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May 2003

Released Prisoners and the Public

The National Commission on Correctional Health Care issued a report saying that hundreds of thousands of the 11 million jail and prison inmates released each year bring AIDS, TB, hepatitis and mental disorders back to their communities. "Growing numbers of incarcerated individuals suffer disproportionately from tuberculosis, HIV/AIDS, hepatitis, mental illness, substance addiction and many chronic diseases," NCCHC said in a statement. "Corrections departments are overwhelmed by the high cost of providing medical care and face serious challenges to providing treatment to patients. Untreated patients jeopardize the health and safety of prison and jail staff, institution visitors, prisoners and the communities to which they return."

The report, funded by the Justice Department, called for a congressional investigation and set forth recommendations for action ranging from setting national requirements for prison health care to funding a national vaccine program for prisoners. Using the most recent nationwide statistics available, the report found that an estimated 98,500-145,500 HIV-positive inmates were released in 1996. An estimated 34,800-46,000 inmates had HIV in 1997, including an estimated 8,900 with AIDS. An estimated 107,000-137,000 inmates had STDs in 1997, and at least 465,000 with STDs were among the released prisoners that year. Vast numbers of prisoners with different forms of hepatitis were released. Approximately 12,000 people in correctional facilities during 1996 had active TB. In 1997, 130,000 inmates tested positive for latent TB. This extrapolated to 566,000 inmates with latent TB reentering society in 1996.

Prisons and jails become breeding grounds for disease, the study states, because many have insufficient money for care and medication, and some do not have enough space to separate sick prisoners from the general population. NCCHC noted that correcting prison health conditions would result in huge savings in medical costs when the prisoners reenter society. The 121-page document also recommended offering prisoners instruction in safe sex, hygiene methods, and programs to help them deal with drug dependency and other health and mental problems. Prisons and jails "offer a unique opportunity for improving disease control in the community by providing comprehensive health and disease prevention programs to inmates," the report said. (United Press International, 01.27.03)

Skin Infection Among Gay Men in Los Angeles

Large, painful skin infections started turning up early last fall among Los Angeles gay men, then appeared with increasing frequency. Although it took a while to confirm a connection between the cases, doctors now know they are facing an emerging epidemic of drug-resistant Staphylococcus aureus, or staph. Although the outbreak seems confined primarily to gay men, doctors say at least one woman contracted the infection, probably from a male sex partner. Because they still know so little about the extent of the outbreak, they cannot predict how many people it may eventually affect. The infection, which causes boils, deep abscesses and widespread surrounding inflammation, has proved impervious to common antibiotics. Although it appears to be spread primarily by skin-to-skin contact, including sex, its origins and precise mode of transmission remain a mystery. Doctors treating it caution that it could also be contracted at health clubs, steam rooms and other warm, moist environments. County health officials, with assistance from CDC, have begun an investigation to understand how the infection is spread, determine who else may be affected, and develop strategies to contain it.

Staphylococcus aureus lives on the skin's surface, usually existing harmlessly. Infections typically start in a cut or other opening. But the infections in L.A. gay men -- the majority with well-controlled HIV/AIDS, but many others in good health took hold in unbroken skin. Federal figures show the percentage of staph specimens resistant to antibiotics increased from 2 percent in 1974 to 50 percent in 1997. But not until 1999 did the public health community begin appreciating the severity of the resistance problem outside hospitals.

Dr. Elizabeth Bancroft, a medical epidemiologist with the Los Angeles County Health Department who is leading the investigation, stressed that until an investigation reveals how the infections are being spread, anyone with a boil or skin infection should maintain good hygiene, washing towels and anything else that comes into contact with infected areas. Any skin infection that looks particularly aggressive should be examined and cultured by a doctor. And, anyone prescribed antibiotics must complete the full course even if they start feeling better. The L.A. investigation has found the local strain resistant to erythromycin and fluoroquinolones, such as Cipro and Levaquin. That limits the drug arsenal to Bactrim, rifampin, clindamycin, and the drug of last resort, vancomycin, which is administered intravenously. Some doctors use the new antibiotic Zyvox, but with a single course costing $1,500, they often have trouble persuading insurers to pay for it. (Los Angeles Times (01.27.03)::Jane E. Allen)

Jails See Outbreak of Skin Infections

A painful skin infection not treatable with most common antibiotics is spreading through the Los Angeles County jail system, affecting more than 1,000 inmates in the last year and causing at least 57 hospitalizations. Federal officials believe that the outbreak of drug-resistant Staphylococcus aureus, commonly called staph, is the largest of its kind in any of the nation's correctional systems.

For months, the Los Angeles infections were misdiagnosed as spider bites and jail officials brought in exterminators. Now sure of the staph cluster, jail doctors are using more powerful drugs to treat all skin lesions and stepping up hygiene measures. "The problem at the jail is not under control yet," said Dr. Jonathan Fielding, the county's public health director.

Staph infections are believed to be spread by skin-to-skin contact or shared personal items in the county's jails, officials said Thursday. The infection causes boils, deep skin abscesses and widespread surrounding inflammation. Similar outbreaks of the same strain have been found in the Los Angeles area since the summer -- among gay men, members of a sports team and newborns in a hospital's nursery. According to data from the jail, 9 percent of infected inmates reported sores within five days of booking, meaning they probably came in contact with the bacteria before they were incarcerated. The jail outbreak is affecting men and women, and the patients' average age is 35.

Most of the 57 inmates hospitalized in the first eight months of 2002 had aggressive skin infections that required intravenous antibiotics or the surgical removal of tissue. Some of the infections spread into bones and blood, but no one is believed to have died, said Dr. Elizabeth Bancroft, a medical epidemiologist with the L.A. County Department of Health Services. To control the outbreak, federal and county health authorities recommend improved access to showers and clean laundry for inmates, and jail officials said they are taking such steps. In addition, medical staff are draining abscesses and administering two antibiotics in tandem. Inmates are being told to seek help if they develop skin sores. (Los Angeles Times (01.31.03)::Charles Ornstein; Jane E. Allen)

Brain Abnormalities in HIV Patients

U.S. researchers found that functional magnetic resonance imaging (fMRI) can offer early warning of neurologic morbidity in HIV patients. "A previous fMRI study demonstrated increased brain activation during working memory tasks in patients with HIV with mild dementia," wrote Thomas Ernst and colleagues at Brookhaven National Laboratory in Upton, N.Y., the Massachusetts Institute of Technology-Cambridge and the University of California-Los Angeles Medical Center in Torrance.

Ernst and colleagues discovered that fMRI screening could detect neurologic abnormalities even in patients who have no overt symptoms of dementia. The researchers evaluated the utility of blood oxygenation level-dependent (BOLD) fMRI for finding abnormal brain activity. A group of 10 HIV patients with low CD4 cell counts underwent neuropsychological tests under fMRI. The investigators compared their results with those of age-, sex-, education-, and handedness-matched seronegative controls. (AIDS Weekly (01.03.03)::Michael Greer)

Syphilis Cases in NYC Up 55 Percent

New York City health officials reported a 55 percent rise in syphilis cases in 2002 from 2001, with the increase primarily among gay and bisexual men. While the numbers are still small (436 cases in 2002, 282 in 2001), the steady increase is a sign that some segments of the population are ignoring warnings about safe sex. Dr. Thomas Frieden, the city's health commissioner, noted that syphilis cases are also increasing in other cities, notably Los Angeles, Miami and Houston. "This is a very troubling multi-city outbreak that is almost exclusive among men who have sex with men," he said.

The steepest increase in reported syphilis cases was among white men in Manhattan, though African-American and Hispanic men throughout the city also have high rates of infection. Two hundred-thirty men diagnosed with syphilis in 2002 also had HIV. About 70 percent of the men said they knowingly risked their partners' health, according to health department statistics. New York had a serious syphilis outbreak in 1990, with 4,265 cases reported. It spread as the use of crack cocaine increased and exchanging sex for drugs became common, officials said. By 1998, the number of cases decreased to 82, most involving MSM. Gay organizations find the statistics troubling. "It shows the magnitude of the challenge of promoting safe sex and the message of prevention," said Ronald Johnson, associate executive director of the Gay Men's Health Crisis. Two years ago, the group began testing for syphilis as well as HIV. "We know that the HIV safer-sex message worked in the late '80s and '90s," Johnson said, "but it has to be retailored to a new generation of gay and bisexual men who are just coming into sexual maturity. They are the ones who must get the message." (New York Times (01.31.03)::Nichole M. Christian)

Lipodystrophy and Quality of Life

Body changes due to lipodystrophy present an important problem for HIV-1-infected patients on HAART. Body changes can erode self-image and self-esteem, stigmatize patients, cause problems in social and sexual relations and lead to depression and anxiety. Many patients adjust to the limitations of lipodystrophy in the interest of survival. Some, however, lose interest in complying with complex drug regimens, which eventually leads them to discontinue control of their HIV infection.

The authors assessed the impact of lipodystrophy on quality of life (QoL) in 150 HIV patients, using standardized questionnaires. Eligible patients were clinically stable, had received more than one year of HAART, and could understand questionnaires. Eighty-four patients (56 percent) had clinical criteria for lipodystrophy. Those with lipodystrophy were older and had been on antiretroviral therapy longer than those without the condition. Data analysis showed that lipodystrophy itself was not an overall influence on quality of life. However, after researchers stratified the patients in categories, data analysis revealed significant differences on some subscales. Patients with lipodystrophy who were homosexual, unemployed and currently undergoing psychiatric treatment showed greater impairment on some quality of life subscales related to physiological well-being. The authors found that homosexual men seemed to be more vulnerable to the psychological impact of lipodystrophy on quality of life than heterosexual patients. They also found that taking psychiatric treatment such as methadone, tranquilizers or antidepressants was associated with a greater impact of lipodystrophy on quality of life. Previous studies, they noted, showed that psychiatric disorders tend to have an increased impact on QoL in HIV-1-infected patients in general. "However," they cautioned, "in our study we could not determine whether patients from our sample were anxious or depressed as a result of lipodystrophic changes."

"Additional studies increasing the power of the analysis by using a greater number of patients should be performed to deepen our understanding of the impact of lipodystrophy on QoL, to improve our ability to measure this impact, and to design strategies to improve or preserve QoL in HIV-infected patients," the authors concluded. "Special attention should be paid to vulnerable subgroups such as homosexual men and patients with psychiatric disorders." (Journal of Acquired Immune Deficiency Syndromes; 12.01.02; Vol. 31: P. 404-407::Jordi Blanch et al.)

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This article was provided by Body Positive. It is a part of the publication Body Positive.