Date: Mon, 21 Mar 1994 09:30:38 -0500 (EST) From: "ANNE WILSON, CDC NAC" Subject: CDC AIDS DAILY SUMMARY 03/21/94 AIDS Daily Summary March 21, 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 1994, Information, Inc., Bethesda, MD "New AIDS Tests Promise Fast Results; Some Bring Worries" Philadelphia Inquirer (03/21/94) P. A3; Neergaard, Lauran People may one day be able to undergo HIV testing without giving blood or going to the doctor, using oral or home AIDS kits now under government review. Currently, specially trained technicians must draw vials of whole blood to conduct the tests, which cost about $75. The Food and Drug Administration says that the new tests will make learning HIV status faster, cheaper, and easier. The oral test, OraSure, is a specially padded stick that, when held between the gum and cheek, absorbs saliva and gum cells. The pad is then sent to a lab for testing. The manufacturer, Epitope Inc., and the Centers for Disease Control and Prevention have found the test to be as effective as using blood. OraSure would be administered at doctors' offices or clinics, and could cost as little as $20. The home kits are being met with more caution and controversy than the oral tests, because they raise the problem of how to counsel home testers who test positive if they never have to step foot inside of a clinic. Users would prick a finger, place a spot of blood on special paper, attach the kit's unique identifying code, and mail it to a lab. They could then obtain the results by phone. This has raised concerns among AIDS activists and state health officials, who fear this system will deliver devastating news without proper counseling. "Once you say they're positive, they don't hear anything else," says Dr. James Pearson, Virginia's director of lab testing. "You really need some kind of personal, long-term relationship to get any message across." "Middle East Should Educate Against AIDS--WHO" Reuters (03/21/94); Maclean, William The Middle East should begin to spend some of its wealth on educating its people frankly, but sensitively, on the issue of AIDS prevention, recommends Michael Merson, director of the World Health Organization's Global Programme on AIDS. Women and young people are especially important targets for AIDS education, he says, because global experience indicates that their access to power and information is limited. "Perhaps the most important prevention measure is to make sure that people have the weapons to control their lives--for example, the power to refuse sex," explained Merson. "Women and young people tend to have the least power to begin with and will require the most help." The top U.N. AIDS official cites that 75,000 people in the Middle East and North Africa are infected with HIV. "Your prevalence is still low which gives you a precious window of opportunity," he told an AIDS conference. "Unlike many other regions, you also have rich resources to harness to AIDS prevention." The explicit AIDS programs seen in the West are unheard of in the Middle East, where tradition restricts public discussion of sexual matters. "Politicians and teachers may fear parental opposition to talking about sexuality in any public forum," concedes Merson. "But we have learned from experience that people all over the world are willing to listen to candid messages once they understand that their lives, or the lives of their children, are at stake." "$30-Million U.S. Blood Bank Hunt for Rare AIDS Virus Comes Up Empty" Los Angeles Times (03/20/94) P. A25; Haney, Daniel Q. In the summer of 1992, the U.S Food and Drug Administration took a noncontroversial step in the war against AIDS and ordered all American blood banks to test the blood supply for HIV-2, a strain of the virus that is virtually non-existent in the United States. A year and a half later, after spending some $30 million testing about 20 million units for traces of HIV-2, the country's blood banks have not discovered a single infected donation. The virus is a cousin of HIV-1 that is largely confined to West Africa, with only 50 cases found in the United States. Although it is more difficult to contract than HIV-1 and causes disease more slowly, HIV-2 ultimately ends in AIDS. It is not known exactly how many Americans have HIV-2, but with no infections found in the blood supply for the past year and a half, some say that testing for the rare strain was driven as much by a fear of violating public desire for blood safety as it was by medical need. Whether the additional, costly testing is protecting the nation from an HIV-2 epidemic is unclear, but the Centers for Disease Control and Prevention says there are no signs that the strain is spreading. "Did we jump the gun, or were we very smart in implementing something before it's needed?" asked Dr. James MacPherson, head of the Council of Community Blood Centers, which represents the non-Red Cross blood banks that collect about 35 percent of the country's blood. "We need a few more years to know." "Regents Alter AIDS Guide; Ask Teaching on Condoms" New York Times (03/19/94) P. 29; Dao, James The New York State Board of Regents voted Saturday to modify its 1987 guidelines on AIDS instruction to advise teachers that HIV can be prevented in ways other than sexual abstinence, including through the use of condoms. The unanimous vote followed criticism of the board for exclusively advising teachers to preach abstinence as the only means of preventing HIV transmission. The guide, critics argued, should emphasize abstinence while also giving teachers advice about condoms, intravenous drug use, and homosexuality--all of which could help teenagers avoid infection. The revised AIDS guide would have to be approved by the Regents--possibly early next year--and sent to teachers in all of the state's 718 public school districts. The effectiveness of the changes will be difficult to gauge, for the AIDS guide is voluntary, and teachers can use all or none of it as they choose. "New HIV Prevention Initiative" Business Wire (03/15/94) The Kaiser Family Foundation is funding a four-part, $875,000 initiative designed to assess and improve HIV prevention efforts across the United States. The Center for AIDS Prevention Studies at the University of California--San Francisco will oversee one part, "HIV Prevention: Looking Back, Looking Ahead." This project will evaluate prevention programs and analyze which strategies are most effective. The Harvard AIDS Institute will focus on "Clinicians' Role in HIV Prevention." The institute will work with the leading physician groups, such as the American Medical Association and the American Association of Medical Colleges, to develop guidelines and recommendations for how physicians can incorporate HIV prevention into routine care. The third segment of Kaiser's new initiative is "International Experience in AIDS Prevention." Family Health International of Research Triangle Park, N.C., will coordinate a review of HIV prevention strategies in developing countries to determine which ones might be effective in the United States. The final component is "AIDSnet Online Network," which will be handled by HandsNet, a national nonprofit communications network. HandsNet will design and implement an online computer forum to distribute the most up-to-date information on HIV prevention, policy, funding, and clinical trials. "Boston Groups to Get AIDS Funds" Boston Globe (03/19/94) P. 84 Boston will receive $3.9 million in federal emergency relief under the Ryan White AIDS Care Act of 1990, announced Sen. Edward M. Kennedy (D-Mass). According to Kennedy, the chief Senate sponsor of the law, the funds will be allocated to more than 30 organizations that provide primary care, home care, and other services for AIDS patients in the Greater Boston area. "Gilead Sciences Begins Human Clinical Trials of Topical GS 504 for HPV-Associated Genital Warts" Business Wire (03/15/94) Gilead Sciences Inc. has begun human clinical testing of its drug candidate GS 504, for the treatment of genital warts caused by the human papillomavirus (HPV) in HIV patients. The study will evaluate the safety and potential efficacy of topical GS 504 when applied once daily to genital warts. The first patient in the dose-escalation study is being enrolled at the University of Washington; however, the trial will also be conducted through the Conant Medical Research Group in San Francisco and the Houston Clinical Research Network. Recent studies suggest that progression of genital warts, the most common form of sexually transmitted disease, may be accelerated in patients infected with HIV. "GMHC Hit With Bias Charge" Advocate (03/22/94) No. 651, P. 11 The Gay Men's Health Crisis, the nation's oldest and largest AIDS service organization, is facing charges of AIDS discrimination. James Fielding, a staffer at the New York City-based agency, charges in a lawsuit that his career advancement at GMHC was blocked after he registered for AIDS counseling at the center in June 1992. According to GMHC spokesman David Eng, however, many people with AIDS work at the agency, and GMHC officials believed the suit will be rejected. Fielding's lawsuit, which is seeking $1.75 million in damages, is the first discrimination case filed against GMHC, said Fielding's attorney, Nancy Tainitor. "High-Compliance Tuberculosis Treatment Programme in a Rural Community" Lancet (03/12/94) Vol. 343, No. 8898, P. 647; Wilkinson, David The worldwide tuberculosis epidemic is fueled by dual infection with HIV type I. Short-schedule chemotherapy works effectively but falls short for operational reasons. About 89 percent of patients finished treatment under clinic conditions in a community-based program of twice-weekly fully monitored therapy. Nonhealth professionals successfully monitored half the patients. David Wilkinson argues that scientists need to take new methods to fight the international TB epidemic. "Don't Mince Words Regarding HIV Infection" American Medical News (03/07/94) Vol. 37, No.9, P. 21; Phillips, William R. Communication is critical to clinical care, says William R. Phillips, MD, MPH, of Seattle. The HIV epidemic is threatening public health, yet the terminology related to the virus seems to downplay the danger, he says, calling it "evasive." Phillips notes that someone who is infected is said to be "seropositive;" however, there is nothing positive about being HIV-positive. How can the message about AIDS prevention get through when people prefer to say that a person "seroconverted," rather than simply admit that they were infected, he asks. Seroconversion, he contends, is referred to as if it were a religious conversion and not a life-threatening crisis. Finally, the term "seroprevalence" simply does not seem strong enough to impart the great burden of HIV disease, disability, and death, says Phillips. Plain talk is better, he says, with clear thinking and effective messages usually producing results. HIV is a communicable disease, he concludes, and doctors must communicate about it clearly with themselves, their patients, and their communities.