HIV/AIDS Newsroom: December 5, 2000
Bottled Up: As UNICEF Battles Baby-Formula Makers, African Infants Sicken
Wall Street Journal (www.wsj.com)
12/05/00; P. A1; Freedman, Alix M.; Stecklow, Steve
Between 1.1 million and 1.7 million infants, mostly in Africa, have contracted HIV from breast-feeding. Often in the developing world, HIV-infected mothers are not told that infant formula is an alternative to breast-feeding that could help protect their children from AIDS. The issue has pitted the $3 billion infant-formula industry, which says it is prepared to donate loads of free formula to infected women, against UNICEF, which will not approve the donations because it does not want to support an industry that it has accused of abusive practices in developing nations. During the 1970s, Nestle SA and other formula companies aggressively promoted formula in developing nations; however, by the time the free samples were used up, the women were often no longer producing their own milk and the formula was too expensive for them to buy. As some women diluted the milk to make it last longer and some babies starved as a result, a global boycott of Nestle was organized by activists and UNICEF began to reject cash donations from any of the large formula makers -- something it has also done with land mine producers and cigarette companies. In the 1980s, UNICEF and the World Health Organization developed a voluntary marketing code for formula makers, one which restricted advertising and virtually prohibited the distribution of free and low-cost formula. But that code was not developed with the AIDS epidemic in mind, and many experts say UNICEF should look past previous events to help poor mothers with HIV and their babies. However, UNICEF head Carol Bellamy asserts that "breast is best," and she points out that the lack of adequate sanitation in many areas poses its own risks for formula users, possibly exposing babies to diarrhea and other deadly diseases, while antibodies in breast milk could help prevent such illnesses. Research indicates that about 15 percent of HIV-infected pregnant women in Africa will transmit the virus to their infants via breast-feeding. UNICEF officials have also voiced concerns that giving formula to HIV-infected mothers could affect support for breast-feeding among healthy mothers. Two years ago, UNICEF and other United Nations agencies modified their position on breast-feeding in the developing world. The "informed choice" policy holds that infected women should be told about the benefits and risks of breast-feeding and of alternatives like formula, but the statement does not say how poor HIV-infected women who want to use formula are supposed to obtain it.
Tuberculosis (TB) has become epidemic in Russia since the fall of the Soviet Union, and doctors are often forced to use outdated medical techniques due to a lack of resources. For example, one commonly used method of fighting drug-resistant TB in the country, using air injections to compress infected lungs, which gives them an opportunity to heal, has not been used in the West for many years. Some experts have called Russia's TB situation the largest outbreak of drug-resistant TB in the world, with a prison system that is considered an "epidemiologic pump" that continuously supplies pockets of disease. However in addition to TB, Russia is faced with soaring rates of other infections -- including hepatitis, syphilis, and AIDS -- and there are frequent reports of regional outbreaks of diseases like encephalitis, typhoid, malaria, polio, pneumonia, and the flu. While once-rampant TB rates in Russia were brought under control before the fall of the Soviet Union, the government's extremely limited resources cannot cope with the new surge of infections fueled by growing poverty, stress, overcrowding, and alcoholism. Martin McKee, an expert at the London School of Hygiene and Tropical Medicine, notes that while "the total cost of infectious diseases in Russia is not that great, . . . the important thing is that it is going up and up." The cost will likely increase even further as the AIDS epidemic spreads. The majority of HIV cases in Russia are among injection drug users, with infection rates among addicts in some areas reaching 30 percent. Officials are concerned that HIV will soon spread even further among the sexual partners of these individuals.
Experts Gather to Fight STDs
Milwaukee Journal-Sentinel Online (www.jsonline.com)
12/04/00); Marchione, Marilynn
Hundreds of health experts are gathering in Milwaukee this week for the National STD Prevention Conference, which is sponsored by the Centers for Disease Control and Prevention and the American Social Health Association. There are over 20 diseases that can be transmitted sexually, including HIV. According to the CDC, the age when people first have sex has dropped over the past 20 years, while the age when people first marry has increased. As a result, there are fewer monogamous relationships and greater risks for sexually transmitted diseases (STDs) for young adults. The CDC's 1999 STD surveillance report shows that girls between the ages of 15 and 19, for example, had the highest rate of gonorrhea of all ages groups. CDC official Ronald Valdiserri noted that while recent statistics indicate "some very promising signs in certain STD trends," others are not so positive. "We believe that as many as two-thirds of all STDs occur in people under 25," he said.
Health officials in Canada announced Monday that 35 people have contracted drug-resistant tuberculosis (TB) after an infected Caribbean man somehow slipped through the health-screening process when he immigrated to Canada late last year. The man had active drug-resistant TB, and a woman who lived with him became infected with the same strain in February. Their illness was only detected in September, and it has already cost C$500,000 to treat them. During the past 12 months, the two people came into close contact with over 1,000 people, most of whom have been tracked down. Of the more than 500 individuals who have been screened, thus far 35 have tested positive for TB. None of these people are contagious, however, and they are being treated with antibiotics for up to a year. Dr. Elizabeth Richardson, medical officer of health for Hamilton, said, "There's a cause for concern but not a cause for panic. This disease doesn't spread easily and the risk to anyone in the general public is 10 percent over a lifetime."
The Canadian government reportedly will soon start testing immigrants for HIV and hepatitis B, and individuals found infected with either disease will not be allowed to enter the country. Immigrants to Canada are already prohibited entry if they test positive for active tuberculosis or syphilis. According to a report in the Toronto Star on Sunday, Canada also has plans for more stringent monitoring of the 1,400 overseas doctors contracted by the government to conduct the exams. Dr. Ron St. John, head of Health Canada's office of health and security, said that Canada, the United States, and Australia will start using the same designated physicians, so if one country discovers evidence of corruption or wrong-doing, the doctor will not do business will any of the three nations.
A new report in the National Social Work Journal indicates that the incidence of HIV/AIDS among native Canadians is three times higher than the national average. The report notes problems in awareness, treatment, and research efforts; however, it also discusses successful campaigns that are working to fight the epidemic.
At a regional AIDS conference in Grenada over the weekend, activists debated whether they should promote abstinence or encourage condom use. While some people, including Winston Duncan of the Grenada Planned Parenthood Association, said they support condoms, others disagreed, noting that it is hard to get some people to use the prophylactics.
The Oman News Agency said Monday that 600 cases of AIDS have been diagnosed in Oman. The report quoted a health ministry official who said that while nearly three-quarters of the cases are among men, the number of women with AIDS is increasing. A health ministry representative also noted that although 600 cases have been reported, the actual number could be much higher.
Many HIV-infected individuals are at risk for depression, as many feel overwhelmed by the substantial changes in their lives. Growing research shows that HIV patients have more negative effects from depression. Jane Leserman, a research associate professor of psychiatry at the University of North Carolina School of Medicine at Chapel Hill, notes that data shows that "psychological factors affect disease progression in HIV." Over 50 percent of older adults with HIV have depression, said Tim Heckman of Ohio University. Doctors, therefore, must be aware that older patients are at risk. Meanwhile, Gail Ironson, psychology professor at the University of Miami in Coral Gables, has found that HIV patients are vulnerable for depression right after diagnosis and also when symptoms first begin to show. Jerry Durham, a nurse and dean at Barnes College of Nursing in St. Louis, explained that HIV comes with an expectation of loss. Not treating depression can have stark results and can cost more in the long run. Depression is associated with low immune response, disease progression, decreased survival, and lower quality of life as well. Leserman's research showed that psychological factors can lead to faster HIV progression to AIDS. Her study of adult gay men and the stresses in their lives found that some patients prefer to remain stoic under stress. Blood samples showed that cortisol levels appeared to predict which men would progress more rapidly to AIDS could lower the immune system. Leserman said that although there is little research available on cortisol, "our own findings showed that cortisol was not a very beneficial hormone for these men."
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.