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The HIV Update: Global AIDS Bill; the politics of testing prgnant women for HIV; HIV Superinfection: another case; having sex without disclosing HIV
status brings criminal charges; syphilis outbreak in NYC; new HIV test
guidelines; non-adherence of HIV drugs continues to be a problem.
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Volume 4, Number 24
May 4, 2003
In this edition:
House Approves $15 Billion Global AIDS Bill
Most Pregnant Women Not Tested for HIV in Ohio
GAO Study Finds Newborn Screening is a Routine State Practice for Many
Diseases
"Simply Saving Babies" from HIV
Illinois Senate Takes 'Half-Step' Toward Reducing Baby AIDS, Chicago
Tribune Editorial Says
Illinois Baby AIDS Compromise Will Allow Dozens of Infants to Be Infected
with HIV Every Year
California Man has HIV "Superinfection"
Memphis Teacher Who Infected Boy with HIV Arrested
Iowa Man Pleads Innocent to Knowingly Transmitting HIV
States Crack Down on Those Who Do Not Disclose HIV Status
Syphilis Outbreak Unabated in New York City
Syphilis Role in HIV Being Studied in California
New HIV Testing Guidelines Will Help Identify More Who Are Unaware that
They Are Infected
Study Finds HIV Diagnosis Improves Life for Many
Many with HIV May Not Take Life-Saving Drugs
Circumcision Shown to Deter HIV Spread
House Approves $15 Billion Global AIDS Bill
The U.S. House of Representatives Thursday approved by an overwhelming
vote of 375-41 an international HIV/AIDS bill, HR 1298, which would
authorize $15 billion over five years to fight HIV/AIDS in Africa and the
Caribbean. The plan was proposed by President Bush in the State of the
Union speech in January. The bill, sponsored by Congressman Henry Hyde
(R-Illinois), would authorize $3 billion a year for five years to
international HIV/AIDS programs, with up to $1 billion in fiscal year 2004
going to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
House Speaker Dennis Hastert, R-Illinois, said: "The situation in
Africa is desperate. Millions of children are now orphans because both of
their parents have been stricken by AIDS and have died. I had a chance to
visit several countries in Africa two years ago, and I witnessed first hand
the devastation that this disease has caused to these poor families. I am
proud that we are taking this important step to help," Hastert continued.
The Congressional Black Caucus also praised the passage of the
legislation. Congressman Elijah E. Cummings, D-Maryland, the CBC chairman,
said the United States "took a very important step in stemming the spread of
HIV/AIDS in Africa and the Caribbean" by passing the bill.
The passage of the bill represents a major win for House conservatives
who had expressed some reservations about the legislation as originally
presented. They successfully added four amendments to the bill.
- The first insists that no less than 33 percent of the funds spent on
prevention go toward the promotion of abstinence-based programs.
- The second provides a freedom of conscience exemption for religious and
faith-based groups. These groups, which might have a moral objection to
some of the strategies proposed to curtail the spread of AIDS, would still
be able to participate in fund activities now that the exemption is in
place.
- The third, which some on Capitol Hill say could have far-reaching
implications, caps the total amount of the U.S. contribution that can be
spent on the fund's administrative expenses.
- The fourth caps salaries paid to Global AIDS Fund administrators at no
more than what the U.S. vice-president is paid annually. If these
limitations prove enforceable, they may find their way into other pieces of
legislation governing U.S. contributions to international organizations.
But not everyone was happy with the outcome. Officials of several
AIDS advocacy organizations voiced strong opposition to the amendment
providing a fraction of funding for abstinence programs. One of them,
Progressive Health Partners President Todd Summers, a former Clinton
administration official, said in an e-mail that a bill with a "33 percent
abstinence-only carve out amendment is worse than no bill at all."
The bill now moves to the United States Senate.
[United Press International, 5/2/03]
Most Pregnant Women Not Tested for HIV in Ohio
A survey of Ohio doctors found that less than half offered HIV tests
to pregnant women as part of routine screening, and about a third said they
offer the test to 25 percent or fewer of their pregnant patients. Treating
HIV-infected pregnant women with antiretroviral drugs can dramatically
reduce the chances that the baby will get HIV before, during or after birth.
Less than half (42 percent) of physicians offered HIV testing as part
of the standard prenatal battery of tests in their practice, while 36
percent of physicians offered testing to less than a quarter of their
pregnant patients and/or tested only those pregnant women with a risk factor
for HIV infection.
Obstetricians did better than family physicians: More than 90 percent
routinely offered HIV tests to patients. Fifty-four percent of respondents
felt HIV testing during pregnancy should be a routine part of care, but 7
percent of doctors felt it was not necessary for most pregnant women. Only
41 percent of physicians included all the elements of HIV pretest counseling
required by Ohio state law.
The Centers for Disease Control and Prevention recommends universal
HIV testing of pregnant women during pregnancy and routine testing of those
newborns whose mothers' HIV status is unknown. Typically, 44 percent to 80
percent of pregnant women who are offered the test agree to it, according to
the study.
Dr. Joan Duggan and colleagues from the Medical College of Ohio-Toledo
surveyed 431 physicians in obstetrics/gynecology and primary care regarding
their HIV screening practices. The results are based largely on the
responses of 261 physicians who routinely saw pregnant women.
The full report, "Survey of Physician Attitudes Toward HIV Testing in
Pregnant Women in Ohio," was published in the journal AIDS Patient Care and
STDs (2003;17:121-127).
[Reuters Health, 4/23/03]
GAO Study Finds Newborn Screening is a Routine State Practice for Many Diseases
The federal Centers for Disease Control and Prevention (CDC) recently
recommended universal HIV testing of pregnant women and newborns. Despite
the fact that treatment has long been available to prevent transmission of
the AIDS virus from infected mother to child, this policy has steadfastly
been opposed by many AIDS advocacy organizations. Some claimed testing of
newborns and pregnant women was a violation of privacy and a dangerous
precedent. But the fact is newborn and prenatal testing has long been a
routine medical practice that, like other public health interventions, was
discarded in the fight against HIV.
The U.S. General Accounting Office (GAO) has released a new study
entitled "NEWBORN SCREENING; Characteristics of State Programs" which
examines states' newborn testing practices. While the GAO report surveyed
only newborn screening programs for genetic and metabolic disorders, it
provides much insight on how newborn testing is both medically necessary and
routine.
According to GAO, "each year state newborn screening programs test 4
million newborns for disorders that require early detection and treatment to
prevent serious illness or death." GAO found that "all states require
newborn screening" and "state newborn screening statutes usually do not
require that parental consent be obtained before screening occurs."
"While the number of genetic and metabolic disorders included in state
newborn screening programs range from 4 to 36, most states screen for 8 or
fewer disorders," GAO reports. "In deciding which disorders to include,
states generally consider similar criteria, such as whether the disorder is
treatable."
With HIV, the disease is not only treatable, it is largely
preventable. Yet only two states-New York and Connecticut-currently require
HIV screening of newborns.
As for the privacy concerns raised by AIDS advocates, GAO notes
"provisions regarding the confidentiality of screening results are included
in state newborn screening statutes and regulations."
And contrary to the claims of opponents who try to portray HIV testing
of newborns as a new and radical concept, GAO found that "Newborn screening
programs in the United States began in the early 1960s."
This report is available on-line at www.gao.gov/cgi-bin/getrpt?GAO-03-449.
GAO is the audit, evaluation and investigative arm of Congress.
["NEWBORN SCREENING; Characteristics of State Programs," GAO, 3/03]
"Simply Saving Babies" from HIV
The following editorial, entitled "Simply saving babies," was printed
in the Indianapolis Star:
"Our position is: HIV testing of pregnant women is a moral necessity.
"House Bill 1630 will save babies' lives. That simple fact should
convince the 2003 legislature to pass it into law. The bill requires HIV
testing of pregnant women during pregnancy or at time of delivery. A woman
may refuse the test but would still be given information about the risks of
HIV-AIDS.
"As of Wednesday, the bill was stuck in conference committee. Its
champions-- Rep. Peggy Welch, D-Bloomington, and Sen. Pat Miller,
R-Indianapolis-- were working valiantly to get it out.
"If any lawmaker doubts the merits of the bill, consider this comment
in its favor from Dr. Martin B. Kleiman, director of the pediatric
infectious disease section at Indiana University School of Medicine: "If a
woman is found to be positive and she is not under treatment, the
probability is 20 to 25 percent that the baby will become infected. On the
other hand, if a woman is identified and treated, the risk to the baby can
be reduced to about 1 percent."
"With that, we rest our case."
[Indianapolis Star, 4/24/03]
Illinois Senate Takes 'Half-Step' Toward
Reducing Baby AIDS, Chicago Tribune Editorial Says
The Illinois Senate has taken a "half-step" toward reducing
mother-to-child HIV transmission by considering a bill, SB 263, that would
require health care professionals to provide pregnant women with HIV
counseling and voluntary testing, a Chicago Tribune editorial says. The
bill, which has already passed the Senate and is expected to be considered
in the House soon, would require that any pregnant woman who decides to be
tested for HIV sign an informed consent form before undergoing the test, a
system otherwise known as "opt-in" testing. However, under the measure,
infants born to women whose HIV status is not known would automatically be
tested for the virus, unless the mother signed a form to "opt-out" of the
infant testing.
"The impact of the legislation is likely to be modest" because women
can still refuse the test, the editorial says. If doctors are "too busy or
too insensitive" to provide adequate counseling, the requirements "could
turn out to be a complete dud," the editorial states.
The editorial concludes, "To make a more serious dent in the spread of
HIV/AIDS ... legislators will have to tackle issues such as teenage sex,
condom distribution, needle-exchange programs-- and in all likelihood, they
will have to revisit the routine testing of newborn babes."
[Chicago Tribune, 5/1/03]
Illinois Baby AIDS Compromise Will Allow Dozens of Infants to Be Infected with HIV Every Year
The following op-ed regarding the failure of the Illinois legislature
to pass a bill requiring universal HIV testing of pregnant women and
newborns was written by Dennis Byrne, a Chicago-area writer and public
affairs consultant, and published in the Chicago Tribune:
"The Illinois legislature is about to pass a 'welcome compromise' that
would allow dozens of infants to be sentenced to a life of pain and near
certain early death.
"I'll say it again, so that it can sink in. Nearly every newborn can
be safeguarded from getting the virus that causes AIDS from his or her
HIV-infected mother. But the General Assembly refuses to pass a law that
would make this so, instead preferring a 'compromise' that would affect
'only' several dozen children a year. Only in Springfield would such a
deadly calculus be considered welcome.
"The compromise is between public health officials who, on one side,
believe that all pregnant mothers should be routinely tested for HIV, so
that they can receive treatments that virtually eliminate its passage to
their children during pregnancy, delivery or afterward, such as through
breast feeding. On the other side are 'civil libertarians' who believe
such testing is an infringement on the mother's right to privacy or
physicians who think that such testing would "scare away" mothers who want
to keep their 'lifestyles' secret. They think HIV-infected mothers have the
right to reject the test, and subject their children to a 30 percent chance
of being infected with HIV.
"So here's the compromise: HIV testing would be routine for infants
born to mothers who have not taken an HIV test themselves, even though the
mother still could forbid the infant from being tested. But the compromise
still does not require the mother to be tested, especially earlier in
pregnancy when it would do the most good.
"That's right, beyond all logic, a mother by law can choose to keep
herself, and everyone else who can help her child, ignorant. By any public
health standard, a 30-percent chance of transmitting a deadly disease to
anyone is unacceptable, if not criminal.
"Public policy does not tolerate drunk drivers who pose a 30 percent
chance of killing someone. Hospitals do not accept a 30 percent fatal
infection rate. Gun-control advocates would go bonkers if each gun sold
posed a 30 percent chance of maiming or killing someone. Feminists would not
tolerate any environmental factor that would result in a 30 percent breast
cancer rate.
"So by what token does anyone-- especially a health professional--
justify a 30 percent risk factor for infecting a newborn with a deadly
disease?
"If you're blind to the human tragedy in all this, then just consider
the cost factors. 'Progressive' public-health activists love to talk about
prevention. They say, correctly, that stopping people from smoking before
they start is much less costly to society than treating smokers after they
get cancer.
"Yet, some health "providers" are willing to accept a 30 percent risk
factor for newborns so that the mother can try to--what?-- hide her drug
use, careless sexual practices or her victimization by an HIV transmitter.
"What kind of ideology embraces such a barbaric imbalance of rights
and responsibilities?
"I'll tell you what kind: The same kind that protests the
double-murder charge in the Laci Peterson case. Marva Stark, president of
the National Organization for Women's Morris County, N.J., chapter, said
Peterson's husband Scott should be charged with only one count of murder,
because the killing of Laci's unborn son, Connor, could not be considered
the killing of a person.
"It's the same kind that prompted National Public Radio's commentator
Daniel Shore to suggest that the Chinese and United States governments were
engaged in some kind of cover-up by not quarantining people infected with
the deadly SARS, or severe acute respiratory syndrome. This demand for
isolation comes from the same ideological corner that flipped over the mere
suggestion that HIV should be subject to standard public health measures,
such as contact tracing.
"The same ideology fills my mailbox with charges that abortion
opponents care more about fetuses than about babies after they are born. If
there ever was a more monumental demonstration of uncaring for babies than
this 'compromise,' I have not heard of it.
"It's the same ideology that condemns the 'insensitive' spending of
money in the name of freedom and security, but denounces President Bush for
not spending enough ($15 billion) to prevent and treat AIDS in Africa.
When, that is, they oppose a simple test that is 100 percent effective at
home."
[Chicago Tribune, 4/28/03]
California Man has HIV "Superinfection"
Researchers report in the May 2 edition of the medical journal AIDS
that a California man has been infected with two different strains of HIV,
including a drug-resistant strain of the virus. Initially enrolled in a
study that was looking at people with drug-resistant HIV, the man was
discovered-- four months after enrolling in the program-- to be infected
with more than one strain of HIV. The infection was confirmed after the
researchers performed a series of genetic tests to show that the second
strain wasn't resistant to reverse transcriptase inhibitors.
The man was infected with HIV strains common in North America. His
superinfection apparently had an adverse effect on his health, driving up
his viral load in two months from 2,400 to over 200,000, while over the
course of 11 months his T-cell count went from a high of over 800 to a low
of 282.
HIV superinfection, or the presence of two strains of HIV in the same
person, has been a controversial issue in AIDS health and social service
circles. It raises issues about HIV-positive people having 'unprotected'
sex even with each other, and raises significant stumbling blocks to
researchers trying to develop an AIDS vaccine. Activists and health
officials also raise concerns about over talking superinfection, since it
could encourage more HIV-infected people to seek out negative partners,
which could increase overall infection rates.
Scientists believe current HIV tests used to show if a patient is
infected with drug-resistant HIV wouldn't work if the patient also is
infected with the wild-type strain. But if the person began drug therapy,
evidence of the drug-resistant strain would emerge.
At least two other HIV super-infections have been reported. In
September 2002 a Swiss research team reported they had discovered a
38-year-old man with dual strain infections, while in July 2002 at the
international AIDS conference in Barcelona, Spain, a researcher reported a
similar infected patient in Boston.
Memphis Teacher Who Infected Boy with HIV Arrested
A Memphis, Tennessee middle school teacher who continued to teach
science for eight months after his indictment for exposing a teenager to HIV
has resigned. Juan Thomas, 33, had been on unpaid leave from Lanier Middle
School since last week, when police came to the Whitehaven campus and
arrested him on a warrant issued in August. He was indicted on one felony
count of criminal exposure to HIV.
Law enforcement officials were unable Tuesday to say why the suspect
was not arrested immediately. They said an informal system to flag priority
warrants didn't work in this case.
Thomas admitted to having a consensual relationship with the
17-year-old boy, who later was diagnosed with the virus, according to an
arrest report. Thomas also allegedly said he knew he had the virus.
Memphis Police Insp. Matt McCann said Tuesday the department acted
immediately to arrest Thomas after learning, through a tip originally given
to the state Department of Human Services, where the teacher could be found.
The police would not necessarily have been notified when Thomas was
indicted, McCann said. "In a perfect world, as soon as they are indicted,
they would be picked up," McCann said.
The Shelby County Sheriff's Office fugitive squad, which serves arrest
warrants, gets 100 new warrants each day and has a backlog of 50,000
warrants, said Chief Deputy William Oldham.
Typically, the fugitive squad relies on prosecutors and police to
alert them to serious cases that require immediate action. For example, when
a suspected child molester may have contact with children.
School officials said a background check on Thomas came up clean, and
that he has taught science at three different schools since October 2000.
Police did not identify the 17-year-old whose allegations led to the
indictment. It is unknown whether he was a student at a school where Thomas
taught.
[The Commercial Appeal (Memphis, TN), 4/30/03]
Iowa Man Pleads Innocent to Knowingly Transmitting HIV
An Iowa man who police say failed to disclose that he was HIV positive
to a woman he had sex with has pleaded innocent to the charges. Adam D.
Musser, 22, of Iowa City, is charged with three counts of criminal
transmission of HIV. He entered pleas to two of the counts April 24 in
Johnson County District Court. He had pleaded innocent to the first count
in March.
Musser denied being HIV positive when asked by the woman and the
relationship continued, police said. He admitted that he was HIV positive
to other people, including a police officer, the complaint states. He was
first charged by North Liberty police in February. Coralville police
charged him with a second count in March and Iowa City police charged him
earlier this month. No trial date was set.
[Associated Press, 4/25/03]
States Crack Down on Those Who Do Not Disclose HIV Status
Legislators across the country have recently passed laws intended to
curb the spread of HIV by imprisoning those who know their positive
serostatus but don't tell their partners. Nationwide, courts are just
beginning to see the effects of those laws. Here are some recent cases:
- Florida. Melissa Jernigan, 24, faced charges that she criminally
transmitted HIV to at least 200 unprotected partners. She told police she
tested positive for HIV in 1999 and continued to have 'unprotected' sex.
The offense is a third-degree felony, punishable by five years in prison.
- Iowa. Aaron Dahlberg, 25, was sentenced to three years probation for
willful injury after originally facing up to 25 years in prison for criminal
transmission of HIV. He was accused of twice lying to an Iowa City man about
his HIV status before they had consensual sex. Adam Donald Musser, 22,
became the second man in Iowa to be charged with a felony count of criminal
transmission of HIV. Musser allegedly had sex with a woman last April
without telling her about his HIV status. Musser has been held without bond
since his February 14 arrest.
- Michigan. A 17-year-old was charged with a felony for having
'unprotected'
sex without disclosing she had AIDS. Police identified four men who claimed
to have had sex with the young woman without being informed she had AIDS.
She was being held in jail on $500,000 bond.
- Missouri. Robert E. Michael, 32, was charged with failing to inform two
women he was HIV-positive. He was charged with two felony counts for
reckless exposure to HIV. He was being held on $250,000 bond.
- Ohio. Mor Rondo Roberts was found guilty of not telling his sexual
partners he had HIV. He sentenced to four years in prison. Roberts, who had
no previous criminal record, was accused of having sex with two women
without telling them of his HIV status. The judge said it would have sent
the wrong message had he not imposed a prison sentence.
- South Dakota. William Jenigan, 36, was sentenced to 45 days in jail and
five years probation for intentionally exposing others to HIV. Jay Woods,
42, Jenigan's roommate and partner, has been charged with three counts of
intentionally exposing others to HIV. A date for a jury trial has not yet
been set.
[AIDS Policy and Law, 4/25/03]
Syphilis Outbreak Unabated in New York City
New York City's health department is predicting that the current
syphilis outbreak among gay and bisexual men will continue through 2003 and
might even grow larger by the end of the year. As of the week of April 7,
105 cases of primary or secondary syphilis have been reported to the health
department, and just six of those cases were among women. There were 102
cases reported during the same period in 2002, with five cases among women.
That trend of men dominating the male-to-female ratio of cases began in 1998
and has increased since then.
The health department is also reporting an increase in the number of
early latent cases of syphilis for the first quarter of 2003. There were 242
such cases, with 32 among women, in 2003 compared to 165 cases, with 31
among women, during the same quarter in 2002. An early latent case is
someone who no longer exhibits the obvious physical symptoms of primary and
secondary syphilis such as lesions on the penis, vagina, or anus or in the
mouth and later a rash anywhere on the body. Early latent cases of syphilis,
like primary and secondary cases, must be treated in order to prevent the
potentially life-threatening final stage syphilis.
The 2003 data are preliminary, but they suggest that the syphilis
outbreak will continue unabated. They also suggest that some gay and
bisexual men have given up 'safe' sex practices. A syphilis infection
increases the likelihood of acquiring HIV.
The health department is recommending that sexually active gay and
bisexual men get tested for syphilis every year, whether or not they have
symptoms. It is also telling physicians to treat patients they suspect have
syphilis even before the result is confirmed with a test.
[Gay City News (New York City), 4/25/03]
Syphilis Role in HIV Being Studied in California
For the past three years, syphilis outbreaks in men who have sex with
men (MSM) have worried health officials because of what they indicate about
a resurgence in high-risk behaviors. But are these syphilis outbreaks
facilitating HIV transmission or is syphilis contained mostly to MSM who are
already HIV-positive?
California's sexually transmitted disease (STD) and HIV health
officials hope to answer that question with assistance from the Centers for
Disease Control and Prevention (CDC) and its new detuned testing technology.
"We need to get some better information quickly, and so we are
combining our HIV and STD efforts to find the answer," says Gail Bolan, MD,
the state's director of STD control.
In March, the state requested the Centers for Disease Control and
Prevention (CDC) to conduct an Epidemic Intelligence Service (EIS)
investigation, also known as an Epi Aid, which can quickly mobilize
resources for a health problem that needs immediate attention. The CDC will
be providing two EIS officers, while the state's existing EIS officer will
help coordinate the effort.
Just how much STDs contribute biologically to facilitating HIV
transmission is an ongoing debate. Three years after large studies in Africa
attempted to quantify the impact, the results have been inconclusive. Most
recently, an analysis of a study in Uganda concluded that STD control has a
minimal impact in an already mature HIV epidemic. While it's clear the
United State's syphilis epidemic is starting a new cycle, the HIV epidemic
is harder to qualify, Bolan says.
In the United States, CDC behavioral surveillance suggests so far that
the syphilis outbreaks haven't facilitated HIV transmission in MSM because
many men appear to be engaging in "sexual positioning" (HIV-positive men
having sex with other positive men).
But information from syphilis partner notification interviews suggests
differently, Bolan says. "Our data really don't support that. We talk to a
lot of men who claim they are having a lot of sex with partners of unknown
status. So we really need to know what is going on here."
Until now, this kind of research hasn't been easy. First, controlling
for behaviors is notoriously difficult. Second, it's hard to always know
which infection came first: syphilis or HIV. With detuned testing of
specimens, however, the time of HIV infection can be pinpointed more
precisely.
The easiest way to measure the syphilis impact on HIV transmission is
to conduct HIV testing in a cohort of MSM recently infected with primary
syphilis, Bolan says.
"That would tell you if the infection was more likely related to an
ulcer," she explains. "You could then compare the results with people who
are not infected with primary syphilis but who have similar behaviors."
California's collaborative effort could be a model for other areas of
the country where syphilis and HIV coexist. "We hope the model we use in
California can be a model the South can use to prove to the CDC that
syphilis has really contributed to HIV," Bolan notes. "They want hard data,
and this can help get some information fairly quickly."
So far, traditional syphilis control efforts have not been able to
quell the outbreaks, which continue to spread into other communities.
"Unless there is a collective approach between HIV and STD prevention,
it's going to be hard for STD control to do it alone," she says. "We can use
our control, but we really need some new innovative strategies," she says.
The state could have preliminary results by this summer, Bolan adds.
[AIDS Alert, 5/1/03]
New HIV Testing Guidelines Will Help Identify More Who Are Unaware that They Are Infected
New national HIV testing guidelines might result in more people
getting tested, Las Vegas health officials said. Under new Centers for
Disease Control and Prevention (CDC) guidelines, family doctors would urge
more patients to get tested, but they would no longer have to first provide
extensive pre-test counseling.
CDC officials still say counseling is important, but they do not want
the education component to deter people from getting tested. They concluded
the counseling requirement might have kept busy doctors from providing tests
and can make getting tested a tedious process for patients.
Local HIV specialist Dr. Jerry Cade estimates there are about 2,000
Las Vegans who have HIV and do not know it. There are approximately 5,000
HIV/AIDS patients in Nevada, with 4,000 of those patients living in Clark
County, according to Reich and the Nevada State Health Division.
Approximately 225 new HIV cases are reported each year in Clark County.
Cade favors the new guidelines so long as patients still get HIV
prevention education. "We still have a bunch of people walking around who
don't know they are positive, and in this day and age, that's a shame," Cade
said. "We've got treatment options now, and if we can get them diagnosed and
into treatment, HIV is not necessarily the death sentence it once was."
The new recommendations urge doctors, health officials, social workers
and counselors to use new rapid testing kits in offices, homeless shelters,
drug treatment centers and STD clinics. The kits can provide results in 20
minutes. But they only provide a preliminary result, which means that
patients who test positive would still need another test to confirm the
diagnosis.
Rick Reich, the communicable disease and AIDS services supervisor at
the Clark County, Nevada, Health District, said the rapid test may be
helpful when testing people who do not usually come back for test results,
such as the homeless, but that those people will still have to get a
confirmation test done if the results are positive.
CDC officials say the new guidelines are an attempt to find and
diagnose the estimated 200,000 people living with HIV in the United States
who are unaware they have the disease.
[Las Vegas Review-Journal, 4/26/03]
Study Finds HIV Diagnosis Improves Life for Many
Nearly a third of patients diagnosed with HIV feel their lives
actually improved after discovering they had the affliction, according to a
U.S. study released on Thursday. Thirty-two percent of the 449 people with
the AIDS virus who were interviewed for the study said their lives got
better after being diagnosed HIV positive because they became less worried
about financial and other problems.
Twenty-nine percent said life was worse and 26 percent said it was
about the same. Thirteen percent said they did not know.
The study's results were presented on Thursday in Vancouver at the
annual meeting at the Society of General Internal Medicine. Study director
Joel Tsevat of the University of Cincinnati Medical Center said the findings
fit with anecdotal reports from nurses and psychologists, as well as the
results a smaller study he conducted in the mid-1990s.
Many of the patients with improved outlooks said they were getting
more out of life than before the diagnosis. "They don't take things for
granted like they used to, such as a nice day," Tsevat said. Those patients
also tended to be more involved in non-organized religious activities,
although Tsevat said it was unclear if that was a cause of their improved
outlook on life or the result of it.
The percentage of people who felt their lives were better was roughly
the same in all three classes of HIV patients: those without AIDS symptoms,
those with symptoms but without AIDS, and those with AIDS.
The researchers said it was important to find out more about why some
patients have an improved outlook on life so that information can be used to
help those who feel their lives have become worse.
Tsevat cautioned that because the research was done on patients in the
United States, it might not apply to those living with HIV in countries that
do not have the same level of medical and welfare support systems.
Tsevat also warned that the results were not an excuse for people to be less
concerned about the disease or their own medical safety. "That would send
the wrong message," he said.
The study was funded by the U.S. Department of Veterans Affairs and
the National Center for Complementary and Alternative Medicine. Interviews
were conducted in 2002 and 2003 in three U.S. cities.
The researchers will continue to track the patients they interviewed
over the next 15 months, with the hope their findings will help develop ways
of helping people cope with the illnesses.
[Reuters, 5/1/03]
Many with HIV May Not Take Life-Saving Drugs
An analysis of HIV-infected patients who died at one Texas hospital in
1999-2000 found that more than half of them were not taking highly active
antiretroviral AIDS therapy.
"I was really startled to see that so many patients were not on HIV
therapy in an era when it's supposed to be widespread, and access is there,"
said the study's lead author, Dr. Mamta K. Jain of the University of Texas
Southwestern Medical Center-Dallas.
The full report, "Changes in Mortality Related to Human
Immunodeficiency Virus Infection: Comparative Analysis of Inpatient Deaths
in 1995 and in 1999-2000," was published in the journal Clinical Infectious
Diseases (2003;36(8):1030-1038).
The researchers compared HIV-positive patients who died in
1995 (before HAART availability) to those who died in 1999-2000. They also
assessed whether or not patients in the later group were taking HAART.
Jain's team evaluated 200 HIV/AIDS patients-- 112 who died in 1995 and 88
who died in 1999-2000.
Despite "widespread availability" of HAART, only 48 percent of
patients who died in 1999-2000 were taking HAART at the time of death, the
authors reported. The main reasons the patients were not taking the drugs
were an inability to adhere to the treatment regimen and an HIV diagnosis
less than six months prior to death. Other reasons included an inability to
tolerate the drugs due to underlying liver disease, the study indicates.
Another finding of the study is that many HIV-infected individuals not
receiving HAART were minorities. Nine out of 12 patients who were diagnosed
with HIV shortly before death, and 12 of 18 patients who did not take HAART
as prescribed, were black or Hispanic, the authors wrote.
The team did see a decline in the number of people dying due to HIV.
However, AIDS-defining illnesses, such as Pneumocystis carinii pneumonia,
were still an important cause of death in patients not taking HAART,
according to the report.
"I don't want to paint a gloomy picture," Jain said. "Definitely, the
number of cases of patients dying with AIDS has decreased radically. But we
were expecting to see a change in the types of diseases people were dying
from, and we didn't see that. I think this study is important because, if
you look at the HIV/AIDS literature, you see these dramatic changes, and
people are living longer... but I think we kind of lose sight of the fact
that there are still areas in the country that still are seeing a lot of the
same problems that we did prior to HAART being available."
Last year, CDC estimated that up to one-third of the nation's
850,000-950,000 HIV-positive people do not appear to be receiving treatment.
[Reuters Health, 4/17/03]
Circumcision Shown to Deter HIV Infection
Circumcised men are at least 50 percent less likely to contract HIV
during 'unprotected' sex than uncircumcised men, according to a soon-to-be
released report by the U.S. Agency for International Development.
Based on a systematic review of 28 scientific studies published by the
London School of Hygiene and Tropical Medicine, the USAID report "found that
circumcised males are less than half as likely to be infected by HIV as
uncircumcised men."
"A sub analysis of 10 African studies found a 71 percent reduction
among higher risk men," said the report obtained by the
Washington Times.
According to the scientific studies, the skin on the inside of the
male foreskin is "mucosal," similar to the skin found on the inside of the
mouth or nose. This mucosal skin has a high number of Langerhan cells, which
are HIV target cells, or doorway cells for HIV.
"HIV looks for target cells, like the Langerhans; it's a lock and
key," said Edward G. Green, senior researcher at Harvard University. "The
rest of the skin on the penis is armorlike."
Green said that if all males in Africa were circumcised, the HIV/AIDS
prevalence rate could be reduced from 20 percent in some regions to below 5
percent. In addition, circumcision reduces the transmission of other STDs,
reduces infections associated with poor hygiene, and makes it easier to use
a condom, Green said.
The 60-page USAID report is based on presentations given at a
conference in September, and will be available on the USAID Web site "soon,"
said Dr. Anne Peterson, assistant administrator for global health at USAID.
She said that while the information "looks profound and wonderful," she
cautioned there may be other factors that reduce HIV transmission in
circumcised men.
If circumcision is promoted, another concern is that circumcised men
may mistakenly believe they are invulnerable to HIV. They are not, said
Peterson. "It reduces your risk. It does not protect you outright," she
said. "People who are circumcised still get HIV. It is still better to
abstain, be faithful in marriage," or use condoms.
[Washington Times, 4/25/03]
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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