HIV/AIDS Newsroom: September 22, 2000
A Distinctive Clade B HIV Type 1 Is Heterosexually Transmitted in Trinidad and Tobago
Proceedings of the National Academy of Sciences Online (www.pnas.org)
09/12/00 Vol. 97, No. 19, P. 10532; Cleghorn, F.R.; Jack, N.; Carr, J.K.; et al.
The HIV epidemic in Trinidad and Tobago and other Caribbean nations is associated with heterosexual activity and non-clade B viruses. A study of the molecular epidemiology of HIV-1 in Trinidad as the epidemic shifted from homosexual to heterosexual transmission looked at the transition without injection drug use playing a role. Thirty-one viral isolates from 1987 to 1995 showed subtype B strains. According to the researchers, "Although the subtype B HIV-1 viruses being transmitted in Trinidad are genetically distinguishable from other subtype B viruses, this is probably the result of a strong founder effect in a geographically circumscribed population rather than genetic selection for heterosexual transmission." The authors, from the Institute of Human Virology and the Ministry of Trinidad and Tobago, note that a typical heterosexual epidemic is possible with the canonical clade B HIV-1.
A new resolution approved by the Kentucky Medical Association (KMA) calls for HIV screening for all pregnant women. Three-quarters of the 8,000 doctors in Kentucky are members of the organization and must abide by its guidelines. The outgoing president of the KMA, Dr. Harry Carloss, noted that although mother-to-child HIV transmission can be prevented, not enough women are being tested for the virus.
AIDS Activists Sponsor Boycott of San Francisco ACT UP
San Francisco Examiner (www.examiner.com)
09/21/00 P. A20; Torassa, Ulysses
AIDS activists in San Francisco are forming a movement against ACT UP/San Francisco, a radical chapter which believes that HIV does not cause AIDS. To promote their cause, the activists published a full-page ad in the local gay press, signed by 194 people and five organizations, asking the gay community not to buy from ACT UP/S.F.'s medical marijuana store, which helps provide money for the group's activities. ACT UP was founded in the late 1980s; however, the chapters are autonomous and the San Francisco group has been non-traditional in its tactics, sometimes disrupting meetings with accusations of murder and some members are now facing misdemeanor battery charges from their actions earlier this year. In addition to boycotting ACT UP/S.F.'s store, the local activists want city officials to keep the group's members from bothering and frightening AIDS educators.
The United Kingdom's Medicines Control Agency has approved an AIDS vaccine candidate for human testing, according to the International AIDS Vaccine Initiative. The modified vaccinia Ankara-strain vaccine is the second part to the vaccination strategy created in Oxford, England. The first component, a DNA vaccine, has entered Phase I trials in England, and will then be tested in Nairobi, Kenya. The vaccines were created by teams from Oxford University and the University of Nairobi, led by Andrew McMichael and J.J. Bwayo, based on testing of sex workers in Kenya, some of whom resisted infection for several years.
News from the Uganda Virus Research Institute in Entebbe, led by James Whitworth, shows that people with HIV may be two times more likely to contract malaria than uninfected people. A study of 484 people in rural Uganda during 1990 to 1998 revealed that malaria was present in 11.8 percent of HIV-infected patients, compared to 6.3 percent of HIV-negative people. The research, published in the Lancet (2000;356:1051), presents a bad forecast for southern Africa, where AIDS is rampant and the malaria mosquito is endemic. The researchers called for more study of the interaction of malaria and HIV, hopefully helping to create better treatments.
Baltimore syphilis rate is no longer the nation's highest. Indianapolis now holds the top spot for the highest number of syphilis cases, after its rate more than doubled in 1999. Preliminary statistics show that Baltimore's syphilis rate fell 45 percent last year, making it No. 3 after Indianapolis and Nashville. Baltimore Health Commissioner Peter Beilenson said it is encouraging to have the city's rate drop, and he predicted that after this year, the city will be out of the top five rankings. In 1997, Baltimore's syphilis rate peaked at 99 cases per 100,000 people. The Centers for Disease Control and Prevention will report in November, when the final results are in, that the rate dropped to 31.1 cases per 100,000 last year, down from 69.4 cases in 1998. Beilenson's department has cracked down on tracking and treating the partners of syphilis patients. He plans to send a monthly report to local doctors about the city's prevention efforts. The department aims to complete syphilis eradication, set for the whole nation, by 2005.
The 24th National Conference on Correctional Health Care brought Spencer Marks, director of Communicable Disease Control at the Dutchess County Health Department in Poughkeepsie, New York, to discuss a $15,000 a year program that helps educate women in prison about HIV. The collaboration between the local health department and the prison has led to a higher rate of voluntary HIV testing at the facility. Marks said that about 95 percent of the women have volunteered for testing during the four years the program has been running. The health department also discusses the women's risk behaviors and treatment options.
The annual report of the United Nations Population Fund (UNFPA) noted that women face many more barriers than men, including rape, abuse, and discrimination. Nafis Sadik, executive director of the UNFPA, said that one solution is to get men to fight for equality as well. The report, Lives Together, Worlds Apart, showed that one woman dies every minute because of complications from childbirth or pregnancy, and that sexually transmitted diseases affect five times more women than men. The study also found that 2 million girls between the ages of five and 15 enter the commercial sex trade every year.
Dr. Richard Crosby of Emory University in Atlanta and colleagues have found that the perceptions of African-American girls regarding the intimacy of relationships influences their concern over infection with sexually transmitted diseases (STDs) and thus their frequency of unprotected sex. Dr. Crosby stated in the report, published in the Archives of Pediatrics and Adolescent Medicine (2000;154:893-899), that not using a condom could be seen as a way to show trust. Interviews with over 500 African-American females ages 14 to 18 found that more than 75 percent had sex with a steady partner, while under 10 percent had casual sex. Girls in both casual and steady relationships were less likely to engage in unprotected sex if they had ever contracted a STD.
As drug-resistant strains of gonorrhea continue to emerge, successful treatment of this sexually transmitted disease is becoming more difficult. In the 1980s, penicillin and tetracycline became ineffective for treatment of gonorrhea due to resistance. Two fluoroquinolone antibiotics -- ciprofloxacin and ofloxacin -- have been recommended by the Centers for Disease Control and Prevention as treatments for gonorrhea since 1989. High levels of fluoroquinolone-resistant gonorrhea are now being reported in Hawaii, where it increased from 1.4 percent of strains tested in 1997 to 9.5 percent in 1999. Consequently, CDC recommends that healthcare providers ask patients with gonorrhea if they or their sex partners could have acquired the disease in Hawaii, other Pacific Islands, or Asia, where fluoroquinolone-resistant gonorrhea is common. If so, patients should be treated with cefixime or ceftriaxone, which are other drugs that are currently recommended for treating gonorrhea, and to which no resistance has been reported.
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.