Monday, April 22, 2002

The CDC National Center for HIV, STD, and TB Prevention provides the following information as a public service only. Providing synopses of key scientific articles and lay media reports on HIV/AIDS, other sexually transmitted diseases, and tuberculosis does not constitute CDC endorsement. This daily update also includes information from CDC and other government agencies, such as background on Morbidity and Mortality Weekly Report (MMWR) articles, fact sheets, press releases, and announcements. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC HIV/STD/TB Prevention News Update should be cited as the source of the information. Contact the sources of the articles abstracted below for full texts of the articles.

“US to Help Caribbean Fight AIDS”
Associated Press (03.21.02) Bert Wilkinson

The United States will send health experts to help Caribbean governments fight the regional spread of HIV/AIDS, Health and Human Services Secretary Tommy Thompson said Saturday in Georgetown, Guyana. “We are here today to extend to you and the Caribbean, the hand of partnership as we fight” against AIDS, Thompson told more than 20 Caribbean health ministers and other officials at a one-day conference. The meeting, sponsored by the United States, focused on patient treatment and care, training health personnel, and collaboration among donor countries to fund programs. Thompson said experts from the CDC would travel to the Caribbean to work with regional officials.

The United States will help the Caribbean get funding from the Global HIV/AIDS Fund, to which the United States has so far pledged $500 million and proposes to give $1.1 billion next year, Thompson said. The US Agency for International Development has already offered $20 million to the Pan Caribbean Partnership to combat HIV/AIDS infection, he said.

“Most Caribbean countries are unable to provide adequate access to care and treatment,” Denzil Douglas, prime minister of St. Kitts and Nevis said, citing a lack of money, skills and technology. Although the infection rate in the United States has declined, it has increased in the Caribbean, Douglas said. People in the Caribbean have the world’s second highest infection rate after sub-Saharan Africa. An estimated 2 percent of people, or 500,000, are HIV-positive, according to the Caribbean Task Force on HIV/AIDS. The statistics include Cuba, where extensive treatment and prevention have kept infection rates low.

“AIDS Services Slow in Reaching Latinos; Number of New Infections Rising”
Washington Post (04.22.02) Steven Gray

Forced to work in low-paying service industry jobs that rarely provide health insurance, more and more Latino immigrants in the United States are overlooking serious HIV-related illnesses until they reach the last stages of the disease. Clinics and hospitals increasingly report disturbing anecdotes illustrating the trend. This year, seven of 10 patients diagnosed with AIDS at La Clinica del Pueblo, a clinic serving Central American immigrants in Washington, D.C., arrived at near-death stages of the disease. “This tells us they probably became infected 10 years ago, and certainly, they’ve infected other people,” said Catalina Sol, the clinic’s HIV/AIDS program coordinator. Many illegal immigrants who suspect having the virus avoid testing or medical care, fearing that a positive HIV result will thwart any chance of gaining legal residency – a strong possibility, according to immigration lawyers.

Latinos accounted for roughly 4 percent of AIDS cases reported in the District last year, up from 3 percent five years ago, according to the city’s HIV/AIDS Administration. Latino AIDS activists said those HIV/AIDS statistics vastly underestimate the number of infections, chiefly because of insufficient testing and, in the District’s case, only recent surveillance of HIV cases.

Nationally, Latinos account for 13 percent of the population but 19 percent of new HIV infections, the CDC reports. Some Latino AIDS activists said that clinics designed to appeal to the general population fail to reach many infected Latinos.

Latino HIV/AIDS experts cite a host of cultural barriers to educating their community about the disease. Among them is a dominant Catholic religion that forbids condom use and inhibits candid discussion of sex, much less homosexuality. Sonia Mora, head of Montgomery County’s Latino Health Initiative, said there is a shortage of bilingual counselors and clinics in many communities – Gaithersburg and Wheaton, for instance – where the Latino population is surging. “The services aren’t there, and some of these people wouldn’t just walk into clinics if they were,” Mora said, noting that her agency occasionally uses vans as HIV prevention and testing posts in heavily Latino neighborhoods.

“Child Prostitution a Global Problem”
Reuters Health (04.19.02)

An estimated one million children around the world are forced into prostitution every year, and the total number of prostituted children could be as high as 10 million, according to a report published in the April 20th issue of the Lancet (2002;359:1417-1421). “Child prostitution, like other forms of child sexual abuse, is not only a cause of death and high morbidity in millions of children, but also a gross violation of their rights and dignity,” wrote co-authors Brian M. Willis, of the CDC, and Dr. Barry S. Levy of Tufts University.

Boys as well as girls are being prostituted and, according to the report, some of the children are as young as ten years old. “Most of these children are exploited by local men, although some are also exploited by pedophiles and foreign tourists,” the authors wrote. They estimate the number of children exploited by prostitution is highest in India (400,000 to 575,000); Brazil is second (100,000 to 500,000); the United States is third (300,000); and in fourth place are Thailand and China (200,000 each).

Willis and Levy report that, worldwide, millions of children are infected with STDs, have abortions, attempt suicide and are raped each year. They note that in parts of Southeast Asia, 50 percent to 90 percent of children rescued from brothels are infected with HIV.

“A coordinated international campaign is needed to prevent child prostitution, provide services to children who are prostituted until they can be removed from prostitution, and implement effective recovery and reintegration programs,” Willis and Levy note. “For [such a] campaign to be successful, it will require global coordination, implementation at national, regional and community levels, and the leadership of many health professionals. The prostitution of children and the related health consequences have been accepted for far too long. The time has come to make them unacceptable.”

“South Africa Mine Firms Unite to Fight AIDS Scourge”
Reuters Health (04.19.02) Allan Seccombe

South African mining firms are looking at a unified approach to tackling AIDS – one of their biggest unresolved challenges as HIV infection rates creep higher. Mining is a vital foreign exchange earner for South Africa, but about 20 percent of the industry’s 400,000 workers are HIV-positive. Its second-largest gold miner, Gold Fields Ltd., reckons the disease will add between $4 and $10 an ounce to production at its mines, where an estimated 26.5 percent of its 50,000 workers are infected. The mining sector makes up about 40 percent of South Africa’s exports. At the end of the 1990s, it contributed about 10 percent to the country’s GDP.

The labor consultancy NMG-Levy reported that some 30 percent of South Africa’s workforce will be HIV-positive in 2005. By 2010, one million South Africans will be sick with AIDS and six million will have died of AIDS-related illnesses. “[South African companies] previously saw it as primarily a human resource issue. Now they acknowledge that it is the single most important strategic issue facing South Africans,” said Andre Levy, NMG- Levy’s director.

Anglo American Plc recently halted its feasibility study on providing antiretrovirals to its workers and will approach the Chamber of Mines (COM), an industrial association, for an industry-wide study. The chamber’s health policy committee will propose a feasibility study to distribute drugs to about 80,000 infected miners, and a decision to go ahead with the study could be made in a month, said Fazel Randera, a medical advisor for COM. The study would have to be backed by the trade unions and government to be implemented, he said.

SG Securities analyst Nick Goodwin said, “Gold mines are making a lot of money from the gold price and the weak rand,” adding that if the mining companies had to foot the bill, “it’s no big deal.” National Union of Mineworkers (NUM) spokesperson Moferefere Lekorotsoana said the industry “could have dealt effectively with AIDS years ago and put in more research and resources.” Nevertheless, he said the union welcomed the unified industry approach.

“Uzbekistan Faces HIV Epidemic”
United Press International (04.16.02) Marina Kozlova

The Uzbekistan Health Ministry said 549 HIV-infected people were officially registered in 2001 – 2.3 times higher than all registrations during the previous 14 years. The total number of reported HIV cases in the country was estimated at 779 and of those, 39 people had died, including 15 who died from AIDS. Rudik Adamyan, an HIV/AIDS specialist working for the UN, said about 10,000 Uzbeks might be HIV-positive. “It is possible to expect development of the epidemic process in Uzbekistan,” Adamyan said.

More than 60 percent of Uzbeks infected with HIV are believed to be intravenous drug users (IDUs). An examination of used syringes in Tashkent revealed 45.5 percent contained blood that was HIV-positive. Less than 1 percent of IDUs visit the nation’s 200 needle exchange centers, according to the government’s national strategic plan on the HIV/AIDS epidemic. Adamyan said the total number of Uzbek drug users has reached 200,000. If HIV becomes prevalent in the IDU population, 40-60 percent of IDUs could contract HIV within two or three years.

The strategic plan reported a high incidence of prostitution, as women who migrate from rural towns and villages to large cities fail to find employment. Generally, Uzbekistan’s prostitutes do not use condoms. Almost all Uzbek prostitutes have STDs, the report said, and up to 30 percent are also IDUs. The median age in Uzbekistan is 23.9 years; unsafe sex among youths is common; and some young men even consider an STD an example of sexual prowess. More than 50 percent of young people have little or no information about AIDS, said Adamyan. In 2000-2001, three children were born to HIV-positive women, and six children under 15 were infected by HIV, the plan reported.

Purchasing and storing illicit drugs are crimes in the country, as is homosexual activity. High-risk groups seek to hide from the authorities, or go to underground private doctors to treat STDs. “Expansion of HIV [is] determined by people’s behavior and is beyond health measures,” said Uzbekistan’s strategic plan. Of the country’s HIV-positive people, 56 percent are under age 30, 90 percent are male and about 46 percent are incarcerated, according to official data.

“Clinical Trials of India-Specific Anti-AIDS Vaccine to Start in 2003” 
Agence France Presse (04.16.02)

India’s National AIDS Control Organization chief, J.V.R. Prasada Rao, announced last Tuesday that the first phase of clinical trials for an AIDS vaccine developed specifically for Indians could start in New Delhi in late 2003. Rao said India had entered into key partnerships and was on a “path to developing a low-cost and effective” India-specific AIDS vaccine.

“The Indian vaccine will counter the strain of HIV sub-type C that is prevalent typically in India,” said Rao. “Developed countries like the United States are putting their resources into developing their own vaccines to combat the virus sub-type A found commonly in their population. So we have to do everything in our power to win the race against time to come up with our own indigenous anti-AIDS vaccine,” Rao said.

India announced in March that it had 3.97 million HIV- positive cases, the largest HIV-positive population after South Africa. Unofficial estimates put the figure closer to five million.

Last year, the health ministry and the Indian Council of Medical Research (ICMR) signed a pact with the US-based International AIDS Vaccine Initiative (IAVI) to develop an AIDS vaccine appropriate for use in India. “Dr. Shekhar Chakraborty of the ICMR is working with Therion Biologicals in the United States to develop the construct of the six genes specific to the Indian AIDS virus,” said Aman Gupta of the IAVI. Dr. Vijay Mehra from the IAVI added that an “efficacious vaccine could take up to 12 years to develop.”

“Incidence and Risk Factors for Acute Hepatitis B in the United States, 1982-1998: Implications for Vaccination Programs “ 
Journal of Infectious Diseases (03.15.02) Vol. 185; No. 6: P. 713-719 Susan T. Goldstein; Miriam J. Alter; Ian T. Williams; Linda A. Moyer; Franklyn N. Judson; Karen Mottram; Michael Fleenor; Patricia L. Ryder; Harold S. Margolis

In 1982, a safe and effective vaccine became available to prevent hepatitis B virus (HBV) infection and was recommended for persons at increased risk for infection. In 1991, a comprehensive immunization strategy was adopted that included routine childhood immunization and, in 1995, adolescent immunization. Since 1982, the CDC has conducted intensive sentinel surveillance of acute viral hepatitis in four US counties – Jefferson County (Birmingham), Ala.; Denver County (Denver), Colo.; Pinellas County (St. Petersburg), Fla.; and Pierce County (Tacoma), Washington – typical of the country with respect to disease incidence and demographic makeup. Researchers examined changes in disease incidence and risk factors for acute HBV during 1982- 1998, and identified gaps in national immunization programs.

Between 1982 and 1998, 3,937 cases of acute HBV were reported. These accounted for 34 percent of all reported cases of acute viral hepatitis in the four counties. The median age of patients increased from 27 years (range, <1 to 90 years) during 1982-1988 to 29 years (range, 2-88 years) during 1989-1993, and to 32 years (range, 5-85 years) during 1994-1998 (P <.001). Overall, 794 (20.2 percent) patients were hospitalized for hepatitis and 35 (.9 percent) died.

The highest incidence occurred in 1987 (13.8 cases per 100,000 population) and declined by 76.1 percent to 3.3 per 100,000 in 1998 (P <.001). Most of the decline occurred during 1987-1993. The decline of HBV incidence was observed in all four counties, in all age groups. The greatest decline occurred among persons 10-19 years old (72.5 percent [probably due to childhood and adolescent immunization]), followed by those 20-29 years old (70.6 percent) and 30-39 years old (53.4 percent) (P <.001 for each age group, 1982-1988 vs. 1994-1998). Average incidence decreased among whites by 70 percent, blacks by 47.7 percent, and Hispanics by 58.6 percent. Rates of disease were higher among males (range, 4.1-19.6 per 100,000) than females (range, 2.5-11.1 per 100,000).

A commonly recognized risk factor for infection during the exposure period was consistently identified for 66 percent (3,296) of subjects interviewed. Heterosexual exposure to an infected partner or to multiple partners (27.4 percent), IDU (18.2 percent), and MSM activity (13.5 percent) were the predominant risk factors, accounting for 88.3 percent of cases where risk could be identified.

During 1988-1998, a 90.6 percent decline in cases associated with IDU was observed, while the age of these patients increased significantly; blacks accounted for proportionately fewer cases during 1989-1998. Decline of HBV among IDUs was attributed by the authors to a reduction of the reservoir for infection due to death associated with HIV, or incarceration for drug-related offenses. During 1982-1986, a 63.5 percent decline occurred in cases associated with MSM, and remained static. This was temporally associated with a decline in high-risk sexual practices in response to the AIDS epidemic, but it was not sustained; MSM with acute HBV reported 1994-1998 were significantly older, with an increasing proportion of black and Hispanic MSM. A 50.7 percent decline occurred 1992-1994 among cases associated with high-risk heterosexual activity; new cases in 1994-1998 involved significantly older patients than before; declines occurred only among whites, whereas the absolute number and proportion of cases among blacks increased; 36.7 percent were exposed to a known infected partner, and 63.3 percent to multiple partners.

Of the 236 patients interviewed since 1996, when lifetime history of both STDs and incarceration was collected, 84 (35.6 percent) reported prior treatment for an STD and 68 (28.8 percent) reported incarceration. In all, 110 (46.6 percent reported one of these factors, and 21 (8.9 percent) reported both.

The authors identified two missed opportunities for HBV vaccination: in STD clinics and correctional facilities, which had the potential to prevent about one-half of new infections. Appropriate pre- or post-exposure immunization could have prevented most of the cases acquired from a known infected sex or household contact. Lack of reimbursement for vaccine purchase is a significant barrier to adult immunization. HBV cannot be eliminated until there is a nationwide program to vaccinate adults at increased risk for HBV, researchers concluded.

“Burmese Migrants Face HIV Test”
BBC News (04.09.02) Larry Jagan

Burma and Thailand have agreed on a plan to repatriate more than 500,000 Burmese illegal immigrants currently residing in Thailand. As part of the deal, Thai Foreign Minister Surakiart Sathirathai said, the Burmese workers will be screened for HIV. Those testing positive will be separated from the other workers being repatriated. The agreement was reached in a bilateral meeting between the two countries in Rangoon, when both were attending a tripartite summit with India. Surakirat said those workers who were diagnosed with HIV would be treated as part of a special repatriation scheme. Thailand has been anxious to get Rangoon to agree to take back more than 500,000 illegal Burmese believed to be living in Thailand. The Burmese government asked Thailand to screen all returning refugees for HIV/AIDS and Thailand agreed. This is likely to anger human rights groups, who have already accused the Thai government of violating the workers’ rights by insisting on a medical examination before they are registered or re-registered.

$28 Million Awarded for HIV/AIDS Funding”
Atlanta Journal-Constitution (04.14.02)

Health and Human Services has awarded Georgia grants of more than $28 million for HIV/AIDS. The money includes $19.3 million for the state’s drug assistance program.