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Volume 3, Number 61
December 18, 2002
In this edition:
AIDS Cases Among Latinos Continue to Rise
Nancy Santiago, 44, of Kensington, Pennsylvania, a native
of Puerto Rico and the mother of five children and grandmother
of six, learned last year she had contracted the AIDS virus
from her boyfriend.
Juana Rodriguez, 51, also from Puerto Rico, took care of
her boyfriend until 1993, when he died of AIDS in her apartment
in North Philadelphia. A few months later she learned she
was HIV-positive, too.
Maria Nieves, 47, got the virus through her last partner,
whom she dated for five years. She arrived from Puerto Rico
when she was 9 and started having sex at 13. Soon she became
an alcoholic. She learned last year that she was HIV-positive.
The experiences of these women illustrate the risk faced
by Latino women in the Philadelphia area and the United States
who make up a growing share of new AIDS cases among Hispanics.
The proportion of new AIDS cases that occur among Latino
women is rising. Their risk is significantly higher than that
of white women, though much lower than that of African American
women.
In 2001, women made up 23 percent-- 1,894 people-- of the
new Latino AIDS cases in the United States, up from 15 percent--
730 people-- in 1990, the Centers for Disease Control and
Prevention reported. (The numbers only account for those diagnosed
with AIDS, the end stage of HIV infection, and not all of
those who are infected with HIV, which comprises a much larger
number of those living with HIV and AIDS).
In 2000, AIDS was the fourth-leading cause of death for Latinos
age 35 to 44 in the United States (after cancer, accidents
and heart disease), compared with the ninth-leading cause
for white women, according to the CDC. Although Latinos make
up only about 13 percent of the female population of the United
States, they have accounted for 21 percent of all AIDS deaths
among women since the beginning of the epidemic in 1981. Of
the 67,557 women who have died of AIDS, 14,236 have been Hispanic.
Many of the women are middle-aged, infected by husbands or
boyfriends who are bisexual or intravenous drug users.
The CDC estimates that Latinos represent 18 percent of new
HIV infections among women in the United States.
Middle-aged women often assume they aren’t at risk
because they have been married for many years.
At Temple Hospital, doctors said they were seeing more HIV
cases among middle-aged Latinos infected by long-term partners
or husbands. “We have many 35-to-40-year-old, lifelong-faithful
HIV widows. The shock for these women is tremendous,”
said Ellen Tedaldi, professor of medicine at Temple.
In New Jersey, women 35 and older made up 45 percent of
all HIV infection cases among Latino women between 1996 and
2000. Often, women don’t know their partners are unfaithful.
Sometimes, they tolerate it. A study conducted in California
among Latino women found that only 41 percent of the participants
had ever used a condom.
Nancy Santiago was infected with HIV by her boyfriend, who
was an intravenous drug user. “I trusted him,”
Santiago said of the man she dated for a year, and who disappeared
after she was diagnosed. “That’s why I didn’t
ask him to use condoms.” Santiago was shocked when she
learned she had been infected, and tried to commit suicide.
She was hospitalized for a month. “This is my story.
It’s full of hurt, anger and betrayal. And still there
is love in it,” wrote Santiago when she left the hospital
in July.
Those words are now the first paragraph of a book she wants
to publish. She also wants to help other women by advocating
for a Pennsylvania law, similar to those in some other states,
that makes it a crime to knowingly infect others with HIV.
[The Philadelphia Inquirer, 12/11/02]
Heroin Abuse and HIV Soar in Massachusetts
as State Restricts Drug Treatment and Increases Access to
Injection Drug Equipment
Deaths from heroin and related narcotics in Massachusetts
soared close to fourfold during the 1990s, an increase the
state’s public health commissioner described as an emerging
health care crisis. And as heroin abuse increases, public
funding for drug addiction treatment is being reduced and
access to syringes for heroin injection is being broadened
and, in effect, decriminalized.
A report issued by the state Department of Public Health
also found that heroin now ranks as the illegal drug of choice
for patients checking into rehab clinics, with 42 percent
of patients who received substance abuse treatment this year
reporting that they had used the drug recently. That compares
with just 19 percent a decade earlier.
A decade ago, heroin was rejected by middle-class users as
the province of street junkies, today the drug has made its
way to the suburbs. “Heroin is suffocating our society,”
said Dr. Howard K. Koh, the Massachusetts commissioner of
public health. “It has invaded every corner of our Commonwealth.”
The effects of heroin addiction are evident across New England.
All six New England states have seen heroin use rise in the
past decade; Portland, Maine, alone recorded 27 overdose deaths
during the first 10 months of this year.
Health officials also report increasing rates of AIDS and
hepatitis C related to injection-drug use. Massachusetts recently
announced that the number of people in Massachusetts living
with HIV or AIDS has reached the highest level in the history
of the epidemic and the rate of HIV infection has not slowed.
For addicts seeking help, the outlook is clouded by budget
cuts to a range of agencies that help fund drug treatment
clinics.
The new study, compiled by reviewing government, hospital,
and drug assistance records, found that in 2000, the most
recent year for which numbers are available, there were 363
overdose deaths from heroin or another narcotic, such as OxyContin,
in Massachusetts. In 1990, there were just 94. Although the
study does not break down that figure into heroin and other
drugs, the counselors who provide treatment to substance abusers
believe that the overwhelming majority of those narcotic-related
deaths can be attributed to heroin.
Tom Magaraci, CEO of Habit Management, the largest provider
of narcotic treatment in the state explained “There’s
a lot of heroin on the street-- on streets everywhere. We’re
talking to suburban kids who tell us they go to parties, and
there are drugs all around, including heroin, and it’s
just an accepted thing.”
The report on heroin was issued two months after another
state study showed that cocaine use tripled among Massachusetts
middle school students and doubled among high school students
in the past three years.
Across New England, heroin in the past five years has begun
claiming more lives than homicides. For example, there were
twice as many overdose deaths (40) in New Hampshire in 1999
as homicides (21), according to the New England High Intensity
Drug Trafficking Area, a consortium of representatives from
law enforcement and health agencies.
In just one city, Lynn, heroin has claimed more than 50 lives
in the past six years, police chief John Suslak said. It has
also spawned crime-- armed robberies, for instance-- by users
trying to support their habits. Increasingly, those users
no longer fit the profile of a heroin junkie. A decade ago,
drug counselors said, the typical addict was a middle-aged
man. Today, the junkie is increasingly likely to be young
and, more than ever,
female.
The Department of Public Health report found that from 1996
to 2001, there was a 230 percent increase in 15- to 24-year-olds
who received hospital treatment because of their addiction
to heroin and other narcotics.
For heroin abusers, gaining access to treatment programs
could prove more difficult in the coming year. Bay Cove Human
Services, which provides drug treatment services in Boston,
has 286 patients in its long-term methadone program, but 50
more are waiting to get in, said Stan Connors, the agency’s
president. Because of federal and state budget cuts, agencies
such as Bay Cove expect that dozens of patients will lose
benefits that help provide methadone to wean them off heroin.
Bay Cove executives estimate that 35 of the patients in the
methadone program will stop receiving care when they lose
government benefits next year.
“Just recently, we had two 19-year-olds come in who
both had five-year histories of using heroin,” Connors
said. “Where are they going to go if we have even more
cuts?”
And while the state is reducing support for treatment, the
state has significantly increased the availability of syringes
for addicts.
The Massachusetts Supreme Court ruled that police officers
may not arrest people for possession of injection drug needles
if they carry a needle exchange card. The ruling, in effect,
legalizes illegal drug paraphernalia. Law enforcement officials
say that the identification cards from needle-exchange programs
could be easily used by non-participants. The cards, designed
to protect anonymity, do not list names or show photographs
of participants.
Boston Mayor Thomas M. Menino announced earlier this month
a proposal to allow hypodermic needles to be sold over the
counter in Boston pharmacies. He said he will file the bill
in the Legislature. Boston already has a needle-exchange program
allowing addicts to swap used needles for clean ones. The
program is one of four in Massachusetts. Currently, a doctor’s
prescription is needed in order to purchase a hypodermic needle
or syringe. Menino said his bill would allow the sale in Boston
pharmacies, but he said he hopes it would be able to be enacted
statewide in time.
And despite having four needle exchange programs in the state,
one third of all AIDS cases in the state were transmitted
through IV drug use-- about the same percentage as are linked
to gay sex. In certain areas of the state, however, the percentage
of cases linked to IV drug use is as high as 45 percent.
[The Boston Globe, 12/18/02; The Boston Globe,
12/7/02; The Boston Globe, 12/2/02; The Boston Herald, 12/3/02]
Missing the Point; Needle Strategy Overshadows
Treatment Issue
The following editorial was published in the Worcester Telegram
& Gazette:
“Using World AIDS Day observances as a springboard,
Boston Mayor Thomas M. Menino this week filed a home rule
bill that would allow pharmacies to sell hypodermic needles
without a prescription.
“The hope- as with the free hypodermic program already
in place in Boston- is that over-the-counter needle sales
will curb the spread of AIDS and hepatitis among intravenous
drug abusers. That the issue is serious is beyond dispute.
About one-third of all AIDS cases in Massachusetts were transmitted
through IV drug abuse.
“It stands to reason that easy access reduces the
rate of shared-needle use among addicts. Nonetheless, the
long-term impact of easy needle access on the spread of blood-borne
disease remains speculative for several reasons.
“A clean needle becomes a dirty needle after the first
use, and it takes only one needle-sharing lapse for an addict
to become infected. Moreover, easy access sends a message
that IV drug abuse is condoned and gives young people the
means to “experiment” with IV drugs.
“The emphasis on easy needle access by well-meaning
politicians, advocates and public health officials has been
counterproductive politically. The protests from neighborhood
advocates about discarded needles on streets are hardly unreasonable.
“Moreover, the divisive needle exchange issue has
all but eclipsed debate on a far more critical issue: lack
of sufficient anti-addiction treatment, counseling and education
for IV drug abusers. Drug treatment facilities across the
state report long waiting lists for those seeking inpatient
rehabilitation.
“There is nothing inherently wrong with distributing
needles to addicts who are working actively to kick the habit
in a clinic-based counseling and treatment program. This comprehensive
“harm and risk reduction” approach is certainly
the easiest sell politically.
“But the notion that needle access alone is an effective
tool in the struggle to curb AIDS is naive at best.”
[Worcester Telegram & Gazette, 12/6/02]
HIV-positive Man Gets 15 Years in Prison for
Sex with Teen
An HIV-positive New York man received a 15-year prison sentence
for having sex with a 15-year-old girl he met on the Internet.
Jose Blas, 48, met the girl from Largo, Florida in a chat
room last year. He initially told her he was 18 and later
showered her with gifts and love notes. He flew down from
Forest Hills, New York, last December and spent the day with
her at a Pinellas Park hotel. He never told her he was infected
with HIV.
Blas and his lawyers said Monday that Blas used condoms,
but the girl faces periodic testing to determine whether she
was infected. She recently suffered head injuries in an accident
and has been in a coma.
Blas was arrested in April. Investigators discovered computer
evidence that showed him courting a second teenager, this
one in Jacksonville, for a similar rendezvous.
Blas pleaded guilty to two counts of using a computer to
pursue minors for sex and one count for traveling to Florida
to have sex with a minor. U.S. District Judge James Whittemore
granted a prosecution request to exceed normal sentencing
guidelines for the first-time offender.
Assistant U.S. Attorney Colleen Murphy-Davis argued that
the health risks Blas introduced warranted a higher sentence.
“He had sex with her despite the fact that he had a
potentially deadly disease,” Murphy-Davis said.
[Associated Press, 12/17/02]
New Study Shows Value of Routine Screening
of Teen Girls for Chlamydia
Testing sexually active teen girls with a simple urine test
during a routine visit to the doctor is an effective way of
catching chlamydia and ultimately helping prevent infertility
problems later in life, a new study has found.
Researchers from the University of California, San Francisco
worked with physicians at 10 Kaiser Permanente managed care
pediatric clinics in Northern California from April 2000 and
March 2002. They found that an average of 5.8 percent of sexually
active girls ages 14 to 18 tested positive for chlamydia in
routine screening-- patients who otherwise would not have
been tested. That rate is on track with the national infection
rate of 6 percent to 9 percent found during routine screening,
according to the Centers for Disease Control and Prevention.
But the new and promising finding was that pediatricians
were receptive to changing their behavior regarding the sensitive
topic of sexual health, according to lead author Dr. Mary-Ann
Shafer, associate director of adolescent medicine at UCSF.
Chlamydia is the most common bacterial sexually transmitted
disease in America with about 3 million new cases each year.
Teenage girls are six times more likely to contract it than
adult women, according to the study in Wednesday’s Journal
of the American Medical Association.
Because more than 75 percent of infections do not have any
symptoms, Shafer said many teenagers do not discover they
have the disease until they try to get pregnant years later.
“We know that if chlamydia is left untreated, 10 percent
to 15 percent go on to pelvic inflammatory disease, and most
of the tubal infertility in adult women is due to chlamydia,”
she said. “It’s not rocket science here.”
Last year, the U.S. Preventive Services Task Force urged
doctors to screen all sexually active women 25 and younger
and the CDC has since issued similar guidelines. However,
nationally only about 20 percent of women ages 15 to 25 that
belong to managed care organizations are screened, according
to the study.
HMOs currently pay for the test and many are now administered
free at public health departments in the form of simple urine
tests. If detected, chlamydia also is easily treatable with
antibiotics. However, many providers may not view the screening
as cost effective, especially if the patients are teenage
girls, said Dr. Kathleen Irwin, chief of the CDC’s health
services research division of STD prevention. “A ranking
was done recently with 50 preventative services, and chlamydia
ranked in the top 10 of cost effectiveness to adults—that’s
higher than mammograms,” Irwin said.
Irwin said Shafer’s study was a great example of what
could be accomplished if chlamydia screenings became a regular
part of preventative health care, similar to annual pap smears.
Shafer’s study found 23 positive results out of 393
urine tests during routine visits. The rate was 7.6 percent,
or 12 positive results out of 157 tests, in clinics that did
not routinely screen for the disease. Shafer attributes the
higher percentage in the non-screening clinics to high-risk
patients coming in specifically for testing.
[The Associated Press, 12/10/02]
Thousands of Patients with HIV in Texas May
Lose Access to AIDS Drug Program
For 15 years, thousands of Texans with HIV have lived longer
on medications the federal and state government provided.
But come next year, two out of 10 Texans now enrolled in the
AIDS Drug Assistance Program would be cut off under a plan
to keep the financially drained initiative afloat.
David Duran of Austin is among 2,500 clients who expect to
be cut from the program, which enrolls 12,500 Texans. He now
pays just $15 a month for three prescriptions-- far shy of
the $1,149 they would cost him otherwise. He’s worried
about how he’ll manage to pay for the drugs that keep
him healthy, out of the hospital and able to work in the hospitality
industry. Another 1,700 new clients who would have signed
on to the program next year also would be excluded based on
new income guidelines the Texas Board of Health is expected
to approve in February.
With demand growing and drug costs soaring, the Texas Department
of Health expects a shortfall of $34 million in the next two-year
budget cycle, which starts in September. The program’s
currently has a $58 million annual budget.
To prevent a hemorrhage of red ink, department officials
proposed tightening income eligibility so that anyone making
more than 140 percent of the federal poverty level, or $12,400
a year, no longer would qualify. Today, the income cutoff
is 200 percent of the federal poverty level, or $17,720, but
that can be raised to cover medication costs. That means an
individual can have an annual income of $26,000 and still
get the benefit.
The Health Department has received more than 2,500 comments
about the proposal, most of them urging the agency to abandon
the cuts. But cutting costs is probably the only way to keep
the program alive, said Linda Moore, director of clinical
resources in the department’s bureau for prevention
of HIV and other sexually transmitted diseases. “The
bottom line for us is, we’re running out of money. We’ve
got to do something,” Moore said. “If we don’t
do something, we will have to close the program.”
Nationally, state and federal aid totaling more than $800
million helps HIV-positive people buy lifesaving medications.
But partly because of their success, programs in various states,
including Texas, Georgia, Kentucky, Maine, Wyoming, New York
and Alabama, are struggling financially and tightening enrollment
requirements.
Moore said the earliest the change could take effect is February,
and the state won’t know about the potential for more
federal money until March.
Sandy Bartlett, community information and education coordinator
at AIDS Services of Austin, said cutting people out of the
drug program will cost Texas more in the long run. It will
push people into other government aid programs and into hospitals
and clinics that care for the poor and uninsured.
“It’s a shell game,” Bartlett said. “If
they’re not able to cover their meds, if they are no
longer able to work, they will go into Medicaid and then they
will go into Medicare. ... If they are going to be denied
their meds by working, they will quit working and they will
go on welfare. There’s nothing cheaper about it.”
Moore said the Health Department is concerned about how the
cuts will affect clients. If its board approves the change,
affected clients would get six months to move out of the program.
The department will try to connect them with free drug programs
offered by pharmaceutical companies, Moore said.
During the board’s meeting in October, HIV-positive
men appealed to members to delay the rule change. They nonetheless
decided to publish the rule, a first step toward adoption.
Bartlett said he would be surprised if the board changes its
position. “It’s very rare for a board not to accept
the recommendations of their staff,” he said.
[Austin American Statesman, 12/14/02]
Federal Funds Continue to Go to Miami Organizations
that Previously Misused AIDS Funds; Patients at Risk
AIDS advocates say dozens of families may be living in the
dark or in jeopardy of losing their homes because the city
of Miami misused federal housing funds meant to assist patients
with utility and mortgage payments. Now the city may award
$3.3 million in new contracts-- without a bidding process--
to the same agencies that activists say wrongly received money
last year.
Those agencies specialize in AIDS education and prevention,
but the funding was supposed to be earmarked for housing needs.
Activists say the city’s Office of the Community Development
never should have given them more than a half-million dollars
in funding by the U.S. Department of Housing and Urban Development.
Activists John Muhammad and Marc Cohen want commissioners
to reject the contracts and order city officials to draw up
a new plan with their input. “The city has made significant
mistakes,” Cohen said. “I don’t trust them.”
Dan Fernandez, acting director of community development,
said there was no bid process this time around because the
four agencies were previously approved by the city for AIDS
prevention. He said the agencies are located in different
regions of the county, and would be more accessible to clients.
The agencies are Spanish American Basic Education and Rehabilitation,
Bethel A.M.E. Church, Care Resource and the Center for Positive
Connections.He said his office did not deliberately violate
federal rules in awarding housing funds to prevention agencies.
“HUD has some rules in black and white, but others have
shades of gray,” he said.
Sherri Kaplan, executive director of Positive Connections,
said she didn’t think it would be difficult to offer
housing services. “All it takes is training and bringing
in the right staff to make it happen,” Kaplan said.
The issue is over how the city administers the $13 million
Housing Opportunities for Persons With AIDS program, designed
to provide housing and related support services to people
living with AIDS or HIV.
The discord comes at a time when more people locally are
being diagnosed with AIDS or its precursor, HIV infection.
Activists contend that for the past five years the city has
refused to consult with the county’s HIV/AIDS citizens
advisory board on its spending priorities. That, activist
Tim McCarron said, created “flawed decisions on how
to use HOPWA funds.”
Fernandez said he was willing to work with the activists,
if they meet him halfway.
Incoming Commission Chairman Johnny Winton said both sides
needed to work out their problems.
The activists’ ire was touched off by two HUD rulings
by in response to charges that the city did not follow federal
procedures in giving out money.
Earlier this year, HUD ordered the city to repay more than
$500,000. The housing funds went to three agencies that provide
AIDS prevention and education-- a violation of federal rules.
The same agencies are up for approval again, this time to
provide housing service.
More recently, the city recently was forced to suspend its
utility and mortgage payment programs because it failed to
follow disbursement guidelines.
Muhammad, chairman of Miami-Dade County’s HIV/AIDS
planning advisory board, said the families were notified this
month that they would not get help with their house and rent
payments. He said about 60 families received the notices,
although city officials said the number was lower. “This
is costing us homes and placing our lives at risk,”
Muhammad said. Fernandez said the city is creating an emergency
program to help with missed payments. “We’re going
to try to provide assistance to prevent homelessness,”
Fernandez said.
[Miami Herald, 12/11/02]
AIDS Groups Split on “Unique Identifiers”
to Track DC HIV Cases
AIDS advocates testified before the District of Columbia
City Council this month on a bill that would restrict the
manner in which the city keeps track of people who test positive
for HIV. On December 2, the Council’s Committee on Health
& Human Services heard conflicting testimony from Bob
Summersgill of the Gay & Lesbian Activists Alliance and
Ron Simmons of the local AIDS service group Us Helping Us.
The two presented opposing views on a bill introduced earlier
this year by Council member Phil Mendelson (D-At-Large), which
would bar the city from using any part of a person’s
Social Security number in a system for identifying people
who test positive for HIV through a “unique identifier”
code.
Summersgill, GLAA’s president, testified in favor of
Mendelson’s bill, claiming the use of a portion of a
person’s Social Security number, as proposed by the
city’s Department of Health, would discourage people
from getting tested. Summersgill said the city’s immigrant
population, especially illegal immigrants, would most likely
choose not to get tested upon learning they would be required
to reveal part of their Social Security number.
Simmons told the committee, chaired by Council member Sandra
Allen (D-Ward 8), that he agreed with Department of Health
officials that use of a partial Social Security number is
needed to ensure the most accurate count of those who appear
for HIV testing. Simmons noted that the U.S. Centers for Disease
Control & Prevention (CDC) requires all cities and states
to put in place an accurate surveillance program of people
who test positive for HIV to insure that states and cities
obtain federal AIDS funds.
A faulty system could cause DC to lose some or all of its
federal funds for AIDS programs, Simmons said, a development
that would be catastrophic for low income people who rely
on government programs for HIV treatment. Simmons said anyone
fearful of being identified could still be tested at various
sites that offer anonymous testing.
DC Council member Jim Graham (D-Ward 1), the former executive
director of the AIDS service agency the Whitman-Walker Clinic,
spoke in favor of the Mendelson bill during the hearing. Allen
said she has yet to decide whether to bring the Mendelson
bill to the full Council for a vote.
The CDC has recommended that HIV cases be reported by name
to ensure the most effective surveillance. AIDS activists
in DC defeated a Health Department plan to enact such a plan.
Most states report HIV and other diseases by name.
[The Washington Blade, 12/13/02]
Survey: Teens Express Cautious Attitude Toward
Early and Casual Sex
Almost two-thirds of teens who have had sex (63 percent)
wish they had waited longer. This is one of several findings
from a new survey suggesting that teens are taking a cautious
attitude toward early and casual sex. The nationally-representative
annual survey of adults and teens, released by the non-profit
National Campaign to Prevent Teen Pregnancy, also reveals
most adults (94 percent) and teens (93 percent) believe it
is important for teens to be given a strong message from society
that they should not have sex until they are at least out
of high school.
Most teens (82 percent) believe that sex should only occur
in a long-term, committed relationship, and only 19 percent
of teens think it’s all right to have sex if two people
have known each other for a short time.
Teens say morals, values, and/or religious beliefs influence
their decisions about sex far more than anything else. Half
of teen boys (51 percent) say they often receive the message
that sex and pregnancy are “not a big deal.”
[National Campaign to Prevent Teen Pregnancy
release, 12/16/02]
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.
Previous editions of the HIV Update are available on-line
at http://www.childrensaidsfund.org/news.asp.
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