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October 2000 Treatment Chronicles

From the CDC National AIDS Clearinghouse

October 2000

Overwhelming Evidence that HIV Causes AIDS. More than 5,000 scientists, doctors, and medical experts have signed the Durban Declaration, which asserts that there is significant evidence that HIV causes AIDS. The declaration was made to end the controversy in South Africa over the HIV-AIDS link. South African President, Thabo Mbeki, has fueled the controversy by asking dissident scientist Peter Duesberg to be on a presidential panel charged with investigating the disease. Those who signed the declaration wrote that by denying the cause of AIDS, countless people will die and vaccine research and prevention efforts will be hampered.

HIV Vertical Transmission Rate Declining in the United States. A study led by B. Joyce Simpson and colleagues at the Yale University School of Medicine shows that the risk of vertical HIV transmission in the United States fell steadily between 1990 and 1997 compared to the previous five years. Simpson evaluated 347 children born to HIV-infected mothers between 1985 and 1990 and between 1990 and 1997. According to a report in the July issue of The Pediatric Infectious Disease Journal (2000; 19:618-624), the researchers found that the rate of vertical HIV transmission dropped from 20.7 percent in the first period to 6.5 percent in the second period. The investigators attribute much of the decline to routine zidovudine therapy for HIV-infected pregnant women.

Website Helps Patients Comply with HIV Regimens. A new website,, from NAM publications offers updated information about HIV drugs, their side effects, and HIV transmission. The site also has a clock showing how treatment can be fit into a schedule, creating a personalized pill planner. "The Wheel -- Your Personal Pill Planner" is based on a series of questions about the individual's drug therapy and lifestyle, and also includes adherence issues the patient should discuss with his or her healthcare provider.

Hoax-busting Website Created by CDC. The Centers for Disease Control and Prevention has developed a website,, to dispel concerns about new diseases or drug safety scares that are passed around the Internet. Mostly spread by concerned people, who pass e-mail messages about health issues to their friends, the good intentions of Web users have a tendency to create an "urban legend," or completely false safety scare. They range from non-existent food contamination to date-rape drugs that exist only in the mind of the message creator, or HIV-infected needles stuck into movie theater seats. After receiving 250 phone calls and 500 e-mails per week for just one hoax, the CDC opted to create its informational website to combat the myths. According to CDC spokesman Tom Skinner, "So many of the hoaxes used the CDC as a supporting voice of authority in their messages, so we decided to make a formal response."

HIV-1 Rebound After Anti-retroviral Therapy. Highly active antiretroviral therapy (HAART) can control replication of HIV-1, but experiments have shown it cannot eliminate the virus completely, because it remains in latent reservoirs in resting memory CD4 T-cells. A study by Tae-Wook Chun et al. in the July issue of Nature Medicine compared the genotype of the virus and the genotype of the latent reservoir. The research concluded that the cause of viral rebound is an unknown source, not the latent reservoir. In a commentary in the same issue of Nature Medicine, David Ho and Linqi Zhang, both of the Aaron Diamond AIDS Research Center in New York, describe a similar (unpublished) study they conducted. HAART suppressed plasma viremia in eight patients for about three years; however, the authors note that the viral rebound after treatment was stopped was the result of "a virus identical to the latent reservoir in five cases." The initial rebounding virus in three other patients was different from the latent reservoir virus, but indistinguishable from minor viral variants in the lymphoid tissues. While the findings are somewhat similar to Chun et al.'s, Ho and Zhang point out "the identity of HIV-1 sequences cannot unequivocally pinpoint the latent reservoir as the source [and that] non-identity also cannot conclusively exclude the latent reservoir as the source." Thus, solid conclusions cannot be taken from the preliminary genetic findings that are available, although the research does provide further insight into HIV.

Metformin in the Treatment of HIV Lipodystrophy Syndrome. Lipodystrophy, or fat redistribution and insulin resistance, is common in HIV-infected patients who are treated with combination antiretroviral drugs. These effects are also considered risk factors for coronary artery disease, and as more HIV patients live longer, they can face heart problems. A study of 26 HIV patients who are non-diabetic and have fat redistribution evaluated the use of treatment with metformin, an insulin-sensitizing agent. Patients were given either 500 mg. of metformin twice a day or a placebo for three months. According to the results, metformin therapy led to lower insulin levels, significant weight loss and decreased diastolic blood pressure. The drug had no effect on waist-hip ratio, energy intake, HIV viral load or cholesterol. Few adverse effects occurred, with mild diarrhea the most frequently reported. The authors conclude that low doses of metformin can reduce insulin resistance and improve signs of lipodystrophy with high levels of tolerance among the subjects. More research is needed to determine the effects for HIV patients over the long term.

Effects of Mycophenolic Acid on Human Immunodeficiency Virus Infection in Vitro and in Vivo. Swiss researchers recently studied the use of mycophenolic acid (MPA) on inhibiting HIV replication. The study evaluated in vitro and in vivo evidence that MPA, a selective inhibitor of the synthesis of guanosine nucleotides in lymphocytes, interferes with the life cycle of HIV through immunological mechanisms. Using flow cytometry to analyze the activated T-cells, the scientists discovered that MPA affected CD4 and CD8 T-cells, suppressing HIV infection. This suggests that by targeting the cells that HIV attacks, a new therapy besides antiretroviral drugs could deter the virus. The researchers recommend that future studies of the effect of MPA and its ester derivate mycophenolate mophetil on HIV-infected cells conducted, as this inhibitor could represent an alter native approach to highly active antiretroviral therapy.

DNA Innovation Lets Team Undermine the AIDS Virus. Biologists, led by Dr. Alan Lambowitz of the University of Texas, have created a new method of singling out regions of DNA, so genes can be disrupted or added to a site. The discovery has been used to disrupt HIV and the gene used by the virus to enter human cells, according to Lambowitz. In the July 21 issue of Science (2000; 289:452-457), the researchers report that they created introns -- DNA pieces that are found between the working parts of genes in numerous species -- to disturb that gene, the human CCR5 receptor. In tests of human cells grown in the laboratory, the researchers found that the manufactured introns all inserted themselves into the expected location in CCR5. To facilitate the experiment, the receptor gene and HIV were carried in small rings of DNA called plasmids instead of their regular position in the chromosomes; the researchers now hope to determine whether the artificial introns work in the chromosomes. If successful, Lambowitz said the new method could be used to create new vaccines and also for genetic engineering.

Intermittent Drug Therapy for AIDS Is Tested. As scientists continue to scramble for ways to improve patient reactions to AIDS drugs, a prominent U.S. government researcher revealed at the 13th International AIDS conference in Durban, South Africa, that giving AIDS patients breaks in their difficult combination medication regimens not only reduces the occurrence of side effects, but helps the body to fight the virus on its own. The news raises hopes in the battle against AIDS, as regulatory bodies like the CDC are concerned that combination therapies may only be effective for a limited time as the virus adapts to resist the drugs. The practice of extending life expectancies with planned medication breaks is currently in about 10 different trials in the United States and Europe, basing the length of the interruptions on HIV viral loads in the bloodstream. So far, those stopping their drug regimens for as long as a month have experienced increased HIV levels, but have pushed their viral loads back down to unmeasurable levels after re-starting therapy. Dr. Anthony S. Fauci, who leads the National Institute of Allergy and Infectious Diseases, hopes that the studies will lead to a better understanding of AIDS drugs and their effects, permitting patients to halt their regimens for as long as six or eight months at a time, though he cautions that the cyclical break system is not, by any means, a cure.

Cheap Antibiotics Seen Helping HIV Patients. Researchers from the CDC have concluded that inexpensive antibiotics may be useful in preventing HIV-infected individuals in Africa from developing AIDS, even if access to potent antiretroviral therapy is limited. Led by Dr. Mark Dworkin, the researchers tested the antibiotic trimethoprim-sulphamethoxazole -- which is used in the United States to preventing Pneumocystis carinii pneumonia (PCP) -- and found that it was effective against a number of diseases. The researchers noted that while the cheap drug did not affect viruses and could not control HIV, it was effective against several opportunistic infections that affect HIV patients. The drug, sold under the names of Bactrim and Septra, lowered the risk of PCP by 40 percent, of toxoplasmosis by 30 percent, and of salmonella by 60 percent.

Immune System Chemical Helps HIV Patients. Researchers from the National Institute of Allergy and Infectious Diseases announced July 8 that a natural immune system compound may help boost the immune systems of HIV-infected individuals. According to the researchers, who studied 78 HIV patients, the patients who received interleukin-2 (IL-2) in addition to highly active antiretroviral therapy saw a significant increase in the number of CD4 cells after one year. The scientists are now investigating whether IL-2 helps slow the progression to AIDS.

Hoffmann-La Roche Studies of Fortovase Included 141 Women. On July 11, Hoffmann-La Roche has announced that a study involving 610 antiretroviral-naive patients with viral loads of more than 5,000 copies/mL shows that Fortovase is effective and safe in treating HIV in both women and men when used in conjunction with two nucleoside reverse transcriptase inhibitors. The pharmaceutical concern also announced that data from the 48-patient study indicates that twice-daily dosing of Fortovase is as effective as three-times daily dosing and does not result in resistance to the drug.

Drugs Help Mothers Stop Giving HIV to Babies. On Tuesday, July 11, Bristol-Myers Squibb released data from a study in South Africa demonstrating that two of its HIV drugs, Videx and Zerit, are equivalent to AZT in preventing mother to child HIV-transmission. Bristol-Myers noted that its two medications are in the same class as AZT and Viramune, both of which are highly regarded as HIV-transmission preventatives. Scientists at Chris Hani Baragwanath Hospital near Johannesburg administered the drugs to pregnant mothers a few weeks before delivery and then to the babies after birth in various combinations and doses. Preliminary six-week data indicates that the transmission rates for children treated with Videx, Zerit or a combination of the two drugs were comparable to those treated with AZT.

Contraceptive Sponge May Move Back to Stores After Reapproval. Having purchased the rights to the Today contraceptive sponge from Whitehall-Robins Healthcare, a division of American Home Products, in 1998, Allendale Pharmaceuticals has been given another boost in its attempt to return the sponge to the market. Withdrawn in 1994 after the Food and Drug Administration (FDA) found water contamination at a Whitehall plant that manufactured the sponges, the product must go through a rigorous examination by the agency before it reaches the market, and the FDA's labeling approval is a major step. Essentially a soft foam cup saturated with nonoxynol-9, a spermicide, the item has already received 3,000 orders from women who liked its convenience and control, despite a failure rate of about 9 to 11 percent among women who used it according to the directions on the packaging. Traditionally, nonoxynol-9 has been associated with a decreased risk of HIV infection; however, a report presented at the AIDS conference in South Africa linked the irritative properties of the spermicide with lesions on the vaginal lining, permitting easier HIV transmission. Skeptics note that the study was conducted with prostitutes who used the gel as many as 20 times per day, and that previous reports had not linked nonoxynol-9 to a higher risk of contracting HIV.

HIV Screening in Pregnancy. The American College of Obstetricians and Gynecologists (ACOG) has issued a new policy that supports routine, voluntary testing of pregnant women in the United States for HIV. Michael Greene, chair of ACOG's committee on obstetric practice, said the organization's goal "is to make HIV testing as commonplace as urinalysis during the first prenatal office visit." ACOG's previous policy recommended testing for women at high risk for infection. Along with its new policy, ACOG has unveiled a new educational effort to help doctors inform their patients about HIV screening and treatment, using pamphlets, posters and tear pads.

Some with HIV Aren't Disclosing Before Sex. Although most HIV-positive people in the United States abstain from sex or inform their partners of their condition, some people persist in having unprotected sex without revealing their status. A study presented at the 13th International AIDS Conference revealed that gay men are the most likely group to keep quiet about their HIV status; 16 percent of the gay men in a survey of 1,397 HIV-positive people across the United States said that they had been involved in at least one episode in the last six months of unprotected sex with a partner who did not know their HIV status. According to Dan Ciccarone, the study's author and a University of California at San Francisco researcher, his talks to the gay community about AIDS invariably brings a debate about the responsibility of informing partners about HIV status. He said the debates have focused on whether it is the partner's responsibility to ask about HIV infection, or whether the HIV-positive should inform without being questioned. The study found that the rate of unprotected sex among heterosexual HIV-positive men and women was about five percent.

Fresh Rise in HIV Rate Rings Alarms: "Prevention Burnout" and a Return of Risky Sexual Behavior Among Gay Men. Questionnaires given in San Francisco's gay neighborhoods are helping health officials learn about risky sexual practices and other habits of gay men in the city. San Francisco is the first American city to confirm a rise in new HIV infections after years of decline. Officials are worried that the city's statistics may be the forerunner of a nationwide rise in HIV infections among gay men. The CDC's Dr. Ronald Valdiserri said, "We take these findings very seriously, and we're very concerned about what they might portend for the future." Valdiserri noted that there are no indications that the number of new HIV infections nationally is increasing. In San Francisco, though, the health department reports that the new infection rate has jumped from 1.3 percent of those tested in 1997 to 3.7 percent in 1999. Some experts note that young gay men do not remember the early days of the epidemic, when there were few treatments available, and they say that older men may be under the influence of "prevention burnout," or fatigue. Using a $1 million grant from the CDC, San Francisco is focusing its prevention efforts on HIV-positive men, who have been largely ignored in campaigns geared toward HIV-negative individuals. The city may also use its $16 million prevention budget for such efforts as a campaign to highlight the side effects of AIDS drugs, reminders that other sexually transmitted infections besides HIV have severe effects, and gearing prevention messages to specific at-risk populations.

HIV Prevalence and Associated Risks in Young Men Who Have Sex With Men. Researchers from the CDC used the Young Men's Survey (YMS), a cross-sectional, multi-site survey conducted between 1994 and 1998, to estimate the prevalence of HIV and related risk behaviors in young men who have sex with men (MSM). The researchers visited a total of 194 bars, dance clubs and social groups frequented by young MSM in seven major cities. In all, 3,492 MSM between the ages of 15 and 22 were interviewed and tested for HIV. According to the CDC, overall HIV prevalence for the group was 7.2 percent, and the rate was lowest in Seattle and highest in New York City. MSM aged 20 to 22 had the highest HIV prevalence; none of the 15-year-olds were infected with HIV. The multivariate-adjusted HIV prevalence was higher among African Americans, young men of mixed or other race, and Hispanics compared to whites and Asian Americans and Pacific Islanders. The CDC noted that factors strongly linked to HIV infection among these men include being African-American, mixed, or other race; having ever had anal sex with a man; or having had sex with at least 20 men. The prevalence of unprotected anal sex in the last six months was 41 percent overall. The results indicate "a critical and widespread public health problem," the researchers conclude, "and underscore a need to evaluate and intensify prevention efforts for young MSM," especially for African Americans, Hispanics, men of mixed race or ethnicity and young adolescents.

The New Face of HIV Is Young, Black. According to a study by CDC, African Americans make up the majority of new HIV cases among people under 25 years of age, at least among the states that collected HIV data between 1994 and 1997. The study discovered that roughly 40,000 people are diagnosed with HIV each year, but the threat of HIV infection does little to prevent risky sexual and drug behavior among young African Americans, who represent about two-thirds of all new HIV cases among people under 25. Experts believe that most people in the United States, including young African Americans, understand the risks of HIV infection in an abstract way, but for some reason do not understand it in a concrete manner when involved in a relationship. Other difficulties include a disinclination among HIV-positive young people to reveal their disease to their partners, whether in long-term or short-term relationships, and some youths' belief that they will live forever. The attitude is prevalent despite the nearly universal awareness of HIV and AIDS among younger people as well as their consequences, which may be a reflection of the United States' slowing interest in the disease.

Study Targets HIV Hot Spots. In order for Miami to change its status as the nation's third-ranking city in HIV infections, health workers must reach people in nightclubs, bars and on the streets, according to crisis teams that surveyed four Miami neighborhoods. The teams suggest using more medical vans staffed by outreach workers to target neighborhoods at risk for HIV. The Rapid Assessment, Response and Evaluation survey (RARE) was given to three U.S. cities -- Miami, Detroit, and Philadelphia -- to track HIV transmission and progression. Miami Mayor Alex Penelas has granted $150,000 for research into HIV and training of health workers. The survey went to the neighborhoods known as Little Haiti, Liberty City, Little Havana and Edison, as researchers observed drug users, prostitutes and alcoholics, gathering information on their sexual practices.

Myths Increase Women's Vulnerability to AIDS. AIDS activists expressed concern on July 13 that myths about AIDS in some cultures are making young women and girls more vulnerable to HIV. One myth is that having sex with a virgin can cure AIDS, and the activists noted that the practice of virginity testing could exacerbate the problem, since it identifies virgins for male AIDS patients. The activists said that HIV is also being spread in some poor urban areas where unemployment has left sex as some young people's only recreation.

GAO Says Many States Not Yet Reporting HIV. The General Accounting Office (GAO) said on July 11 that many U.S. states still do not report HIV cases. Speaking before the House Commerce Subcommittee on Health and the Environment, the GAO's Janet Heinrich said that only about three-fifths of the states report HIV infections and that could affected plans to distribute Ryan White CARE Act funds based on numbers of HIV cases instead of cases of AIDS. Heinrich noted that even when all states do report new cases of HIV, CDC said it could take another few years to make sure all previous cases were entered into the system as well. Sponsors of the measure urged Congress to start shifting its funding methods, noting that the change will enable the U.S. government to take pro-active steps.

House OKs Continued Funds for AIDS Care; Revised Formula Would Cut S.F.'s Share. The House of Representatives voted July 26 to renew the Ryan White CARE Act using a new funding formula that could cut San Francisco's share from the program. The current act expires at the end of September. Co-sponsored by Reps. Tom Coburn (R-Okla.) and Henry Waxman (D-Calif.), the new measure includes plans to gradually shift the focus to HIV from AIDS. According to activists, however, the new funding formula -- part of an effort to shift funds to areas where the disease is increasing -- could cut San Francisco's Ryan White funds by up to 25 percent over five years. At present, San Francisco receives some $5,000 a year per AIDS patient, which is about two times as much as most cities. Rep. Nancy Pelosi (D-Calif.) objected to the formula change, although she voted for the overall measure. She noted that "the solution to the continuing AIDS crisis is to increase overall funding rather than to redistribute existing dollars."

Senate OKs $600 Million for AIDS. The Senate has passed legislation that grants up to $600 million in U.S. funding to fight HIV and AIDS in Africa and other parts of the world. The Senate approved the bill, proposed by Senators Bill Frist (R-Tenn.) and Jesse Helms (R-N.C.), which calls on the U.S. Treasury to set up a trust fund with the World Bank for HIV prevention and treatment and also for the care of children orphaned by AIDS. The measure will supply $300 million in U.S. aid in each of the next two years and also provides $120 million to fight tuberculosis in developing nations.

Levels of HIV Infection and AIDS Fail to Decline in the U.S., Health Data Show. New data from the CDC indicate that levels of HIV and AIDS are remaining stable in the United States and that about five million Americans are at high risk for infection due to risky behaviors. The statistics, from the first two quarters of 1999, show there were about 4,000 AIDS deaths and 10,000 AIDS cases diagnosed during each quarter. Dr. Helene Gayle, director of the CDC's National Center for HIV, STD, and TB Prevention, noted, "Prevention is more critical than ever." According to Dr. Gayle, treatment failure, a lack of early testing and treatment for some individuals, and difficulty following new treatment regimens are to blame. The CDC's analysis of data from a number of national surveys suggests that two to four percent of Americans, or about four to five million people, are at high risk for HIV infection, including men who have sex with men, prostitutes, injection drug users and people who have sex with individuals known to have HIV. A CDC report also notes that HIV infection rates have stayed high among some groups, particularly homosexual men. Infection rates among gay men have remained stable for the past decade, with rates of new infections averaging one to four percent each year. Among certain groups, such as young gay men and individuals who visit clinics for sexually transmitted disease treatment, the rates of infection are much higher.

Albright Says HIV/AIDS Is Number One Security Threat in SE Asia. U.S. Secretary of State Madeleine Albright has called the spread of AIDS in Southeast Asia the chief threat to security in the region. Albright, speaking to officials from the Association of Southeast Nations (ASEAN), noted, "There is no greater danger to the health and security of this region" than HIV and AIDS. According to the United Nations, there were 1.3 million new HIV cases in Southeast Asia in 1999. Albright said the United States will continue to help ASEAN nations fight AIDS, tuberculosis, and malaria in the region.

Grounds for Hope on AIDS in Africa. The 13th International AIDS Conference in Durban, South Africa, took a few steps towards the goal of providing affordable treatment for AIDS patients in Africa, note the editors of Nature. Renewed global attention for the AIDS epidemic has led to increased funding from various places, including the U.S. House of Representatives and several pharmaceutical companies. The meeting also brought to light progress made with antiretroviral treatments that can reduce HIV transmission from mother to child, even with breastfeeding. While the question of how developing nations can pay for the costly drugs has still not been resolved, help has come in the form of price reductions from drug firms and an offer to supply nevirapine for free for a limited time. Former South African President Nelson Mandela closed the conference with a call for programs that prevent mother-to-child HIV transmission-a move that the editors note "should make it easier for government officials to press for the introduction of treatment programmes for HIV-positive mothers" and offers some hope for the millions who are infected with HIV.

How AIDS Undercuts Education in Africa. Many teachers in sub-Saharan Africa are dying from AIDS, according to a recent UNICEF report, with at least 860,000 school children in the region losing an instructor to the disease last year. In Kenya, 1,500 teachers died in 1999, compared to just 10 teachers' deaths in 1993. UNICEF's "Progress of Nations 2000" report notes that "all over sub-Saharan Africa, hard-won gains in school enrollment -- and the returns on investments countries have made to improve education -- are being eroded." Kenya's education system is being hit hard, as the teachers' deaths, increased staff absenteeism, and reduced attendance by pupils who must care for their parents or who can no longer afford school take their tolls. While the country stopped hiring new instructors two years ago as part of a plan imposed by the International Monetary Fund, the UNICEF regional representative for Eastern and Southern Africa, Urban Jonsson, argued it is "short-sighted" for donor nations to tell developing countries to reduce their education budgets. "All these countries need more teachers and better teachers and better-supported teachers, not less teachers," he said.

Bristol-Myers Finds Pledging AIDS Aid Is Easier Than Giving It. Bristol-Myers Squibb's 1999 announcement of a five-year $100 million donation to Botswana and four other African countries appeared at the time to be a much-needed boost to the ailing nations in their losing battle against HIV and AIDS, but activists and African humanitarian workers in the region are discovering that the funding is not easy to use because of restrictions and regulations put in the way seemingly at random by Bristol-Myers. Bristol-Myers executives' complaints that the difficulties are frustrating to them demonstrates the cultural differences between Western corporations and African nations, where Bristol-Myers has little understanding and less experience and is working at odds with the region's AIDS goal of preventing future illness, not treating those already very ill. Bristol-Myers was surprised in the early stages of the philanthropy by the low quality of grant proposals, but activists note that writing skills are reserved for the elite few in Africa, and those interested in helping the poor and sick often have little formal education and less experience with the bureaucratic processes common to Western organizations, as grant competition is unknown in Africa. The drugs company placed the restrictions on its donations, such as requiring strict record maintenance, denying the purchase of furniture or the rental of office space, and limiting the hiring of multiple employees, to prevent notoriously corrupt African governments from using the funding for purposes other than AIDS relief. However, these restrictions have essentially prevented small nonprofit organizations in Botswana from performing the relief work, despite donations as large as $400,000.

HIV Spreading in Brazil. Blood samples taken from an anonymous test site in Santos, Brazil, between 1995 and 1999 suggest that HIV infection is no longer declining in the country, according to researchers from the University of California at San Francisco and their Brazilian colleagues. The researchers noted a sharp increase in infections among heterosexual women, and they also said it appeared that drug-resistant HIV strains were being spread. Earlier research had indicated a high rate of HIV infection among homosexuals and injection drug addicts. Brazil provides free antiretroviral therapy to individuals testing positive for HIV.

Iran Warns of AIDS "Infiltration" Into Prisons. Morteza Bakhtiari, the head of Iran's penitentiary system, voiced concern Saturday about the spread of HIV in the nation's prisons. "AIDS has infiltrated our prisons and if nothing is done, society will be seriously hurt," the state news agency IRNA quoted the official as saying. While he offered no statistics on the number of prisoners with AIDS, Bakhtiari said his office would hold HIV prevention workshops for the inmates.

HIV Drugs Reduce AIDS Cases in Europe. Combination antiviral drug therapy may reduce the number of people with HIV who develop AIDS, according to European studies. Scientists from the Department of Infectious Disease at Hvidovre University Hospital in Copenhagen, Denmark, said that drug cocktails have cut the risk of opportunistic infections, but long-term studies are needed. The researchers studied 8,700 patients receiving highly active antiretroviral therapy (HAART) and found that patients taking the drugs had a lower rate of AIDS than patients not taking HAART. According to their report in the July 22 issue of The Lancet (2000; 9226), there were declines in all of the more than 20 AIDS-defining illnesses, except for non-Hodgkin's lymphoma.

Romania Has Half of Europe's Juvenile AIDS Cases. Romania has recorded almost 9,000 cases of pediatric HIV infection and accounts for over half of Europe's juvenile AIDS cases, according to Mariana Mardarescu, vice president of the country's national AIDS commission. While the nation's total number of AIDS cases is fairly low for Europe, the epidemic's impact on Romania's children has been high, as poor sanitation and unscreened blood during the Communist era resulted in thousands of infections. Statistics show that since 1985, 2,263 Romanian children and 288 adults have died from AIDS, and the number of adult infections is expected to increase, in large part due to unprotected sex. In an effort to stem the spread of HIV, Romania now requires HIV tests for individuals at high risk of infection, including people with sexually transmitted diseases or severe viral illnesses.

Former Golf Prodigy Finds Fulfillment as AIDS Caregiver. Sally Quinlan, a former member of the Ladies Professional Golfing Association tour and recovering alcoholic, has spent the last three years generating funds for Siloam Ministries, a Philadelphia interfaith organization that caters to the spiritual needs of people afflicted with HIV and AIDS. Quinlan's stint at an alcohol treatment center eventually inspired her to give up golf and do something she found more meaningful with her life. At the center, she realized that she was no better or worse than any other person. Quinlan feels that the joy resulting from giving people with AIDS a safe haven outweighs the negatives of watching them eventually surrender to a fatal disease. Prior to her association with Siloam, Quinlan had employment stints at a juvenile detention facility, a prison, and a halfway house.

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This article was provided by AIDS Survival Project. It is a part of the publication Survival News.
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