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The HIV Update
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Volume 3, Number 47
September 18, 2002
In this edition:
- New York HIV Partner Notification Law: Increased Testing, New Momentum
for Notification-based Prevention
- AIDS-Related Deaths and Syphilis Infections Declining in the U.S.
- D.A., Health Commission Ignore Pleas for Help from Man Infected with HIV
by Former San Francisco Official
- Los Angeles Prostitute's HIV-Related Charge Dropped in Plea Bargain;
- Vets Home Failed to Notify Patient We Had HIV
- Judge Orders New York City to Provide Proper Housing for Homeless AIDS
Patients
- In Midst of Syphilis Outbreak, Detroit Health Department Fires 2
- HIV Risk Prompts San Francisco Official to Call for Ban on N-9 Spermicide
New York HIV Partner Notification Law:
Increased Testing, New Momentum for Notification-based Prevention
Most people who test positive for HIV are willing to participate in
partner notification programs, a survey of New York City individuals seeking
HIV testing has found. In 1998, New York State legislators passed an
amendment to the public health law mandating partner notification for people
newly diagnosed with HIV, note Dr. Alex Carballo-Dieguez of the New York
State Psychiatric Institute and colleagues.
"Before the partner notification law passed, there were a lot of
questions. Will people continue to be tested confidentially, or will they
avoid testing?" explained Drew De Los Reyes, director of the David Geffen
Center for HIV Prevention and Health Education at Gay Men's Health Crisis in
New York. "We saw no drop in numbers at all. As a matter of fact, we've
seen a slight increase in the numbers being tested, with a return rate over
99 percent." He believes this is one of the best return rates in the
country for HIV testing sites.
"Perhaps no area of STD research has been more neglected than partner
notification," Dr. Matthew R. Golden, from the University of Washington in
Seattle, writes in an editorial accompanying the article by Carballo-Dieguez
and colleagues. "Fortunately, some momentum appears to be developing in
support of a renewed emphasis on this longstanding disease control
activity."
According to reports, not all HIV-infected individuals do personally
notify current or past sex partners, Carballo-Dieguez and his colleagues
write. Therefore, if he or she does not, the healthcare provider should do
so, they conclude. De Los Reyes noted that he and his associates are
planning to publish details of their methodology within the next year.
The successful HIV partner notification law was authored by
Assemblywoman Nettie Mayersohn (D-Queens) and opposed by nearly all AIDS
advocacy organizations. A federal companion bill‹which was never passed--
authored by Congressmen Gary Ackerman (D-NY) was also opposed by AIDS groups
and the federal Centers for Disease Control and Prevention. Both proposals
were, however, supported by the Children's AIDS Fund and the American
Medical Association.
[Sexually Transmitted Diseases 2002, 29:465-471, 472-475; Reuters Health,
9/18/02]
AIDS-Related Deaths and Syphilis Infections Declining in the U.S.
AIDS-related deaths and syphilis infections are declining in the
United States, according to a new Centers for Disease Control and Prevention
report on the state of health in America. The report, titled "Health,
United States, 2002," analyzes health trends spanning the second half of the
20th century.
The syphilis rate in 2000 dropped to 2.2 cases per 100,000 people,
marking the lowest infection rate since national reporting of the disease
began in 1941. The report noted, however, that the average annual rate of
decline in primary and secondary syphilis slowed to 8 percent between 1998
and 2000, following average annual reductions of more than 20 percent after
1990.
More than 40,000 new AIDS cases were reported in 2000, but this number
marks a decline from recent years. CDC's AIDS case data do not reflect the
total number of patients with HIV infection but only those who have
progressed to the end stage of HIV disease. Among males ages 13 and older,
11 percent fewer AIDS cases were reported in 2000 compared to 1999, while 4
percent fewer cases were reported over the same time period among females in
that age group. Of the new AIDS cases reported in 2000, 75 percent occurred
among males. The report noted that AIDS-related deaths have declined since
1995, when antiretroviral therapy was made more widely available.
Although AIDS-related causes were the leading cause of death among
adults ages 25 to 44 in the mid-1990s, AIDS-related mortality dropped to the
fifth leading cause of death among people in this age group in 1999.
AIDS-related deaths have dropped "sharply" for black and Hispanic males, but
AIDS-related causes remained the leading cause of death for black males ages
25 to 44 and the third-leading cause of death for Hispanic males in this age
group in 1999. Among people ages 25 to 44, AIDS-related mortality rates have
remained "much higher" for black and Hispanic males than for non-Hispanic
white males.
["Health, United States, 2002," 9/02; The Kaiser Daily HIV/AIDS News Report,
9/13/02]
D.A., Health Commission Ignore Pleas for Help from
Man Infected with HIV by Former San Francisco Official
Nearly six months after winning a $5 million default judgment in civil
court against former San Francisco Health Commissioner Ron Hill, Hill's
ex-lover addressed the Health Commission last week to ask that it support
him in his efforts to have the district attorney's office file criminal
charges against Hill for allegedly infecting him with HIV. One of the problems
dogging the case, however, is that Hill has seemingly vanished. Another
problem is the law itself.
Hill, 44, was appointed to the Health Commission in 1997 by Mayor
Willie Brown. At the time of his appointment, Hill openly disclosed his HIV
status. Hill resigned from the commission in October 2000 after he was
arrested on suspicion of writing bad checks at a Sonoma County furniture
store.
Hill's former lover, Thomas Lister, 37, said that he met Hill online
in early 2000. He has maintained that he did not know Hill's HIV status and
in July 2000, he discovered Hill was HIV-positive. Lister told the Bay Area
Reporter that he found out Hill was on the Health Commission the first time
they met in person, but he did not know Hill was HIV-positive.
"When I confronted this person with documentation proving he was
HIV-positive and had full-blown AIDS he denied these facts," Lister told the
Health Commission earlier this month, adding that the person to whom he was
referring was Hill.
Lister, a senior brokerage firm manager, went public with his
statement on September 3 and spoke with the B.A.R. in an effort to persuade
the district attorney's office to file criminal charges against Hill. "I'm
really frustrated," Lister said. "I just don't know where to turn that's
why I went to the Health Commission. My emphasis is that it's a health
issue."
California Health and Safety Code Section 120291 states that any
person who exposes another to HIV by engaging in unprotected sexual activity
is guilty of a felony, when the infected person 1) knows he/she is infected;
2) has not disclosed his/her HIV-positive status; and 3) acts with the
intent to infect the other person with HIV. The district attorney's office
noted that the law does not mention a statute of limitations.
It is the intent part of the law, however, that apparently has the
district attorney's office perplexed about the case. In order for the intent
part of the law to be proven, there would likely need to be some
collaborating evidence such as a witness or a statement from Hill.
Additionally, no one seems to know where Hill is. Lister said that he
doesn't know; the district attorney's office would not comment on the
whereabouts of Hill.
"The investigation is continuing and we have conducted an active
investigation," Mark McNamara, spokesman for District Attorney Terence
Hallinan, told the B.A.R. Lister said it was in late October 2000 that he received word from his
doctor that he had become HIV-positive. He has no doubt that he was infected
by Hill. "Still, after terminating the relationship with Ron Hill I had
given him several opportunities to be honest with me about his status, even
after I became positive, a fact he was aware of. He never would. Instead he
continued to deny he was HIV-positive," Lister told the commissioners. "I
later learned that he had been positive for over 15 years and that being
HIV-positive was one of the reasons for him being appointed to the Health
Commission."
In December 2000, Lister filed a police report. In February 2001
Lister filed his civil suit for an unspecified amount, which Hill later
defaulted on. Lister has yet to collect on the lawsuit, but told the Health
Commission that he did not specify a dollar amount in the suit that
determination was made earlier this year by San Francisco Superior Court
Commissioner Loretta M. Norris. Department of Public Health spokeswoman
Eileen Shields told the B.A.R. that neither Health Commission President Dr.
Edward Chow, nor Health Director Dr. Mitch Katz would comment on Lister's
statement made at last week's meeting.
[Bay Area Reporter, 9/12/02]
Los Angeles Prostitute's HIV-Related Charge Dropped in Plea Bargain
In a last-minute plea bargain, prosecutors have dropped charges
against a 46-year-old California woman who is HIV-positive and accused of
engaging in prostitution. Panchita Hall was facing a second trial under a
1988 law that requires prostitutes who are HIV-positive and who have been
informed of their test results to be charged with a felony upon their second
arrest. She has been convicted of prostitution six times since she learned
in 1995 that she is HIV-positive. Hall was arrested by an undercover
officer in April. The jury in her first trial deadlocked, and an impasse
was declared.
Deputy District Attorney Lori-Ann Jones, who tried the initial case,
said the decision not to seek a second trial was made because "there was no
assurance that another jury was going to reach a guilty verdict."
Conviction under the 1988 statute carries a three-year sentence, but Jones
had planned to ask for an enhanced sentence of as much as nine years for
Hall.
Hall was sentenced instead Thursday in Compton Superior Court to four
years in prison for violating probation on a previous prostitution
conviction. Jones said that with time served, Hall probably would be free in
a year.
The law was first invoked in Los Angeles County in 1990 against a male
prostitute who was sentenced to two years in state prison. Tens of
thousands of prostitutes have been tested for HIV in the county as a result
of the law. But slightly more than 200 have been convicted on a felony
charge since 1995, officials said.
In late August 2001, after her most recent conviction, Hall had been
put on probation for four years. Two days before her April arrest, a judge
issued an arrest warrant after she failed to show up for a progress report
and left a drug rehabilitation program without permission.
[Los Angeles Times, 9/13/02]
Vets Home Failed to Notify Patient We Had HIV
The Connecticut state Veterans Home and Hospital failed to notify a
patient for eight months he was HIV-positive, though he reported to the
hospital a week after the test results came in, state officials said. The
case is of one of numerous violations cited by the Department of Public
Health in a report dated August 23. The patient, whose name has been
withheld, was tested for HIV on October 3, 2001 and reported to the hospital
a week later but wasn't told of the test results until returning again June
2, officials said. State law requires hospitals to notify HIV-positive
patients of their diagnosis.
"There's no excuse for this," said state Sen. Alvin W. Penn,
D-Bridgeport and co-chairman of the General Assembly's Public Safety
Committee, which oversees the hospital. "It's not something we can just
slough off."
The patient was due to return for an appointment October 10, but
failed to appear. When he did arrived October 12, he was not told of the
test results, officials said. They could not explain why. The lapse
surfaced in June when the patient returned to the hospital and asked for a
copy of his medical records. He tested positive for HIV at another hospital
and wanted to check the results against his Rocky Hill test.
In response to the case, the hospital established a new HIV-testing
policy in June, prohibiting testing patients who plan to stay in the
hospital for less than 24 hours. The ban addresses the possibility that
patients may be discharged by the time test results are ready. HIV tests
usually take more than 24 hours to process. The policy also calls for pre-
and post-test counseling by the patient's primary care physician. The
hospital's director of medicine must make sure the patient is notified when
a test is positive.
[Associated Press, 9/14/02]
Judge Orders New York City to Provide Proper Housing for
Homeless AIDS Patients
A Manhattan judge has ordered the New York City to obey the law and
provide "medically appropriate" housing to homeless AIDS sufferers who
reportedly have been living in deplorable, life-threatening conditions. New
York State Supreme Court Justice Eileen Bransten issued the order after
seven homeless people with AIDS complained last November that the city was
sending them to virtually uninhabitable single-room occupancy hotels.
The seven said the hotels were infested with rats and roaches, had filthy
bathrooms, lacked heat, hot water, electricity, clean mattresses and bed
linens, and had no elevators for disabled clients on upper floors.
One petitioner whose complaints were typical was a 33-year-old woman
who has cancer and asthma in addition to AIDS. The judge said she was put in
a filthy rodent-infested room on the fourth floor of a hotel with no
elevator. The woman, who took numerous life-sustaining medications, had no
refrigeration for them, the judge said, and when she complained, a hotel
employee told her in rude terms to leave if she was unhappy.
A 31-year-old man who was sent to a Bronx hotel suffered a seizure
"brought about as a result of the pain and fatigue caused by repeatedly
hauling his belongings up five flights of stairs," Bransten said.
When the man was moved to a hotel in Manhattan, he was displaced again when
that hotel was ordered closed five days later because it did not meet
minimum housing standards, the judge's decision said.
Bransten's ruling, issued Thursday, said the "petitioners'
statements establish that their housing is not suitable for healthy
individuals, much less for persons with severely compromised immune
systems."
The judge directed the HIV/AIDS Services Administration, the agency
within the city's Human Resources Administration that is responsible for
housing homeless AIDS sufferers, to provide:
- Housing with "suitable and appropriate furnishings;"
- accessible rooms when buildings without elevators are used;
- "usable" bathrooms that are maintained and cleaned;
- placements free of vermin;
- operating utility services such as electricity and hot water.
City law requires that homeless people with AIDS be provided housing.
Thomas Crane, chief of general litigation for the city's Law
Department, said, "We plan to appeal this decision." Meanwhile, David
Neustadt, spokesman for HRA, said that four of the seven petitioners have
been placed in "more permanent type housing," and the other three are being
housed in compliance with Bransten's orders.
[Associated Press, 9/13/02]
In Midst of Syphilis Outbreak,
Detroit Health Department Fires 2
Two Detroit Health Department employees have been fired as part of an
agency shake-up in the midst of a syphilis outbreak in the city. Both
employees supervised the department's disease intervention specialists, who
investigate syphilis and other sexually transmitted disease cases and
attempt to locate sex partners. The unidentified employees were fired this
week, The Detroit News said Wednesday.
Staffing changes will continue as pressure mounts to slow the city's
syphilis outbreak, which is expected to top 500 new cases this year, Loretta
Davis-Satterla, director of the Michigan Department of Community Health's
division of HIV/AIDS and STDs said. "The pressure is on all of us to
perform, and I have no problem with that," said Davis-Satterla, who also
oversees the Detroit Health Department's STD program. "We're in the midst
of a very serious situation with syphilis."
New syphilis cases are expected to increase five fold this year, the
newspaper said.
The Detroit Health Department and the Michigan Department of Community
Health have failed to curtail the outbreak despite warnings and advice from
the federal Centers for Disease Control and Prevention since 1999. It said
state health officials received numerous letters detailing the issues and
suggesting ways to attack the syphilis spread. The CDC said the city's
health department lacked properly trained staff, left key positions vacant
and lacked an adequate plan to attack the disease.
[Associated Press, 9/18/02]
HIV Risk Prompts San Francisco Official to
Call for Ban on N-9 Spermicide
San Francisco Supervisor Mark Leno on Tuesday requested legislation
that would ban the sale in San Francisco of sexual lubricants that contain
the spermicide nonoxynol-9. Recent studies by the Centers for Disease
Control and Prevention (CDC) and the World Health Organization found that
the disinfectant could increase the risk of contracting HIV. Originally
thought to reduce the risk of HIV, the CDC studies found just the opposite.
The nonoxynol-9 lubricants "are a danger to public health and should be
banned as soon as possible," Leno said.
According to a recent CDC study, most men who have sex with men (MSM)
in San Francisco who have heard of N-9 have used it during anal sex
encounters during the previous year‹many without condoms-- despite the fact
that the N-9 has been found to increase HIV risk. The study found that 55
percent of men who were aware of N-9 used it in the previous year.
Eighty-six had used it in their lifetime. Forty-one percent of those who
used N-9 during anal sex in the past year did so without a condom because
they thought it would be protective against HIV.
The CDC and the Food and Drug Administration (FDA) had previously
promoted N-9 use but the CDC reversed its position in 2000. The FDA has yet
to advise manufacturers of products containing N-9 that they should warn
consumers of the increased HIV risk associated with N-9 use.
Studies have indicated since the late 1980s that N-9 increased HIV
risk. Earlier this year Congress asked the General Accounting Office to
conduct an investigation into the funding, distribution and promotion of
condoms containing N-9 by the U.S. government both within the United States
and to other countries. "If the U.S. government made thousands, or tens of
thousands, of men and women more susceptible to acquiring this disease, then
we have done a huge disservice to people throughout the world. It is,
therefore, critically important that a determination be made as to the
numbers of people who may have been adversely affected and if this dangerous
practice is still ongoing," said the letter signed by Congressmen Mark
Souder, Joe Pitts and Dave Weldon.
[The San Francisco Chronicle, 9/18/02; CDC release, 7/10/02; Congressional
letter, 2/7/02]
The HIV Update is a weekly report of articles, studies and other information
related to HIV/AIDS, sexually transmitted diseases and related risk
behaviors compiled from various news sources by the Children's AIDS Fund.
The Children's AIDS Fund is a non-profit, non-partisan organization
dedicated to helping limit the suffering of HIV-impacted children through
direct assistance and resources, as well as through technical assistance for
their parents and care-givers. For additional information, call (703)
471-7350.
Previous editions of the HIV Update are available on-line at
www.childrensaidsfund.org/news.asp
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