Articles in the Newsline section were abstracted by the National Prevention Information Network (NPIN) of the U.S. Centers for Disease Control and Prevention (CDC).
City Fined on Failing to Shelter AIDS Patients
State Supreme Court Justice Emily Jane Goodman found the administration of New York City Mayor Rudolph Giuliani in contempt of a 1999 decree requiring that homeless people with AIDS be housed on the same day they seek help. Goodman ruled that the city's AIDS service agency had failed to house five such people and imposed fines of $250 for each person for each night housing was denied, plus reimbursement of their legal bills. The judgment is expected to total in the tens of thousands of dollars. The justice reserved decision on 17 other people who said they were also denied prompt shelter.
City officials called the decision unfair and said they would appeal. "To be in contempt, there has to be a significant violation," said Lorna Bade Goodman, spokesperson for the city's Corporation Counsel. "There were only five cases, and they were all in housing by the next night." But Housing Works, the nonprofit group that won the original court order and organized the latest case, called the city a flagrant violator. Armen H. Merjian, attorney for the group, said the instances in question were "just a sample of at least hundreds of cases." Merjian told of homeless persons being sent to addresses that were not accommodations or to remote hotels where they were not allowed to register. "The basic problem is the city's failure to build more housing for people with AIDS and diverting millions of dollars in federal funds earmarked for housing," he said. City officials countered that New York does more for homeless persons and those with AIDS than any other city. (New York Times (05.19.01) Bruce Lambert)
AIDS in Prisons
"Tens of thousands of prisoners around the country are infected with the virus that causes AIDS, making prisons one of the most potentially dangerous incubators of the epidemic," began the editors. Such a concentration of HIV-infected prisoners "means that healthy inmates run an increased risk of catching the disease by having sex or sharing hypodermic needles with them -- behaviors that are illegal but widespread in American prisons." But most prisons "ignore these risks" and do not provide "adequate tools to slow the spread of the virus. Only a few prison and jail systems in the country offer condoms for safer sex or bleach to disinfect needles. This is shortsighted. Officials should not only work to reduce prisoners' risk of catching AIDS in prison, they should also help a captive audience learn about safer practices in a way that would stick when the inmates returned to the community," asserted the editors.
Although "the amount of AIDS transmission in prison is unknown . . . there is anecdotal evidence that people have gotten HIV in prison, and it is very likely that the number is high," the editors wrote. One Tennessee study "found that 28 percent of inmates reported injecting drugs in prison. Since needles are rare behind prison walls, they are almost always shared, accelerating the spread of AIDS," they wrote. The editors also pointed to consensual homosexual behavior and forcible sex as modes of HIV transmission among prisoners.
"Education about AIDS prevention is often not done in a way that resonates with prisoners, and such programs need to be linked with health care on the outside so that patients on antiretroviral drugs continue their treatment. . . . Prison offers the opportunity to give these high-risk people the medical care and AIDS education they will not get once outside," the editors concluded. (New York Times (05.21.01))
The Impact of Harm-Reduction-Based Methadone Treatment on Mortality Among Heroin Users
Users of intravenous drugs are at increased risk of premature mortality. The most important natural causes of death among those using intravenous drugs are infections -- AIDS, hepatitis, endocarditis -- that are acquired largely through non-sterile injection practices. The HIV epidemic has greatly increased the mortality rate of this population, but in most countries overdose is still the predominant cause of death among drug users.
The purpose of the study was to evaluate the impact of harm-reduction-based methadone programs on the mortality of heroin users. Researchers performed a prospective cohort investigation among 827 participants in the Amsterdam Cohort Study. Of the 827 drug users, 60 percent were male and 27 percent were of foreign nationality. Mean age was 31.0 years, and 27 percent were HIV-positive. Seventy-seven percent had a history of drug injection, and the mean injection use was 10.0 years. Sixty-two percent used more than one type of hard drug, most often a combination of heroin and cocaine. Methadone was received in low-threshold programs for 65 percent of participants, medium-threshold for 16 percent, high-threshold for 3 percent and other (received in jails, or not at all). Poisson regression was used to identify methadone maintenance treatment characteristics that are significantly and independently associated with mortality due to natural causes and overdose.
Methadone treatment was defined by most recent methadone dosage, mean dosage, frequency of program attendance, most recent type of program and main type of program. Population characteristics were adjusted for variability. These included socio-demographic characteristics, physical and mental health and drug use. The second set of characteristics included HIV status.
Mental health was assessed through a General Health Questionnaire. Drug use information included years since first drug injection; years since initiative of regular heroin use; frequency of current use of heroin, cocaine, barbiturates, tranquilizers; total number of illicit drugs currently used and drinks of alcohol per day.
According to the investigators, 89 participants between 1985 and 1996 died of natural causes, and 31 died as a result of overdose. After controlling for HIV and underweight status, "there was an increase in natural-cause mortality among subjects who left methadone treatment (relative risk [RR]= 2.38, 4.55). Leaving treatment was also related to higher overdose mortality, but only among injection drug users (RR=4.55, 95% CI=1.89, 10.00)."
In conclusion, the investigators pointed to results indicating that "harm-reduction-based methadone treatment, in which the use of illicit drugs is tolerated, is strongly related to decreased mortality from natural causes and from overdose. Provision of methadone in itself, together with social-medical care, appears more important than the actual methadone dosage." (American Journal of Public Health (05.01.01) Vol 91; No 5: P 775-780. Miranda W. Langedam, Ph.D.; Geil H. A. van Brussel, M.D.; Roel A. Coutinho, M.D., Ph.D.; Erik J. C. van Ameijden, Ph.D.)
Changing America and AIDS: Asian Americans and Pacific Islanders
According to US Surgeon General David Satcher, current data indicate that less than 1 percent of reported US AIDS cases are among Asian Americans/Pacific Islanders (AA/PIs). Satcher listed a number of reasons to believe that this is a great under-representation of the incidence of HIV/AIDS in this population. HIV/AIDS data on AA/PIs is partial and hides risks. Additionally, there is a lack of visibility of the increase in the epidemic around the world. Currently, 36 million people are living with HIV/AIDS, including an estimated 6 million to 7 million people in Asian and Pacific Basin nations.
AA/PIs make up 4 percent of the US population and are the fastest growing racial/ethnic group. With 40 cultures and 100 languages spoken, little research has been done on the roles of culture and language on health status and health seeking behaviors. According to the article, "AA/PI communities have over 5,500 reported AIDS cases out of the 753,907 in the US to date. Nearly 75 percent of cases were found among this diverse population's gay and bisexual men. A six-city study by the Centers for Disease Control and Prevention (CDC) found that among young gay and bisexual Asian American and Pacific Islander men in the US, 3 percent were HIV-positive."
There are other risks ahead. About 40 percent of Asian Americans and Pacific Islanders have limited English proficiency, with Southeast Asians having the highest rates of linguistic challenge (70 percent). About 1.4 million, or 13 percent, of AA/PIs in 1998 were living at or below the federal poverty level. "Several studies have shown that those who are linguistically isolated also lack knowledge about HIV transmission and are more likely to believe myths about who is at risk."
The lack of written materials in the native language is a clear obstacle, but addressing cultural attitudes is even tougher. "I don't know any community that readily discusses sexuality, especially homosexual and bisexual behaviors," Satcher wrote. ". . . It is not a stretch to say that homophobia leads many gay/bisexual men to participate in high-risk behaviors and that stigma associated with HIV/AIDS leads many to not seek testing or treatment for their disease."
Satcher's initiative, The Leadership Campaign on AIDS (TLCA), is working on issues of HIV among communities of color to support leadership involvement. In addition, the White House Initiative on Asian Americans and Pacific Islanders has, in recent years, crafted its recommendations on actions dealing with a broad array of issues including health, human services, education, housing, labor, transportation and economic and community development. Its Web site (www.aapi.gov) outlines action items.
In conclusion, Satcher emphasized that "Asian Americans and Pacific Islanders are a significant part of our ever-changing nation, and we must include them when putting together our priorities, funding, and programs. This sustainable drive must come from AA/PI and public health leaders." To learn more about TLCA, visit: www.surgeongeneral.gov/aids/tlcapage1.html. (US Surgeon General David Satcher, MD (O5.01))
"Quilt's Message Endures"
Two decades after the CDC first reported that a deadly new disease had begun circulating among young gay men in Los Angeles, the AIDS Memorial Quilt remains a powerful icon of the epidemic and a uniquely personal view of the social, political and cultural impact of AIDS. In his book, Stitching a Revolution: The Making of an Activist (written with Jeff Dawson), Cleve Jones said he conceived the idea of the quilt on Nov. 27, 1985, as he and other demonstrators papered a wall of San Francisco's old Federal Building with cardboard sheets bearing the names of those who had died of AIDS. "It reminded me of a quilt, like the one made for me by my grandmother," he wrote.
Jones felt a quilt would be a "comfortable middle-class symbol" that most people could accept. As it grew, the quilt earned a reputation as "the battle flag in the war against AIDS." Thousands of panels honoring gay white men were soon joined by others memorializing hemophiliacs, African-Americans, Latinos, children and women. In 1996, when the quilt was displayed for the fifth time in Washington, D.C., its 50-ton expanse reached from the Washington Monument to the doors of Congress. (USA Today (05.29.01) Steve Sternberg)
Health Officials Express Concern over Infection Rate of Young Gays, Bisexuals
Gay men too young to remember the earliest reports of AIDS are now spreading the disease at alarming rates that remind US health officials of the epidemic's explosive first years. According to a government survey, 4.4 percent of gay and bisexual men ages 23 to 29 are newly infected each year with HIV. Among blacks in the same age group, 14.7 percent, or one in seven, become HIV-positive each year.
"The numbers we're publishing right now are more like the findings you see in the '80s than the findings you see in the '90s," said the CDC's Linda Valleroy, who led the survey in which 3,000 gay and bisexual men were tested anonymously between 1998 and 2000 in Baltimore, Dallas, Los Angeles, Miami, New York and Seattle. The survey, timed to mark the 20th anniversary of the discovery of AIDS, is the government's most sweeping evidence yet of a resurgence in the disease among young gay men. The one-in-seven infection rate for young black gays and bisexuals is roughly the same as the current rate in South Africa, Valleroy said.
"People don't perceive that you get infected and you die in two months anymore," said Phill Wilson, executive director of the African-American AIDS Policy and Training Institute at the University of Southern California. "There's all these posters around that say you can climb mountains and do whatever with HIV and AIDS. There's not enough messages about the price you have to pay."
"We have to stop and take a look at the devastation that potentially could occur among these young men," said Dr. Helene Gayle, the CDC's AIDS chief. "These are precious and important lives." The CDC wants to cut the number of new US infections from the current 40,000 annually to below 20,000 in five years, chiefly by improving prevention, targeting at-risk groups and urging more Americans to be tested for HIV. (Associated Press (05.31.01) Erin McClam)
Second Lot of Counterfeit Serostim Surfaces, Serano Warns Customers
A lot of drugs labeled as Serano's AIDS-wasting medication Serostim (somatropin, rDNA origin), bearing the lot number MNH605A, is counterfeit, the Norwell, Mass.-based Serano said. The company has sent notice to wholesale distributors, pharmacies, physicians and AIDS service groups telling them to immediately return any product labeled with that lot number. An investigation by the Food and Drug Administration has so far revealed that the fake product contains a "small amount" of human growth hormone -- but not the recombinant human growth hormone used in Serostim -- and "significantly less" growth hormone than the genuine product, said Serano spokesperson Carolyn Castel. (Reuters (05.18.01))
Discrepancies in People with AIDS May Be Linked to Gene Variation
Scientists have found a common genetic variation that may help solve the long-standing mystery of why HIV is rapidly lethal in some people yet takes decades to affect the health of others. The discovery, published in today's New England Journal of Medicine (Vol 344; No 22: P 1668-1675), ultimately could help in developing a vaccine against the AIDS virus. The discovery could also allow physicians to design an individualized medical plan for each patient, with those most at risk of quick progression getting the strongest doses of drugs at an early stage.
The genetic variation, called "Px," is present in about 12 percent of the population. It is only slightly different from other versions of a gene that acts as a critical part of the body's defenses against foreign invaders, such as HIV. The variation is benign in people who aren't infected with the virus, and it may even help by boosting the body's defenses against malaria, said study senior author Mary Carrington, an immunologist at the National Institutes of Health.
However, in the study of 850 people, the presence of the Px gene variation appeared to accelerate the onset of full-blown AIDS by four to five years. In the study group, it took only about seven years after infection for half of those with Px to develop full-blown AIDS, compared with about 11 to 12 years for those with other versions of the gene. One theory for this difference holds that the Px gene is "just sitting there and not doing its job" in AIDS patients, Carrington said. Another holds that "it may be actively damaging" to the body's defenses against the disease, she added. (Wall Street Journal (05.31.01) Laura Johannes)