stewart said.
Sex at a younger age does not imply improved knowledge about risks. "Few adolescents recognize the behaviors and infections that pose the greatest threats to their sexual health," said the report. Only half of the girls interviewed said their partner used a condom. Only 60 percent of unmarried teens reported having used contraception over the past six months.
The study reported soaring rates of syphilis, chlamydia and gonorrhea. Between 1991 and 2000, syphilis incidence increased 62 percent among males and 22 percent among females. In 2001, women accounted for 25 percent of HIV-positive people in Canada, up from 10.7 percent in 1985-1995. Most of the cases were traced to heterosexual exposure.
Relatively potent new AIDS therapies have led to a certain complacency about the disease, Stewart said. She said women's vulnerability to domestic violence makes them reluctant to insist on precautions such as condoms.
Associated Press
"Nebraska Revokes License of Doctor in Hepatitis Outbreak"
(10.01.03)::Kevin O'Hanlon
On Wednesday, the state of Nebraska revoked the license of Dr. Tahir Javed, who is accused of causing one of the nation's largest hepatitis C outbreaks, in which 99 patients were infected. One patient has died. Javed, who returned to his native Pakistan a year ago, around the time the first hepatitis cases were detected, admitted in a settlement to using unsanitary practices at his Fremont Cancer Clinic, abandoning his patients, and breaching patient confidentiality. Javed agreed to admit to the allegations in seven charges in exchange for five charges being dropped, said Kathie Osterman, spokesperson for the state Health and Human Services System. He did not contest the allegations in the five other counts relating to the infections.
At least 81 lawsuits have been filed against Javed on behalf of his former patients. It was not immediately known how Javed's settlement with the state would affect the civil lawsuits.
South Florida Sun-Sentinel
"Palm Beach Lakes High Student Is Diagnosed with Tuberculosis"
(10.01.03)::Nancy McVicar
Palm Beach County, Fla., health officials are preparing to test about 150 students and teachers who regularly shared classrooms with a Palm Beach Lakes High School student who has been hospitalized with an active case of tuberculosis. Tim O'Connor, spokesperson for the health department, said the case is unrelated to a case still under investigation at Boynton Beach High School, where continuing TB testing has revealed no active cases.
Associated Press
"Officials Suspect Four Poultry Processing Plant Workers Have TB"
(10.02.03)
Four workers at a Stillmore, Ga., poultry processing plant probably have active cases of tuberculosis, health officials determined. The workers were sent home. Public health nurse Molly
Diggs said the workers' chest X-rays suggest active TB, but blood tests will confirm the diagnosis. The workers are among 277 people at the Crider processing plant who tested positive for TB after a former employee, now living in Tennessee, was diagnosed with the disease.
Associated Press
"TB Tests Turning Up Negative in Two Counties"
(10.01.03)
More than 60 people from Cass and Grand Forks counties in North Dakota have tested negative for tuberculosis in recent weeks, according to health officials. Those tested had contact with a North Dakota State University student who developed TB in September. Dr. John Baird of the Fargo-Cass Public Health Agency said a few more people still need to be tested, and the entire group will be retested next month.
Associated Press
"TB Tests Offered at Two Nappanee Bars After Patron Becomes Ill"
(10.01.03)
Health officials offered free tuberculosis tests to patrons and employees of two Nappanee, Ind., bars frequented by a local resident who has developed the disease. Elkhart County Health
Department nurses plan to offer skin testing Friday afternoon, October 3, at Duke's Tavern and Hunter's Hideaway in Nappanee, a town about 20 miles southeast of South Bend. "People should not panic, but we want to make sure those people who have been exposed have the opportunity to be skin tested," Peg Ramy, the health department's communicable disease supervisor, told the local Goshen News.
CDC HIV/STD/TB Prevention News Update
Wednesday, October 01, 2003
Associated Press
"Prisons Acting as an Incubator for Hepatitis C Virus"
(09.28.03)
Hepatitis C is spreading in Michigan's prisons, threatening the lives of inmates and the public as released prisoners spread the virus to families, friends and others. Between 12,000 and 18,000 of the state's 48,800 prisoners are believed to have HCV, which by 2010 will cause more deaths in the United States than AIDS, according to CDC.
The Lansing State Journal reported Sunday that Michigan's handling of HCV has discouraged testing and prevented prisoners from knowing they are infected - resulting in some inmates unwittingly spreading the virus when they leave prison.
Corrections officials say they are overwhelmed by HCV and cannot afford the estimated $130 million a year needed to treat infected inmates. "There's no way we could treat every infected inmate with the resources available," said Dr. George Pramstaller, chief medical officer of the Michigan Department of Corrections' Bureau of Health Care Services.
But prisoner advocates and health experts say that estimate is inflated, and that many inmates would decline the drugs, which cause side effects. They maintain that only the sickest would need help.
With 20-40 percent of the nation's prison population believed to have HCV, experts say treating inmates will help curb its spread among the general public. "That's going to protect me and everyone else," said Ed Harrison, president of the National Commission on Correctional Health Care.
Once in prison, inmates accelerate HCV's spread through sex and sharing items like razors and toothbrushes. According to CDC, up to 3 percent of infected inmates acquired the virus while in prison.
A federal lawsuit accuses the MDC, its health care provider and others of negligence when it failed to share results of tests showing an inmate to be HCV-infected. The prisoner's medical file indicated he tested positive at least four times beginning in September 1998. The prisoner did not know he had HCV until July 2001, when he was accidentally shown his medical file.
"They let an infected person walk free without even telling them to be careful," said Steven Croley, a lawyer for the prisoner and his girlfriend. Prison officials declined to comment on the case.
AIDS Alert
"Interventions Can Ease Dangers of Cybersex: Counselors Educate While
in Chatrooms"
(10.01.03)
Two successful Internet prevention programs targeted at MSM who use the Internet to meet anonymous sex partners could easily be replicated. Each site compiled a database on HIV/AIDS resources and facts that allows it to quickly answer questions, make referrals, and communicate safe sex messages.
Prevention Organizations With Empowerment Resources On The Net (PowerON) of Seattle and SexEd4U of Ferndale, Mich., provide counselors with training in deflecting sexual propositions and understanding common Internet symbols and abbreviations, said Jeffrey Neil Weldon, program director of the Friend-to-Friend Project and PowerON of the HIV/AIDS Project Development and Evaluation Unit of the School of Social Work at the University of Washington-Seattle.
SexEd4U, a program of the Midwest AIDS Prevention Project, sent letters to gay publications and newspapers announcing the intervention was legitimate to establish trust and rapport with
Internet users. When HIV counselors - who log on using SexEd4U as their pseudonym - found the same questions coming up repeatedly, they established a topic-of-the-month feature. The counselors provide answers promptly because about 80 percent of people in MSM sex chatrooms are looking for casual sex partners and will not waste much time with other agendas, according to Michael Odom, SexEd4U project director.
SexEd4U receives no grants or extra funding but relies on a core group of committed HIV counselors. SexEd4U has averaged three MSM interventions during each one-hour online discussion in the past year, Odom added, and has made referrals to local agencies for HIV testing, treatment and other services.
"We knew that saying it was about HIV prevention wouldn't interest people, so we marketed it as a gay health site," said PowerON's Weldon. PowerON's $150,000 two-year budget pays for referral site research and Web site design. PowerON's referral service, updated monthly, helps users find the agency and the particular staffer who can help them with a problem or issue. The site received more than 55,000 hits in its first two months.
Internet HIV prevention interventions have two advantages over traditional interventions: They reach people when they are seeking an anonymous sexual partner, and they give people anonymity regarding their questions and problems, Weldon said.
CDC HIV/STD/TB Prevention News Update
Tuesday, September 30, 2003
New York Times
"Big Increase Seen in People Lacking Health Insurance"
(09.30.03)::Robert Pear
The Census Bureau reported Tuesday that the number of Americans without health insurance grew by 2.4 million last year, the largest increase in a decade, as health costs soared and many workers lost coverage provided by employers. The increase brought the proportion of uninsured people to 15.2 percent, up from 14.6 percent in 2001. The figure's recent peak was 16.3 percent in 1998. The main reason for the increase, the bureau said, was the continued erosion of employer-sponsored coverage. The proportion of Americans with insurance from employers declined to 61.3 percent, from 62.6 percent in 2001 and 63.6 percent in 2000. "Workplace coverage is becoming unaffordable for many employers and employees," said Kate Sullivan, director of health care policy for the US Chamber of Commerce. The number of full-time workers without health insurance rose by 897,000 last year to 19.9 million. Health and Human Services Secretary Tommy G. Thompson said the numbers show that "the nation must do more" to help the uninsured. Congress should provide tax credits for the purchase of private insurance, Thompson said. "Monitoring Socioeconomic Inequalities in Sexually Transmitted Infections, Tuberculosis, and Violence: Geocoding and Choice of Area-Based Socioeconomic Measures - The Public Health Disparities Geocoding Project (US)" Public Health Reports (05-06.03); Vol. 118; P. 240-260::Nancy Krieger, PhD; Pamela D. Waterman, MPH; Jarvis T. Chen, ScD; Mah-
Jabeen Soobader, PhD; SV Subramanian, PhD
The current study employed cross-sectional analysis of public health surveillance data, geocoded and linked to area-based socioeconomic measures (ABSMs) generated from 1990 census tract, block group, and ZIP code data, to determine which ABSMs, at which level of geography, are suitable to monitor socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence in the United States. The researchers studied populations and areas in Massachusetts and Rhode Island enumerated at or around the 1990 census. Each state's Department of Public Health provided STI and TB data; only the Massachusetts DPH provided violence data on non-fatal weapons-related injury. In each surveillance system, reporting is mandatory. The scientists gathered data on age, gender and race/ethnicity through a mixture of self- and observer-reports. They analyzed data on cases, instead of individuals, since there is little individual socioeconomic data in public health surveillance systems for the outcomes they were reviewing.
The study included all new chlamydia, gonorrhea, and syphilis infections among Massachusetts residents from 1994-1998, and cases among residents of Rhode Island from 1994-1996. The researchers analyzed data on 36,344 Massachusetts cases and 6,403 from Rhode Island. TB cases comprised all new infections among Massachusetts residents from 1993-1998 and among Rhode Island residents from 1985-1994. Massachusetts cases numbered 1,786 and
Rhode Island cases, 576. New non-fatal weapons-related injury data came from the Weapons-Related Injury Surveillance System (WRISS), which provided information on intentional and non-intentional gunshot wounds and intentional stabbings. The researchers analyzed 5,571 cases from the WRISS database for 1995-1997.
"This study," the researchers wrote, "part of the first systematic US investigation of ABSMs suitable for monitoring population health across a range of health outcomes and also the first simultaneously comparing diverse ABSMs within and across levels of geography, provides empirical evidence that both choice of measure and level of geography matter. Specifically, examining STI, TB, and non-fatal weapons-related injury rates for two New England states during the period around 1990 in conjunction with 1990 census data, we found that measures designed to detect economic deprivation, including the percent below poverty, were most robust, consistently detecting expected gradients across all outcomes, whereas measures pertaining to educational level, wealth, and income inequality often detected smaller gradients or missed them entirely."
The study found incidence rates for STIs were highest in areas with high crowding and next highest in areas with high poverty. TB showed the same pattern, with highest rates among cases in highly crowded areas, followed by rates among cases with high levels of economic deprivation. Data for non-fatal weapons-related injuries showed that "the ratio of the median rate of intentional to unintentional injury increased steeply with economic deprivation" from approximately 12 times higher for areas with the most economic resources, to more than 70 times higher in areas with the least economic resources.
The authors found census tract and census block group data more reliable than ZIP Code measures in detecting gradients, and the analyses found that "the single variable and composite measures explicitly capturing aspects of economic impoverishment consistently detected the sharpest socioeconomic gradients in STIs, TB, and non-fatal weapons-related injuries, [highlighting] the profound impact of material deprivation on health."
The researchers concluded, "Supplementing US public health surveillance systems with census tract or block group area-based socioeconomic measures of economic deprivation could greatly enhance monitoring and analysis of social inequalities in health in the United States."
Chicago Tribune
"Hooking Up on the Internet"
(09.28.03)::Candace Purdom
Health officials expect the rates of sexually transmitted diseases to rise as more people use the Internet to meet for casual sex. Chicago is among several US cities now using the Internet for health interventions.
Andy Delicata, a disease intervention specialist at Chicago's Howard Brown Health Center, uses the Internet to contact people who tested positive for syphilis, so he can notify their sex partners. "Oftentimes, they only have an e-mail address or screen name," he explained.
Health educator Daniel Pohl offers information and answers questions for Howard Brown's predominantly gay clientele through a Web site (www.howardbrown.org) or by entering chat rooms. Although Pohl visits gay bars and other locations to talk to those at risk, on the Internet, "It's easier for guys to talk to me," he said. "They tell me more - and more private things - online."
Next month, Chicago's Syphilis Elimination Task Force will launch a new campaign funded by a $500,000 federal CDC grant. The effort will include a Chicago Transit Authority and neighborhood poster campaign and an interactive Web site at www.gettestedchicago.com.
Chicago is one of eight cities that have seen rising rates of syphilis recently. "We see a little under 400 cases a year, which doesn't sound like a whole lot, but it's very disconcerting because of a high rate of co-infection with HIV," noted Beau Gratzer, men's health promotion manager at Howard Brown.
Some 300 public health professionals met in Washington, D.C., in August for a conference on STD/HIV prevention and the Internet. On the Web, "you can meet more partners faster and therefore have potentially more sex," conference organizer Mary McFarlane of CDC said. "We need to keep up with that [technology] as public health [officials] and to understand what the implications are, both for risk and prevention."
USA Today
"Hepatitis Threatens Two Amazon Tribes"
(09.24.03)
The UN has launched a vaccination drive to save the Sharpas and Candoshi, two tribes in the Peruvian Amazon that are threatened with extinction by a hepatitis B outbreak. "Local leaders warned that [the two tribes] could face extinction within 10 to 12 years," UNICEF said in a statement. Peru asked for help after 40 Candoshi died of the disease in 2002. The tribe has 2,500 members. There were no data for the Sharpas tribe. UNICEF wants to vaccinate all the tribes' 150 babies three times before one year of age to try to stamp out the disease.
CDC HIV/STD/TB Prevention News Update
Thursday, September 18, 2003
Associated Press
"Nevada Agency's Abstinence Ad Pulled from Radio"
(09.16.03)
Nevada's Health Division has pulled a public service radio announcement that suggested teenage girls will feel "dirty and cheap" if they have sex with their boyfriends. Health Division spokesperson Martha Framstad said the radio spot was suspended because the language was not appropriate for the 9- to 14-year old girls the agency wanted to reach. The ad was broadcast as recently as last Thursday during a break in the Howard Stern radio show, which is broadcast in Reno and Las Vegas.
Greg Bortolin, spokesperson for Gov. Kenny Guinn, said Monday he thought the ad had been pulled last month. He said he and Marybel Batjer, Guinn's chief of staff, had discussions then with Yvonne Sylva, Health Division administrator, to express concerns about the message.
"We were concerned about how the ad was received by listeners," Bortolin said. "If another ad is aired, it hopefully will be less offensive to people. We probably should have been more sensitive."
The ad to encourage girls to abstain from sex until marriage was developed with part of a $157,000 grant from the federal Child and Maternal Health Agency. Jessica Cowee, abstinence-only coordinator for the Health Division, wrote the message. The Health Division had to match the federal funding with $118,000 in order to get the grant. The grant did not require radio advertisements. Nevada agreed to pay $5,000 a month to the Nevada Association of Broadcasters to air the ad, but NAB agreed to donate most of the broadcast costs.
Planned Parenthood and the American Civil Liberties Union had complained about the message, particularly about the "dirty and cheap" line, when the ad was first broadcast in early August.
Framstad said her agency is developing a new announcement more in line with the language and thoughts of 9- to 14-year-olds. This ad may be broadcast as early as next week. Plans to run an abstinence ad on television have been dropped.
Casper Star-Tribune
"Hepatitis Outbreak Slows"
(09.11.03)::Matthew Van Dusen
Casper, Wyo., residents watching late-night MTV might recognize Dr. Mark Dowell in an advertisement telling people to get tested for hepatitis and avoid risky behavior. "Hepatitis is not something to mess around with," says the Casper-Natrona County health officer in the ad, which runs on cable channels.
The advertisement comes as Natrona is still facing an outbreak of hepatitis B and C that has drawn the attention of CDC. The confirmed number of infections continues to slowly increase, with 49 cases of hepatitis B and 74 cases of hepatitis C - 123 cases total - since late March. Of that total, 15 people are infected with both viruses.
Hepatitis B and C are viruses of the liver that can lead to chronic conditions. They are most often spread through unprotected sex and sharing drug paraphernalia. Hepatitis B is highly communicable and health officials are most concerned about it.
Fewer people are checking into the hospital with hepatitis B symptoms, said Dowell. He has seen a couple of people with the virus in recent weeks, compared with almost one every day during the summer months. Hepatitis B has a 30-day incubation period, he said, so it is likely the outbreak has mostly run its course. Many people with hepatitis C can function for years without showing symptoms.
State Hepatitis Coordinator Clay Van Houten credited local, state and federal health officials for stopping the outbreak. Health officials, including a CDC team, tested and vaccinated for hepatitis B in Casper during the summer. There is no vaccine for hepatitis C. No infected person has died because of the virus, Van Houten added.
Van Houten said CDC will likely report within a few months and will clarify how the viruses were transmitted. Health officials have previously said methamphetamine users were, in part, responsible for spreading the viruses. The Casper-Natrona Health Department continues to offer no-cost vaccinations to people at risk. For more information, telephone 307-235-9340.
Washington Blade
"Baltimore Health Clinic Turns 25"
(09.12.03)::Bryan Anderton
In 1978, Chase Brexton Health Services opened in Baltimore to stem the spread of STDs. Back then, it was known as the Gay Health Clinic for Venereal Diseases. It has since expanded its services to include primary and mental health care for gay as well as non-gay patients. In recent years, CBH has become a full service health center with 120 staff members. CBH will celebrate its 25th anniversary on Sept. 28 with an afternoon of cocktails, a silent auction and a show on Nov. 2 by Australian drag personality Dame Edna.
CBH now provides a full range of outpatient mental health services, including therapy and counseling for individuals, couples and families. In addition to primary care for men, women and children and STD and HIV/AIDS diagnoses and treatment, CBH provides physicals, immunizations and dental care among its services.
"We probably are seeing more people who are coming here simply because they are hearing good things about the services we provide," explained Dr. David Haltiwanger, the clinic's mental services director.
There are advantages for people who are gay or HIV-positive to be able to talk openly about their individual needs, said Dr. Eva Hersh, CBH's primary care medicine director. "It just cuts away a whole layer of explaining," she said. For example, many lesbians have been asked by
a doctor whether they use birth control medication, she said, and most doctors do not ask men if they engage in anal intercourse.
Despite the success CBH has had providing medical services, David Shippee, the clinic's executive director, said he would like the organization to take on more of an advocacy role in addressing health care and public policy issues in Baltimore. "For the last 20 years, we've pretty much stuck to the rendering of care instead of the shaping of policy," he said. But now, he said, CBH has "made the commitment to become a much more active player."
CDC HIV/STD/TB Prevention News Update
Tuesday, September 16, 2003
Agence France Presse
"North America's First Supervised Heroin Injection Site Opens"
(09.15.03)::Deborah Jones
The first supervised heroin injection site in North America officially opened Monday in Vancouver. Organizers estimate that as many as 800 addicts a day will go to the site to shoot up instead of using back alleys, thus helping reduce overdose deaths as well as AIDS and hepatitis infections among injection drug users. Thirty-seven IDUs have died from overdose this year.
"It's going to make a large difference," said Mayor Larry Campbell. "This is a historic day for Vancouver and a turning point in our approach to dealing with addictions."
The facility is in Downtown Eastside, a poor Vancouver neighborhood with thousands of drug addicts. Campbell warned, "no one should expect the Downtown Eastside drug scene to change overnight. However, in combination with other prevention, treatment and policing efforts, we hope to reduce drug related deaths, and see injection drug users get the health care, treatment and support they need to live healthier lives," he said.
The storefront injection site is modeled after sites in approximately 50 cities in Europe and Australia. But for North America, which has traditionally regarded drug addiction as a law enforcement rather than a health issue, the facility is controversial. Canadian opposition politicians are watching the site closely. US drug czar John Walters, on a trip to Vancouver earlier this year to speak out against Canada's drug policy, called the site "state-sponsored personal suicide."
Organized by the Vancouver Coastal Health Authority, the site's staff includes 16 nurses and several counselors who offer medical treatment, watch for overdose, and give advice about rehabilitation options. Addicts will have to bring their own drugs, which they still must purchase illegally.
The Canadian government approved the site in June, after an 18-month investigation, as part of a new national drug strategy. Funded by the federal and British Columbia provincial governments, the injection site is part of a three-year research and harm reduction trial.
CDC HIV/STD/TB Prevention News Update
Friday, September 12, 2003
Edmonton Journal
"Teens Know Less About Sex Risks"
(09.10.03)::Allison Lampert
Despite years of public health campaigns, a new study shows Canadian teenagers know less about safe sex now than they did in 1989. "We would have hoped that today, in 2003, teens would know more about [sexually transmitted] diseases. But despite all the information available, we're realizing that teens aren't necessarily assimilating it," said researcher Dr. Christian Fortin.
Coordinated by the Council of Ministers of Education, the Canadian Youth, Sexual Health and HIV/AIDS Study is a broader update of a 1989 study that focused on STDs. The study questioned more than 11,000 7th, 9th and 11th grade students about sex, drugs, parents and school.
The study revealed that teens of both genders are less likely to report having had multiple partners than teens of the recent past. More boys are postponing sexual intercourse, with about 20 percent in 9th grade and 40 percent in 11th grade reporting they have had sex at least once - a decline of about 8 percent from 1989.
But teenagers who are having sex are having it more frequently, and are doing it with less knowledge of its dangers. About half of 11th graders were unaware that people with STDs may not have any visible symptoms. Almost one-quarter of 9th grade students said they would feel too embarrassed to see a health care provider if they thought they had an STD. And 12-16 percent of students said they did not know where teens were most likely to get condoms.
One of the most alarming findings, according to Fortin, was that half of 9th graders believed AIDS could be cured if treated early.
These responses come at a time when STD rates are highest among 15- to 24-year-olds, according to Health Canada. In 2000, girls ages 15-19 made up about 40 percent of the national
chlamydia and gonorrhea infection cases reported.
Fortin said the study shows that sex education must become more of a priority in schools. "This information must be integrated into the curriculum, or else we're losing an extraordinary opportunity to do prevention," said Fortin.
CDC HIV/STD/TB Prevention News Update
Wednesday, September 10, 2003
Associated Press
"Assembly Approves Changes to Sex Education in Public Schools"
(09.09.03)::Jennifer Coleman
The California Assembly approved a bill Tuesday that would streamline the process for allowing students to attend sex education classes, over Republicans' objections that it would weaken parental authority.
Sponsored by Sen. Shelia Kuehl (D-Santa Monica), the bill would require schools to send notices at the beginning of the school year alerting parents to the dates students will take sex education, HIV/AIDS prevention, and student health surveys.
Should parents not want their children to attend those classes or take surveys, they would need to notify the school - the same opt-out system schools currently have for sex and HIV/AIDS education.
Assembly member Darrell Steinberg (D-Sacramento) said the programs all have different deadlines and procedures for parental notification. Kuehl's bill would consolidate those, and schools would send the announcements just once, at the beginning of the year - a time when parents are more likely to be looking for letters from school, said Steinberg. Steinberg said the law still requires teachers to stress abstinence as the only sure way to prevent STDs and pregnancy.
But several Republican Assembly members said the bill would take the decision away from parents. Sharon Runner (R-Lancaster) worried that parents could overlook the notice in backpacks full of information" coming home at the beginning of the school year.
Those opposing the bill also objected to allowing the surveys, some of which ask questions about drug use and sexual behavior, without parental permission. But the bill's supporters said the surveys measure how well schools teach sex education, and that the opt-in system caused such low survey return rates that the results were statistically insignificant. If Kuehl's bill became law, the surveys would change to an opt-out system, but would be limited to surveys that are anonymous, confidential and inquire only about the student, said Kuehl.
The bill was approved 44-31 and returns to the Senate for approval of Assembly changes.
Los Angeles Times
"Police Accused of Interfering with Needle-Exchange Efforts"
(09.10.03)::Steve Hymon
New York-based Human Rights Watch on Tuesday accused police in California of interfering with legitimate needle exchange programs intended to slow the spread of HIV and hepatitis C. By arresting or harassing patrons of locally approved exchange programs throughout the state, police are discouraging people from using a public health program that could save lives, said HRW's report. The group interviewed 67 Californians who use the programs, said Jonathan Cohen, an HIV/AIDS researcher with HRW.
About 28 percent of new US AIDS cases in 2002 can be traced to dirty needles, according to CDC. California made needle exchange programs legal several years ago, but possessing drug paraphernalia such as syringes is still illegal, and it is illegal to buy syringes at a pharmacy without a prescription.
Sacramento lobbyist John Lovell accused HRW of lying. Lovell represents the California Narcotics Officers Association, the California Police Chiefs Association and the California Peace Officers Association. These groups support needle exchange programs, Lovell said, but he added that it is inevitable that some drug addicts who use the exchanges will run afoul of the law for other reasons, such as disorderly conduct.
Program Director Shoshanna Scholar of Clean Needles Now in Hollywood, which distributes 70,000 needles monthly, said the group has a good working relationship with the Los Angeles Police Department. But she said some program users have complained that officers sometimes take their needles or destroy their exchange ID cards.
"We have received some complaints that there have been some isolated cases of police harassment... but I don't think it's a major problem right now," said Jerry Davila, assistant AIDS coordinator for Los Angeles.
SB 774, being debated in the Legislature, would allow pharmacies to sell a limited number of needles without a prescription. Gov. Gray Davis, who vetoed a similar bill last fall, has not said whether he will support the new one.
Los Angeles Times
"Finding the Right Combination to Fight Hepatitis C"
(09.01.03)::Linda Marsa
Just half of the millions of Americans infected with hepatitis C respond to treatment, while others who are infected live with the constant threat that their health could suddenly, and fatally, deteriorate. But a new drug could help improve these odds.
When used with the antiviral drug interferon, the drug Zadaxin could help thousands of patients better fight HCV. "This medication looks promising for people who don't respond to other drugs," said Dr. Sammy Saab, liver specialist at UCLA's David Geffen School of Medicine. "It may also be used as part of a combination drug cocktail for all hepatitis C sufferers, since it seems to work by a different mechanism of action than other medications," added Saab.
Current HCV treatment - a combination of interferon and Ribarvirin - helps only half of those with active infections and less than a third who are infected with the more prevalent and more dangerous form of hepatitis C known as genotype 1.
Zadaxin is a synthetic version of thymosin alpha 1, a naturally occurring protein that stimulates the production of certain immune system cells. The drug, which has no apparent side effects, is approved for sale in 30 countries as an antiviral drug to treat hepatitis B but only in a few countries to fight hepatitis C.
However, results of a US study using Zadaxin to treat HCV were encouraging. The test involved 31 patients with high levels of genotype 1 who had not responded to standard therapy. Zadaxin, used in combination with interferon, greatly reduced levels of HCV in up to 36 percent of the patients.
The findings were particularly significant because patients who do not respond to the initial round of treatment rarely benefit from subsequent therapy. "We purposely chose the most difficult of the most-difficult-to-treat patients," said researcher Di Bisceglie. Zadaxin is in the final phase of US trials.
Around 4 million Americans are infected with HCV, and about 2.7 million of those have an active infection in which the liver is inflamed. Hepatitis C, which kills 10,000 people a year, is the leading cause for liver transplants in the United States.
Gazette (Montreal, Quebec)
"Sex Education Course to Be Abolished: Province's Changes to Curriculum Affect Discussions of Sexuality in Schools"
(09.10.03)::Allison Lampert
When Quebec's reform of the school curriculum takes full effect in 2005, students will no longer be required to take a class that includes a sex education unit. Johanne Methot, a spokesperson for Quebec's Education Department, said information on sexually transmitted diseases would instead be integrated into regular classes.
"We will have discussions on sexuality in French class," Methot said. She explained that the French teacher could have the class do a project on infection rates.
Educators worry that teachers in such integrated classes might not choose to teach sex education. "If it's not planned, there are some [teachers] who will do it and others who won't," noted Robert Cadotte, a member of the Commission Scolaire de Montreal. "It depends on whether the teacher is comfortable with it or not."
Another concern is that students in regular classes might be reluctant to ask personal questions about sex. Denise Chakar, a drug and sex education consultant at Villa Maria High School in Notre Dame de Grace, teaches her students through the French program by allowing them to freely express themselves without worries about grades or their vocabulary. She allows slang references to male and female body parts.
Chakar noted that teachers need to do more than simply show a film or assign a text on sex and disease. "Showing them a video on reproduction and saying, 'Do you have any questions?' - you will get very few results," she said.
About 40 percent of 11th grade students reported having had sexual intercourse at least once. Students most often cited school as their main source of sexual health information, but only half of 9th grade students reported receiving five or more hours of instruction over the past two years.
Standard (St. Catharines, Ontario)
"Funding Boost Urged for Needle Exchange"
(09.09.03)::Kalvin Reid
Canada's Niagara region is considering an additional $50,000 (US$36,600) for StreetWorks, a regionally funded program of AIDS Niagara providing clean syringes to drug users in an effort to combat the spread of HIV/AIDS and hepatitis C. StreetWorks is expected to use the money to ensure its survival. "This program is currently in a crisis situation because we are turning people away," Steve Byers, executive director of AIDS Niagara, told the regional council's community and health services Monday.
StreetWorks' $113,000 (US$82,700) budget is not enough to cover growing expenses and increasing demand. At the current funding level, StreetWorks loses more than $4,000 US$2,900) a month. It ran a $16,000 (US$11,700) deficit last year. The committee is recommending the region's budget review committee approve additional funding of up to $50,000 (US$36,600) for the program next year.
"The best way to get some of these people off drugs is to have them exposed to people who can help them," said Fort Erie Mayor Wayne Redekop. Thorold Mayor Robin Davidson said investing in programs to reduce the incidence of illnesses such as HIV would produce greater savings in the health care sector by reducing the number of patients who have to be treated. "This program is very difficult, politically, to support," Davidson said. "There are people out there who don't understand harm-reduction programs."
The number of needles StreetWorks has distributed has jumped from 15 per client in 1993, to 62 per client last year. One of the main reasons for the increase is the change in the drug of choice from heroin to crack cocaine, said StreetWorks Coordinator Rhonda Thompson. Where a heroin addict may shoot up to two or three times a day, a crack cocaine addict may inject the drug up to 20 times a day.
There were lingering concerns the program is not meeting its objective. "This program is focused on needles for offsetting potential dangers down the road," said Niagara-on-the-Lake
Regional Councilor David Eke. "But we've got to stop the runaway use of needles and get to the root cause."
CDC HIV/STD/TB Prevention News Update
Tuesday, September 09, 2003
Associated Press
"Doctor Denies Blame in Hepatitis C Outbreak"
(09.09.03)::Phil Rooney
Dr. Tahir Javed, who is accused of using unsanitary practices that caused the hepatitis C infections of 99 patients at his Nebraska cancer clinic has denied any wrongdoing. The patients, who were receiving treatment at Javed's Fremont Cancer Clinic, contracted hepatitis C between March 2000 and December 2001. One of the infected patients has died.
Nebraska filed a petition against Javed in July that could result in the loss of his medical license. More than 80 lawsuits have been filed against the doctor. Although the state was not made aware of problems at the clinic until September 2002, two months after Javed left the country, area doctors had warned Javed for months that something was amiss, the state's petition contends.
Javed, who is now Punjab health minister in northeastern Pakistan, told Pakistan's Daily Times newspaper that the allegations are part of anti-Muslim propaganda in the wake of the
Sept. 11, 2001, terrorist attacks against the United States. "There is currently an anti-Muslim campaign in America that is also targeting educated Muslims," he told the paper. But attorney
James Allen Davis, who represents about 20 lawsuit plaintiffs, said concerns about Javed were raised more than two years before the attacks.
Javed said he was not responsible for the negligence of his nurses or other staff. He said it is ridiculous to blame him for the outbreak since hepatitis C takes more than three years to
develop, the length of time he was in charge of the clinic.
Javed challenged Nebraska to try and revoke his medical license in New York, where he said he remains on four prominent medical boards and can still practice medicine. He also denied allegations of sexual misconduct with a patient.
CDC HIV/STD/TB Prevention News Update
Friday, September 05, 2003
Women's Health Weekly
"Sexually Transmitted Diseases: Sexually Active Young Women Often Underestimate STD Risk"
(08.21.03)
Most sexually active single women believe they are at low risk for contracting STDs, but a study, "Factors Associated with Condom Use Among At-Risk Women Students and Nonstudents Seen in Managed Care," published in Preventive Medicine (2003;37;(2):163-170), says otherwise. According to the research, the group's risk profiles are similar to women in higher-risk populations.
Researchers from Duke University Medical Center, the University of Washington-Seattle and Group Health Cooperative of Puget Sound said their study highlights the need for health care
clinicians to spend more time with young women identifying risk factors, explaining consequences of unprotected sex, and promoting condom use. STDs are a significant problem for young women, with national rates of HPV, genital herpes and chlamydia particularly high among women ages 15 to 24. STDs can cause serious health complications, and recent research indicates HPV causes virtually all cervical cancer.
Researchers conducted phone surveys with 1,210 women to elicit information about demographic characteristics and risk behaviors such as episodes of binge drinking, history of vaginal sex and STDS, perceived STD risk, overall condom use and partner-specific condom use. Women surveyed were sexually active, unmarried, not pregnant, and heterosexual, ages 18-25. Students and nonstudents participated in the analysis.
"Most research into condom use and STD risk focuses on populations considered 'high risk,' such as patients seen at STD clinics, inner-city clinics and student clinics," said Kimberly Yarnall, MD, lead author of the study. "In this study we wanted to include women not currently enrolled in college to find out what the average 'Jane' thinks. Nonstudents haven't really been surveyed to understand their views about condom use and STD risk."
Nonstudents tended to be older and nonwhite and reported more lifetime partners, having more partners over the previous 12 months than students, according to Yarnall. Both students and nonstudents reported the same rates of unprotected sex in the last 3 months, and more than 75 percent of all women surveyed perceived themselves at low risk for contracting an STD in the next year.
"In both groups, women were less likely to use condoms if they were older, white, on birth control pills or had partners that didn't see condoms as important," Yarnall said. "In the nonstudent women, binge drinking was significantly associated with unprotected sex among nonstudents, but that was not the case with the students." Yarnall said the connection may be explained by the fact that college students have educational programs about binge drinking and impaired judgment, while most nonstudents do not have access to such information.
Nonstudents were also more likely to have unprotected sex with someone they did not consider a committed partner, the study found. "Neither group had a great track record as far as safer sex," Yarnall noted. "But the college students did a little better overall. Students were less likely to have unprotected sex with someone they met at a party or a bar. Nonstudents were just as likely to have unprotected sex with their boyfriend as they were a man they had just met."
Yarnall believes it is important to recognize and understand predictors of unprotected sex so clinicians can identify and counsel women who may not see themselves at risk for sexually transmitted diseases. "Once we identify at-risk women, we should refer them for appropriate testing, follow-up counseling and education," she said.
Associated Press
"Health Officials Search for Source of Parasite Outbreak"
(09.04.03)
Officials in Lawrence, Kan., are assuring residents the city water supply is safe, but they still have not determined the source of a cryptosporidium outbreak. There have been 23 confirmed cases since the first was reported Aug. 22, and health officials believe there probably will be more. The diarrhea-causing parasite can be fatal to people with weakened immune systems, such as the young, the elderly and people with HIV. More than two-thirds of those who contract cryptosporidiosis are children. As part of their investigation, health officials visited two day-care centers, finding a case at one. Students at four Lawrence elementary schools last week took home questionnaires designed to determine the extent and source of the epidemic. More than 600 responses were returned over the weekend. "We are working as hard as we can and we hope to have some results [on how far the parasite has spread] in the next few days," said Dr. Gianfranco Pezzino, the Kansas state epidemiologist.
CDC HIV/STD/TB Prevention News Update
Tuesday, September 02, 2003
Associated Press
"Herpes Treatment Approved to Reduce Infection's Spread, Too"
(08.29.03)
The widely used genital herpes drug Valtrex (valacyclovir) can now be advertised as helping to prevent the spread of herpes simplex virus type 2, the Food and Drug Administration ruled Friday. Until now, the only advice for not transmitting genital herpes has been to use condoms
and avoid sexual contact during the infection's periodic flare-ups, when lesions appear. But condoms do not always cover all the sores, and the virus sometimes can be transmitted when there are no visible lesions.
Valtrex treats herpes flare-ups by suppressing the virus. A recent study tracked whether that suppression would be enough to also protect an infected person's sexual partner.
Researchers enrolled almost 1,500 couples in which one partner had herpes and the other partner did not, and gave the infected partners either a once-daily Valtrex or a placebo. Valtrex use cut in half the healthy partner's risk of becoming infected. Based on that study, the FDA ruled that manufacturer GlaxoSmithKline now can advertise Valtrex to reduce the risk of spreading herpes when used in combination with safer sex practices - condom use and abstinence during outbreaks.
Associated Press
"Syphilis on Rise in New Mexico"
(09.01.03)
Offering food, cash and other freebies, public health workers set up an RV in downtown Albuquerque and waited for people to show up for syphilis tests.
In the past few years, New Mexico has seen a steady rise in syphilis. Though the numbers are not high, the increase is. The state reported about 20 syphilis cases in 1999. Last year, 63 were reported. In the first six months of 2003, 47 cases were reported, according to Al Chowning, STD program manager for the state Department of Health.
Dr. Bruce Trigg, medical director of STD programs for the Albuquerque public health office, said the majority of cases in the state are among prostitutes and IV drug users. American Indian cases in the first six months of 2003 already equal the total for all of last year, said Chowning. Bernalillo, San Juan and McKinley counties have seen the largest syphilis increases in 2002 and for the first half of this year.
Rather than wait for people to come to clinics, public health workers are hitting the streets and teaming up with local agencies that can help them reach those most at risk. In Albuquerque, public health workers targeted prostitutes for testing, and they traveled to Farmington, Bloomfield, Gallup and Shiprock to test alcoholics and drug addicts.
In the RV in Albuquerque one night, public health workers not only did a brisk business in syphilis tests, but also vaccinated people for hepatitis A and B and offered tests for hepatitis C.
Syphilis test results usually take around 20 minutes to show results. To keep people around that long, the workers offered a $10 payment at the end and handed out food and other giveaways.
CDC HIV/STD/TB Prevention News Update
Friday, August 29, 2003
Los Angeles Times
"Officials Target Spermicide in Condoms"
(08.28.03)::Lisa Richardson
Behind-the-scenes efforts to persuade some of the largest condom manufacturers to stop using a spermicide that may increase the risk of HIV and urinary tract infection have failed, so several California legislators, AIDS activists and women's groups set out Wednesday to shame them into it.
At a news conference in Sacramento, Assemblymember Paul Koretz (D-West Hollywood) and Assembly Speaker Herb Wesson expressed frustration after the presidents of three major condom producers recently refused to meet with them to discuss the spermicide nonoxynol-9. "Since
January, I've tried to negotiate quietly with representatives... to encourage them to phase out nonoxynol-9," said Koretz.
Koretz, Wesson, AIDS Healthcare Foundation President Michael Weinstein, Sonja Herbert of the National Women's Health Network and others signed an open letter to the Food and Drug Administration, retailers and condom and lubricant makers. "Until recently, N-9 was believed to be an effective chemical barrier against HIV and a variety of other sexually transmitted infections," said the letter. "Recent studies published by [UNAIDS], the World Health Organization, [CDC] and numerous peer-reviewed medical journals have concluded the N-9 not only does not help prevent [STDs], in some circumstances it actually increases the risk of contracting HIV."
Wesson, who said he has lost three family members to AIDS, called on the companies to put ethics over profit. Assemblymember Sally Lieber (D-Mountain View) stressed that the letter-signers did not object to the use of N-9 in over-the-counter vaginal spermicides specificallyused for birth control.
Among manufacturers cited at the conference were Church & Dwight, maker of Trojans, and Ansell Limited, an Australia-based company that makes Lifestyles condoms. Other condom producers such as Johnson and Johnson and Mayer have stopped using N-9.
In a statement, Church & Dwight said consumers could become confused by the calls for market removal, resulting in reduced condom use. Rather, condom makers "are already working with the FDA on revised labeling" for condoms with N-9 "to ensure they are used appropriately."
Around 35 percent of condoms sold in the United States contain a spermicide, and N-9 is the only one used.
CDC HIV/STD/TB Prevention News Update
Wednesday, August 20, 2003
Associated Press
"Hepatitis A Outbreak Spreads Through Northeast Georgia"
(08.18.03)
One hundred people in northeast Georgia have been infected with hepatitis A in the first half of this year, and health officials are uncertain as to the cause of the outbreak.
"That compares to 20 cases during the same period in 2002," said Julie Wolthuis, epidemiologist with the Georgia Department of Public Health. "Most of the reported cases have been in adults, but that may be because adults tend to be much more symptomatic," added Wolthuis.
Outbreaks of hepatitis A are typically connected to daycare centers, restaurants or prisons, but this year's cases have occurred randomly throughout the 13-county district, according to Wolthuis. "There's no pattern to it," she said. "We've done phone interviews [with patients] and haven't been able to pinpoint one risk factor over another. Nothing jumped out at us."
Hepatitis A is usually spread through fecal-oral contact, such as touching the mouth after using the restroom or changing a diaper, and infects about 23,000 Americans each year. It generally causes mild illness, with a few days or weeks of fever, nausea and jaundice. And unlike hepatitis B and hepatitis C, which can cause chronic liver infection, long-term liver damage is not associated with hepatitis A.
"We noticed an increase in cases [of hepatitis A] when school started last year," said Mamie Coker, health services coordinator for the Hall County school system. "Usually, we get only a couple of cases, but during the past school year we had seven or eight. At least one of the students was hospitalized," reported Coker.
Melody Stancil, director of the public health office in Gainesville, said the outbreak peaked in February and March, and the number of cases has been dropping since then. In Georgia, children are immunized against hepatitis B only, although vaccines are available for hepatitis A.
Philippine Daily Inquirer
"Medicine, Worker Lack Plaguing Campaign vs. TB"
(08.20.03)
Medicine shortages and the lack of medical technologists are threatening the Philippines' TB program with failure, particularly in far-flung areas of the country, according to medical officers and workers at a recent meeting in Davao City. These problems explain the nation's failure to reduce TB in recent years, they said. Health workers nationwide have been implementing the Directly Observed Treatment Short-Course (DOTS) strategy, said Dr. Rogelio Chua, regional health chief. "Seventy percent of those affected by TB are breadwinners. For every Filipino who develops TB, one family goes hungry," Chua said. "DOTS will help prevent economic displacement brought about by absenteeism and the loss of jobs from current illness." At least
75 Filipinos die every day from TB.
CDC HIV/STD/TB Prevention News Update
Wednesday, August 13, 2003
Age (Melbourne)
"Call to Start Chlamydia Screening"
(08.09.03)::Amanda Dunn
Fearing a huge rise in female infertility, sexual health experts in Victoria, Australia, are calling for routine screening of young women to help stop skyrocketing rates of chlamydia.
Victoria's chlamydia notifications increased from 814 in 1991 to 4,846 in 2002. Nationally, notifications increased from 4,763 in 1991 to 24,011 last year.
Melbourne Sexual Health Center Director Christopher Fairley said the disease - the most commonly reported STD in Victoria - has serious health consequences. While chlamydia begins by infecting the cervix, in 10 percent to 40 percent of cases it travels into the pelvis and causes pelvic inflammatory disease, which can cause chronic pelvic pain, ectopic pregnancies and severe pain during sex. In one in five of those cases, the woman can become infertile, as scarring in the fallopian tubes stops an egg from passing through.
Fairley said women under age 25 - the group most at risk due to the number of sexual partners and low condom use - should be screened annually by their doctor.
Chlamydia is the leading cause of infertility in women, making the increase in infections a serious public health issue, said Lynne Jordan, Family Planning Victoria's chief executive.
"In years to come, there'll be a significant proportion of women who'll be seeking infertility treatment," she said.
Already, chlamydia is partly responsible for rising infertility rates, said Julie Quinlivan, senior lecturer in obstetrics and gynecology at Melbourne University. She advised screening men and improving condom education.
A spokesperson for federal Health Minister Kay Patterson said the minister is looking at ways to address the issue with the states and territories.
Associated Press
"Two Inmates with HCV Plan Suit"
(08.11.03)
Two hepatitis C-infected prisoners at Bolduc Correctional Facility in Warren, Maine, want the state to treat their disease, but do not want to be transferred from their minimum-security facility to the Maine State Prison to do it. This fall, the state Department of Corrections will implement an HCV treatment program. One of its requirements is that participants live at the Maine State Prison. But inmates Donald Bowden and John J. Morton do not want to be transferred to the state prison, which they liken to a "war zone." The prisoners say they plan to sue the state for not implementing a treatment program sooner and for requiring them to transfer facilities to receive treatment. The men claim the state has denied medical treatment for HCV, and thus discriminated against them, noting that inmates with AIDS are provided similar costly treatment benefits. Eleven percent, or 209, of the state's 1,995 inmates have hepatitis C and 10 inmates have AIDS, Associate Commissioner Denise Lord said.
Asociated Press
"Casper Hepatitis Cases Expected to Linger"
(08.12.03)
The Casper-Natrona, Wyo., Health Department said a hepatitis outbreak that began in February is expected to remain a threat for another six months. The number of cases in the county has topped 120, and more than 350 people have been vaccinated against both hepatitis A and B. Hepatitis A is the "restaurant" hepatitis usually spread through food handlers. "It is mostly transmitted through what we call fecal-oral and occurs through food workers not washing their hands after using rest facilities, and then proceeding to fix your salads and other foods," Health Department spokesperson Marty Thone said Monday. Hepatitis A is also prevalent among daycare workers who change diapers and travelers who visit countries with poor sewage treatment. Hepatitis A symptoms may not present for up to two weeks and cases can be mild to serious. Hepatitis A is curable; hepatitis B is not and lasts a lifetime. About 25 percent of those with hepatitis B die of either cirrhosis or liver cancer.
CDC HIV/STD/TB Prevention News Update
Tuesday, August 12, 2003
Worcester Telegram & Gazette
"ABCs of STDs"
(08.10.03)::Yvonne Woon
Statistics from the Massachusetts Department of Public Health show that 15- to 24-year-olds have the highest rates of chlamydial and gonorrheal infection in the state, and the rate is rising. Since 1996, there has been a 53 percent increase in chlamydia and a 38 percent increase in gonorrhea among teens ages 15 to 19. In the past two years, the rates for teens younger than
15 have risen from 2 percent to 5 percent for chlamydia and from 1.7 percent to 5.5 percent for gonorrhea.
The rates are consistent with findings that show increased sexual activity among teens and a lack of STD awareness, said Dr. Alfred DeMaria, DPH director of communicable disease control. A study in May by the National Campaign to Prevent Teen Pregnancy found that one in five adolescents has had sex before his or her 15th birthday.
Many teens mistakenly think hormonal birth control pills, patches and injections prevent infections as well as pregnancies, according to a June study by the Kaiser Family Foundation. Many young women are using birth control pills or patches rather than a physical barrier to infection, such as condoms. The majority of teens are not aware that STDs can be transmitted through oral sex, the report also found.
Oral sex has become popular among teens, and young people are not being educated about its risk factors. "Sex education has focused on harm reduction for HIV, and has taught that the risk is lower during oral sex, for HIV transmission," DeMaria said. "However, it is certainly not zero. And with other STDs, such as chlamydia and gonorrhea, the risk is just as high as it is for sexual intercourse."
Drugs and alcohol are other counterparts to risky sexual behavior. "Condoms are used more sparsely and kids just don't think about the repercussions," said DeMaria. "There have also been more people exchanging sex for drugs, which is obviously not helping the problem."
Associated Press
"Rise in Chlamydia Cases Overwhelms Fort Wayne Clinic"
(08.09.03)
A spike in diagnosed chlamydia cases has strained the Allen County, Ind., health department's two-nurse clinic that treats people with STDs. "Our STD Clinic is turning people away at the door every day," acknowledged Loren Robertson, the county's health administrator. "Chlamydia is at epidemic levels in the area."
In the first half of the year, 885 cases of chlamydia were reported, up from 654 in the same time period last year. From April to June, the increase was 45 percent more than last year.
According to Fort Wayne-Allen County Health Department Director Kathryn Thornson, the clinic, which cares for many uninsured patients, has been overwhelmed because of the increased number of chlamydia cases and because of the economy.
The rise in diagnosed cases concerns Linda Hathaway, program manager at the McMillen Health Education Center. She fears that many people who have one STD often have several, thus potentially allowing the diseases to continue to spread. "If they're having sexual contact with other people, they're probably passing more than one," said Hathaway. "If they've got more than one in their body, it makes them more susceptible to others as well," she noted.
Hathaway, a member of a countywide task force on STDs, believes the solution lies in educating the entire community about the risk of STDs and creating a comfortable environment that empowers teenagers to make safe decisions.
CDC HIV/STD/TB Prevention News Update
Friday, August 08, 2003
Associated Press
"Alaska Rise in Sexually Transmitted Diseases Reported"
(08.07.03)
For the second consecutive year, Alaska reported the highest chlamydia rates in the country, and state Division of Public Health officials say the numbers are growing. In 2002, 3,805
cases of the STD were reported in Alaska, a 40 percent increase over 2001. The state also reported an increase in gonorrhea rates, with 642 cases in 2002, a 41 percent increase over 2001.
Advanced screening technologies could be partially responsible for detecting more cases of chlamydia and gonorrhea, said Alison Bell, a state medical epidemiologist. Also, more
people are being tested for chlamydia, which became reportable in the state in 1996. The numbers could be skewed by the fact that not all 50 states report incidences of chlamydia, Bell said. Bell attributed part of the increase in gonorrhea to more testing, as well. "The gonorrhea numbers have been coming down significantly for decades," she said.
The state also reported an increase in HIV/AIDS cases, from 51 cases in 2001 to 87 cases in 2002. Bell said that does not necessarily represent a lasting trend.
Females comprised 2,576 of the chlamydia cases in 2002, and males made up 1,229. There were 289 male cases of gonorrhea and 353 female cases. People ages 15 to 24 represent the highest-risk group for contracting the two diseases.
By race, Alaska Natives constitute 44 percent of the chlamydia cases reported, followed by whites at 39 percent, blacks at 11 percent and Asians at 6 percent. For reported gonorrhea cases, Alaska Natives represented 55 percent, with whites at 26 percent, blacks at 15 percent, Asians at 3 percent and others at 1 percent. The report noted that the high numbers reported among blacks and Natives could be due in part to detection bias, noting that minority groups often seek health care through publicly funded institutions that frequently have a better reputation for reporting STDs.
Washington Post
"Bush Misuses Science, Report Says; Democrats Say Data Are Distorted to Boost Conservative Policies"
(08.08.03)::Rick Weiss
According to a report released Thursday by Rep. Henry A. Waxman (D-Calif.), the Bush administration has repeatedly mischaracterized scientific facts to bolster its political agenda
in areas ranging from abstinence education and condom use to missile defense. Compiled by the minority staff of the House Government Reform Committee's special investigations division,
"Politics and Science in the Bush Administration" alleges that President Bush - much more than his predecessors - has been spiking science with politics to justify conservative policies. The White House quickly dismissed the report as partisan sniping.
Several prestigious scientific journals - including Science, Nature, and the New England Journal of Medicine - have editorialized recently about the administration's dealings in science. An editor at Science recently wrote that the administration was injecting politics into arenas of science "once immune to this kind of manipulation." Lancet editors noted "growing evidence of explicit vetting of appointees to influential [scientific] panels on the basis of their political or religious opinions" and warned against "any further right-wing incursions" on those panels.
The General Accounting Office has been investigating such allegations since September, but it has not released any findings.
Among the abuses alleged in the report:
*"Performance measures" used to determine the effectiveness of federally funded abstinence-only sex education programs were altered by the administration in ways that made it easier to say the programs were effective. And information about how to use a condom - along with scientific data showing that sex education does not lead to earlier or increased sexual activity in youths - was removed from a CDC Web site.
*Bush has appointed to key scientific advisory committees numerous people with political, rather than scientific, credentials. For example, his appointee to a presidential AIDS advisory committee, marketing consultant Jerry Thacker, has described homosexuality as a "deathstyle" and referred to AIDS as the "gay plague."
A Waxman spokesperson said the report, posted at www.politicsandscience.org, would be updated as new examples arise.
Reuters
"Women Unaware of Viral Link to Cervical Cancer"
(08.04.03)
A survey released Tuesday showed that many women are unaware that the human papillomavirus is the main cause of cervical cancer, and that birth control pills offer no protection against it. HPV, linked with about 95 percent of cases of cervical cancer, is one of the most common worldwide causes of sexually transmitted disease.
Fewer than one-third of the 1,000 women questioned during 15 months at a London clinic had ever heard of HPV. Less than half knew it was linked to cervical cancer. Those who knew tended to be older women who had had an abnormal cervical smear. Average age of the women surveyed was 30.
"In this relatively well-educated sample, awareness and knowledge of HPV were poor," Jo Waller of the University of London said in the report "Awareness of Human Papillomavirus
Among Women Attending a Well Woman Clinic," published in Sexually Transmitted Infections (2003;79;(4):320-322).
Almost all women with cervical cancer have HPV, but studies have shown that only a small percentage of women with HPV develop cervical cancer. HPV also causes genital warts, the most easily recognized sign of HPV infection. Only one-third of the women surveyed knew that genital warts did not cause cervical cancer.
"Public education is urgently needed so that women participating in cervical cancer screening are fully informed about the meaning of their results," Waller noted.
Reuters Health
"Poor Quality Pap Smears Tied to Precancer Changes"
(08.06.03)
New research suggests that women with poor quality Pap smears appear more likely to develop changes in their cervix that lead to cancer. "The clinical and prognostic significance of inadequate smears is unknown," said Dr. Ye Lin Hock of Manor Hospital in Walsall, West Midlands, and colleagues.
Researchers followed a cohort of 1,972 women with an inadequate Pap smear for five years. Two percent of the women developed precancerous lesions during follow-up, compared to 1 percent of all women with cervical smear tests reported at the same laboratory over the same time period. Smears for which multiple reasons were listed for inadequacy showed the strongest link between poor quality smears and precancerous lesions.
The authors noted that their findings support current recommendations in the United Kingdom that women with inadequate smears receive further tests due to their greater risk for precancerous lesions. "The way forward in our opinion would be for the National Health Service Cervical Screening Program to study the outcome (if possible nationally) of inadequate smears, and to formulate its guidelines for further management based upon the evidence," Hock and co-authors wrote. Their report, "Outcome of Women with Inadequate Cervical Smears Followed Up for Five Years," was published in the Journal of Clinical Pathology (2003;56;(8):592-595).
Associated Press
"Study: Cervical Cancer Vaccine May Wane During Ovulation"
(08.05.03)
New research suggests an experimental vaccine against cervical cancer might lose some effectiveness when a woman ovulates. Certain strains of the human papillomavirus cause most cervical cancer, and scientists are trying to develop a vaccine to fend off the riskiest strains of the virus.
An early-phase trial of Merck & Co.'s vaccine generated excitement last fall when it appeared highly effective for at least a year after inoculation. But most of the women in the trial were also taking oral contraceptives, according to Dr. Douglas Lowy of the National Cancer Institute.
Because hormonal changes during the menstrual cycle can alter levels of virus-fighting immune cells in cervical tissue, Lowy and a Swiss colleague, Denise Nardelli-Haefliger, conducted a study to see if that were true for the HPV vaccine as well.
They gave the vaccine to seven women who took birth control pills and 11 women who did not. In the non-pill users, levels of HPV-fighting antibodies fluctuated substantially, reaching their lowest point around ovulation, the scientists reported. Women taking the pills had consistent antibody levels throughout the month.
Lowy said the study did not measure whether the vaccine is less protective in women who ovulate. He called for the advanced studies of the HPV vaccine that are currently underway to directly examine whether the drug prevents viral infection as well in ovulating women as in those who do not ovulate. Merck officials did not return phone calls asking if they plan to study the issue.
The report, "Specific Antibody Levels at the Cervix During the Menstrual Cycle of Women Vaccinated with Human Papillomavirus 16 Virus-Like Particles," was published in the Journal of the National Cancer Institute (2003;95;(15):1128-1137).
Associated Press
"CDC: Doctors Should Not Use Two-Drug Therapy on Latent TB Patients"
(08.07.03)
A two-drug combination to treat latent TB can cause severe liver damage and even death, according to a CDC study. The danger involves a two-month therapy regimen with rifampin and
pyrazinamide. In data collected from January 2000 to June 2002, CDC received reports of 48 latent TB patients with confirmed cases of severe liver injury after receiving the treatment.
Eleven patients died. The regimen should be used only if potential benefits "outweigh the risk for severe liver injury and death associated with it," CDC said. The agency recommended a nine-month regimen of isoniazid as the preferred treatment for latent TB. The report, "Update: Adverse Event Data and Revised American Thoracic Society/CDC Recommendations Against the Use of Rifampin and Pyrazinamide for Treatment of Latent Tuberculosis Infection - United States, 2003," was published in Morbidity and Mortality Weekly Report (2003;52;(31):735-739).
Associated Press
"Dozens of Work-Release Inmates Test Positive for TB After One Develops Active Case"
(08.08.03)
More than 90 inmates at a Mobile work-release facility have tested positive for TB, and health officials said they are still investigating how another inmate developed an active case of the disease. The investigation began in July, when a work-release inmate who had been working at a restaurant became seriously ill. Joe Jablecki, TB control coordinator for Mobile County, said he is optimistic that none of the other cases will prove to be active. He said health officials did not detect symptoms of active TB in a preliminary screening. Most of the restaurant's other employees have been tested, and seven will undergo drug treatment as a result of showing signs of exposure to the disease. Department of Corrections officials said prisoners are tested for TB when they enter the system and each year thereafter. They said they are trying to determine how the inmate's active case escaped notice for so long.
CDC HIV/STD/TB Prevention News Update
Wednesday, August 06, 2003
Reuters Health
"Syphilis Rates Soar in Britain"
(08.01.03)
On August 1, Britain's Health Protection Agency warned that syphilis rates have risen to the highest level since the early days of the AIDS epidemic. The HPA's newsletter, Communicable
Diseases Review, said diagnoses of infectious syphilis rose 67 percent in men and 33 percent in women between 2001 and 2002.
"Diagnoses of syphilis made in genitourinary medicine clinics are the highest seen since 1984, before the time of widespread awareness to HIV/AIDS in the UK," the report stated.
The biggest concentration of syphilis was in London, where 980 people were diagnosed between April 2001 and May 2003. Manchester reported 495 cases between January 2001 and the end of June 2003. Other places affected include Bristol, Edinburgh, Newcastle-upon-Tyne, Glasgow, Nottingham, Brighton and Northern Ireland.
The report traced the recent growth in syphilis to the popularity of sexual market places such as saunas, Internet chat rooms and cruising grounds, which increase the opportunity to acquire new sexual partners. According to the report, the Bristol outbreak was associated with heterosexual activity, commercial sex work and crack cocaine use, while the outbreaks in Brighton, Manchester, and London occurred among men who have sex with men, some of whom had concurrent HIV infection.
"The characteristics of the outbreaks are very similar to those seen in Western Europe and the United States, infection being associated with high incidence areas, high rates of partner change within risk groups and concurrent HIV infection," the report said.
TB & Outbreaks Week
"Occupational Health Hazards: Respiratory Tuberculosis Mortality Risk Evaluated by Job Type"
(07.01.03)
Researchers at CDC's National Institute for Occupational Safety and Health recently listed occupations and industries with higher incidence of deaths from respiratory tuberculosis. K.M.
Bang, D.N. Weissman, and J.M. Wood studied National Center for Health Statistics multiple-cause-of-death data from 1990-1999, restricted to states for which industry and occupational information was available, and restricted to US residents age 15 or older.
Their findings, presented at the 36th Annual Society of Epidemiological Research Meeting in Atlanta in June, revealed significantly elevated tuberculosis mortality, in descending order of proportionate mortality ratios, adjusted for age, sex and race, associated with: (1) offices and clinics of health practitioners; (2) nonmetallic mining and quarrying, except fuel; (3) agricultural production, crops; (4) coal mining; (5) hospitals; and (6) construction.
Occupations associated with significantly elevated TB mortality were: (1) crushing and grinding machine operators; (2) farm workers; (3) mining machine operators; (4) construction laborers.
The researchers reported that "industries and occupations involving mining and construction with significantly elevated tuberculosis mortality were also associated with high silicosis mortality." They believe their "findings may be useful in guiding occupationally targeted tuberculosis prevention programs."
CDC HIV/STD/TB Prevention News Update
Monday, August 04, 2003
New York Times
"Paris Tries to Raise Its Condom Consciousness"
(07.31.03)::Matthew Rose
Posters for Paris' 1,300 municipal kiosks wittily remind residents and tourists to celebrate the city's romantic neighborhoods safely. St. Michel in the Latin Quarter, famous for its fast food, is depicted as a condom-shaped spinning gyro. La place de la Bastille, a hip area, is represented in a poster with its famous column as a golden condom with a tattoo and a piercing ring. The poster for Montmartre, home to the Moulin Rouge, shows a bright red windmill spinning around a condom.
"Paris is the city of pleasure, fashion and light; it shouldn't be the capital of AIDS," said Olivier Henry, an advertising agency executive. "But it is." Henry and his partner, Caroline Nammour, at the agency Lowe Alice, conceived the idea for the 13 posters, illustrated
by Jean-Louis Cornalba. According to the office of Mayor Bertrand Delanoë, Paris has two AIDS-related deaths a day. Of the 120,000 HIV patients in France, half live in Paris.
In addition to the posters, the mayor's campaign, titled "Paris Plasirs, Paris Capotes" ("Paris Pleasures, Paris Rubbers") includes distribution of 500,000 free condoms. This summer, the government plans to pass out 100,000 postcards of the poster designs.
Philippe Lasnier, spokesperson for the mayor, said the posters "are not very risqué - for the French - but do have a certain visual shock." He added that the mayor's sexual orientation was irrelevant to the project, adding, "That Mayor Delanoë is homosexual doesn't change anything. He's known many people, homosexual and heterosexual, over the years affected by this disease."
The poster for Le Marais, a quarter popular with gays, shows condoms arranged into a rainbow flag. The most blatantly phallic image represents Ile St. Louis, where Berthillon makes famous ice cream. The poster shows an ice cream cone condom topped with two scoops.
Health & Medicine Week
"UNAIDS Report Focuses on HIV, TB in Prisons"
(07.07.03)
A UNAIDS "Best Practice" report noted that prisons are ideal environments for HIV transmission, since they are often overcrowded, filled with violence, tension, and fear, and boring. "Release from these tensions, and from the boredom of prison life, is often found in the consumption of drugs or in sex," the report said.
"Poverty is a defining characteristic of both prisoner and HIV positive populations alike," noted another report, "HIV/AIDS in Prison: Problems, Policies and Potential," compiled by the Pretoria-based Institute for Security Studies. "Policies to address HIV transmission in prison cannot be effective without immediate and urgent prison reforms," the report stressed. "Overcrowding, corruption, and gangs are the primary culprits behind rape, assault, and violence in prisons, and this environment is horrifying, even without the risk of HIV infection."
In southern Africa, according to the UNAIDS report, appalling prison conditions, coupled with inadequate nutrition and health services, exacerbate the incidence of AIDS. TB is also a serious problem. People with HIV are particularly vulnerable to TB, and can transmit the disease to non-HIV-positive inmates.
STDs are another problem. Lack of information, education, and proper medical care can lead to untreated STDs, which increase a person's vulnerability to HIV through sexual contact, UNAIDS warned. Most prison authorities in southern Africa refuse to provide condoms to inmates, according to the report, even though they know that sexual activity occurs in prison.
"Recognizing the fact that sexual contact does occur and cannot be stopped in prison settings, and given the high risk of disease transmission that it carries, UNAIDS believes that it is vital that condoms, together with lubricant, should be readily available to prisoners. This should be done either using dispensing machines, or supplies in the prison medical service," the report stated.
American Journal of Health Behavior
"Rural and Nonrural African American High School Students and STD/HIV Sexual-Risk Behaviors"
(07-08.03) Vol. 27; No. 4: P. 373-379::Robin R. Milhausen, MSc; Richard Crosby, PhD; William L. Yarber, HSD; Ralph J. DiClemente, PhD; Gina M. Wingood, ScD; Kele Ding, PhD
Compared to adults, adolescents in the United States are disproportionately infected with STDs, including HIV. Among adolescents, African Americans are particularly at risk. Despite widespread recognition that African-American adolescents represent a priority for interventions designed to reduce the risk of STD/HIV, studies have not assessed differences in STD/HIV sexual-risk behaviors between rural and nonrural African-American adolescents. The purpose of this analysis is to examine differences in STD/HIV sexual-risk behaviors and selected antecedent factors among a nationally representative sample of rural and nonrural African-American high school students in the United States.
Data from CDC's 1999 Youth Risk Behavior Survey were used for this analysis. The YRBS biannually measures the prevalence of 6 categories of priority health-risk behaviors among youth through representative national, state and local surveys. The 1999 YRBS is a school-based survey employing a 3-stage cluster design yielding a nationally representative sample of students in grades 9 through 12 in private and public schools. In the first stage, counties were selected. The second and third stages consisted of selecting schools and intact classes of students, respectively. All students in the selected classes were eligible to participate in the survey. To enable separate analysis of data, African-American and Hispanic adolescents were purposefully
oversampled. Randomly selected classrooms of students completed an 88-item questionnaire, administered by trained data collectors. Parental consent was obtained prior to survey administration. The student participation rate was 86 percent.
Approximately 16 percent of the sample attended rural high schools, with the remaining participants attending urban and suburban high schools. The sample was 2,083 African-American female high school students (359 rural and 1,724 nonrural), and 1,893 African-American male high school students (304 rural and 1,589 nonrural). The mean age for males was 16.29. The mean age for females was 16.6. The sample was equally distributed across each of the 4 high schools.
Among those who reported ever having sex, the median age of first intercourse was 13 years old for males and 14 years old for females. Females reported a median of 2 lifetime partners, whereas males reported a median of 4. The median number of partners over the past 3 months was 1 for both genders. Compared to their nonrural counterparts, rural African-American adolescent females were 46 percent more likely to report ever having sexual intercourse, 44 percent more likely to initiate sex before age 15, 38 percent more likely to have a lifetime number of at least 3 sexual intercourse partners, 80 percent more likely to have more than one sexual partner in the past 3 months, and 34 percent more likely to report they had not used a condom during their last intercourse experience. Compared to their nonrural counterparts, rural African-American adolescent males were 65 percent more likely to report ever having sexual intercourse and 96 percent more likely to report they had not used a condom during their last intercourse experience.
The findings indicate that, overall, the rural African-American female students engaged in greater level of sexual-risk behaviors than did their nonrural counterparts. Fewer differences in sexual-risk behaviors between rural and nonrural males were found. However, in analyses of females and of males, all of the significant differences observed suggested greater risk for the rural adolescents. Thus, the findings indicate rural high school students, particularly females, may experience an increased risk of STD/HIV infection in comparison to their nonrural peers. The findings of this analysis suggest that rural African-American adolescent females and males would benefit from behavioral intervention programs designed to reduce their risk of potential infection with STDs, including HIV.
CDC HIV/STD/TB Prevention News Update
Friday, August 01, 2003
Atlanta Journal-Constitution
"High Herpes Rate Found in Metro Atlanta"
(07.31.03)::Catherine E. Shoichet
A recent study showed that more than one-third of participants surveyed in suburban Atlanta tested positive for the virus that causes genital herpes. The study, presented recently at a meeting of the International Society for Sexually Transmitted Diseases in Ottawa, shows that patients in affluent suburbs are as likely as lower-income patients to contract the disease.
Only 5 percent of the 915 Atlanta-area patients had a history of genital herpes, which can be asymptomatic. Atlanta had the highest rate of infection of the six cities in the survey, and a higher rate than the national average of about 25 percent.The study's authors used results from blood tests of patients at six unidentified, randomly selected primary care physician's offices in suburban Atlanta. Combining the Atlanta results with those of more than 4,500 patients in suburbs of Baltimore, Boston, Chicago, Dallas, and Denver, researchers found that one in four patients tested positive.
"These findings help to break the stereotype that there are only certain types of people that have herpes," said Douglas Fleming, the study's lead author and an assistant professor at the Robert Wood Johnson Medical School in Piscataway, N.J.
The study may also have an impact on doctors. "When you talk to private physicians, there's a tendency to think that isn't really true of their population," said Peter Leone, co-author and an associate professor of medicine at the University of North Carolina-Chapel Hill. "If physicians don't believe that it's important for their patient population... they may not think of doing testing."
CDC estimates 1 million people are newly infected with the virus each year in the United States."Study Says STD Risk Higher for Young Working Women"Seattle Times (08.01.03)::Julia Sommerfeld
Single, working women ages 18 to 25 are having even more unprotected sex, with more partners, than college students, according to research released today by Group Health. A telephone survey of 1,100 single women found that among sexually active young women outside the college setting, 61 percent reported having sex without a condom in the past three months, compared to 56 percent of female college students. A higher percentage of women ages 21 to 25 reported having unsafe sex than women ages 18 to 20. Those with more sex partners were more likely to have unprotected sex than those in monogamous relationships. Two-thirds of the women surveyed were from the Puget Sound area, and one-third from North Carolina.
Study co-author Delia Scholes, associate investigator at Group Health's Center for Health Studies, said despite having unsafe sex, the young women weren't worried about the risks.
Seventy-eight percent felt they were at low risk for contracting an STD.
Despite their feelings of immunity, this group is hard hit by STDs. About 70 percent of STDs diagnosed in Washington state are in women under 25. Also, 77 percent of the state's 15,000 reported cases of chlamydia last year were in women between 15 and 24. Gonorrhea, the second most common Washington STD, infects women ages 20 to 24 more than any other age group.
The findings are "very counterintuitive," according to Lisa Gilbert, director of research at the American Social Health Association, an STD awareness group. "You would certainly expect they would get less wild, more mature and make better decisions as they get older," she said. She speculated that safe sex is more on the minds of college students, since safe sex messages proliferate on campus.
The full report, "Factors Associated with Condom Use Among At-Risk Women Students and Nonstudents Seen in Managed Care," was published in the journal Preventive Medicine (2003;37;(2):163-170).
Associated Press
"Fremont Hepatitis Case Could Wipe Out Malpractice Fund"
(07.31.03)::Kevin O'Hanlon
The scores of lawsuits filed in connection with the largest hepatitis C outbreak of its kind in the United States will probably wipe out Nebraska's malpractice fund. To date, 81 lawsuits have been filed against Dr. Tahir Javed, who is accused of being at fault for the unsanitary practices that caused 99 patients at his Fremont Cancer Clinic to contract the disease. One patient has died. Nebraska's Excess Liability Fund, established in 1976, is used to pay claims in excess of a doctor's malpractice insurance. About 3,100 doctors pay into the fund. It now has about $55 million, but is expected to pay out an estimated $46 million to settle pending claims - excluding those filed against Javed. The fund pays any claim against a doctor in excess of $200,000 for a single case and a cumulative total of $600,000 in any one year. If the Javed case exhausts the fund, the doctors would be required to pay the remaining claims, which could potentially equal tens of millions of dollars, said Tim Wagner, head of the Nebraska Department of Insurance, which administers the fund. In the last session, state legislators increased the cap on malpractice claims from $1.25 million to $1.75 million. The state filed a petition Tuesday seeking disciplinary action against Javed, who returned to his native Pakistan last year.
Associated Press
"Three More Iowa City Students Test Positive for TB"
(07.31.03)
Nine students who had close contact with an ill West High School student have had positive skin tests for TB. Only the original student was diagnosed with active TB, and she has been receiving treatment for some weeks, said Nancy Spalj, health supervisor of the Iowa City School District. The health department identified 300 people who had close contact with the student, and about 165 were tested. Officials said it is unlikely the disease will spread further when school starts in August.
CDC HIV/STD/TB Prevention News Update
Wednesday, July 30, 2003
Associated Press
"State Pursues Discipline of Doctor in Hepatitis Outbreak"
(07.29.03)::Kevin O'Hanlon
Nebraska is filing disciplinary action against a Fremont oncologist linked to one of the largest hepatitis C outbreaks in the nation - and possibly the world. Charges may also be filed against at least one other health care professional connected with the outbreak.
Dr. Tahir Javed is accused of being at fault for 99 people contracting hepatitis C after treatment at his Fremont Cancer Clinic between March 2000 and December 2001. According to a petition filed Tuesday by the Nebraska Health and Human Services System, one female cancer patient died while awaiting a liver transplant after becoming infected at Javed's clinic.
The state is also prepared to file more charges "within the very near future" against others possibly connected to the outbreak, said Richard Nelson, head of regulation and licensure for the state health system. Nelson declined to comment on whether a nurse in Javed's office, who allegedly used the same syringe on multiple patients, and other health care professionals, who allegedly observed unsanitary practices in the office but failed to notify regulators, would be charged.
"There are some significant issues here about the responsibility of other professionals," said Nelson. "There are regulations in place for mandatory reports that are imposed upon other professionals."
According to the petition, Javed's "lack of supervision of the basic care his medical practice provided and his failure to correct the improper basic infection control practices" constituted "gross negligence" on his part.
Javed has since returned to his native Pakistan and his clinic is now closed. His attorney, Michael Jones of Omaha, declined to comment.
The petition also alleges that Javed had a sexual relationship with a female patient, whom he falsely told had a fatal disease and it charges him with abandoning his patients by not telling them he was leaving the country.
The outbreak involved genotype 3A - a strain that accounts for fewer than 10 percent of all US viral hepatitis C cases.
Associated Press
"Fear of Tainted Blood Triggers Censure of Japanese Red Cross"
(07.30.03)
Japan's Red Cross shipped about 6,419 blood products possibly tainted with HIV, hepatitis or syphilis to patients across the country, officials said Wednesday. The Red Cross said it had recalled only 13 of the 6,419 units shipped over the last year, and added that the remainder were likely used in making blood products and transfusions, Health Ministry spokesperson Takako Tsujisaka said.
Contamination may have occurred because screening tests are often unable to detect viruses during the initial incubation after infection, said Red Cross spokesperson Yoshifumi Iijima.
More than 7,000 blood donors who gave blood at least twice over the past year eventually tested positive for HIV, hepatitis or syphilis. But their earlier blood samples tested negative, and
6,419 units were processed into blood products and shipped for use.
The ministry is advising recent transfusion recipients to seek follow-up testing and has urged the Red Cross to improve its blood screening methods, Tsujisaka said. It also urged the association to store blood products for at least four to six months, to allow time for suspected cases of infection to arise before being shipped for use. Blood products can be stored for up to a year, and organizations overseas often allow such lag time to make it easier to pull suspect units from their inventories.
"The Japanese Red Cross, to ensure safe blood donations, has pioneered the use of top-of-the-line technology," the Red Cross said in a statement. "But, at this point, a way of completely eliminating the risk of virus-infected blood has not been established." By this fall, the Red Cross plans to probe records dating back to 1995 for similar incidents.
TB & Outbreaks Week
"Pakistani Injection Drug Users Twice as Likely to Donate Blood"
(07.08.03)
Thirty percent of Pakistani injection drug users are paid to donate blood, which could contaminate the blood supply and increase the spread of HIV/AIDS as well as hepatitis B and C, according to a study by the Johns Hopkins Bloomberg School of Public Health. The study, "HIV/AIDS Risk Behaviors and Correlates of Injection Drug Use Among Drug Users in Pakistan," was published in the June issue of Journal of Urban Health (2003;80(2):321-329).
"We found that injection drug users were twice as likely to donate blood as non-injectors, which is not surprising since some blood donor clinics in Pakistan pay for blood donations. Unless appropriate screening of blood occurs, blood-borne infections could spread to the Pakistani general population like wildfire, as has been the case in other countries, like China," said Steffanie Strathdee, associate professor of epidemiology and international health at Johns Hopkins Bloomberg School of Public Health and senior author of the study.
The authors looked at the awareness of HIV/AIDS and risk behavior of 608 drug users serviced by a nongovernmental organization in three Pakistani cities. The study participants were mostly married men, median age 32, who lived with their families. The majority of the participants used heroin, and 15 percent injected the drugs. Almost half (44 percent) had no formal education, and 59 percent had never heard of HIV/AIDS.
Of the study participants who injected drugs, half reported sharing needles with other IDUs. When methods to sterilize needles were attempted - washing them in plain water, boiling water, or other methods - they were insufficient for disinfecting.
A 2000 study in Pakistan found that only 8 percent of blood banks screened donors for risks such as IV drug use, none screened for other high-risk behavior, and testing for blood pathogens did not occur regularly. Should HIV seriously penetrate the IV drug user population in Pakistan, the current "findings suggest that a generalized epidemic could subsequently occur," according to the authors.
To prevent the spread of blood-borne infections in Pakistan, Strathdee and colleagues recommended interventions to discourage a transition to injection drugs, scaling up needle exchange programs, and HIV testing and educational counseling for drug users. The authors also called for an end to paid blood donations as well as the implementation of blood screening to safeguard the blood supply in Pakistan.
Associated Press
"Iowa City Now Reporting Six TB Cases"
(07.30.03)
Six people in Iowa City, Iowa, who had close contact with a West High School student suspected of having pulmonary tuberculosis have tested positive for the disease, according to
Johnson County Public Health Department officials. "We're still well below what would be expected," said Kot Flora, Johnson County Public Health assistant director-disease prevention
manager. On July 8, the health department tested 165 of the 293 people identified as having had close contact with the student. Overall, 233 people have been tested, some using their own doctors or being tested by appointment at the health department. The department is sending follow-up letters to those who have still not been tested and is planning to schedule a second round of testing for those who tested negative in July or who have not yet been tested.
Associated Press
"About 325 People Will Be Tested for Disease After One Worker Tests Positive"
(07.29.03)
In Maricopa County, Ariz., close to 325 people will be tested for TB because of contact with a worker who recently tested positive. Slated for testing are 146 children, ranging from 18 months to 12 years old, and 21 staff members of a private Phoenix day care center. The same worker may have also exposed approximately 150 children and staffers at a day care center and
head start program affiliated with the John C. Lincoln-North Mountain facility in Phoenix. Health care workers will administer skin tests at all three centers Wednesday. Health officials are
investigating how the worker contracted the disease. Dr. Jonathan Weisbuch, Maricopa County's director of public health, said he expected few children and staffers to test positive.
Associated Press
"Band Works with CDC to Look into Hepatitis Cases"
(07.29.03)
Health officials are investigating outbreaks of hepatitis A among fans of the band String Cheese Incident who travel from show to show. "We've gotten reports of a number of hepatitis A
cases among the young adults that attend those concerts," said Llelwyn Grant, a spokesman for CDC. She said contaminated food or water could potentially have caused the outbreak. Band publicist Carrie Lombardi said the band is working with health officials. Many fans of the Boulder-based band spend their summers following them from concert to concert, often camping out near their outdoor venues. Grant said a number of states may be affected, based on how the tour has traveled. She noted CDC is working with health officials in California, where 10 cases have been reported.
Associated Press
"Teen Pregnancy Rate Falls"
(07.29.03)
A new state report showed Montana's teen pregnancy rate fell 32.6 percent in the past two decades, a decline that far exceeded the drop in the national teen pregnancy rate, which fell 15.5 percent in the same time period. "These decreases are important indicators for the state's family planning program, and a testament to the importance of prevention," said Stacey Anderson, teen pregnancy prevention coordinator for the Department of Public Health and Human Services. "Despite the many complex factors causing teens to become pregnant at an early age, it is encouraging that we are identifying 'best practices' and making recommendations based on programs that work." A decline in teen pregnancy reflects teens waiting longer to initiate sexual activity and having less sex when they do, and a significant increase in contraceptive use. Despite the declines, US teen pregnancy rates remain among the highest in the developed world, Anderson noted.
CDC HIV/STD/TB Prevention News Update
Friday, July 25, 2003
Philadelphia Inquirer
"Prisons to Reduce Hepatitis Treatment"
(07.24.03)::Mark Fazlollah
A state budget crunch is forcing Pennsylvania prisons this fall to reduce by about 75 percent the number of inmates being treated for hepatitis C.
The state currently has 8,030 inmates infected with the virus - about 23 percent of the prison population - and is treating 550, said Fred Maue, chief of medical services for the Department of Corrections. Maue said those 550 prisoners would receive their medicines, which cost $16,000 per patient for a 48-week treatment course.
But beginning in September, prisons will apply stricter eligibility rules and will focus on prisoners with a highly curable form of hepatitis C - about 15 percent of those infected. Maue estimates that 130 prisoners a year would receive treatment and that number may ultimately be reduced to less than 100. "We felt that we needed to prioritize our budget," said Maue. He added that the reduction is justified because Pennsylvania is doing better at targeting which patients could benefit from the medicine.
That approach may get the state more bang for the buck, according to Thomas Shaw-Stiffel, a specialist at Pittsburgh's Center for Liver Diseases. "It's to the patients' benefit to be more focused," said Shaw-Stiffel. "On the surface, [the reduction] may look ominous, but it may be beneficial," he noted.
Despite treatment cutbacks, Pennsylvania still provides more care than many states. For example, New Jersey is treating 33 prisoners for hepatitis C, up from treating just one inmate last year. Under the leadership of Govs. Tom Ridge and Mark Schweiker, Pennsylvania developed one of the most aggressive treatment programs in the nation.
The new guidelines, which are in line with national prison standards, will require inmates to have at least 18 months - up from 12 months previously - remaining on their sentence and to undergo liver biopsies before being considered for treatment.
Associated Press
"Health Board Approves Testing Some Foreign Students for TB"
(07.24.03)::Tom Parsons
Under a measure approved Thursday by the Arkansas Board of Health, some foreign-born students attending colleges and universities in the state will have to be tested for TB. The regulation, approved unanimously, will require TB skin testing, followed by a chest X-ray if the skin test is positive. The measure will not take effect until signed by Gov. Mike Huckabee, according to Dr. Joe Bates, deputy health officer for the state Health Department.
The requirement covers "only... students who come from countries where the prevalence of tuberculosis is high," Bates said. It will apply to students from all of Asia, Africa, Central
America and South America, as well as some former parts of the Soviet Union. In Russia and some of its neighboring countries, TB rates have skyrocketed since the collapse of the Soviet Union and much of its broad-based public health program.
About 2,500 foreign students are registered at Arkansas colleges and universities. Because some have had undiagnosed active TB when they enrolled, other students were infected, Bates said. In 1997, the University of Arkansas tested 122 students for the disease after two international students were found to be carriers. A student from India died from the disease. "They come from all over the world, in some places where tuberculosis is a problem. As they come here to be students, they bring that problem with them," Bates told a legislative committee in May. "This regulation is intended to help us discover them as they matriculate and control that situation if they happen to have it."
Rita Sklar, executive director of the American Civil Liberties Union in Arkansas, had previously expressed concerns about the testing proposal, but said on Thursday the group will not oppose the requirement.
The regulation will cover only newly enrolled foreign students in its first year. Later, testing will be an enrollment requirement for all students from the countries covered.
CNN.com
"Hip-Hop Condoms to Hit Stores"
(07.11.03)::Meriah Doty
A line of condoms will join the growing hip-hop market of fashion lines and magazines in select drug stores in early 2004. Dubbed "Jimmie Hatz," the condoms are held in graffiti-style packages, and come in three selections - XL Great Dane (extra large condom), Mixed Breed (contoured condom with dotted and ribbed texture) and the Rottweiler (standard size condom). Harry Terrell, CEO of Common Ground USA, the condom's manufacturer, said the condom line is a "full blown effort on our part to save our community." Terrell says he was inspired to start the grassroots campaign when he was coaching high school baseball and one of his students got infected with HIV. "I wanted to be supportive of him as possible. I wanted to learn as much as I could about HIV and AIDS." The company's aim has been to spread the word in high schools and colleges about abstinence and protection. "Jimmy hat" is a commonly used slang word for condom. Terrell says he wanted to make wearing condoms "cool or the 'in' thing to do." "The problem is really miseducation or lack of education," Terrell says. "I wanted to save the subculture called hip-hop."
CDC HIV/STD/TB Prevention News Update
Thursday, July 24, 2003
Christian Science Monitor
"Schools Stumble over Sex Education"
(07.22.03)::Marjorie Coeyman
Two camps have emerged over sex education in US schools. Abstinence-only sex education programs teach that sex outside of marriage, at any age, is wrong. Concerned about presenting a mixed message, or promoting promiscuity, most advocates insist on not including any information about contraceptives. Comprehensive sex education, however, may include teaching students that abstinence outside marriage is either one option or perhaps the best course. But they generally follow up with information about how contraceptives work, where to get them, and why they are important for avoiding STDs and teen pregnancies.
Abstinence-only supporters are so adamant about preventing sex outside marriage that they may squelch useful information, said Douglas Besharov, of the American Enterprise Institute. But, he said, those who favor comprehensive sex education often fail to distinguish between the needs of a 12-year-old and those of a 17-year-old. They fail to appreciate that, "beyond some kind of moral issue, having sex too early can be horribly damaging to young people," he said.
The federal government spends $120 million annually on abstinence programs, with a proposal to increase that to $135 million in fiscal 2004. With such funding, states must make sex education classes' "exclusive purpose" to teach "the social, psychological, and health gains to be realized by abstaining from sexual activity."
Kaiser Family Foundation surveys of young people show a strong desire for more information about sex, said foundation Vice President Tina Hoff. Children ages 10 or 11 want that information to come from their parents. However, by about ages 13 and 14, teens begin to say they prefer talking to their friends.
Associated Press
"Health Officials May Ask Gaston Schools to Review Sex Education"
(07.23.03)
Hoping to reduce teen pregnancy rates and curb the spread of STDs, public health officials may soon ask the Gaston County, N.C., school system to expand its sex education curriculum beyond abstinence.
Health Board Chair Simon Roe said a meeting about a possible change with school officials could be upcoming. On Monday, a panel of five students, part of the HIV Education Led by Peers group, told board members that simply telling teenagers to abstain from sex until marriage is not enough.
"These teenagers are having sex whether we tell them about abstinence or not," said 17-year-old Angel Putnam, who became pregnant at 15. "We're asking the school to change their policy.
We are begging them. These students need the information to make the individual decision about whether to have sex, to make a wiser decision."
Gaston County Schools teach abstinence-until-marriage and the making of the healthy lifestyle choices, according Alice Ray, the school's director of public health services. Condoms and birth control are not included in the sex education component, said Ray, adding that the instruction is "what the community wanted." "We teach there is no safe sex. We give them instruction on responsible behavior and lifestyle choices," she said.
Board member Kemp Michael said he is unaware of any changes planned in school policy. "If the Board of Health comes before us, I am sure we would discuss any possible changes," said
Michael.
In 2001, according to health department data, Gaston County had a rate of 76.5 pregnancies per 1,000 girls, compared to the state average of 69.3 pregnancies per 1,000 girls. In the same year, 460 girls ages 15-19 became pregnant.
Pittsburgh Post-Gazette
"Study Tackles Effectiveness of Sex-Counseling Methods"
(07.18.03)::Karen Hoffmann
A new study to examine computer-assisted sexual health counseling will determine if it is more effective in preventing pregnancy and STDs than traditional counseling methods, according
to researchers. The computer is used to gather information about the participants that human counselors use in their counseling sessions.
"The computer's nonjudgmental, and people feel very comfortable putting the information in," said Dr. Melanie Gold, a pediatrician at the Children's Hospital of Pittsburgh and researcher that developed the approach. Traditional sexual health counseling provides general information that is not necessarily tailored to individual needs, she said.
Gold and her team will research the effectiveness of the computer-assisted counseling in the five-year Sex Abstinence Feedback and Education (SAFE) study. For six months, 660 girls ages 13-21 in the Pittsburgh area will participate in three counseling sessions. Half of the participants will receive computer-assisted sessions; the other half will receive traditional sessions. The young women will then return every three months for another year to measure their progress and modify their plans. "We want to see what are the shorter- and the long-term impacts of these visits to counseling," Gold said.
One out of every 28 girls ages 13-19 in Allegheny County became pregnant in 2000, according to the Family Health Council, an organization that provides health-care services to women in western Pennsylvania.
The researchers expect that the women who received personalized computer-assisted counseling will have fewer unintended pregnancies and STDs than those who receive general counseling. Participants in the SAFE study will be reimbursed for their time. For more information, telephone 412-692-6386