HIV/AIDS Newsroom: November 7, 2000
HIV Seroprevalence by Anonymous Testing in Patients With Mycobacterium Tuberculosis and in Tuberculosis Contacts
10/28/00; Vol. 356, No. 9240, P. 1488; Bowen, E. Frances; Rice, Phillip S.; Cooke, Nigel T.; et al.
A study of HIV prevalence among patients with tuberculosis (TB) in south London revealed the ethnic origin and number of patients with TB who were tested for HIV-1. Coinfection rates for TB and HIV range from 18 percent to 23 percent in New York and Los Angeles. A survey of three south London chest clinics showed that out of 202 patients with TB, 23 were HIV-1-positive. All HIV-infected patients who were of African origin were younger than 34. The blood samples revealed that prevalence of HIV in TB patients is double the number estimated previously. The actual coinfection rate in south London could be as high as 20 percent, according to the authors, because they excluded patients already known to have HIV. Furthermore, they note that the 4 percent TB infection rate among new entrants to the United Kingdom "has serious implications for the provision of health care to asylum seekers, which in London is already overstretched."
President Clinton signed a bill on Monday that requires hospitals and clinics to use safer needles and needle disposals systems. The Needlestick Safety and Prevention Act was passed in large part due to the efforts of nurse Karen Daley, who contracted HIV and hepatitis C from a needle prick two years ago. Daley, a nurse at Brigham & Women's Hospital in Boston, is president of the Massachusetts Nurses Association. Mary Foley, the president of the American Nurses Association, asserts that "Karen was single-handedly the healthcare worker who got that bill passed, by channeling her experience into a brave and really calm presentation of the issues" before Congress. The new law mandates that healthcare facilities use new types of needles that automatically retract, and workers must cover or blunt needles as soon as they are used. An estimated 800,000 healthcare workers are accidentally stuck with needles each year.
Clinton Signs Legislation for 3rd World Debt Relief
Washington Post (www.washingtonpost.com)
11/07/00; P. A13
President Clinton signed a foreign aid bill on Monday that gives $435 million to forgive the debts of the poorest nations. "By lifting the weakest, poorest among us, we lift the rest of us as well," the president said. The money was included in a nearly $15 billion foreign aid measure that included $300 million to fight HIV worldwide and lifted restrictions for U.S. aid to overseas family planning organizations that support or are involved with abortions.
Nurse Catherine Phiri of Malawi contracted HIV during the rule of Hastings Kamuzu Banda, who prohibited any public discussion of the disease. When a democratic government took over in 1994, Phiri founded a support group for anyone affected by HIV, and last month, she received a Race Against Poverty Award from the United Nations Development Program and UNAIDS. Phiri said the new president of Malawi, Bakili Muluzi, has helped increase awareness about HIV and AIDS. She also noted that the press is now free enough to help show residents the extent of the problem in the country, where 25 percent of the urban work force is expected to die from AIDS within 10 years. Phiri said, "I hope that we will be recognized by being given the award, and that the government will now have something to do with us. ... I've been writing [the president] proposals that have never been answered." The three other recipients of the Race Against Povery Awards were Maire Bopp Dupont, a radio journalist who has worked to inform Pacific islanders about AIDS; Rita Arauz, a Nicaraguan psychologist who set up a foundation to study and deal with HIV and other sexually transmitted infections; and the Rev. Arkadiusz Nowak, a priest who opened the first AIDS hospice in Poland.
Women who seek artificial insemination often want to perform it at home. However, most very few sperm banks -- and none in Canada -- will ship directly to patients. Because of this, Jacqueline Beaudoin of Ontario started an Internet mailing list to match male donors with women looking for donors. The Web practice raises several medical concerns, since the semen may not be screened for HIV or other diseases. The Centers for Disease Control and Prevention recommended in 1994 that sperm banks freeze semen specimens for six months prior to use, a time period which allows for retesting of donors for antibodies to HIV, which may not show up immediately after infection. The CDC's Ronald Valdiserri said, "It does not surprise me to learn that people are using the Internet as a way to identify donors." However, Valdiserri warned the practice is dangerous, noting that it is "essentially like having sex with somebody you don't know anything about."
Dr. A. Mocroft from University College London and colleagues analyzed treatments for patients at an HIV clinic in Southern Alberta, Canada. The researchers found that equal access to healthcare does not mean equal treatment occurs for men and women who have HIV. The study, published in the Journal of Acquired Immune Deficiency Syndromes (2000;24:475-482), involved 1,403 patients, including 126 women. The researchers concluded that women were much less likely to start highly active antiretroviral therapy than men in the study, and they tended to start treatment a few months later than the men.
The growing number of priests who have died from AIDS has been documented by the Kansas City Star, based on estimates from experts and priests. The Star has identified over 300 AIDS-related deaths among priests nationwide, using death certificates and interviews with family members and colleagues; however, the actual number is unknown. According to the Star, the AIDS death rate among priests in 14 states is more than two times that of adult males in those states. AIDS expert Richard Selik of the Centers for Disease Control and Prevention stated that data shows the HIV death rate is higher in priests than in men 25 years of age and over. Rev. Jim Walsh of the National Catholic Educational Association said he was surprised by the data, which he said reflect a "need to talk about celibacy and to do it in the sense of people witnessing how they're living it and where it's not working for them." The Star's state-by-state examination of the problem shows that hundreds of priests have died from AIDS, including a rector, seminary vocation directors, and college chaplains. However, there are signs of growing concern about sex and AIDS in the church. The National Federation of Priests' Councils is creating a new document concerning how dioceses should respond to priests with AIDS, and a study endorsed by the National Conference of Catholic Bishops will examine problems faced priests in their first five years after ordination. According to Brother Bernard Stratman, director of the federation, more priests are needing treatment for chemical, alcohol abuse, personality problems, and sexuality dysfunctions. Earlier this year, the Church of England acknowledged that 25 of its priests had died from AIDS-related causes. More recently, spurred by the enormity of the AIDS epidemic in southern Africa, the church said that all Anglican bishops in the region would be tested for HIV.
Swaziland, located between South Africa and Mozambique, has been ineffective at responding to the AIDS epidemic thus far. The latest measures involved parliament banning miniskirts in schools to reduce sex between teachers and students. AIDS activists in Swaziland struggle against the country's traditions and shame surrounding AIDS. Out of a population of 1 million, an estimated 22 percent are infected with HIV, and 40 percent of all pregnant women are HIV-positive. According to Christabel Motsa, chairwoman of the government's crisis committee on disease, people there are afraid to talk about AIDS and deny that it is a problem. Tradition is hard to overcome, as the kingdom is ruled by a monarch with seven wives. Polygamy is rampant in rural areas, and contraceptives are ignored. King Mswati declared HIV a national disaster last year and has urged HIV testing, but proposals to place HIV-infected people in camps or sterile them highlight the mindset of the kingdom. Without frank talk about AIDS, little prevention or treatment can be reached. Motsa is worried that her group's five-year plan to fight AIDS will be overshadowed by odd suggestions from lawmakers. The nation's plan will center on AIDS prevention and education of traditional leaders.
On Monday, UNAIDS director Peter Piot, speaking before a regional AIDS conference in Brazil, urged Latin America and the Caribbean to face their AIDS epidemics and take on issues like gay sex and condoms. Piot praised Brazil's response to the problem, but noted that other countries in Latin America are doing nothing to address AIDS. The Caribbean has the second highest HIV rate in the world. Most countries the region spend less than $50,000 a year on HIV prevention directed towards gay communities. Piot called that sum "a joke," noting that "it doesn't reflect the size of the epidemic in those communities." The influence of the Catholic Church has also hampered condom use and frank discussion of sex in Latin America. Brazil's HIV infection rate has steadied to about 0.5 percent to 0.6 percent of the country's adults, and it has challenged pharmaceutical giants by producing AIDS drugs at a fraction of their original price.
The HIV/AIDS Treatment Information Services (ATIS) announces the Perinatal HIV Guidelines Working Group has updated the information in the Public Health Service Task Force Recommendations for the Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States.
The primary changes include: the addition of a new section titled, "Perinatal HIV-1 Transmission and Mode of Delivery" (pages 23-32), and the addition of information about Lopinavir (Kaletra) in Table 2.
The guidelines are available in 2 formats:
You can request a copy of these updated guidelines in hardcopy or have a PDF file sent directly to your email address through our easy on-line ordering system at http://hivatis.org/request.html?list. Or if you prefer, you can call 1-800-448-0440 to request a single copy.
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.