HIV/AIDS Newsroom: December 12, 2000
HIV Pretest and Posttest Counseling: Still Missing From Medical School Curriculum
Archives of Internal Medicine Online (archinte.ama-assn.org)
11/27/00; Vol. 160, No. 21,; Green, Sonya; Del Rio, Carlos
In an editor's correspondence in the Archives of Internal Medicine, Sonya Green and Carlos del Rio report that most recent medical school graduates have received no training regarding HIV pretest and posttest counseling. In a study supported under a cooperative agreement from the Centers for Disease Control and Prevention, the researchers asked incoming medical interns at Emory University about their experience with and knowledge of HIV testing. The survey, conducted in June 2000, involved 71 graduates from 41 medical schools. Only 13 percent of the participants had received any formal training for HIV pretest and posttest counseling while in medical school, and most of this education was extremely brief. The survey also revealed that only 24 percent had ever delivered an HIV-positive result, in most cases only one time, and that knowledge of HIV testing guidelines was limited.
U.S. Secretary of State Madeleine K. Albright announced on Monday that the United States will supply Botswana with 200 trailers to be used as HIV counseling centers. The United Nations estimates that more than one-third of the adults in Botswana are infected with HIV, and Health Minister Joy Phumaphi said that 8,700 of the 62,000 babies born in the country every year also have the virus. While Botswana offers infected pregnant women AZT to help prevent mother-to-child HIV transmission and also baby formula to guard against virus transmission via breast milk, the stigma surrounding the disease is so great in some areas that many women are too scared to avail themselves of the programs. The United States' donation will include 200 televisions and video recorders which will be used to play a new video to show pregnant women how to prevent HIV transmission to their children. Speaking outside a prenatal clinic in Botswana, Dr. Albright also praised singer Mayoress Molefi-Mochangana, who publicly revealed she has HIV, for her bravery.
[Virginia] Teacher Has TB; Arlington to Test Students
Washington Post (www.washingtonpost.com)
12/12/00; P. B2; Wax, Emily
Hundreds of middle and high school students in Arlington, Virginia, are being tested for tuberculosis (TB) after a substitute teacher who worked in the county school system was diagnosed with the disease. In all, students at three area middle schools and three high schools will be tested, likely by the end of January, Public Health Services said. TB tests will also be given three months from now as an extra precaution. The substitute teacher was diagnosed with TB last week after feeling ill; a TB test in September came back negative. The teacher is currently at home resting and receiving drug therapy.
Several national organizations, including the American Public Health Association and the Infectious Diseases Society of America, are contesting the dismissal of a dental hygienist in Atlanta on the basis of his HIV infection. The man, Spencer Waddell, filed suit after being fired in 1997, when he informed his employer that he had HIV. A briefing filed by attorney Stephen R. Scarborough of the Lambda Legal Defense Fund indicates that dentist Eugene Witkin confirmed that he has had no training regarding HIV transmission and he has not been to any seminars about HIV with regards to dentistry. Also backing Waddell is Northern Arizona University's Dr. Donald Marianos, who participated in the development of the Centers for Disease Control and Prevention's 1991 protocol for HIV-infected healthcare workers.
As part of their World AIDS Day events, students from Cleveland Naval ROTC Academy in St. Louis talked about HIV and AIDS with eighth graders from Nottingham Middle School. The Cleveland Naval students -- who had been trained with the American Red Cross YouthCorps program -- discussed methods of HIV transmission, including casual unprotected sex, contaminated needles, and blood-to-blood contact with an HIV-infected individual. The program noted that while there are drug regimens that can help control HIV, there is still no cure. The student educators also worked to dispel myths surrounding the disease, such as the belief that one can contract HIV via casual touching or kissing. Statistics from the Missouri Department of Health show there were 1,222 cases of HIV and 2,315 cases of AIDS in St. Louis last year, with the fastest-growing rate of infection among individuals between the ages of 15 and 44.
A new report from Dr. Luke Mullany of the Johns Hopkins University reveals large gaps in HIV awareness among migrant workers living along the border of Thailand and Burma (Myanmar). The survey, which included 233 men and 492 women, found that while more than 80 percent of the respondents could list major risk factors for HIV infection, only 27 percent were aware that they could learn their own HIV status from a blood test. According to Dr. Mullany, there were key gender-based differences regarding knowledge of HIV prevention and transmission, with men scoring higher than women for basic HIV knowledge. Dr. Mullany noted that only 15 percent of the women reported having ever seen a condom, and less than 2 percent of the women had ever used a condom, compared to almost 13 percent of the men.
Researchers report in the November 20 issue of AIDS Research and Human Retroviruses (2000;16:1831-1843) that new HIV-1 recombinants identified in Myanmar appear to stem from the HIV-1 subtypes B', E, and C. Scientists from the National Institute of Infectious Diseases in Tokyo studied HIV-1 env and gag subtypes from 25 samples taken in central Myanmar. A total of 19 specimens had concordant env and gag subtypes, with five identified as subtype C, 10 as subtype E, and four as subtype B'. There was discordance between the env and gag subtypes in the remaining specimens, with three showing a gag subtype B' and an env subtype C, one with a gag subtype B'/env subtype E, another gag subtype C/env subtype B', and the last showing gag subtype C/env subtype E.
At the recent African Development Forum in Ethiopia, Nigerian President Olusegun Obasanjo stressed that debt cancellation would help African nations better fight the AIDS epidemic. "Africa is groaning under the demands of debt burden and repayment," the president said, pointing out that African countries spend $15 billion a year on debt servicing, while experts have estimated they need $3 billion annually to control HIV and AIDS. Obasanjo also noted that other infectious diseases, such as tuberculosis and malaria, are problematic, and he called on Africa's leaders to provide the necessary leadership to help fight AIDS.
The number of men over age 45 with AIDS has doubled since 1995, and approximately one-quarter of the newly infected women are between the ages of 35 and 44. These statistics, as well as the ability of antiretroviral drugs to extend HIV patients' lives, lend support the suggestion that the HIV-infected population will increasingly shift to people in their middle years. People with HIV in their 50s or older have specific concerns, including depression. Timothy Heckman, associate professor of psychology at Ohio University in Athens, has helped with two studies of depression among older HIV patients. Because older people often live alone, they suffer from feelings of depression, and HIV infection can cause loss of independence and discrimination, leading to thoughts of suicide. Suicide is a top 10 cause of death for adults aged 45 to 65, and HIV infection makes the risk significantly higher. Heckman studied how healthcare workers can help this group of people. Among other things, he found that they should increase group support of older adults, who enjoy meeting people their age with HIV. Coping training is also important, and a support group can create goals to help prevent depression after the loss of a loved one or lost job. Disclosing HIV status is also painful to older adults, who need help with telling their family. A support group provides an arena to practice HIV disclosure. Telephone support groups can link several people at the same time, so they can have a normal conversation, if they are not all together. Internet chat rooms can provide similar support, but many low-income people say that a telephone conference is a more viable option.
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.