CDC HIV/Hepatitis/STD/TB Prevention News Update (091120)

The CDC National Center for HIV, STD and TB Prevention provides the following information as a public service only. Providing synopses of key scientific articles and lay media reports on HIV/AIDS, other sexually transmitted diseases and tuberculosis does not constitute CDC endorsement. This daily update also includes information from CDC and other government agencies, such as background on Morbidity and Mortality Weekly Report (MMWR) articles, fact sheets, press releases and announcements. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC NCHSTP Daily News Summary should be cited as the source of the information. Copyright © 2009, Information Inc., Bethesda, MD.

NATIONAL NEWS

CALIFORNIA: Research Shows Neighborhoods Where AIDS Treatments Lag

New York Times (11.06.09) - Friday, November 20, 2009

A project to map HIV viral loads in San Francisco shows that while more HIV cases are in the largely gay Castro neighborhood, residents with HIV in poorer neighborhoods tend to be sicker or untreated. The city's health department is combining medical data with epidemiological tools to help target treatment in a groundbreaking effort to lower viral loads and reduce the chance of transmission. In the future, the strategy may be employed nationwide.

"These hot spots are perpetuating themselves, increasing infection in marginalized communities," said Dr. Julio Montaner, president of the International AIDS Society. "As long as we don't deal with that problem, the reservoir of HIV will ensure that we're promoting the continued spread of HIV in perpetuity." In San Francisco, "you can identify hot spots where, in all likelihood, most transmission is occurring," he noted.

"If you're monitoring the epidemic by just following the number of cases there are, you haven't prevented new cases," said Dr. Moupali Das-Douglas, lead investigator on the project. "If you have a marker upstream that may predict new cases, you can know where to target your services to prevent transmission." "The more people I start on medication, the more people will be virologically suppressed and the less likely they will be to transmit HIV," he explained.

"If any place is able to reduce infections by treating people effectively, San Francisco should have the best chance. We're hoping it will be a model," said Dr. Grant Colfax, director of HIV prevention and research at the city's Department of Public Health.

All involved agree that acting on such mapping will be controversial. Officials still have to decide on responses, such as whether to shift services, conduct highly targeted campaigns, or directly contact patients with the highest viral loads. Approaching patients could be seen as acting like a "police state," scaring some away, Montaner said.

INTERNATIONAL NEWS

AUSTRALIA: Victoria Calls for HIV Protocols

Sydney Star Observer (11.19.09) - Friday, November 20, 2009

HIV/AIDS advocates in Victoria want authorities to provide clearer policies for determining when criminal charges should be lodged against HIV-positive people who risk infecting others. Though there are national guidelines, a recent review suggests many state policies are unclear about what circumstances trigger a health department's referral of an HIV-related case to the police, said Mike Kennedy, executive director of the Victoria AIDS Council.

"I'm not aware of any Australian state that has any clear guidelines to say how this will happen, so that's the missing bit from the reviews that were done around the country," Kennedy said. "Our view is that [protocols] ought to be governed by a set of agreed procedures, not just rely on goodwill and a set of relationships between people in the health department and people in the police service, because those people change."

"If someone goes out and deliberately attempts to infect, or does infect someone with HIV, most people are going to say if it's deliberate and there's intent, then that's criminal," said Kennedy. "If a slip-up happens, which they do, most people, including a lot of police, are going to say, 'Well, that's not criminal,' but there's an awful lot of space between the two of those."

The call for clearly stated policies follows the release of a National Association of People Living with HIV/AIDS monograph advocating a halt to the upward trend in HIV-related criminal prosecutions. Since 1993, 22 such prosecutions have gone forward in Australia, with half occurring since 2007.

MEDICAL NEWS

UNITED STATES: Cervical Cancer Screening Can Wait Until 21, Group Says

Washington Post (11.20.09) - Friday, November 20, 2009

Women should have their first cervical cancer screening at age 21, and most can be rescreened less frequently than previously recommended, the American College of Obstetricians and Gynecologists (ACOG) said today. The new guidelines are based on scientific evidence that more frequent testing does not prevent significantly more cases of the cancer, which is caused by the STD human papillomavirus (HPV).

"We really felt that the downsides of more frequent screening outweighed any benefits," said Alan G. Waxman, an OB/GYN professor at the University of New Mexico who led ACOG's revision. "More testing is not always more intelligent testing."

Under prior guidelines, women were to start annual cervical screening within three years of becoming sexually active. Now ACOG says women can wait to start until age 21, regardless of age at sexual debut. Women younger than 30 can be rescreened once every two years rather than annually, and women age 30 and older whose previous three tests are negative can be rescreened every three years, ACOG says. Women at increased risk, however, should continue to be screened more frequently, it said.

Annual testing for low-risk women could precipitate unnecessary stress, anxiety, and potentially harmful interventions - all to treat growths that would not necessarily cause problems, ACOG found. HPV is not unusual among sexually active young girls and women, and because the cervix is immature, their incidence of precancerous lesions is higher. Nonetheless, HPV infection clears within one to two years among most adolescents, and the large majority of cervical dysplasias among adolescents resolve on their own, ACOG said.

Cervical cancer is very rare in women under age 21, ACOG said. And the cancer grows relatively slowly, so waiting until age 21 to screen would not pose a significant risk, the organization concluded.

LOCAL AND COMMUNITY NEWS

CALIFORNIA: Stimulus Money to Support UCSF HIV Studies

Bay Area Reporter (San Francisco) (11.19.09) - Friday, November 20, 2009

Using federal stimulus funds, the National Institutes of Health has awarded $1 million grants to two HIV studies that will be conducted by University of California-San Francisco researchers.

The first study will examine mobile phone text-messaging to improve treatment adherence among HIV patients who face complex regimens. More than 250 participants from San Francisco General Hospital's Positive Health Program will be involved, said Dr. James S. Kahn, a professor of clinical medicine in the UCSF program.

The method has been tried before, "but not for our patients, who are on the opposite side of the digital divide and who don't have as many resources as other persons receiving health care," Kahn said. "We'll know whether this is useful or not within two years."

The second study will test the feasibility and acceptability of a self-administered, Web-based drug and alcohol intervention to improve HIV treatment adherence and prevent transmission. The strategy involves patients screening for drug and alcohol use, a brief intervention and referral for treatment (SBIRT). In one SBIRT group, patients will be able to access information securely online from their own medical records. This will be compared with a provider-administered protocol during clinic appointments.

"We are hoping to find out whether patients are more open to responding to sensitive topics with a self- administered, Web-based approach than they are talking directly with their clinician," said Carol Dawson-Rose, an associate nursing professor at UCSF's Center for AIDS Prevention Studies.

SOUTH CAROLINA: SHARE Informs Students About AIDS

Daily Gamecock (University of South Carolina) (11.18.09) - Friday, November 20, 2009

USC's student sexual health awareness activities, which uses the acronym SHARE, hands out about 15,000 condoms every year along with printed material on safe-sex practices. In addition to World AIDS Day events, SHARE launched a campaign in October that focused on domestic violence awareness and in the spring of 2010 will put on "Project Condom."

Wilson called attention to the disproportionate effect of HIV/AIDS among South Carolina's African-American community. While African Americans comprise one-third of South Carolina's population, they account for seven of every 10 newly diagnosed cases of HIV.

EDITORIALS AND COMMENTARY

UNITED STATES: The Cost and Causalities of Silence: HIV/AIDS in Black America

New York Beacon (10.08.09) - Friday, November 20, 2009

"There is a terrible and terrifying creature stalking the black community night and day. This terrible and terrifying creature is called HIV/AIDS, and it has come to our community and is consuming our life energy and undermining our future. It is now the number-one killer of our people between the ages of 22-45.

"First, we must embrace the victims for who they are - above all, members of our community and families, our friends and fellow human beings, deserving the respect we are all due as bearers of dignity and divinity.

"Fourth, we must each of us help to build a national conversation about this most deadly disease. This will include an honest discussion of the varied sexual practices people engage in secretly and openly.

"Fifth, we must urge testing as a key strategy for detection and prevention of its spreading. Testing is especially important for men in jail and prison who have engaged in high-risk activity and who will be reintegrating back into their families and community.

"Seventh and finally, we must realize and act on the knowledge that we are our own resources and rescuers. Indeed, it is our efforts which are decisive in any struggle we wage. 'For a people that cannot save itself is lost forever.'

"This is a fundamental point in the struggle against HIV/AIDS. We must repair our own selves, raise ourselves from the ruins of disease and oppression, hold ourselves and others responsible, and together build the community and world we all want and deserve to live in."

NEWS BRIEFS

SOUTH AFRICA: 32 Percent of South African Children to Lose a Parent to AIDS by 2015

Business Day (South Africa) (11.19.09) - Friday, November 20, 2009

Citing data from its latest survey, the South African Institute of Race Relations reports that 32 percent of all children in the nation will have lost one or both parents to AIDS by 2015. The SAIRR report says that in 2007, 2.5 million children had lost one or both parents, and AIDS was the cause of more than half these deaths. By 2007, 701,000 children had lost both parents, almost twice the number without parents in 2002. During the same period, the number of children living in child-headed households increased from 118,000 to 148,000. "Vulnerable children need additional support that is not necessarily monetary in nature, as these children have lost their primary caregiver," said Gail Eddy of SAIRR.

NEW YORK: N.Y. Protestors Target Uganda Anti-Gay Law

Agence France Presse (11.19.09) - Friday, November 20, 2009

On Thursday in Manhattan, about 40 people gathered at Uganda's UN mission to protest that nation's proposed new anti-homosexuality law. The United States and France have condemned the measure, which would impose the death penalty for "aggravated homosexuality," including acts by persons who are HIV-positive. "It's unimaginable. You're talking about the death penalty for an entire class of human beings," said Brendan Fay, a filmmaker. "It's incredible that in 2009 a nation's parliament is considering this." Earlier this month, Ugandan legislator David Bahati was unmoved by the furor against the bill. "The fact that the moral fabric of America and Europe has been put under siege by the supporters of this creeping evil of homosexuality should not suggest that we follow suit," Bahati said. The International Gay and Lesbian Human Rights Commission organized the protest.

PENNSYLVANIA: World AIDS Day Confab Offered in Bethlehem

Pocono Record (11.19.09) - Friday, November 20, 2009

On World AIDS Day, Dec. 1, the AIDS Activities Office at Lehigh Valley Health Network and the Allentown Health Bureau will present a conference entitled, "HIV: The Aging of a Growing Population." The keynote address will be delivered by Jane Fowler, who was diagnosed with HIV at age 55. She is the founder and director of HIV Wisdom for Older Women and has served as national coordinator for the National Association of HIV over 50. The conference, which is approved for continuing education credits, is open to all HIV agencies and caregivers. The $25 advance fee includes breakfast and lunch. For more information, telephone 610-969-2400 or e-mail aao.hcc@LVH.com.

CDC HIV/Hepatitis/STD/TB Prevention News Update

For Friday, November 20, 2009