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The HIV Update: Global AIDS Bill; the politics of testing prgnant women for HIV; HIV Superinfection: another case; having sex without disclosing HIV status brings criminal charges; syphilis outbreak in NYC; new HIV test guidelines; non-adherence of HIV drugs continues to be a problem.
  Volume 4, Number 24 May 4, 2003
In this edition:
  • House Approves $15 Billion Global AIDS Bill

  • Most Pregnant Women Not Tested for HIV in Ohio

  • GAO Study Finds Newborn Screening is a Routine State Practice for Many Diseases

  • "Simply Saving Babies" from HIV

  • Illinois Senate Takes 'Half-Step' Toward Reducing Baby AIDS, Chicago Tribune Editorial Says

  • Illinois Baby AIDS Compromise Will Allow Dozens of Infants to Be Infected with HIV Every Year

  • California Man has HIV "Superinfection"

  • Memphis Teacher Who Infected Boy with HIV Arrested

  • Iowa Man Pleads Innocent to Knowingly Transmitting HIV

  • States Crack Down on Those Who Do Not Disclose HIV Status

  • Syphilis Outbreak Unabated in New York City

  • Syphilis Role in HIV Being Studied in California

  • New HIV Testing Guidelines Will Help Identify More Who Are Unaware that They Are Infected

  • Study Finds HIV Diagnosis Improves Life for Many

  • Many with HIV May Not Take Life-Saving Drugs

  • Circumcision Shown to Deter HIV Spread


    House Approves $15 Billion Global AIDS Bill
    The U.S. House of Representatives Thursday approved by an overwhelming vote of 375-41 an international HIV/AIDS bill, HR 1298, which would authorize $15 billion over five years to fight HIV/AIDS in Africa and the Caribbean. The plan was proposed by President Bush in the State of the Union speech in January. The bill, sponsored by Congressman Henry Hyde (R-Illinois), would authorize $3 billion a year for five years to international HIV/AIDS programs, with up to $1 billion in fiscal year 2004 going to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
    House Speaker Dennis Hastert, R-Illinois, said: "The situation in Africa is desperate. Millions of children are now orphans because both of their parents have been stricken by AIDS and have died. I had a chance to visit several countries in Africa two years ago, and I witnessed first hand the devastation that this disease has caused to these poor families. I am proud that we are taking this important step to help," Hastert continued.
    The Congressional Black Caucus also praised the passage of the legislation. Congressman Elijah E. Cummings, D-Maryland, the CBC chairman, said the United States "took a very important step in stemming the spread of HIV/AIDS in Africa and the Caribbean" by passing the bill.
    The passage of the bill represents a major win for House conservatives who had expressed some reservations about the legislation as originally presented. They successfully added four amendments to the bill.
    • The first insists that no less than 33 percent of the funds spent on prevention go toward the promotion of abstinence-based programs.

    • The second provides a freedom of conscience exemption for religious and faith-based groups. These groups, which might have a moral objection to some of the strategies proposed to curtail the spread of AIDS, would still be able to participate in fund activities now that the exemption is in place.

    • The third, which some on Capitol Hill say could have far-reaching implications, caps the total amount of the U.S. contribution that can be spent on the fund's administrative expenses.

    • The fourth caps salaries paid to Global AIDS Fund administrators at no more than what the U.S. vice-president is paid annually. If these limitations prove enforceable, they may find their way into other pieces of legislation governing U.S. contributions to international organizations.

    But not everyone was happy with the outcome. Officials of several AIDS advocacy organizations voiced strong opposition to the amendment providing a fraction of funding for abstinence programs. One of them, Progressive Health Partners President Todd Summers, a former Clinton administration official, said in an e-mail that a bill with a "33 percent abstinence-only carve out amendment is worse than no bill at all."
    The bill now moves to the United States Senate.

    [United Press International, 5/2/03]
    Most Pregnant Women Not Tested for HIV in Ohio
    A survey of Ohio doctors found that less than half offered HIV tests to pregnant women as part of routine screening, and about a third said they offer the test to 25 percent or fewer of their pregnant patients. Treating HIV-infected pregnant women with antiretroviral drugs can dramatically reduce the chances that the baby will get HIV before, during or after birth.
    Less than half (42 percent) of physicians offered HIV testing as part of the standard prenatal battery of tests in their practice, while 36 percent of physicians offered testing to less than a quarter of their pregnant patients and/or tested only those pregnant women with a risk factor for HIV infection.
    Obstetricians did better than family physicians: More than 90 percent routinely offered HIV tests to patients. Fifty-four percent of respondents felt HIV testing during pregnancy should be a routine part of care, but 7 percent of doctors felt it was not necessary for most pregnant women. Only 41 percent of physicians included all the elements of HIV pretest counseling required by Ohio state law.
    The Centers for Disease Control and Prevention recommends universal HIV testing of pregnant women during pregnancy and routine testing of those newborns whose mothers' HIV status is unknown. Typically, 44 percent to 80 percent of pregnant women who are offered the test agree to it, according to the study.
    Dr. Joan Duggan and colleagues from the Medical College of Ohio-Toledo surveyed 431 physicians in obstetrics/gynecology and primary care regarding their HIV screening practices. The results are based largely on the responses of 261 physicians who routinely saw pregnant women.
    The full report, "Survey of Physician Attitudes Toward HIV Testing in Pregnant Women in Ohio," was published in the journal AIDS Patient Care and STDs (2003;17:121-127).

    [Reuters Health, 4/23/03]
    GAO Study Finds Newborn Screening is a Routine State Practice for Many Diseases
    The federal Centers for Disease Control and Prevention (CDC) recently recommended universal HIV testing of pregnant women and newborns. Despite the fact that treatment has long been available to prevent transmission of the AIDS virus from infected mother to child, this policy has steadfastly been opposed by many AIDS advocacy organizations. Some claimed testing of newborns and pregnant women was a violation of privacy and a dangerous precedent. But the fact is newborn and prenatal testing has long been a routine medical practice that, like other public health interventions, was discarded in the fight against HIV.
    The U.S. General Accounting Office (GAO) has released a new study entitled "NEWBORN SCREENING; Characteristics of State Programs" which examines states' newborn testing practices. While the GAO report surveyed only newborn screening programs for genetic and metabolic disorders, it provides much insight on how newborn testing is both medically necessary and routine.
    According to GAO, "each year state newborn screening programs test 4 million newborns for disorders that require early detection and treatment to prevent serious illness or death." GAO found that "all states require newborn screening" and "state newborn screening statutes usually do not require that parental consent be obtained before screening occurs."
    "While the number of genetic and metabolic disorders included in state newborn screening programs range from 4 to 36, most states screen for 8 or fewer disorders," GAO reports. "In deciding which disorders to include, states generally consider similar criteria, such as whether the disorder is treatable."
    With HIV, the disease is not only treatable, it is largely preventable. Yet only two states-New York and Connecticut-currently require HIV screening of newborns.
    As for the privacy concerns raised by AIDS advocates, GAO notes "provisions regarding the confidentiality of screening results are included in state newborn screening statutes and regulations."
    And contrary to the claims of opponents who try to portray HIV testing of newborns as a new and radical concept, GAO found that "Newborn screening programs in the United States began in the early 1960s."
    This report is available on-line at www.gao.gov/cgi-bin/getrpt?GAO-03-449.
    GAO is the audit, evaluation and investigative arm of Congress.

    ["NEWBORN SCREENING; Characteristics of State Programs," GAO, 3/03]
    "Simply Saving Babies" from HIV
    The following editorial, entitled "Simply saving babies," was printed in the Indianapolis Star:
    "Our position is: HIV testing of pregnant women is a moral necessity. "House Bill 1630 will save babies' lives. That simple fact should convince the 2003 legislature to pass it into law. The bill requires HIV testing of pregnant women during pregnancy or at time of delivery. A woman may refuse the test but would still be given information about the risks of HIV-AIDS.
    "As of Wednesday, the bill was stuck in conference committee. Its champions-- Rep. Peggy Welch, D-Bloomington, and Sen. Pat Miller, R-Indianapolis-- were working valiantly to get it out.
    "If any lawmaker doubts the merits of the bill, consider this comment in its favor from Dr. Martin B. Kleiman, director of the pediatric infectious disease section at Indiana University School of Medicine: "If a woman is found to be positive and she is not under treatment, the probability is 20 to 25 percent that the baby will become infected. On the other hand, if a woman is identified and treated, the risk to the baby can be reduced to about 1 percent."
    "With that, we rest our case."

    [Indianapolis Star, 4/24/03]
    Illinois Senate Takes 'Half-Step' Toward Reducing Baby AIDS, Chicago Tribune Editorial Says
    The Illinois Senate has taken a "half-step" toward reducing mother-to-child HIV transmission by considering a bill, SB 263, that would require health care professionals to provide pregnant women with HIV counseling and voluntary testing, a Chicago Tribune editorial says. The bill, which has already passed the Senate and is expected to be considered in the House soon, would require that any pregnant woman who decides to be tested for HIV sign an informed consent form before undergoing the test, a system otherwise known as "opt-in" testing. However, under the measure, infants born to women whose HIV status is not known would automatically be tested for the virus, unless the mother signed a form to "opt-out" of the infant testing.
    "The impact of the legislation is likely to be modest" because women can still refuse the test, the editorial says. If doctors are "too busy or too insensitive" to provide adequate counseling, the requirements "could turn out to be a complete dud," the editorial states.
    The editorial concludes, "To make a more serious dent in the spread of HIV/AIDS ... legislators will have to tackle issues such as teenage sex, condom distribution, needle-exchange programs-- and in all likelihood, they will have to revisit the routine testing of newborn babes."

    [Chicago Tribune, 5/1/03]
    Illinois Baby AIDS Compromise Will Allow Dozens of Infants to Be Infected with HIV Every Year
    The following op-ed regarding the failure of the Illinois legislature to pass a bill requiring universal HIV testing of pregnant women and newborns was written by Dennis Byrne, a Chicago-area writer and public affairs consultant, and published in the Chicago Tribune:
    "The Illinois legislature is about to pass a 'welcome compromise' that would allow dozens of infants to be sentenced to a life of pain and near certain early death.
    "I'll say it again, so that it can sink in. Nearly every newborn can be safeguarded from getting the virus that causes AIDS from his or her HIV-infected mother. But the General Assembly refuses to pass a law that would make this so, instead preferring a 'compromise' that would affect 'only' several dozen children a year. Only in Springfield would such a deadly calculus be considered welcome.
    "The compromise is between public health officials who, on one side, believe that all pregnant mothers should be routinely tested for HIV, so that they can receive treatments that virtually eliminate its passage to their children during pregnancy, delivery or afterward, such as through breast feeding. On the other side are 'civil libertarians' who believe such testing is an infringement on the mother's right to privacy or physicians who think that such testing would "scare away" mothers who want to keep their 'lifestyles' secret. They think HIV-infected mothers have the right to reject the test, and subject their children to a 30 percent chance of being infected with HIV.
    "So here's the compromise: HIV testing would be routine for infants born to mothers who have not taken an HIV test themselves, even though the mother still could forbid the infant from being tested. But the compromise still does not require the mother to be tested, especially earlier in pregnancy when it would do the most good.
    "That's right, beyond all logic, a mother by law can choose to keep herself, and everyone else who can help her child, ignorant. By any public health standard, a 30-percent chance of transmitting a deadly disease to anyone is unacceptable, if not criminal.
    "Public policy does not tolerate drunk drivers who pose a 30 percent chance of killing someone. Hospitals do not accept a 30 percent fatal infection rate. Gun-control advocates would go bonkers if each gun sold posed a 30 percent chance of maiming or killing someone. Feminists would not tolerate any environmental factor that would result in a 30 percent breast cancer rate.
    "So by what token does anyone-- especially a health professional-- justify a 30 percent risk factor for infecting a newborn with a deadly disease?
    "If you're blind to the human tragedy in all this, then just consider the cost factors. 'Progressive' public-health activists love to talk about prevention. They say, correctly, that stopping people from smoking before they start is much less costly to society than treating smokers after they get cancer.
    "Yet, some health "providers" are willing to accept a 30 percent risk factor for newborns so that the mother can try to--what?-- hide her drug use, careless sexual practices or her victimization by an HIV transmitter. "What kind of ideology embraces such a barbaric imbalance of rights and responsibilities?
    "I'll tell you what kind: The same kind that protests the double-murder charge in the Laci Peterson case. Marva Stark, president of the National Organization for Women's Morris County, N.J., chapter, said Peterson's husband Scott should be charged with only one count of murder, because the killing of Laci's unborn son, Connor, could not be considered the killing of a person.
    "It's the same kind that prompted National Public Radio's commentator Daniel Shore to suggest that the Chinese and United States governments were engaged in some kind of cover-up by not quarantining people infected with the deadly SARS, or severe acute respiratory syndrome. This demand for isolation comes from the same ideological corner that flipped over the mere suggestion that HIV should be subject to standard public health measures, such as contact tracing.
    "The same ideology fills my mailbox with charges that abortion opponents care more about fetuses than about babies after they are born. If there ever was a more monumental demonstration of uncaring for babies than this 'compromise,' I have not heard of it.
    "It's the same ideology that condemns the 'insensitive' spending of money in the name of freedom and security, but denounces President Bush for not spending enough ($15 billion) to prevent and treat AIDS in Africa. When, that is, they oppose a simple test that is 100 percent effective at home."

    [Chicago Tribune, 4/28/03]
    California Man has HIV "Superinfection"
    Researchers report in the May 2 edition of the medical journal AIDS that a California man has been infected with two different strains of HIV, including a drug-resistant strain of the virus. Initially enrolled in a study that was looking at people with drug-resistant HIV, the man was discovered-- four months after enrolling in the program-- to be infected with more than one strain of HIV. The infection was confirmed after the researchers performed a series of genetic tests to show that the second strain wasn't resistant to reverse transcriptase inhibitors.
    The man was infected with HIV strains common in North America. His superinfection apparently had an adverse effect on his health, driving up his viral load in two months from 2,400 to over 200,000, while over the course of 11 months his T-cell count went from a high of over 800 to a low of 282.
    HIV superinfection, or the presence of two strains of HIV in the same person, has been a controversial issue in AIDS health and social service circles. It raises issues about HIV-positive people having 'unprotected' sex even with each other, and raises significant stumbling blocks to researchers trying to develop an AIDS vaccine. Activists and health officials also raise concerns about over talking superinfection, since it could encourage more HIV-infected people to seek out negative partners, which could increase overall infection rates.
    Scientists believe current HIV tests used to show if a patient is infected with drug-resistant HIV wouldn't work if the patient also is infected with the wild-type strain. But if the person began drug therapy, evidence of the drug-resistant strain would emerge.
    At least two other HIV super-infections have been reported. In September 2002 a Swiss research team reported they had discovered a 38-year-old man with dual strain infections, while in July 2002 at the international AIDS conference in Barcelona, Spain, a researcher reported a similar infected patient in Boston.

    Memphis Teacher Who Infected Boy with HIV Arrested
    A Memphis, Tennessee middle school teacher who continued to teach science for eight months after his indictment for exposing a teenager to HIV has resigned. Juan Thomas, 33, had been on unpaid leave from Lanier Middle School since last week, when police came to the Whitehaven campus and arrested him on a warrant issued in August. He was indicted on one felony count of criminal exposure to HIV.
    Law enforcement officials were unable Tuesday to say why the suspect was not arrested immediately. They said an informal system to flag priority warrants didn't work in this case.
    Thomas admitted to having a consensual relationship with the 17-year-old boy, who later was diagnosed with the virus, according to an arrest report. Thomas also allegedly said he knew he had the virus.
    Memphis Police Insp. Matt McCann said Tuesday the department acted immediately to arrest Thomas after learning, through a tip originally given to the state Department of Human Services, where the teacher could be found. The police would not necessarily have been notified when Thomas was indicted, McCann said. "In a perfect world, as soon as they are indicted, they would be picked up," McCann said.
    The Shelby County Sheriff's Office fugitive squad, which serves arrest warrants, gets 100 new warrants each day and has a backlog of 50,000 warrants, said Chief Deputy William Oldham.
    Typically, the fugitive squad relies on prosecutors and police to alert them to serious cases that require immediate action. For example, when a suspected child molester may have contact with children.
    School officials said a background check on Thomas came up clean, and that he has taught science at three different schools since October 2000.
    Police did not identify the 17-year-old whose allegations led to the indictment. It is unknown whether he was a student at a school where Thomas taught.

    [The Commercial Appeal (Memphis, TN), 4/30/03]
    Iowa Man Pleads Innocent to Knowingly Transmitting HIV
    An Iowa man who police say failed to disclose that he was HIV positive to a woman he had sex with has pleaded innocent to the charges. Adam D. Musser, 22, of Iowa City, is charged with three counts of criminal transmission of HIV. He entered pleas to two of the counts April 24 in Johnson County District Court. He had pleaded innocent to the first count in March.
    Musser denied being HIV positive when asked by the woman and the relationship continued, police said. He admitted that he was HIV positive to other people, including a police officer, the complaint states. He was first charged by North Liberty police in February. Coralville police charged him with a second count in March and Iowa City police charged him earlier this month. No trial date was set.

    [Associated Press, 4/25/03]
    States Crack Down on Those Who Do Not Disclose HIV Status
    Legislators across the country have recently passed laws intended to curb the spread of HIV by imprisoning those who know their positive serostatus but don't tell their partners. Nationwide, courts are just beginning to see the effects of those laws. Here are some recent cases:
    • Florida. Melissa Jernigan, 24, faced charges that she criminally transmitted HIV to at least 200 unprotected partners. She told police she tested positive for HIV in 1999 and continued to have 'unprotected' sex. The offense is a third-degree felony, punishable by five years in prison.

    • Iowa. Aaron Dahlberg, 25, was sentenced to three years probation for willful injury after originally facing up to 25 years in prison for criminal transmission of HIV. He was accused of twice lying to an Iowa City man about his HIV status before they had consensual sex. Adam Donald Musser, 22, became the second man in Iowa to be charged with a felony count of criminal transmission of HIV. Musser allegedly had sex with a woman last April without telling her about his HIV status. Musser has been held without bond since his February 14 arrest.

    • Michigan. A 17-year-old was charged with a felony for having 'unprotected' sex without disclosing she had AIDS. Police identified four men who claimed to have had sex with the young woman without being informed she had AIDS. She was being held in jail on $500,000 bond.

    • Missouri. Robert E. Michael, 32, was charged with failing to inform two women he was HIV-positive. He was charged with two felony counts for reckless exposure to HIV. He was being held on $250,000 bond.

    • Ohio. Mor Rondo Roberts was found guilty of not telling his sexual partners he had HIV. He sentenced to four years in prison. Roberts, who had no previous criminal record, was accused of having sex with two women without telling them of his HIV status. The judge said it would have sent the wrong message had he not imposed a prison sentence.

    • South Dakota. William Jenigan, 36, was sentenced to 45 days in jail and five years probation for intentionally exposing others to HIV. Jay Woods, 42, Jenigan's roommate and partner, has been charged with three counts of intentionally exposing others to HIV. A date for a jury trial has not yet been set.


    [AIDS Policy and Law, 4/25/03]
    Syphilis Outbreak Unabated in New York City
    New York City's health department is predicting that the current syphilis outbreak among gay and bisexual men will continue through 2003 and might even grow larger by the end of the year. As of the week of April 7, 105 cases of primary or secondary syphilis have been reported to the health department, and just six of those cases were among women. There were 102 cases reported during the same period in 2002, with five cases among women. That trend of men dominating the male-to-female ratio of cases began in 1998 and has increased since then.
    The health department is also reporting an increase in the number of early latent cases of syphilis for the first quarter of 2003. There were 242 such cases, with 32 among women, in 2003 compared to 165 cases, with 31 among women, during the same quarter in 2002. An early latent case is someone who no longer exhibits the obvious physical symptoms of primary and secondary syphilis such as lesions on the penis, vagina, or anus or in the mouth and later a rash anywhere on the body. Early latent cases of syphilis, like primary and secondary cases, must be treated in order to prevent the potentially life-threatening final stage syphilis.
    The 2003 data are preliminary, but they suggest that the syphilis outbreak will continue unabated. They also suggest that some gay and bisexual men have given up 'safe' sex practices. A syphilis infection increases the likelihood of acquiring HIV.
    The health department is recommending that sexually active gay and bisexual men get tested for syphilis every year, whether or not they have symptoms. It is also telling physicians to treat patients they suspect have syphilis even before the result is confirmed with a test.

    [Gay City News (New York City), 4/25/03]
    Syphilis Role in HIV Being Studied in California
    For the past three years, syphilis outbreaks in men who have sex with men (MSM) have worried health officials because of what they indicate about a resurgence in high-risk behaviors. But are these syphilis outbreaks facilitating HIV transmission or is syphilis contained mostly to MSM who are already HIV-positive?
    California's sexually transmitted disease (STD) and HIV health officials hope to answer that question with assistance from the Centers for Disease Control and Prevention (CDC) and its new detuned testing technology. "We need to get some better information quickly, and so we are combining our HIV and STD efforts to find the answer," says Gail Bolan, MD, the state's director of STD control.
    In March, the state requested the Centers for Disease Control and Prevention (CDC) to conduct an Epidemic Intelligence Service (EIS) investigation, also known as an Epi Aid, which can quickly mobilize resources for a health problem that needs immediate attention. The CDC will be providing two EIS officers, while the state's existing EIS officer will help coordinate the effort.
    Just how much STDs contribute biologically to facilitating HIV transmission is an ongoing debate. Three years after large studies in Africa attempted to quantify the impact, the results have been inconclusive. Most recently, an analysis of a study in Uganda concluded that STD control has a minimal impact in an already mature HIV epidemic. While it's clear the United State's syphilis epidemic is starting a new cycle, the HIV epidemic is harder to qualify, Bolan says.
    In the United States, CDC behavioral surveillance suggests so far that the syphilis outbreaks haven't facilitated HIV transmission in MSM because many men appear to be engaging in "sexual positioning" (HIV-positive men having sex with other positive men).
    But information from syphilis partner notification interviews suggests differently, Bolan says. "Our data really don't support that. We talk to a lot of men who claim they are having a lot of sex with partners of unknown status. So we really need to know what is going on here."
    Until now, this kind of research hasn't been easy. First, controlling for behaviors is notoriously difficult. Second, it's hard to always know which infection came first: syphilis or HIV. With detuned testing of specimens, however, the time of HIV infection can be pinpointed more precisely.
    The easiest way to measure the syphilis impact on HIV transmission is to conduct HIV testing in a cohort of MSM recently infected with primary syphilis, Bolan says.
    "That would tell you if the infection was more likely related to an ulcer," she explains. "You could then compare the results with people who are not infected with primary syphilis but who have similar behaviors."
    California's collaborative effort could be a model for other areas of the country where syphilis and HIV coexist. "We hope the model we use in California can be a model the South can use to prove to the CDC that syphilis has really contributed to HIV," Bolan notes. "They want hard data, and this can help get some information fairly quickly."
    So far, traditional syphilis control efforts have not been able to quell the outbreaks, which continue to spread into other communities. "Unless there is a collective approach between HIV and STD prevention, it's going to be hard for STD control to do it alone," she says. "We can use our control, but we really need some new innovative strategies," she says. The state could have preliminary results by this summer, Bolan adds.

    [AIDS Alert, 5/1/03]
    New HIV Testing Guidelines Will Help Identify More Who Are Unaware that They Are Infected
    New national HIV testing guidelines might result in more people getting tested, Las Vegas health officials said. Under new Centers for Disease Control and Prevention (CDC) guidelines, family doctors would urge more patients to get tested, but they would no longer have to first provide extensive pre-test counseling.
    CDC officials still say counseling is important, but they do not want the education component to deter people from getting tested. They concluded the counseling requirement might have kept busy doctors from providing tests and can make getting tested a tedious process for patients.
    Local HIV specialist Dr. Jerry Cade estimates there are about 2,000 Las Vegans who have HIV and do not know it. There are approximately 5,000 HIV/AIDS patients in Nevada, with 4,000 of those patients living in Clark County, according to Reich and the Nevada State Health Division.
    Approximately 225 new HIV cases are reported each year in Clark County.
    Cade favors the new guidelines so long as patients still get HIV prevention education. "We still have a bunch of people walking around who don't know they are positive, and in this day and age, that's a shame," Cade said. "We've got treatment options now, and if we can get them diagnosed and into treatment, HIV is not necessarily the death sentence it once was."
    The new recommendations urge doctors, health officials, social workers and counselors to use new rapid testing kits in offices, homeless shelters, drug treatment centers and STD clinics. The kits can provide results in 20 minutes. But they only provide a preliminary result, which means that patients who test positive would still need another test to confirm the diagnosis.
    Rick Reich, the communicable disease and AIDS services supervisor at the Clark County, Nevada, Health District, said the rapid test may be helpful when testing people who do not usually come back for test results, such as the homeless, but that those people will still have to get a confirmation test done if the results are positive.
    CDC officials say the new guidelines are an attempt to find and diagnose the estimated 200,000 people living with HIV in the United States who are unaware they have the disease.

    [Las Vegas Review-Journal, 4/26/03]
    Study Finds HIV Diagnosis Improves Life for Many
    Nearly a third of patients diagnosed with HIV feel their lives actually improved after discovering they had the affliction, according to a U.S. study released on Thursday. Thirty-two percent of the 449 people with the AIDS virus who were interviewed for the study said their lives got better after being diagnosed HIV positive because they became less worried about financial and other problems.
    Twenty-nine percent said life was worse and 26 percent said it was about the same. Thirteen percent said they did not know.
    The study's results were presented on Thursday in Vancouver at the annual meeting at the Society of General Internal Medicine. Study director Joel Tsevat of the University of Cincinnati Medical Center said the findings fit with anecdotal reports from nurses and psychologists, as well as the results a smaller study he conducted in the mid-1990s.
    Many of the patients with improved outlooks said they were getting more out of life than before the diagnosis. "They don't take things for granted like they used to, such as a nice day," Tsevat said. Those patients also tended to be more involved in non-organized religious activities, although Tsevat said it was unclear if that was a cause of their improved outlook on life or the result of it.
    The percentage of people who felt their lives were better was roughly the same in all three classes of HIV patients: those without AIDS symptoms, those with symptoms but without AIDS, and those with AIDS.
    The researchers said it was important to find out more about why some patients have an improved outlook on life so that information can be used to help those who feel their lives have become worse.
    Tsevat cautioned that because the research was done on patients in the United States, it might not apply to those living with HIV in countries that do not have the same level of medical and welfare support systems. Tsevat also warned that the results were not an excuse for people to be less concerned about the disease or their own medical safety. "That would send the wrong message," he said.
    The study was funded by the U.S. Department of Veterans Affairs and the National Center for Complementary and Alternative Medicine. Interviews were conducted in 2002 and 2003 in three U.S. cities.
    The researchers will continue to track the patients they interviewed over the next 15 months, with the hope their findings will help develop ways of helping people cope with the illnesses.

    [Reuters, 5/1/03]
    Many with HIV May Not Take Life-Saving Drugs
    An analysis of HIV-infected patients who died at one Texas hospital in 1999-2000 found that more than half of them were not taking highly active antiretroviral AIDS therapy.
    "I was really startled to see that so many patients were not on HIV therapy in an era when it's supposed to be widespread, and access is there," said the study's lead author, Dr. Mamta K. Jain of the University of Texas Southwestern Medical Center-Dallas.
    The full report, "Changes in Mortality Related to Human Immunodeficiency Virus Infection: Comparative Analysis of Inpatient Deaths in 1995 and in 1999-2000," was published in the journal Clinical Infectious Diseases (2003;36(8):1030-1038).
    The researchers compared HIV-positive patients who died in 1995 (before HAART availability) to those who died in 1999-2000. They also assessed whether or not patients in the later group were taking HAART. Jain's team evaluated 200 HIV/AIDS patients-- 112 who died in 1995 and 88 who died in 1999-2000.
    Despite "widespread availability" of HAART, only 48 percent of patients who died in 1999-2000 were taking HAART at the time of death, the authors reported. The main reasons the patients were not taking the drugs were an inability to adhere to the treatment regimen and an HIV diagnosis less than six months prior to death. Other reasons included an inability to tolerate the drugs due to underlying liver disease, the study indicates.
    Another finding of the study is that many HIV-infected individuals not receiving HAART were minorities. Nine out of 12 patients who were diagnosed with HIV shortly before death, and 12 of 18 patients who did not take HAART as prescribed, were black or Hispanic, the authors wrote.
    The team did see a decline in the number of people dying due to HIV. However, AIDS-defining illnesses, such as Pneumocystis carinii pneumonia, were still an important cause of death in patients not taking HAART, according to the report.
    "I don't want to paint a gloomy picture," Jain said. "Definitely, the number of cases of patients dying with AIDS has decreased radically. But we were expecting to see a change in the types of diseases people were dying from, and we didn't see that. I think this study is important because, if you look at the HIV/AIDS literature, you see these dramatic changes, and people are living longer... but I think we kind of lose sight of the fact that there are still areas in the country that still are seeing a lot of the same problems that we did prior to HAART being available."
    Last year, CDC estimated that up to one-third of the nation's 850,000-950,000 HIV-positive people do not appear to be receiving treatment.

    [Reuters Health, 4/17/03]
    Circumcision Shown to Deter HIV Infection
    Circumcised men are at least 50 percent less likely to contract HIV during 'unprotected' sex than uncircumcised men, according to a soon-to-be released report by the U.S. Agency for International Development.
    Based on a systematic review of 28 scientific studies published by the London School of Hygiene and Tropical Medicine, the USAID report "found that circumcised males are less than half as likely to be infected by HIV as uncircumcised men."
    "A sub analysis of 10 African studies found a 71 percent reduction among higher risk men," said the report obtained by the Washington Times.
    According to the scientific studies, the skin on the inside of the male foreskin is "mucosal," similar to the skin found on the inside of the mouth or nose. This mucosal skin has a high number of Langerhan cells, which are HIV target cells, or doorway cells for HIV.
    "HIV looks for target cells, like the Langerhans; it's a lock and key," said Edward G. Green, senior researcher at Harvard University. "The rest of the skin on the penis is armorlike."
    Green said that if all males in Africa were circumcised, the HIV/AIDS prevalence rate could be reduced from 20 percent in some regions to below 5 percent. In addition, circumcision reduces the transmission of other STDs, reduces infections associated with poor hygiene, and makes it easier to use a condom, Green said.
    The 60-page USAID report is based on presentations given at a conference in September, and will be available on the USAID Web site "soon," said Dr. Anne Peterson, assistant administrator for global health at USAID. She said that while the information "looks profound and wonderful," she cautioned there may be other factors that reduce HIV transmission in circumcised men.
    If circumcision is promoted, another concern is that circumcised men may mistakenly believe they are invulnerable to HIV. They are not, said Peterson. "It reduces your risk. It does not protect you outright," she said. "People who are circumcised still get HIV. It is still better to abstain, be faithful in marriage," or use condoms.

    [Washington Times, 4/25/03]
    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 http://www.childrensaidsfund.org/news.asp
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