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Volume 4, Number 13
March 4, 2003
In this edition:
Survival of AIDS Babies Cause for Joy and
Concern
Effective AIDS drugs are allowing an increasing number of
babies born with HIV to survive long enough to become sexually
active and pregnant, according to a U.S. study released on
Thursday. The study, published by the U.S. Centers for Disease
Control and Prevention, highlights a need to tailor reproductive
health programs for a group who until recently had not been
expected to live past childhood, the agency said.
“It’s a landmark in the HIV epidemic at least
in the U.S.,” said Dr. Michelle McConnell, an epidemiologist
in the CDC’s HIV/AIDS division and the author of the
study. “Survival has increased to such an extent that
not only are they (infected babies) surviving but they’re
healthy enough to get pregnant and have healthy kids,”
McConnell said.
The conclusion was based on data compiled from eight females
in Puerto Rico who were infected with HIV at birth and who
later became pregnant. Five of the case patients became pregnant
accidentally and only two reported using condoms when they
conceived. None of the babies born to the women, all of whom
were teenagers when they conceived, were infected with the
virus, according to the study. All the mothers had received
antiretroviral AIDS drugs consistently during pregnancy.
The CDC said it was concerned by data showing that some women
in the study reported becoming sexually active at around the
same age that they learned of their HIV-positive status.
That finding could indicate that teens and young adults infected
with AIDS at birth are just as likely to engage in risky sex
later in life as their peers who were not infected with the
virus. It may also fly in the face of the decision by many
parents to shield their children from knowledge of the disease
until later in adolescence.
McConnell, however, noted that it was difficult to make such
generalizations because the study sample was so small.
HIV/AIDS has killed about 450,000 Americans since it was
first diagnosed in 1981. About one million Americans have
been infected with HIV in the past two decades.
Secondary transmission of the virus by those infected in
the womb did not hit the radar screens of public health officials
until the 1990s when the emergence of antiretroviral drugs
markedly improved patients’ survival rate. Before then,
the majority of infected infants died well before reaching
puberty.
The CDC, however, said more study of this tiny but growing
group was needed to better understand mother-to-child transmission
of HIV as well as the spread of drug resistant forms of the
virus.
All of the case patients who were tested for resistance to
AIDS drugs in the CDC study carried multiple drug-resistant
strains of the HIV.
[Reuters, 2/27/03]
Oklahoma Sees a Jump in AIDS Cases
Apathy may be the cause of an increase in the number of AIDS
cases in Oklahoma, health officials say. In a recent medical
study, Oklahoma City and Tulsa were among cities with the
highest percent of change in the number of reported AIDS cases
in the last decade.
The state Health Department recorded 4,098 Oklahomans living
with AIDS at the end of last year. Almost half the carriers--
1,942 people-- range in age from 30 to 39 years old. Less
than 50 people with AIDS are under age 20.
The number of new AIDS cases reported in Oklahoma City has
more than doubled since 1990, according to a study conducted
by the SUNY Downstate Medical Center in New York. The report
shows 94 new cases of AIDS in Oklahoma City in 2000-- an incidence
of about 18.6 new cases for every 100,000 residents. In 1990,
officials recorded 46 new AIDS cases in Oklahoma City.
In Tulsa, the report showed 34 new cases in 2000, up from
28 in 1990. The study used data from the Census Bureau and
from the federal Centers for Disease Control and Prevention
to track AIDS rate changes in the nation’s 100 largest
cities from 1990 to 2000.
Michelle Green-Gilbert, a training director for the state
Health Department, said the increase in AIDS may be attributed
to risky behaviors among local residents.
Health officials have also seen an increase in AIDS cases
in the black community. One in five new cases of HIV are among
blacks. “If you look at the amount of African Americans
in this state they amount to about 11 to 12 percent of the
population, but still account for one in five with HIV,”
she said.
Jean Ann Van Krevelan, executive director of the Regional
AIDS Interfaith Network estimates the state’’s
2,600 reported HIV cases account for only about one-third
of those living with the disease in Oklahoma.
[Associated Press, 2/28/03]
Is Oral Sex ‘Safe’ Sex?
How safe is oral sex? That question has been debated ever
since HIV/AIDS emerged.
Now one expert says that fellatio may not be risky at all,
at least when it comes to spreading HIV. Dr. Jeffrey Klausner,
who heads the sexually transmitted disease prevention effort
at the San Francisco Department of Public Health, bases his
conclusion on a new study of 239 gay or bisexual men who reported
no anal or vaginal sex and no injection-drug use in the prior
six months. Ninety-eight percent said they had performed oral
sex without condoms. Twenty-eight percent said they knew their
partner was HIV-positive, and of those, 39 percent said they
had swallowed semen. None of the men became infected. The
risk of HIV transmission via oral sex, Klausner maintains,
“is very, very, very, very, very low and may be zero.”
A 2002 Spanish study supports Klausner’s view. Researchers
there followed 110 women and 25 men, all HIV-negative, for
10 years. Each participant had an HIV-positive partner. The
investigators estimated that over the course of the study,
the couples engaged in 19,000 acts of ‘unprotected’
fellatio or cunnilingus. None of the negative partners converted.
A 1998 Emory University study analyzed 24 epidemiological
investigations of HIV transmission via oral sex among heterosexuals
or gay men. Generally, oral sex was not found to be a risk
factor, though five of those studies concluded that among
some gay men and crack users, sucking did transmit HIV.
“Yes, it does occur,” says Richard Rothenberg,
a professor at Emory University’s School of Medicine.
“It’s probably a relatively small contribution
to the epidemiology of HIV transmission.”
Klausner’s comments set off Rex Wockner, a journalist
whose syndicated news stories and commentaries have appeared
in the gay press for 18 years. “I know four people who
I believe when they tell me that they seroconverted from sucking,”
Wockner told the Village Voice. Of those four friends, Wockner
notes, one is now dead. Wockner says “the unfortunate
thing about this study is that nobody asked them how many
times they did that. Doing it only once and staying negative
doesn’t prove a thing.”
There is disagreement even within the San Francisco health
department. “I certainly agree that the risk from oral
sex is very low,” says director Mitchell H. Katz. “The
part of the message I don’t think is beneficial is the
part that says ‘and may be zero.’ I myself would
not have oral sex with someone who was positive or of an unknown
status.” Katz says he tells people they have a 1-in-2500
chance of getting HIV from ‘unprotected’ oral
sex with ejaculation.
A 2000 study from the University of California San Francisco,
San Francisco General Hospital, and the Centers for Disease
Control and Prevention tends to support Katz. Investigators
interviewed 102 HIV-positive men, and eight of them reported
that ‘unprotected’ oral sex was their only risky
activity.
The Emory University study included case reports, dating
from 1984 to 1993, documenting HIV transmission within lesbian
couples that practiced oral sex. But a 1994 study that followed
18 lesbian couples in which one partner was HIV-positive concluded
that the risk of transmission was “nonexistent.”
Few studies have investigated heterosexual women and HIV
transmission via oral sex. The issue is far from academic,
since heterosexual transmission accounted for 15 percent of
AIDS cases diagnosed in New York State in 1999, the latest
year for which complete data is available. Of the more than
41,000 AIDS cases in the state to date, nearly 13,000 are
attributed to heterosexual transmission and more than a third
of these were diagnosed between 1996 and 1999. Women are twice
as likely as men to make up these heterosexual cases. Yet
neither the city nor the state have studied the method of
sexual transmission among heterosexuals--or gay men.
Most AIDS groups claim that oral sex is a low-risk activity,
but some, such as Gay Men’s Health Crisis, betray a
certain agnosticism. GMHC’s 1996 pamphlet on oral sex
is titled “To Suck or Not to Suck.” It explores
the pros and cons of fellatio and tells readers, “Only
You Can Decide What You Put in Your Mouth.” In the pamphlet,
GMHC rates oral sex “low risk.” In Canada, health
officials describe the risk from fellatio as “negligible.”
But it is indisputable that oral sex can transmit syphilis,
gonorrhea, herpes, warts, and other diseases. (New York City’s
health department recently noted a 50 percent increase in
syphilis cases, mostly among gay men.) However, when it comes
to HIV, researchers have two different missions. One is to
document risky behavior for individuals; the other is to establish
which practices could change the course of a deadly epidemic.
Some researchers argue that if gay men adopted fellatio as
their sole sexual behavior, the AIDS epidemic in that population
would disappear.
But here, too, there is disagreement. Jim Koopman, a professor
of epidemiology at the University of Michigan and a highly
regarded AIDS researcher, takes the risk of HIV transmission
through oral sex among gay men seriously. He thinks the statistics
used to bolster the claim that sucking is ‘safe’
are faulty. “A standard analysis will not show the effects
of oral sex,” Koopman says. That’s because, if
an infected person is having both anal and oral sex, most
researchers assume that anal sex is the source of the infection.
Therefore, the effect of fellatio is masked.
“Oral sex plays a key role,” Koopman argues.
“My feeling is if we are going to control HIV, we’re
going to have to take some actions along the line of stopping
transmission from oral sex.”
[The Village Voice, 2/25/03]
HIV-positive Inmates Frequently Have ‘Unprotected’
Sex Before, After Release
Inmates infected with HIV engaged in unprotected sex both
before imprisonment and after their release at “exceedingly
high rates,” according to a new University of North
Carolina (UNC) at Chapel Hill School of Medicine study.
Seventy-eight percent of North Carolina men and women prisoners
carrying the virus who had a main sex partner reported unprotected
sex with that person in the year before they were locked up,
the study showed. Twenty-six percent of them interviewed again
soon after release admitted to already having sex without
condoms with their main sex partners.
For about half the subjects, the time between regaining their
freedom and having sex averaged fewer than 9 days and ranged
from 1 hour to 31 days. Two-thirds of inmates had least one
other sex partner prior to imprisonment, and of those with
multiple partners, the average number was eight, researchers
found.
Given their current sexual behavior, 29 percent of former
inmates felt it was “very” or “somewhat”
likely that they would infect their HIV-negative main sex
partner. It was not clear why that did not change their behavior
or why others did not think they could pass on the disease.
“This clearly should be a wake-up call for public
health experts, physicians, prison officials and others concerned
about reducing the spread of HIV,” said Dr. David A.
Wohl, assistant professor of medicine at UNC and an infectious
disease expert. “Despite progress made in the past decade
or so, AIDS remains a deadly illness and is a major social
and economic burden across the United States and around the
world. We need to develop better educational and other types
of interventions that can reduce HIV transmission behaviors
among those infected. This study highlights the need to also
concentrate prevention efforts in communities where HIV and
incarceration are both endemic.”
Wohl presented the findings in Boston at the 10th Conference
on Retroviruses and Opportunistic Infections. The annual scientific
meeting is the largest of its kind in the United States.
In their study, which ran from May 2001 to the present, UNC
researchers enrolled and interviewed inmates from larger facilities
across North Carolina, including Central Prison, about their
behaviors before being locked up. Investigators have so far
reached 75 of them again via telephone after their release
and asked comparable questions. Two interviewed earlier already
had died of HIV-related illnesses, and 5 were locked up again
before the second interview.
Subjects ranged in age from 18 to 55 and averaged 36 years
old. Fifty-seven percent were women, 74 percent were black,
4 percent were Native American and 83 percent described themselves
as heterosexual. Half had at least a high school education.
“Prior to incarceration, 72 percent had a main sex
partner, and 57 percent of those were reported to be HIV-negative,”
Wohl said. “Post-release, 93 percent had a main sex
partner, and 82 percent of releases returned to their prior
main partner.”
About two-thirds of former inmates with multiple partners
reported having at least one partner before going to prison
who did not have the virus yet.
Just over 3 percent of the U.S. population-- 6.5 million
people-- were in some form of correctional custody nationwide
in 2002, according to Bureau of Justice statistics. Of those
in prisons and jails, between 35,000 and 47,000 were HIV-infected,
which was more than 10 times the prevalence of HIV among those
not incarcerated. The vast majority were infected outside
prison, not inside, Wohl said.
A recent study led by Dr. Adaora Adimora, assistant professor
of medicine at UNC, of 244 black men and women with and without
HIV showed that HIV-positive men were six times more likely
than HIV-negative men to have had a sex partner who had been
incarcerated in the previous year, Wohl said. HIV-positive
women were four times more likely than others to have had
a partner who had been locked up in the past year.
Others involved in Wohl’s continuing study were Dr.
Becky Stephenson, assistant professor of medicine; Dr. Andrew
Kaplan, associate professor of medicine; Dr. Ronald P. Strauss,
professor and chair of dental ecology at the UNC School of
Dentistry; research assistants Laura Shain and Monica Adamian;
and Dr. Carol Golin, assistant professor of medicine. Support
for the research came from the UNC Center for AIDS Research.
[AIDS Weekly, 3/3/03]
South Dakota Panel Approves Criminal HIV Transmission
Bill
A South Dakota Senate committee approved a bill Friday that
would allow the State Health Department to release otherwise
confidential HIV information to prosecutors if ordered to
do so by judges. Health officials also could notify the attorney
general or prosecutors if they suspect someone has intentionally
exposed others to HIV without telling them.
The Judiciary Committee had previously heard testimony but
delayed action on HB 1019. The panel voted 5-2 on Friday to
send the bill to the full Senate.
Senator Gene Abdallah, R-Sioux Falls, said the bill is necessary
and has been supported by several health and legal organizations.
“It’s got to be here for the protection of the
public and for the people of the state,” Abdallah said.
[Associated Press, 2/28/03]
Missouri Man with HIV Accused of Not Informing
Sexual Partners
A Missouri man has been charged with failing to tell two
women that he was infected with HIV before they had sexual
intercourse. Robert E. Michael, 32, of Springfield was expected
to appear Monday in Greene County court on two felony counts
of reckless exposure to HIV. Michael, who was charged in November,
was told in February 2000 that he had tested positive for
HIV, according to court records. Michael admitted to police
that he had been informed of his obligation to tell his sexual
partners about the illness.
Michael allegedly had ‘protected’ intercourse
with a 43-year-old Springfield woman on June 1, 2002, but
did not tell her that he was HIV-positive, court records showed.
Michael denied having sex with the woman when he was interviewed
by police.
Michael also was charged with having intercourse the next
night with a 53-year-old Springfield woman. Michael told police
that he informed the woman the next morning that he was HIV-positive.
Michael told authorities he did not use a condom. Michael
told police that he didn’t tell the woman sooner because
others had treated him like he had “leprosy” once
they knew.
Michael was arrested in January in Weatherford, Texas. He
was returned in February to Greene County, where he was jailed
on $250,000 bond.
[Associated Press, 3/4/03]
New Skin Infection Concerns Doctors, Activists
Public health officials in California are alerting gay men
to the dangers of a new skin infection that is communicable
during sex, but some activists charge they’re not doing
enough to prevent its spread. The San Francisco Health Department
has sent out informational bulletins on methicillin-resistant
staphylococcus aureus (MRSA), or “staph,” to chiropractors,
masseurs and gymnasium and sex-club operators, alerting them
to increases of the infection. Officials also have held informational
forums at homosexual community centers.
More recently, Los Angeles health officials also have identified
an increase in MRSA among male homosexuals.
Officials, however, can’t provide numbers of staph
infections because MRSA is not a reportable disease in California.
“We’ve heard anecdotally that there are increases,
but we haven’t been able to substantiate it,”
said Colleen Johnson, a San Francisco Health Department spokeswoman.
“We will be creating a surveillance system in the next
couple of months, but it will take a while in order to have
enough data for it to be accurate.”
The Health Department is working with the University of California,
local health authorities and doctors to prevent the infections
from spreading, she said.
Michael Petrelis, a longtime AIDS activist, said the Health
Department in San Francisco is failing to control staph infections
as it has failed to control other sexually transmitted diseases,
including HIV infections. “We’ve had a doubling
of syphilis cases; gonorrhea is up, and now, we have a new
drug-resistant staph infection. To me, it says the Health
Department in San Francisco is a failure,” Petrelis
said.
Drug-resistant staph is not new, but this strain is more
contagious because it produces a toxin that is passed through
the skin, experts said. “What’s new is that some
of these are being spread by skin-to-skin infections, and
the skin-to-skin contact seems to be of a sexual nature,”
said Dr. John Diggs, a medical consultant to the Family Research
Council. “The difference is that this is treatable and
that it can be spread through more casual contact. It doesn’t
have to be contact of a sexual nature,” he added. However,
the disease could spread rapidly among gay men, who have high
rates of sexual promiscuity, Diggs said.
Doctors are not accustomed to seeing this type of infection
in their offices, Diggs said. It’s the kind of infection
they expect to see in patients who might be hospitalized or
who are otherwise debilitated with diabetes or chemotherapy,
he said.
Since early last summer, for example, the San Francisco Health
Department has identified an increasing number of patients
with soft tissue infections among city jail inmates, the department
reported.
The infections can cause pneumonia and bladder, skin and
blood infections. In some cases, the disease can be fatal,
doctors report.
But in order to control an epidemic, officials need to have
some idea what the incidence is, “and they’re
not doing anything to find out what the incidence is,”
Diggs said. “The problem from the beginning is that
most of these sexually transmitted diseases have been treated
as political issues rather than public health issues,”
he said. “The approach they’re taking is you treat
people, and if they don’t get better, then you test
them for MRSA,” he said. “There could be people
you treat who do get better who still have MRSA. To have MRSA
doesn’t mean it’s not treatable. What it means
is it’s not treatable by the common methicillin-type
antibiotics,” he said.
While no official figures are available on the number of
staph infections, one San Francisco doctor estimated the city’s
cases number between 200 and 300.
[CNSNews.com, 2/26/03]
Massachusetts Investigates Drug Resistant-bacteria
Infections
The Massachusetts Department of Public Health is investigating
how five men in Boston were infected with a drug-resistant
staph infection. Doctors at the Fenway Community Health Center
last fall started seeing patients with pneumonia, sinus infections
and skin conditions caused by Methicillin-resistant Staphylococcus
aureus, or MRSA-- a bacteria usually caught only in hospitals
by patients already sick.
All five men were treated and have recovered without lasting
complications. But doctors are worried about the incidence
of this bacteria, resistant to traditional antibiotics, outside
hospitals and nursing homes.
Dr. Scott Fridkin, a medical epidemiologist at the U.S. Centers
of Disease Control and Prevention said “The reports
are becoming more frequent and it appears to be a growing
problem.”
The Department of Public Health is now investigating, hoping
to find out whether there is a link and a common source of
infection.
All five who were infected are HIV-positive, but physicians
and medical investigators don’t know whether that was
a factor in their infection.
Drug-resistant bacteria can be especially dangerous because
doctors initially try treating with traditional antibiotics,
which don’t work, and patients get sicker as the bacteria
advances. This kind of bacteria spreads through close skin
contact, making other people susceptible to infection. Larger
outbreaks were reported in Los Angeles County jails last year,
with 928 reported cases. Earlier this year, public health
authorities in Los Angeles and San Francisco reported MRSA
clusters in the cities’ gay communities.
[The Boston Globe, 3/2/03]
DC Reports Resistant Skin Infection Among
Gay Men
At least seven gay men in the District of Columbia have been
diagnosed with a skin infection resistant to commonly prescribed
antibiotics that began surfacing late last year among gay
men in San Francisco and Los Angeles, two D.C. physicians
said last week.
Dr. Douglas Ward, of the Dupont Circle Physicians Group,
said his office has treated at least three gay men for the
skin condition, known as Methicillin-Resistent Staphylococcus
Aureus, or MRSA, since late November or early December. Ward’s
office treats a large number of D.C. area gay men.
Dr. Bruce Rashbaum, whose D.C. practice also sees large numbers
of gay male patients, said he has treated at least four cases
of MRSA among gay men during the past two to three weeks.
An epidemiologist with the U.S. Centers for Disease Control
and Prevention said the D.C. cases appear to confirm earlier
findings by CDC researchers that a new, undetermined factor
is causing MRSA to flourish in a wider group of people, including
gay men. Until the late 1990s, the pesky skin infection had
been confined mostly to elderly patients in hospitals and
nursing homes, CDC officials said.
Ward and Rashbaum said that similar to the cases in San Francisco
and Los Angeles, the D.C. infections have manifested themselves
as boils and abscesses on various parts of the patients’
bodies, including the penis. Public health officials in Los
Angeles said the infections appear to be spread from skin
to skin contact, including, but not limited to, sexual contact.
There have been no reported deaths from the MRSA cases reported
in gay men, but physicians monitoring the infections say they
have the potential to cause life-threatening complications
if they are not treated promptly with potent antibiotics.
Rashbaum said one of his patients had to be hospitalized and
treated with an intravenous antibiotic.
“We have been contacted about MRSA cases occurring
in men who have sex with men in several cities outside of
California,” said CDC epidemiologist Dan Jernigan. “So
this is something we would expect,” he said, in referring
to the D.C. cases, though he would not confirm their existence.
He said the agency was compiling information about the geographic
spread of the infection for further public release.
A spokesperson for the D.C. Department of Health said the
department had not been aware of the MRSA cases in D.C. until
an inquiry from the Washington Blade this week prompted a
department epidemiologist to contact Dr. Ward’s office
for information.
“The problem we face is that local and federal law
doesn’t require physicians to report this to government
health departments,” said D.C. Health Department spokesperson
Charles Ellison. Ellison said the D.C. health department would
take steps to monitor MRSA-related developments in the District.
Ward said his office reported the outbreak to the CDC soon
after the cases were confirmed, several weeks ago.
Both Ward and Rashbaum said they confirmed the MRSA cases
through laboratory culture tests. Ward’s physician’s
assistant, Tom Kantor was awaiting word from a medical laboratory
to determine whether another five cases of MRSA can be confirmed
among the office’s gay male patients.
Bob Bolen, a physician with the L.A. Gay & Lesbian Center,
said a number of the several dozen gay men in L.A. and San
Francisco who contracted MRSA appear to have become infected
in gyms or sex clubs that cater to gay men.
The CDC has said MRSA is almost always spread by direct physical
contact, and not through the air. CDC officials have said
transmission has also likely occurred through indirect contact
by touching objects such as towels, sheets, clothes, workout
areas, and sports equipment contaminated by the infected skin
of a person with MRSA or staph bacteria.
Public health officials in San Francisco and Los Angeles
began noticing MRSA cases among gay men last fall, according
to a February 7 edition of the CDC’s authoritative journal
Morbidity & Mortality Weekly Report.
A separate CDC fact sheet on MRSA says the ailment has been
confined mostly to elderly hospital and nursing home patients
for the past 50 years. But beginning in 1997, the CDC fact
sheet says, non-hospital population groups such as prison
inmates, members of athletic teams, Native Americans and,
most recently, gay men have contracted the condition.
“This is not an issue that is exclusive to the gay
community,” said Nicolle Coffin, a CDC official monitoring
MRSA cases in non-hospital population groups.
Last month, Coffin arranged for CDC epidemiologists to brief
the heads of gay health clinics in several cities on the status
of the MRSA outbreak among gay men through a telephone conference
call.
[Washington Blade, 2/28/03]
Oregon Syphilis Rate Hits 9 Year High
When higher numbers of Oregonians got syphilis in 2000, health
officials increased their efforts to teach disease prevention
even as they questioned whether the spike in cases was an
isolated event. Two years later, the number of syphilis cases
hit a 9-year high, and 2000 is increasingly looking like the
start of a dangerous trend.
Oregon logged 47 syphilis cases last year, up from 22 in
2001-- the sixth-biggest percentage increase in cases of any
state. Health care workers worry that Portland might see the
very large increases in sexually transmitted diseases (STDs)
that now plague other large West Coast cities. So public health
workers and ‘safe’ sex activists are redoubling
their efforts to stop the spread of STDs taking their battle
to newspapers, clubs, chat rooms and other venues used by
people at increased risk for syphilis, including young adults
and gay men.
Syphilis is a bacterial infection that starts with a sore,
or chancre, at the infection site, then progresses to a second
stage with a rash and fever months later. A third stage can
hit years later, causing tumor-like growths and perhaps fatally
damaging the heart or brain.
Syphilis worries doctors because, like gonorrhea and some
herpes infections, it causes ulcers in or on sexual areas
of the body, making it easier to pass on many blood-borne
infections. Such ulcer-causing diseases and HIV are an especially
dangerous combination, because the immune cells that gather
at the site of the sores are the same cells in which the human
immunodeficiency virus hides in the body, said Dr. Mary O’Hearn,
an HIV expert at Oregon Health & Science University. “Even
with patients whose virus is fully suppressed in the bloodstream”
by AIDS drugs, HIV can pass on through chancres, O’Hearn
said.
Syphilis and HIV may have other links. Some health officials
think STDs are increasing because fewer people are listening
to ‘safe’ sex messages, partly because new drugs
have successfully prolonged the life of people with AIDS.
Some may mistakenly think AIDS is no longer a life-limiting
disease, O’Hearn said, but the AIDS drugs are expensive
and have serious side effects, and AIDS remains fatal.
Margaret Lentell, who runs STD programs for Multnomah County,
which logged four-fifths of last year’s syphilis cases,
said that surveys also show younger people, ages 15 to 35,
are tiring of ‘safe’ sex messages, perhaps partly
because people in their teens and early 20s didn’t see
the first frightening days of the AIDS epidemic.
Whatever the causes, several STD rates have been rising in
Oregon. In 1999, the state logged 14 cases of “early
syphilis”-- meaning a recent infection-- followed by
31, 22 and 47 cases in the next three years. Rates of chlamydia
and gonorrhea have also risen in the past five years, though
they are still well below the high levels of the 1970s.
Oregon’s increases join a disturbing national trend
for several STDs, whose rates decreased steadily through the
1990s but started rising in the new millennium-- just as the
government was plotting to wipe out syphilis.
Syphilis had grown so rare by 1999 that the Centers for Disease
Control announced a “National Plan to Eliminate Syphilis
in the United States.” Instead, from 2000 to 2001 the
nation logged its first annual increase in syphilis cases
since 1990.
The biggest syphilis increases have been in the Northeast
and on the West Coast, especially in big cities.
In 1996, King County—Seattle’s home-- logged
one case. That grew to 65 in 1999. While King County’s
count has since declined somewhat, Washington’s state
case count rose four of the last five years to 93 early syphilis
cases in 2002-- more than three times the 1997 level.
California’s epidemic started with a Los Angeles-area
syphilis outbreak in early 2000. Driven by cases in the L.A.
and San Francisco areas, California’s syphilis cases
more than doubled, from 680 in 2000 to 1,708 last year.
In the West and nationwide, the re-emergence of syphilis
is driven by men. Women’s rates continue to decline.
That, combined with investigations of the L.A. and Seattle
outbreaks, has state and federal health officials to think
gay and bisexual men are one focus of the outbreaks.
Lentell said that gay men seem to be one group hit by Oregon’s
increase in syphilis cases, but not the only one. In addition
to gay and bisexual men, she said, sex workers and anyone
who has ‘unprotected’ sex with people they don’t
know well are affected by rising STD rates. So are young people:
15-to-19-year-olds have the county’s highest chlamydia
and gonorrhea rates, followed by 20-to-24-year-olds.
County health officials are trying several steps to fight
rising rates of syphilis and other STDs, Lentell said. Cascade
AIDS Project is also adding more information about syphilis
into its outreach efforts, said Philip Knowlton, who coordinates
the nonprofit’s Men’s Prevention and Wellness
program. That program sends workers to places where men might
seek sex, such as bathhouses and adult bookstores, so they
can pass out condoms and answer ‘safe’ sex questions.
[The Oregonian, 3/1/03]
Minnesota AIDS Programs Survive Budget Cuts
for Now
A statewide AIDS hot line and HIV testing services in Minnesota
have survived the budget knife-- at least for now.
Officials of the Minnesota AIDS Project anticipated $1.2
million in cuts to AIDS-prevention efforts. But officials
of the state Department of Health reworked the numbers the
last few days to ease the effect.
“We’re completely surprised and shocked, but
the Department of Health worked creatively to come up with
much less Draconian cuts that-- at least for the moment--
leave most HIV- and STD- [sexually transmitted disease] prevention
grants in place,” said Bob Tracy, the community affairs
director of the Minnesota AIDS Project.
Health Department spokesman Buddy Ferguson said the $1.2
million in cuts originally announced will be restored with
$400,000 in federal grant money, $385,000 in unspent subsidies
to local public health agencies and $400,000 in grant cuts
to those agencies.
“We worked with the Finance Department and the governor’s
office to mitigate the impact of the cuts on these programs,”
he said.
The AIDS Project, a statewide nonprofit agency, was expected
to lose 40 percent of funding for its AIDSline, substantially
reduce access to HIV testing and eliminate many counseling
and street- outreach programs. It will lose some funding for
educational and technical assistance it gives to state pharmacies.
In addition to the 4,500 Minnesotans known to be living with
HIV, experts estimate that another 3,000 state residents have
HIV but are unaware of it. The AIDSline numbers, which offer
resources and referrals, are 612-373-2437 in the Twin Cities
and 1-800-248-2437 statewide.
[Star Tribune (Minneapolis-St. Paul), 2/12/03]
Consistent Condom Use Not Effective in Preventing
HPV Infection According to New Study
Incidence data on human papillomavirus (HPV) are limited,
and risk factors for transmission are largely unknown, according
to a new study published in the American Journal of Epidemiology.
The study also found that consistent condom use was not effective
in prevention HPV infection.
The authors of the study followed 603 female Washington State
University students between 1990 and 2000 at four-month intervals.
At each visit, a nurse-practitioner administered a face-to-face
interview and a standardized pelvic examination and collected
separate cervical and vulvovaginal specimens for HPV DNA analysis.
A subset of 529 women provided 2,640 toothbrush samples of
the buccal mucosa, which were also analyzed for HPV DNA. Participants
answered questions about socioeconomic status, gynecologic
and obstetric history, current and past sexual behavior, and
history of genital tract infections at the first visit. On
subsequent visits, this information was updated.
The researchers focused their analyses on the 444 women who
were HPV-DNA negative at the time they enrolled in the study.
The mean age of the subjects at enrollment was 19.2, and the
mean lifetime number of partners of the 296 women who were
sexually active was 1.8. One hundred forty-eight participants
were virgins at enrollment.
Investigators found that the cumulative 24-month incidence
of HPV in women who were sexually active at enrollment was
38.8 percent, compared to 38.9 percent of virgins who initiated
sexual activity. The most common types of first infections
were HPV-16, -56, and -6. Twenty-one women were infected with
multiple types. Incidences calculated from the time of new-partner
acquisition were comparable for virgins and non-virgins.
Smoking, use of oral contraceptives, and reporting a new
male sex partner - especially one known for less than eight
months or who had other partners - were predictive of increased
risk of HPV infection. Always using male condoms with a new
partner was not protective.
The 24-month cumulative incidence of HPV in virgins was 7.9
percent. “Infection in virgins was rare, but any type
of nonpenetrative sexual contact was associated with an increased
risk,” Winer and colleagues wrote. Analysis of oral
specimens found no association between incident oral HPV infection
and oral-penile contact.
“In conclusion,” the researchers summarized,
“the present study showed that the incidence of genital
HPV associated with acquisition of a new sex partner is high
and that risk of infection is especially high if a partner
has been known for less than eight months and if a partner
reports having had sex with other partners. Oral HPV infection
is rare and not clearly associated with oral-penile contact.
Genital HPV infection in virginal women seems to be rare,
but non-penetrative sexual contact is a plausible route of
transmission.”
[American Journal of Epidemiology, 2/1/03]
Eligibility Unchanged for Texas AIDS Drug
Assistance Program
For now, eligibility won’t change for a program that
helps low-income Texans get lifesaving HIV drugs, the state
board of health decided Thursday. Health officials had been
considering reducing the income levels of those who qualify
to get state money for the medicine. But the board decided
Thursday to table the plan, effectively killing it. Instead,
the health department will look for other ways to save money
and will work to keep the HIV medicine program going, Stanley
said.
The Texas Department of Health has a $41.5 million deficit
in the program, said Dr. Sharilyn Stanley, associate commissioner
for disease control and prevention. She cautioned that in
the coming months there “very likely might be a temporary
halt to the enrollment of new clients.”
The proposed change would have affected as many as 2,500
people, about 20 percent of the 12,000 Texans who use the
program. Currently a person can earn up to twice the federal
poverty level and get help. That’s $17,720 a year, not
counting the cost of their HIV medicine. The new rules would
have dropped that income cap to 140 percent of the federal
poverty level, or $12,404.
[Associated Press, 2/27/03]
Six State ADAPs Join Together To Press for
Cheaper AIDS Drugs
Officials from the six biggest state AIDS Drug Assistance
Programs (ADAPs) in the country are planning to meet with
drug manufacturers in March to press for additional rebates
on AIDS medications. While ADAPs-- which are state-managed,
federally funded programs that offer antiretroviral drugs
to low-income people who lack health insurance-- have traditionally
fended for themselves in price negotiations with drug companies,
officials from California, New York, Texas, Florida, Illinois
and New Jersey have decided to bring unity to the discussions,
hoping to secure lower drug prices for all 56 of the nation’s
ADAPs.
The new initiative will focus on securing price concessions
not just for new drugs, which previous negotiations had focused
on, but for all AIDS drugs. The ADAPs have invited Roche,
GlaxoSmithKline, Merck, Pfizer, Abbott Laboratories and Bristol-Myers
Squibb to attend the meetings.
Program officials are particularly interested in discussing
pricing options for Roche’s new antiretroviral drug
Fuzeon, which is designed for HIV-positive patients who have
failed to respond to other medications. Roche earlier this
week announced that Fuzeon will cost $20,385 per year in Europe,
more than double the price of the most expensive AIDS treatments
on the market. While Roche has not announced the U.S. price
for the drug, many patient advocates fear that the drug will
be too costly for ADAPs to offer.
Roche is already involved in separate discussions with state
officials and AIDS groups over the price of the drug, which
is expected to get FDA approval next month. “We’ll
be working to put together the best package [of prices] for
all payers,” a Roche spokesperson said.
States have become “increasingly aggressive”
in seeking to control the rising cost of the drugs despite
drug company claims that such cost-containment strategies
are illegal.
Despite a price freeze last year by several drug manufacturers,
budget cuts and the increasing number of people needing assistance
have forced many states to restrict eligibility or to create
waiting lists for the programs. Nearly 700 people in twelve
states are currently waiting to enroll in ADAPs.
The programs currently serve 80,000 people-- 30 percent of
the U.S. AIDS drugs market.
[Wall Street Journal, 2/28/03; Kaiser Daily
HIV/AIDS Report, 2/24/03, 2/28/03]
HIV-infected Firefighter Prompts Testing
in Connecticut Town
Paid firefighters in a New Haven area town of Connecticut
have been tested for HIV because of a colleague’s compensation
claim that he was infected with the deadly AIDS virus on the
job.
“We know the risks of the job and we’ve taken
that as our career, but if the (HIV) test is available to
you, you’d be foolish not to take it,” said the
president of the Professional Fire Fighters Union in the town.
The union president chose to take the test offered last month.
Twenty of the department’s career firefighters took
the test, motivated by the rare opportunity rather than a
fearful reaction that they may have contracted the illness
from their comrade, said the town’s fire chief.
“I just wanted to make sure, so, at least if my test
results came back positive, I could begin treatment early,”
said one firefighter, who tested negative, though he’s
been exposed to various illnesses and trauma as an emergency
medical technician since 1974.
The main reason the town offered testing only to paid firefighters
and not its 50 active volunteers is that they worked closer
to the ill firefighter, said the fire chief. However, the
chief said he would not deny testing to any volunteer who
asked to be tested, since many of them are also certified
paramedics and EMTs and may have responded to the same calls
as the firefighter.
For every burned person, delivering mother, injured victim
and pool of blood a firefighter encounters, there is a greater
risk of exposure to blood-borne pathogens or bodily fluids
that can result in disease or death, according to the town’s
fire chief.
According to the International Association of Fire Fighters,
this would not be the first time a firefighter in the United
States has been infected with HIV on the job. Although it
is difficult to determine the exact number of firefighters
afflicted with the disease, there are a handful of individuals
who felt comfortable revealing their health status in an effort
to increase HIV/AIDS awareness, said IAFF spokesperson George
Burke.
Most recently, Stephen Derrig, 35— an Akron, Ohio,
firefighter— publicized his AIDS diagnosis to push his
state legislature to cover firefighters who contract infectious
diseases and certain types of cancer while they are on duty.
State Department of Public Health spokesperson Michael Purcaro
said the agency could not confirm the first selectman’s
assertion or whether the claimant would be the first reported
case of a Connecticut firefighter to contract HIV on the job,
because all information gathered on HIV and AIDS cases is
protected by strict confidentiality in state statutes and
is not broken down by occupation.
In 2002, there were 374 new cases of HIV reported in the
state; 48 percent of the reports lacked information on the
mode of transmission, the Public Health Department’s
statistics showed.
With even a suspected work-related HIV case, the town must
now answer a “serious social question,” according
to the human resource director. That is, the town must decide
whether to require that the annual physicals administered
to all local, paid firefighters include HIV testing.
The Fire Department’s inoculations and testing budget
was hit to the tune of $4,000 as a result of the recent round
of HIV testing, each of which costs $200, according to the
chief’s calculations.
Even if the town approved such a plan, mandatory testing
could not take effect until 2004 because the Fire Department
already drafted this year’s budget. The town also needs
to discuss potential liability, the chief said.
Who should take the test is also a question, since not all
of the town’s volunteer firefighters are required to
take annual physicals, but do so on a staggered schedule depending
on age. But since all the firefighters are at risk for transmission
of infectious diseases, the town will consider making it a
mandatory requirement.
“There will be a day, I am sure, that it will become
routine testing (for paid and volunteer firefighters), but
right now it’s not,” a firefighter said. “It’s
just something we’ll have to look at.”
[New Haven Register, 2/26/03]
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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