Volume 3, Number 15
April 3, 2002

In this edition:

• Scope of Rural HIV/AIDS Epidemic Unknown
• AIDS Researcher Asks "Why Do We Tolerate People Who Are HIV-positive and Spreading the Disease?"
• Study: Males Less Likely to Tell Partner About STD; Partner Notification Improvements Needed
• Should Lying About One's HIV Status to a Sexual Partner Be a Crime?
• Criminal Investigation Launched Against HIV-infected Woman Who Infected Man During Robbery
• HIV-infected Nurse Used Needles to Inject Drugs That Were Later Reused on Patients
• Routine HIV Testing Could Stem Rising Rates of Infection
• CDC Study Finds Chlamydia, Gonorrhea Underreported, Urges Improvement in Reporting System
• New Washington Law Allows Sale of Syringes to Drug Addicts
• Man Sues After Being Infected with HIV from Transfusion
• High Hepatitis C Rates in San Francisco Area; Study Finds Possible Links to Herpes, Cocaine Use
• Hepatitis C Cluster Traced to Long Island Heart Surgeon
• Hepatitis B on Decline but Many Still at Risk

Scope of Rural HIV/AIDS Epidemic Unknown

According to the Centers for Disease Control and Prevention, only about 5.4 percent of AIDS patients newly diagnosed between July 2000 and June 2001, or a little over 3,000 people, lived in rural areas. But new cases in communities with fewer than 50,000 people are likely to be seriously under-reported, according to Linda Brandt, founder and executive director of the Rural AIDS Action Network (RAAN), headquartered in Minneapolis. "It's really about 10-12 percent of new cases in Minnesota and surrounding states," says Brandt. "And it could be far more because cases are geographically assigned from where the diagnosis was made, and many diagnosed with AIDS return to the rural communities where they were raised."

The CDC also cautions that its surveillance reports are not "accurate" profiles. Seventeen states, for instance, do not conduct HIV surveillance at all and report only AIDS cases. More ominously, despite a nationwide decline in new AIDS cases, nine of the 17 states that do not report new HIV infections had more new AIDS cases in 2000-2001 than in the prior year. Six of them-- California, Georgia, Kentucky, Montana, Pennsylvania, and Washington-- have extensive rural populations.

[USA Today, 3/27/02]

AIDS Researcher Asks "Why Do We Tolerate People Who Are HIV-positive and Spreading the Disease?"

HIV infections continue to increase among gay and bisexual men across the country, and according to Dr. Tom Coates, a leader in HIV prevention and AIDS studies the gay community has to change its attitudes toward the disease and toward people who are HIV-positive. "We are so used to thinking of HIV-positive people as victims, we are afraid to think of an HIV-positive person as responsible," said Coates, who is HIV-positive. "Why do we tolerate people who are HIV-positive and spreading the disease?" Coates asks.

Coates spoke to more than 100 people who gathered recently at the University of California, San Francisco to hear about the latest HIV/AIDS research and treatments. Coates first expressed his exasperation with the gay community's attitudes toward safe sex and prevention last fall. His frustration was still apparent at the forum.

Also discussed at the forum is the ballooning epidemic of hepatitis C, with 4 million already infected. Unlike hepatitis A and B, there is no vaccine for hepatitis C, and health officials do not fully understand how it is transmitted. But the researchers stressed the need for people to get vaccinated for hepatitis A and B, practice safe sex, and talk about HIV/AIDS with their sexual partners.

"Prevention has got to go back to the community. The community has got to say it is not okay to spread HIV," Coates said. "Until that is done, nothing is going to change."

[Bay Area Reporter, 3/21/02]

Study: Males Less Likely to Tell Partner About STD; Partner Notification Improvements Needed

Men and teenage boys are far less likely than females to tell their main sexual partners they have been diagnosed with an STD, a study in France suggests. Researchers found that 14 percent of men diagnosed with an STD in the past five years had not told their main partners, compared with just 2 percent of women. Similarly, 51 percent of boys who had ever been diagnosed with an STD had not talked about it with their partner at the time, in contrast to 9 percent of girls, according to findings published in the February issue of Sexually Transmitted Infections. However, both sexes-- adults and teens-- usually did not tell past or casual sex partners about their STDs, reported Josiane Warszawski and L. Meyer of the French national research institute INSERM. Researchers concluded that "procedures must urgently be developed to improve the notification of sexual partners, particularly female partners and adolescents." Females, they note, are particularly unlikely to get early STD testing without such notification-- in part because their STDs are more likely to have no symptoms or visible signs. Women are also at risk of long-term complications from untreated STDs, including pelvic inflammatory disease, infertility and pregnancy complications related to chlamydia or gonorrhea. The study involved 177 adults and 45 adolescents who had been diagnosed with an STD.

[Reuters Health, 3/29/02]

Should Lying About One's HIV Status to a Sexual Partner Be a Crime?

When asked "Should lying about one's HIV status to a sexual partner be a crime?," more than two-thirds-- 69 percent-of respondents said "yes" according to an April 2 on-line poll by the Gay.com/PlanetOut.com Network. Only eight percent said "no." Another 20 percent answered "only if someone is infected as a result."

The poll results reflect a recent legal decision in which a San Francisco court awarded $5 million in damages to a man who claims he was infected with HIV from his ex-lover, a former city health commissioner, who lied about his HIV status.

When Thomas Lister, 36, started dating Ron Hill, 44, in March 2000, Hill said he was HIV-negative. However, Hill had publicly disclosed his positive status after being appointed to the San Francisco Health Commission in 1997 by Mayor Willie Brown.

The two men parted ways in August 2000 after Lister, who was negative, discovered documentation about Hill's HIV-positive status. The relationship was reportedly sexually monogamous. Lister tested positive in October 2000.

After filing a police report, Lister was told by the district attorney's office that criminal charges based on intent would be too hard to prove. After the ruling, however, San Francisco District Attorney Terence Hallinan told the San Francisco Chronicle that his office may reconsider criminal charges against Hill. In California, infecting someone intentionally with HIV is a felony.

The ruling was a default judgment, since the defendant did not contend the lawsuit. The nature of the ruling may not enhance the likelihood for a criminal trial, said Bill Hirsh, executive director of the AIDS Legal Referral Panel. "The judgment doesn't tell us conclusively if the facts could have been proved," Hirsh told the Gay.com/PlanetOut.com Network.

Lister, who told the Gay.com/PlanetOut.com Network that he didn't specify a monetary figure in his lawsuit, said the settlement amount for general and punitive damages sent a strong message. "This says that it's not acceptable behavior to lie about your HIV status in relationship - especially after being asked about it repeatedly," Lister said.

[Gay.com/PlanetOut.com Network, 4/2/02; 3/29/02]

Criminal Investigation Launched Against HIV-infected Woman Who Infected Man During Robbery

Authorities in West Palm Beach, Florida, said a criminal investigation has begun against an HIV-infected prostitute who bit a 90-year-old man during a 1994 robbery, transmitting the deadly virus. He died later from complications of AIDS. It was the first known transmission of HIV through a human bite. State attorney's office spokesman Mike Edmondson said that Naomi Morrison, 28, is still under investigation in Elmer Hutto's death, which the medical examiner ruled a homicide. Morrison had grabbed Hutto's wallet and during a struggle bit him on the left hand, left arm and right leg. He died of pneumonia in 1997. She pleaded guilty to aggravated battery and was released in 2001 after serving six years of a 10-year sentence. Morrison was back in court last week on a probation violation charge. Since her release, she also has been arrested on misdemeanor prostitution and drug charges. Prosecutors are seeking the harshest possible sentence for the alleged probation violation. The maximum prison term is eight years, court records indicate.

[Associated Press, 3/28/02]

HIV-infected Nurse Used Needles to Inject Drugs That Were Later Reused on Patients

An HIV-positive Texas nurse allegedly injected herself with a drug she stole from her hospital, then refilled the vials with saline solution using the same syringe, officials said. Those vials of saline, containing a small amount of nurse Jacqueline Fillingim's blood, may have been inadvertently given to patients. Administrators said Fillingim stole Demerol from the hospital in December and January, injected herself with the drug and refilled the vials to cover her tracks. The South Texas Regional Medical Center in Jourdanton has sent letters to about 1,100 patients who received the drug during that time frame, advising them to get a blood test, although the contamination risk is considered minimal.

Fillingim, of Pleasanton, was fired from the hospital, and the state has begun disciplinary proceedings to revoke her nursing license. No criminal charges have been filed. The case has been referred to the state Department of Public Safety and other state and federal agencies.

[Associated Press, 4/1/02]

Routine HIV Testing Could Stem Rising Rates of Infection

The failure of educational programs to stem the rates of HIV infection may be overturned by new policies on testing, said a Central Michigan University health sciences professor who is calling for routine tests as part of annual checkups. Joseph "Jeff" Inungu, a faculty member in The Herbert H. and Grace A. Dow College of Health Professions, said despite all the education that has been done about HIV and the advent of highly active therapies, a majority of people still do not get tested nor change their
behavior.

"After 20 years of educating people about HIV, the majority of adults in the United States have never been tested for HIV. Unless people are tested in greater numbers, it will be impossible to break down the cycle of HIV transmission in this country," he said. Research indicates that patients would accept having the test as a routine part of their clinical care.

"We need to reevaluate our strategies and make HIV testing a routine part of clinical care by every provider," said Inungu, who was a physician in Africa before coming to the United States 12 years ago. "The old belief that exposing people to the right information will somehow result in behavior change is a recipe for failure and must be reevaluated."

Inungu analyzed data on people ages 18 to 80 who participated in a National Health Interview Survey conducted by the National Center for Health Statistics. He found the groups least likely to be tested for HIV were men, people over the age of 50 or between 18 and 19, people with a low level of education, people in rural areas, and people in the Northeast or Midwest.

Older adults who are HIV infected also progress more rapidly to AIDS and have a shorter survival time. While adolescent groups are among the fastest growing population of HIV/AIDS sufferers, few are tested for HIV unless they come to a physician for a sexually transmitted disease. Older populations - over the age of 50-- have tended to feel they were not at risk but have actually seen increases in the numbers of cases of HIV.

The groups that were most likely to get tested included non-Hispanic blacks, people with higher educational levels and people who were separated, divorced or widowed.

To break the cycle, new approaches are necessary, he said. A new testing policy must be proactive, community-oriented and based on a strong patient-physician relationship. While there is a justifiable need for confidentiality, evidence from several studies indicate that most U.S. adults do not discriminate against people with HIV/AIDS, said Inungu. "People who are infected must become aware of their condition and change their behaviors to avoid infecting their uninfected partners," said Inungu. "They also can take advantage of therapies that are highly effective today."

[Medical Letter on the CDC & FDA, 3/31/02]

CDC Study Finds Chlamydia, Gonorrhea Underreported, Urges Improvement in Reporting System

More than one-third of gonorrhea cases and up to 22 percent of chlamydia infections from Colorado, Massachusetts and Minnesota were not reported to public health officials between 1995 and 1999. The conclusions are from a study was conducted by the Centers for Disease Control and Prevention and three state health departments and three managed care companies: Kaiser Permanente of Colorado, Massachusetts-based Harvard Vanguard Medical Associates and Minnesota-based HealthPartners. The researchers examined the reporting practices of gonorrhea and chlamydia cases by the three managed care organizations between 1995 and 1999.

The study states that 78 percent to 98 percent of chlamydia cases and 64 percent to 80 percent of gonorrhea cases were reported to health departments. Researchers noted that the amount of time it took positive test results to travel from the laboratory to public health officials varied widely, ranging from one week to more than one year. Kathleen Irwin of the CDC said that this time lapse is important because health departments need to closely monitor sexually transmitted disease trends in order to have a sense of groups at risk for the infections. CDC officials said that some doctors may be withholding case reports out of privacy concerns and that other data may be "getting lost in paperwork mix-ups."

The study urges more clinics and laboratories to adopt electronic reporting systems. Peter Carr of the Minnesota Health Department said that many Minnesota health organizations have already adopted such systems and that the state health plans get a "passing grade" for complying with mandatory STD reporting regulations. Most states have some type of law regulating STD reporting, although such laws vary by state.

[The Kaiser Daily HIV/AIDS Report, 3/29/02]

New Washington Law Allows Sale of Syringes to Drug Addicts

Washington Governor Gary Locke last week signed House Bill 1759 which allows the sale of hypodermic syringes to drug users. Locke vetoed part of the bill sponsored by the House Committee on Health Care, eliminating a provision that would have required syringe buyers to turn in an equal number of used needles when buying new ones. Locke said such a requirement would have posed a health risk to pharmacy workers and a burden on legal syringe users such as diabetics.

[Associated Press, 3/29/02]

Man Sues After Being Infected with HIV from Transfusion

David Autrey, a ranch hand infected with HIV from blood donated in San Antonio, Texas, has filed a $100 million negligence lawsuit. The lawsuit was filed March 15 in Dallas. The lawsuit names Abbott Laboratories; Dr. Mark Elliott Lawrence, a surgeon; Scott & White Clinic; and the South Texas Blood and Tissue Center. Medical experts confirm the Autrey case is the first time in three years that HIV-tainted blood has slipped through the nation's tougher screening system. Autrey, 51, who is living in Durango, was infected from an August 2000 blood transfusion he received during emergency heart bypass surgery at Scott & White Hospital in Temple. The product came from South Texas Blood and Tissue Center.

The blood center said it will explain its position in court, rather than try the case in the media. "We are greatly saddened by Mr. Autrey's situation as our mission is to save lives and to do no harm," the center said in a statement. "We hope that his misfortune will not be used to distort our risks or, of equal importance, to minimize the lives saved every hour of each day as a result of blood transfusions."

The incident was the first time that HIV has been transmitted through a transfusion since U.S. blood banks implemented new screening technology in 1999, said Dr. Michael Busch, a professor at the University of California-San Francisco and an executive with Blood Centers of the Pacific.

[Associated Press, 3/28/02]

High Hepatitis C Rates in San Francisco Area; Study Finds Possible Links to Herpes, Cocaine Use

Young low-income women in San Francisco and Alameda County, California are infected with potentially deadly hepatitis C at more than double the national average, according to a study by the University of California at San Francisco. Beside the shocking infection rates on both sides of the bay among poor women ages 18 to 29, the research found a possible connection to herpes and noninjection drug use, namely cocaine snorting.

Herpes produces a sore that may be a "portal of entry" for hepatitis C, said lead author Dr. Kimberly Page-Shafer, assistant professor of medicine at UCSF's Center for AIDS Prevention Studies. She and her researchers found that 34.2 percent of the women in the study had genital herpes and that 17.5 percent reported having snorted powder cocaine. The research, published in the April issue of the American Journal of Public Health, covered 1,707 women in four counties-- San Francisco, Alameda, San Joaquin and San Mateo.

The study showed 4.3 percent of the women studied in San Francisco and 3.8 percent of those in Alameda County were infected with hepatitis C-- well above the national average of 1.8 percent. Young poor women in two other counties-- San Joaquin and San Mateo-- had infection rates below the national average at 1.4 percent and zero, respectively.

Hepatitis C (or HCV for short) affects 4 million people in the United States. In 15 percent to 20 percent of patients HCV leads to cirrhosis, liver cancer or similar illnesses. Each year, 8,000 to 10,000 people die from HCV. Hepatitis C usually strikes drug users.

"I think the study shows that hepatitis C prevention needs to extend beyond just blood-to-blood transmission," Page-Shafer said. "The population at risk for hepatitis C requires a more complex risk-reduction strategy that addresses both STD (sexually transmitted disease) prevention and reduction of intravenous drug use. It shows these risk factors go hand in hand."

"The presumption is people contract this from needles" said Joey Tranchina, CEO of the HCV Global Foundation in Redwood City. But, he noted, blood has also been found on straws used to snort cocaine. "We need to be looking for other sources, including home remedies involving use of needles in immigrant communities, tattoos and piercings and sex involving a lot of blood." The study was conducted between April 1996 and January 1998.

Dr. Jeffrey Klausner, director of STD prevention for the San Francisco Department of Public Health and a co-author of the UCSF study, said the research underscores the need for people with HCV to know their status and be screened for other STDs. "It's been known the association of hepatitis C and drug use, but the association with STDs is new and parallels what we're finding in HIV. It's not the only STD you're going to get. We can now use hepatitis C as a marker for potential risk for other STDs and improve screening."

The federal Centers for Disease Control and Prevention recommends people get tested if they've ever injected illegal drugs, received a blood transfusion or organ transplant before July 1992, received a blood product for clotting problems before 1987 or been on long-term kidney dialysis.

[The San Francisco Chronicle, 2/2/02]

Hepatitis C Cluster Traced to Long Island Heart Surgeon

Former patients of a Long Island heart surgeon infected by hepatitis C may have been exposed to the potentially fatal disease over the past nine years. The surgeon was found to be infected only after epidemiologists focused on the doctor after discovering a cluster of seven hepatitis C cases among his patients. The only thing they had in common was having been operated on by the surgeon, who works at the North Shore University Hospital in Manhasset, Kristine Smith, a spokeswoman for the state Health Department, said Thursday. The surgeon, who did not know he had the disease, agreed to be tested last August, and was found to be infected. His name was not released. The oldest of the cases in the cluster dates back nine years.

"We are working with the Centers for Disease Control and the hospital to decide how far back we should go to track his former patients and exactly who should be notified," said Smith. "We don't know when he contracted the virus," she said.

Smith said the surgeon continues to operate but is taking extra precautions, such as wearing two pairs of gloves and notifying patients that he has the virus and of its risks. No patient of the doctor has tested positive for hepatitis C since August, Smith said.Hepatitis C is a blood-borne disease that can cause serious long-term liver disease.

[Associated Press, 3/28/02]

Hepatitis B on Decline but Many Still at Risk

New cases of hepatitis B have decreased substantially in recent years, but widespread programs to vaccinate high-risk adults, according to a study, could reduce the incidence even further.

CDC researchers worked with local public health officials in four U.S. counties-- Denver County, Colorado; Pierce County, Washington; Jefferson County, Alabama; and Pinellas County, Florida-- to gather detailed information on adults and children infected with hepatitis B from 1982, when the hepatitis B vaccine became available, to 1998. The researchers chose these counties because they are representative of the general population.

Results published in the Journal of Infectious Diseases (2002;185;6:713-719) showed that while infection rates fluctuated somewhat until 1987, when they peaked, they declined 76 percent between 1987 and 1998, from 13.8 cases per 100,000 people to 3.3 cases per 100,000.

Vaccination is largely credited for decline. Declines among gay men from 1982 to 1986 were attributed to increased safe sex practices in response to the AIDS epidemic, though the number of new hepatitis B infections remained fairly static after that time.

More than half of infected people interviewed from 1996 to 1998 reported being treated for another STD or spending time in jail prior to diagnosis with hepatitis B, the study found. As a result, many hepatitis B infections could have been avoided if there were routine vaccinations both at STD clinics and jails, researchers said. "Our concern is that more than half of these cases could have been prevented if vaccinations had been given," said study author Miriam J. Alter, an epidemiologist at the CDC.

[Reuters Health, 3/18/02]

_____________________________________________________________

The HIV Update is a weekly report of articles, studies and other information related to HIV/AIDS, sexually transmitted diseases and related risk behaviors compiled from various news sources by the Children's AIDS Fund.

The Children's AIDS Fund is a non-profit, non-partisan organization dedicated to helping limit the suffering of HIV-impacted children through direct assistance and resources, as well as through technical assistance for their parents and care-givers. For additional information, call (703) 471-7350.