HIV/AIDS Newsroom: December 19, 2000
Hepatitis B virus (HBV) is a particular threat to unaware international travelers. A new study done by researchers at the University of Zurich Institute of Social and Preventive Medicine found that almost 75 percent of the 9,000 survey participants exhibited risk factors for contracting HBV. However, only about half knew the virus' routes of transmission, and only 17 percent had been vaccinated against HBV. Travelers should be more aware of the potential risks of infection through deliberate careless behavior and also involuntarily, through exposure to contaminated medical equipment or blood because of automobile accidents or unintentional injuries.
The Dilemma: Submit or Suffer--'Uninformed Consent' Is Rising Ethic of the Drug Test Boom
Experts are concerned that some principles behind "informed consent," rules that prohibit coercion and deception in human drug testing, may be violated as pharmaceutical firms recruit thousands of subjects at a time from distant nations, including those in Eastern Europe, the former Soviet bloc, Africa, and China. Researchers note that some patients give their consent because they do not think there is an alternative, while other situations raise the issues of consent among mentally ill patients or whether an illiterate individual in the Third World who does not know much about today's medicine can give the same "informed consent" as a patient from the West. Several studies have found ethical problems or breakdowns in consent procedures used for drug testing. In one survey from a South African medical council, nearly 90 percent of the women enrolled in one AIDS study said they felt required to participate, despite the fact that they had signed a form indicating that they had volunteered. Almost one-third of the participants said they thought their hospital care would be affected if they did not take part, and virtually all of the women thought the hospital would not let them leave the study after it began. In another study, patients testing Pfizer's schizophrenia drug Zeldox at a Bulgarian mental institution last year were given an information sheet about the drug but were not informed of the U.S. Food and Drug Administration's concerns that Zeldox might affect heart rhythms and that the agency had issued a "not approvable letter," which meant that additional human tests were needed before the drug could be approved in the United States. Meanwhile, some experts point out that there may not be a translation for "placebo" in the indigenous language, which then forces researchers to use metaphors and analogies. Karen Barnes, an infectious disease expert in South Africa, notes that some desperate researchers may not always be willing to take the "enormous effort" involved to properly obtain informed consent in some developing countries. She estimates that it takes about 45 minutes to counsel each volunteer, a situation which also might require the individual's family and local medical workers.
An article published in the current issue of Family Planning Perspectives discusses facts found regarding the promiscuity of adolescent males and the risk factors for sexually transmitted diseases (STDs). The national survey reveals the statistics related to the types of sexual activities being pursued by teenaged boys, including oral and anal sex. Among other things, the report brought to light the confusing perceptions of what activities teenagers consider is not sex or is abstinence. "While 55 percent of teenage males say they've had vaginal sex, two-thirds have had experiences with noncoital behaviors like oral sex, anal sex, or masturbation by a female," says Freya L. Sonenstein, director of the Population Studies Center at the Urban Institute and one of the study's authors. "These behaviors put kids at risk of getting sexually transmitted diseases, which compromise their health." Linda Alexander, the president of the American Social Health Association, notes there is growing concern about STDs, as evidenced by the 400,000 hits her group's Web site for teenagers, www.iwannaknow.org, receives each month. The results, Alexander and others say, indicate that parents and clinicians should take a broad view of sexual activity when discussing sex with young people. Indeed, Ward Cates, the head of the Family Health Institute and former director of the Division of STDs at the Centers for Disease Control and Prevention, notes that "the most important message of these findings is to encourage communication about the whole range of sexual behavior, and to get away from the dichotomy we've set up between sex and abstinence, the view that sex is vaginal intercourse and abstinence is nothing more than holding hands."
Starting January 1, injection drug users in New York will be allowed to purchase syringes without a prescription. Previously, new syringes were only available with a prescription, which made them expensive on the black market and resulted in needle sharing among addicts. The new law is a public health effort intended to reduce needle sharing and to stem the spread of blood-borne diseases, including HIV and hepatitis C. New York State Assemblyman Richard Gottfried (D-Manhattan), who has pushed for the law for over a decade, estimated that the HIV epidemic would be only half what it is were it not for the practice of needle sharing. "We are talking about tens of thousands of lives," he said. According to supporters of the new measure, the success of similar programs in other states was critical to the passage of the New York bill. After a needle law was adopted in Connecticut, needle sharing dropped by 50 percent and HIV infections fell by 33 percent in 1992 and 1993. Under the new measure, individuals will be able to buy up to 10 needles at a time from state-registered pharmacies, health care facilities, and professionals. The needles will be packaged with information about the risks of injection drug use, the correct ways to dispose of needles, and the possibilities of treating drug abuse and HIV infection.
Despite the lack of progress on international trade issues, President Clinton and European leaders did manage to agree on world measures related to infectious diseases. The parties announced that concerted measures would be taken to try to ensure the production affordable drugs to fight AIDS, malaria, and other infectious diseases in the developing world.
In an interview with the New York Times, Phill Wilson, the executive director of the African American AIDS Policy and Training Institute at the University of Southern California, discusses AIDS in the African-American community. Wilson notes, "Let's be clear, when you hear about women and AIDS or babies with AIDS or now even men who sleep with men who have AIDS, whether it's stated or not, those are overwhelmingly black women, black babies, and black men." Statistics from the Centers for Disease Control and Prevention indicate that AIDS is the No. 1 cause of death among African-American men between the ages of 18 and 44 and the No. 2 cause of death for African-American women in that age group. In addition, more than 50 percent of the new HIV infections reported in the United States in 1999-2000 were among African Americans. Wilson explains that, in recent years, there have been renewed efforts to fight AIDS in the African-American community, led by the Congressional Black Caucus, the NAACP, Jesse Jackson and the Rainbow Coalition, and others. He also notes, in response to a question about the value of widespread HIV screening, that testing "is a portal to care and treatment" and that "too many African Americans don't know their [HIV] status."
New statistics show that the percentage of teenage births in Illinois dropped to a 40-year low in 1999, the fifth consecutive year of decline. In 1999, girls 19 and younger delivered more than 21,800 babies, representing 12 percent of all births in the state. Experts from the Illinois Department of Public Health attribute the continuing decline in teen births to increased pro-abstinence messages, greater awareness of HIV and other sexually transmitted diseases, and sex education efforts in school. "The environment that's been created over the past 10 years for teens is making it more comfortable today for them to say no to having sex, or if they are sexually active, to take precautions from getting pregnant or getting sexually transmitted diseases," said agency spokesman Tom Schafer.
Researchers from the U.S. Department of Agriculture recently diagnosed five strains of human tuberculosis (TB) in eight Asian elephant herds across the country. It is suspected that the elephants may have been exposed to the disease by human contact either in their native countries or infected zoo handlers here in North America. Since 1996, 18 active or contagious cases of Mycobacterium tuberculosis have been reported in elephants, including four at zoos. Only 12 of the animals are still living, although it has not been determined just how closely the deaths of the other six were associated with TB. The research, reported this summer at the fifth annual International Elephant Research Symposium at Portland, Oregon's zoo, is published in the November issue of Zoo Biology. Statistics from the Centers for Disease Control and Prevention indicate that there were 17,531 human TB cases reported in the United States last year.
Researchers say that a Hawaiian plant may be useful in fighting tuberculosis (TB), which takes the lives of about 2 million people each year. The researchers, led by Jonel Saludes, who was formerly based at the University of Santo Tomas in Manila, studied the "Noni" plant, also known as Morinda citrofolia. The plant, already used as a folk remedy to fight a variety of conditions, has chemical compounds that the investigators found were able to kill TB bacteria in the lab. While the research is still in its early stages and any possible side effects are not known, the authors said they hope the findings could be used to help create a new TB drug.
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.