>From: "ANNE WILSON, CDC NAC" >Subject: CDC AIDS Daily Summary 12/28 >Date: Tue, 28 Dec 1993 13:53:38 GMT AIDS Daily Summary December 28, 1993 The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse makes available the following information as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1993, Information, Inc., Bethesda, MD "Free Needles a Sticking Point in Neighborhood" Philadelphia Inquirer (12/28/93) P. B1 (Copeland, Larry) Concerned about morality and respect, residents in a Philadelphia neighborhood want a clean needle exchange program removed, but health officials refuse to budge. The program was implemented in an effort to curb the spread of AIDS in the city. Each Saturday, a van operated by a Public Health Department contractor pulls up to the corner of Kensington Avenue and Cumberland Street, where it dispenses some 3,000 clean syringes to intravenous drug users. But, insists Assistant Philadelphia Health Commissioner Mark Bencivengo, "This is much, much more than just a needle exchange." He adds that the van also offers condoms, educational material, medical information and services, and testing for tuberculosis. Nevertheless, the van has become a controversial subject. Neighborhood residents want the van moved several blocks away, where there is less opportunity for children to find used needles. They note that the current exchange site is within five blocks of four schools, and recount finding and collecting pails of discarded needles. Residents also claim that the needle exchange draws more drug addicts to their area, and merchants say the users are having an unfavorable effect on their businesses. Health authorities, however, claim that relocating the program would reduce the effectiveness of the program. Moving the van even a short distance could mean losing some of the people who use it, which defeats the purpose of the program, explains Bencivengo. "Children for Sale in Thailand" Washington Post (12/28/93) P. A1 (Branigin, William) Protected by police corruption, Thailand's commercial sex industry--particularly among child prostitutes--continues to boom despite the risk of AIDS. Many child prostitutes have tested positive for the virus, and thousands of other young girls are still in brothels across the nation. In Thailand, many clients specifically seek out young girls, believing them less likely to be infected with the AIDS virus. In actuality, the reverse may be true, for the young girls are far more likely to suffer vaginal wounds, which aid transmission of the virus. According to Saisuree Chutikul, an adviser on child protection in the prime minister's office, there are some 200,000 commercial sex workers in Thailand, 50,000 to 80,000 of which are under the age of 18. The Rev. Lauren Bethel, who operates the New Life Center shelter for rescued minor prostitutes, notes that while brothel owners provide the girls with birth control pills, they rarely are able to use condoms. "Usually the customers are drunk, and most of them aren't using condoms," she said. The young prostitutes, consequently, are increasingly becoming infected with the AIDS virus. But, according to Bethel, many of them do not comprehend the disease or know how the virus is transmitted. "Philippine Church Leader Condemns Use of Condoms" Reuters (12/27/93) Manila, Philippines--The most influential religious official in the Philippines declared on Monday that health authorities who promote contraception are evil and that young people ought not to believe that condoms can prevent transmission of the AIDS virus. Through sterilization and contraception, the "Evil One" hopes to prevent God from creating new life, declared Cardinal Jaime Sin, the Roman Catholic archbishop of Manila. "Do not be deceived by those who say that sexually transmitted diseases can be stopped by external devices and gadgets," his message warned. "Man-made devices are bound to fail. Only a small number of failures is required for the AIDS virus to spread rapidly." While the archbishop declined to name any specific official, the church has in the past attacked Health Secretary Juan Flavier for his advocacy of condom use to stem the spread of AIDS in the Philippines. Some 500 Filipinos are registered in the health department with an HIV-positive diagnosis, but Flavier challenges that the true number of infections is closer to 50,000. "Russia's Dirty Little Secret" Business and Society Review (Fall 1993) No. 87, P. 21 (Lewis, J. Patrick) First detected with the death of a Leningrad prostitute seven years ago, AIDS is Russia's "dirty little secret." Known in Russian as SPID, the country initially blamed the disease on foreigners or a plot by the CIA. Official statistics dictate that only 73 people have died from AIDS in Russia, and only 750 more are infected with the AIDS virus. But the truth, according to one American health official working in Moscow, is that these official figures grossly underestimate the problem. Many children have been exposed to HIV through blood transfusions and unsanitary needles, yet there has been no public outcry or sympathy. Instead, people with AIDS are treated no better than lepers; some have even had their homes set afire. And although Boris Yeltsin lifted the ban on homosexuality a year ago, staying in the closet still seems the safest thing for gays in this sexually repressive society. Not surprisingly, little has been done to educate people about AIDS transmission and prevention. Imported condoms are more widely available, but the expensive price places them out of the reach of most. Soviet-made condoms, while cheap, are highly unreliable. "Program Dedicated to Gay Adolescents Fills Support Gap" AIDS Alert (12/93) Vol. 8, No. 12, P. 188 Gay youths, who account for nearly one-quarter of U.S. adolescent AIDS cases, are at a higher risk for the virus than are heterosexual youths, yet they have fewer support systems and information resources for the disease, reports Gary Remafadi, director of one of the country's first AIDS prevention programs for homosexual adolescents. "Because they face such an extraordinarily high exposure to HIV, they need very good help--and few schools and communities offered that assistance," says Remafadi, an assistant professor of pediatrics at the University of Minnesota School of Medicine in Minneapolis. To better meet these needs, the University of Minnesota established its AIDS prevention program for gay and bisexual males under 21 who are HIV-positive or at high risk for infection. More than 500 youngsters have used the service, which provides risk-reduction counseling and peer education, as well as HIV testing and treatment. The program also focuses on such issues as the misconception that protection is not necessary with steady partners, coercion to have unprotected sex--particularly by an older partner, substance abuse, and self-destructive tendencies. The program is funded with state and local dollars, and its success is documented, although such a program is still too controversial for many communities. "AIDS" Advocate (12/28/93) No. 635, P. 15 In 1992, AIDS was the second leading killer of young Americans aged 25 to 44, according to statistics released in November by the Centers for Disease Control and Prevention. That year, AIDS was also the leading cause of death for young American men--including the No. 1 killer of young black men and young Latino men, and the No. 2 killer of young white men. Among women, AIDS was the fourth leading cause of mortality for young American women of all races--including the No. 2 killer of young black women, and the third leading cause of death for young Latino women. "A Slippery Defence Against HIV" Lancet (12/18/93-12/25/93) Vol. 342, No. 8886/8887, P. 1500 (Thompson, Clare) Mucosal-associated lymphoid tissue accounts for the largest area of immunologically active tissue in the body, the busiest of which is mucosa of the gastrointestinal tract, which is perpetually dealing with pathogens picked up in food. Ways of using this area for host defense have not been extensively explored, but the possibilities for immunotherapy against diseases of the mucosal surface are significant. One of the most exciting new applications is a possible vaccine for HIV. Lehner et al. theorize that stimulation of secretory IgA in the body areas most at risk for HIV transmission, such as the vaginal, rectal, and genitourinary mucosa, will prevent the virus from crossing the epithelium and entering the immunologically active area below. The researchers also hope for a general action on mucosal-associated lymphoid tissue. If their theory is correct, IgA antibodies directed at the gut could produce secretory IgA antibodies in the respiratory, salivary, and genital areas, as well as other mucosal sites. While they sound promising, one must view these theories with caution. The strategy depends heavily on at least one crucial factor: if the vaginal, rectal, or genital epithelium is torn in any way, increased secretory IgA will be fruitless. If the primed T and B cells in the epithelium act as a second line of defense, however, the future of mucosal vaccination is even more promising. "Clinical Manifestations of AIDS in the Era of Pneumocystic Prophylaxis" New England Journal of Medicine (12/23/93) Vol. 329, No. 26, P. 1922 (Hoover, Donald R. et al.) Pneumocystic carinii pneumonia once occurred in as much as 75 percent of the AIDS population. Prophylactic regimens against the infection are not known to alter HIV or immune function, nor do they protect against other AIDS-related conditions--except toxoplasmosis--or directly alter the patho-psychologic processes leading to other AIDS-related illnesses. By preventing or delaying death from p. carinii pneumonia, however, prophylaxis does shift the clinical manifestations of HIV infection from p. carinii pneumonia to illnesses that occur when immune function is more suppressed. Researchers must now determine what other AIDS-related conditions should be targeted for further prophylaxis and treatment. Hoover et al., therefore, conducted a study of 844 men with AIDS. The results indicated that prophylaxis could delay the onset of the first AIDS-related illness by six months to a year. The study also concluded that only four--myobacterium avium, esophagus candidiasis, wasting syndrome, and cytomegalovirus disease--out of thirteen AIDS-related conditions were observed to surface more often in patients who received prophylaxis against p. carinii pneumonia than in those who did not.