Date: Thu, 10 Feb 1994 09:19:09 -0500 (EST) From: "ANNE WILSON, CDC NAC" Subject: CDC AIDS DAILY SUMMARY 02/10/94 AIDS Daily Summary February 10, 1994 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 "Confusion Feared When AIDS Vaccine Tests Grow" Philadelphia Inquirer (02/10/94) P. A4 (Collins, Huntly) As AIDS vaccine trials are stepped up, the government is preparing to deal with the confusion that results when uninfected trial participants test positive for HIV. Although vaccines have so far proven to be safe, they do produce antibodies in the blood; therefore, individuals who have been inoculated with a protective AIDS vaccine will likely test HIV-positive on ELISA blood tests, even though they are not actually infected. Because ELISA is routinely used as a screening mechanism by insurance companies, the Job Corps, the military, and other agencies, the confusion has already created problems for a few uninfected volunteers participating in small-scale, preliminary trials. They have had run-ins with insurance companies, the Immigration and Naturalization Service, the ROTC, and the Peace Corps, for example. "What we have is a society that discriminates against HIV-positive people," says Sten H. Vermund, chief of AIDS vaccine trials at the National Institutes of Health. Most often, these misunderstandings have been straightened out with a letter or phone call from the government, but there are concerns about upcoming large-scale trials, which will enroll more than 10,000 volunteers. The government is trying to modify a more sophisticated HIV test that can distinguish between natural infection and vaccine-induced infection. Known as polymerase chain reaction, the test is expensive and can only be conducted in state-of-the-art labs. Scientists are working on a less costly version. "Five Charged in German AIDS Blood Scandal" Reuters (02/10/94) Bonn--Employees from a German pharmaceutical company that was shut down in the wake of a national AIDS scandal have been charged with neglecting to protect their blood products from infection. Two managers and three scientists from UB Plasma stand accused of failing to screen blood supplies for HIV in order to save money, said Koblenz prosecutor Norbert Weise. They have been charged with grievous bodily injury over three cases in which hospital patients were found to be infected with HIV. They also face charges of attempted bodily injury over sales of $8.5 million worth of potentially infected plasma to hospitals and other pharmaceutical firms. Weise said he would have preferred to press manslaughter charges, but admitted that it was impossible to prove that the five defendants had been willing to kill anyone, even though AIDS is fatal. If convicted, the UB Plasma staffers could spend as many as 10 years in jail. "Nigerians Wake Up to AIDS Scourge" Reuters (02/10/94) (Jukwey, James) Lagos--After years of denying the deadly threat of AIDS, Nigerians today are openly discussing the epidemic, and alarming statistics are being reported on the scourge of the disease in this most populated country of Africa. The epidemic was not identified there until 1986, and since then, only about 971 cases of full-blown AIDS have been reported, says Dr. Abiola Tilley-Gyado, national coordinator of Nigeria's national AIDS control campaign. But experts know that in this population of 88.5 million people, most diseases are under-reported--especially AIDS, because of its novelty and stigma. From surveys conducted throughout the country, Tilley-Gyado's unit calculates that there are at least 650,000 HIV-positive Nigerians. Casual sex is the primary means of transmission in Nigeria, where one man can have several wives as well as mistresses. After finally admitting the AIDS problem, the country has launched a massive campaign to control the spread of the disease. Each state now has an AIDS coordinator and all 589 local governments have units dealing with the disease. Television and radio messages are common. Tilley-Gyado says her campaign stresses behavior modification--such as chastity before marriage and intra-marital fidelity--rather than condom use. Flourishing condom sales, however, suggest that perhaps Nigerians cannot alter their sexual attitudes, but do want to protect themselves. The British government has helped establish two screening centers in each state, and the United States has allocated $15 million for an AIDS program in Nigeria. "Clinton Unveils Anti-Drug Strategy With More Money" United Press International (02/09/94) (Gruenwald, Juliana) Upper Marlboro, Md.--President Clinton yesterday introduced "a new national attack on drug addiction" that emphasizes prevention, treatment, and education. Through $355 million in increased funding, the new drug policy will provide treatment for more than 140,000 chronic drug users each year. Clinton said the strategy, which he believes to be the most comprehensive ever, will tackle problems linked to drug abuse--including violent crime, increased health care costs, and the spread of AIDS. "State Health Officials to Release a Comprehensive Plan for Combatting Tuberculosis in California" Business Wire (02/09/94) State health officials are preparing to unveil a comprehensive strategy for battling tuberculosis in California, which accounts for 20 percent of the nation's TB cases. Although it is preventable, efforts to control the recent upsurge in TB have been complicated by the related HIV epidemic, as well as the increase in drug abuse and immigration from countries with a high prevalence of TB. Health officials are particularly disturbed by the rise in multi-drug resistant strains of TB, which can occur in patients who neglect to follow the necessary treatment regime, or who receive improper treatment. "Big City Hospitals in Flux" Advocate (02/08/94) No. 648, P. 18 Public health systems are the only treatment options for HIV patients who have no insurance. But with the approaching health care reform, the face of those systems is changing, and San Francisco may well be the harbinger of such evolution. The municipal health department there on Jan. 4 announced that it will overhaul the city's entire hospital system in hopes of keeping it afloat in the changing times. Under the plan, San Francisco General Hospital, the city's public facility, will focus on AIDS care and other areas in which it is strongest in an effort to coax back insured patients who are increasingly looking to private facilities for treatment. Industry insiders predict these changes may occur soon as big urban public hospitals like Bellevue in New York City and County-USC in Los Angeles try to carve out niches to attract insured patients who have their choice of hospitals. By forcing public facilities to raise the overall level of AIDS services, AIDS policy analysts say the competition may ultimately favor people with AIDS, regardless of whether or not they are insured. "AIDSWatch: Calling All Guinea Pigs" Men's Fitness (02/94) Vol. 10, No. 2, P. 98 People who are at risk for HIV infection could enroll in an AIDS vaccine trial as early as this year. Participation, however, is not without risk. For example, participants will not know whether they are receiving an experimental vaccine or a placebo. Furthermore, it is unlikely that any vaccine in current development will be anywhere near 100 percent effective. In addition, if a trial volunteer does receive a vaccine, it may fail to protect; in fact, it could even harm the participant. Also, those receiving a vaccine could develop antibodies, which might cause the volunteer to falsely test HIV-positive. Faced with all of these risks, what motivates the majority of people who want to participate in these trials? According to Kathleen MacQueen of the Centers for Disease Control and Prevention, altruism is the motivating factor. MacQueen has interviewed 1,386 HIV-negative homosexual men in San Francisco, Denver, and Chicago. Of those, 73 percent said that, despite doubts and reservations, they are definitely or probably interested in participating. Researchers at Johns Hopkins University have conducted similar interviews with intravenous drug users in Baltimore. "Where All That AIDS Money Is Going" Fortune (02/07/94) Vol. 129, No. 3, P. 139 (Nulty, Peter) The anti-AIDS effort may well be the most visible charity in search of private donations as well as the most persistent lobby in search of government funding. AIDS is getting a good deal of money because the disease is deadly, communicable, and--as one health official puts it--"out of control." Some critics, however, imply that the disease is taking up more than its fair share of resources. In 1992, the amount of money spent on each life lost to AIDS totaled about $38,500 compared to $3,700 for cancer and $1,000 for heart disease. In contrast, AIDS only accounted for 34,000 deaths, while 500,000 died from cancer and 700,000 died from heart disease. Some people, like author Michael Fumento, grumble that the distribution represents a bias toward AIDS. "The blunt fact is that people will die of these other communicable diseases because of the overemphasis on AIDS," says Fumento in his controversial book, "The Myth of Heterosexual AIDS." But, as Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, explains, AIDS takes fewer lives, but kills younger people. Calculating years of potential life lost, AIDS is at least as devastating as cancer and worse than heart disease. Where is all of this money going? Charitable donations to the 18,000 or so individual AIDS charities added up to between $575 million and $850 million in 1992. The three largest fundraisers were the American Foundation for AIDS Research, the Gay Men's Health Crisis, and AIDS Project Los Angeles. All of the organizations tend to focus on services--nursing, food, counseling, and education, while they leave research to the government. "Partner Notification Programs Seek Less Controversy, More Sensitivity" AIDS Alert (01/94) Vol. 9, No. 1, P. 11 More flexible intervention techniques can improve the outcome of partner notification, according to recent studies. But unless there is a "change in community norms, so that the expectation is that telling your partner is appropriate," says Georgia epidemiologist Kathleen Toomey, many HIV-positive patients will continue to avoid notifying their partners. With states grappling over confidentiality laws and providers struggling with ethical issues, partner notification for HIV infection has emerged as a confidential and voluntary choice. Currently, all 50 states provide patient notification, some more comprehensive than others. The biggest issues facing partner notification, according to Toomey, are better training for counselors and improved collaboration with private physicians. Because doctors are not held legally liable for notifying or failing to notify partners, many are not inclined to promote the practice and often avoid the issue completely, agrees Ronald Bayer, a professor of public health at Columbia University. Other obstacles in the way of partner notification come from the patients themselves. Some never return to receive their HIV test results or don't show up for post-test counseling. A study by the Centers for Disease Control and Prevention found that, for those that refused to notify partners, about half feared a breakup. The most common response, however, was that the patient could not locate all partners. The CDC is trying to analyze different partner notification strategies to determine which works best for health departments and clinics. "Story Telling and HIV Prevention" Focus (01/94) Vol. 9, No. 2, P. 8 The early success of an HIV prevention program in Detroit suggests that story telling can prompt Hispanic families to talk about HIV-related topics, and help parents discuss AIDS with children. The program aims to let participants share their HIV-related behaviors, knowledge, attitudes, and beliefs. A second goal is to enable participants to identify effective prevention strategies at individual, family, and community levels. Finally, it seeks to encourage participants to model HIV-related family communication techniques to each other. The program is based on the idea that discussion helps participants clarify their understanding of the story and adopt communication skills and HIV prevention into their lifestyles. At sessions which are attended by several families, a counselor presents a story which, while basic, is helpful in opening up discussions that explore what families know and feel about HIV. Early evaluation of the program indicates that the story telling technique is well-accepted by both the counselor and the participating families. It also appears to be effective in increasing knowledge, developing skills, and conquering attitudinal barriers, prejudices, and myths about HIV.