Source: Page 61 of White Noise Keywords: "uniqueness," "trends," "participants"

From: prevention-news-admin@cdcnpin.org Subject: [CDC News] CDC HIV/STD/TB Prevention News Update 08/11/03 Date: 11 Aug 2003 Newsgroups: soc.support.aids-hiv+

CDC HIV/STD/TB Prevention News Update Monday, August 11, 2003 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 HIV/STD/TB Prevention News Update should be cited as the source of the information. Contact the sources of the articles abstracted below for full texts of the articles. HEADLINES NATIONAL NEWS "HIV Patients' Aid May Be Cut by New State Rules" "Most North Carolina Schools Focus on Abstinence in Sex Education Courses" "Study Examines How Teenagers View First-Time Sex; Most Described the Relationship as 'Romantic'" INTERNATIONAL NEWS "South Africa Says It Will Fight AIDS with a Drug Plan" "AIDS Spreads in Nigeria Under Cloak of Denial" MEDICAL NEWS "Adherence to HIV Antiretrovirals Among Persons with Serious Mental Illness" LOCAL AND COMMUNITY NEWS "Study Finds Many Ignore Warnings on Sex Practices" NEWS BRIEFS "Teaching the ABCs" "W. Va. Rape Rate Is One in Nine, Federal Report Says" "Conway Mill Offering Tuberculosis Test to 500 Employees" "AIDS Survival Project Launches Statewide Training Program" ************************************************************ NATIONAL NEWS ************************************************************ "HIV Patients' Aid May Be Cut by New State Rules" Houston Chronicle (08.08.03)::Polly Ross Hughes HIV-infected Texans could find it harder to access needed medications should a state budget crunch trigger the cost-saving measures adopted Thursday by the Texas Board of Health. Health officials stress the new rules concern only those HIV patients who apply for the medication program in the future and will not affect those already enrolled. According to Terry Wilson, state coordinator of AIDS Coalition of Texas, the Legislature boosted the HIV medication budget to $44.6 million - the largest state budget of its kind ever granted - prompting him to question Thursday's decision, particularly when it looks as if the budget could end in a surplus. Health officials say the adopted measure functions as a contingency in case projections showing the HIV medication program will run an $11 million deficit in the next two years prove accurate. "You've got a plan in place so you don't have to scramble and come up with a plan at the last minute," said Texas Department of Health spokesperson Doug McBride. Dr. Sharilyn Stanley, associate commissioner for disease control and prevention, points out none of the rules would go into immediate effect. Rather, they would kick in only when necessary and in a certain order, she said. "The Legislature did give us $26.5 million [increased funding], which was an incredible, wonderful, substantive act, but it doesn't fully meet our projected deficit," Stanley said. The first rule to kick in pending a budget crunch would be a change in the medical criteria for paying for HIV drugs - basically delaying treatments until the patient's condition worsens. Should the first measure not be enough to stem budget woes, a second would no longer allow patients to subtract the cost of HIV medications - as much as $20,000 a year - when calculating income. The third rule would lower eligibility from annual income of $17,960 or less to as little as $11,225 a year, and the fourth would close enrollment to new clients entirely until budget constraints are resolved. "Most North Carolina Schools Focus on Abstinence in Sex Education Courses" Associated Press (08.10.03) All but about a dozen North Carolina school districts limit sex education to a focus on preventing STDs through abstinence, state education officials recently said. In districts where parents request expanded instruction, a 1995 state law allows condom demonstrations and more in-depth discussion of STDs and birth control. "There are only about 12 school systems that have held public hearings and expanded their programs in the state," said Sherry Lehman of the state Department of Public Instruction. More than 100 districts statewide offer health education courses that discuss puberty and STDs and present abstinence until marriage as the best way to avoid disease. Condoms and birth control methods are discussed only in describing their rates of effectiveness, Gaston County Health Instruction Coordinator Alice Ray said. In New Hanover County, the community supports an expanded program. Beginning in fifth grade, boys and girls are separated and taught about puberty, reproductive systems and personal safety. In middle school, parents are given a choice between abstinence-only and expanded sex education programs. The abstinence curriculum focuses on friendships, strong families, puberty and safety. The expanded program also offers information on birth control and condoms. Local health officials have urged Gaston County schools to offer more information about birth control and disease prevention. "They show you pictures of stuff and they show you a video of a woman having a baby," said Marcus Filchuk, a student at Belmont Middle School. "They don't really say a whole lot about it, except 'This is a woman having a baby.'" Marcus' dad, Bob Filchuk, said it should be a parent's job to teach children about sex. "Abstinence is what they ought to preach," he said. A 1997 statewide study found 61 percent of high school students were sexually active. North Carolina had a pregnancy rate of 69.3 per 1,000 girls ages 15 to 19 in 2001, compared to the national rate of 55 pregnancies per 1,000 girls, according to CDC. "Study Examines How Teenagers View First-Time Sex; Most Described the Relationship as 'Romantic'" USA Today (08.07.03)::Karen S. Peterson Looking back on the first time they had intercourse, 85 percent of sexually active teens viewed their relationship as a "romantic" involvement rather than a casual fling, says a study from Child Trends, a group that researches children and families. The project is intended to help parents and educators understand the dynamics of teen relationships and not just focus on statistics. The study hopes to put adults "in a better position to help teenagers make more responsible decisions about sex," says the report, "The First Times: Characteristics of Teens' First Sexual Relationships." The study analyzed data on 1,909 sexually active teens in grades seven through 12 tracked in the National Longitudinal Study of Adolescent Health, partially funded by the federal government. While the teens were interviewed in the mid-1990s, the findings are the most recent data available, said study coauthor Suzanne Ryan. More than half (61 percent) of those who said they had a romantic relationship had intercourse within three months. "The important message to parents is these romantic relationships transition to sex early on, and they have a small window of opportunity" to influence teens' behavior, said Ryan. Some teens will choose abstinence, but others will not. Parents can talk with them about delaying sex or using contraception, the report says. About 25 percent of the teens experienced some form of abuse in their first relationship. Verbal abuse included name-calling and insults; physical abuse included throwing objects, pushing and shoving. Hispanics were the most likely to experience physical abuse. Such findings "show parents and educators need to talk about what a relationship is, what intimacy is," said Tamara Kreinin of the Sexuality Information and Education Council of the US. She said the research is "hugely helpful" to those planning programs for teens. ************************************************************ INTERNATIONAL NEWS ************************************************************ "South Africa Says It Will Fight AIDS With a Drug Plan" New York Times (08.09.03)::Lawrence K. Altman On Friday, the South African government changed its stand on providing HIV/AIDS drugs, saying it would develop a plan to offer them to infected people through its public health system by Oct. 1. "Government shares the impatience of many South Africans on the need to strengthen the nation's armory in the fight against AIDS," the cabinet said in a statement after a special meeting to assess the financial costs and options involved in a national HIV drug plan. The government said that because not every infected person needed HIV drugs, its program would provide them initially to people with more advanced cases of AIDS. The government program is also expected to provide prevention programs aimed at tens of millions of people who are not infected. The costs of treating those infected are difficult to calculate but are expected to run into billions of dollars. UNAIDS estimates that about 5 million of South Africa's 43.8 million population are HIV-infected. The government said it would follow WHO guidelines describing the combinations of HIV drugs that work best and the simplest acceptable laboratory tests to monitor their use. The guidelines were intended to show doctors in poor areas how to prescribe the drugs safely. Zachie Achmat, chair of South Africa's advocacy group Treatment Action Campaign, said that although he welcomed the decision, TAC "will wait to see the actual plan before celebration." In a BBC interview, he also said, "For all of us living with HIV in South Africa, and our families, this is the first sign of hope." The cabinet took note of concerns regarding the proper use of the drugs. It said AIDS experts in the country and specialists from the William J. Clinton Presidential Foundation would assist the government in developing an operational plan. The foundation said it had worked with the South African government in reviewing drafts of the plan. "AIDS Spreads in Nigeria Under Cloak of Denial" Financial Times (London) (08.05.03)::Michael Peel HIV infection rates in Nigeria are lower than in many African nations, but Nigeria's huge population (128 million) makes it one of the worst affected in terms of absolute numbers. Government statistics show a steady rise in the percentage of HIV-infected people, from 1.8 percent in 1991 to 5.8 percent in 2001. The health ministry thinks Nigeria has the third-highest number of infected people in Africa, after South Africa and Ethiopia. "It may just be that Nigeria is at an earlier phase of the epidemic," said Dr. E. Oni Idigbe, director-general of the Nigerian Institute of Medical Research. A 1999 government survey showed that 94.7 percent of men and 91 percent of women put their risk of contracting AIDS at small or none. "Nigerians seem to be overly confident in their ability to avoid getting AIDS," the health ministry noted. The military regime that ended in 1999 did not take HIV/AIDS seriously. The current government set up a national body to coordinate AIDS prevention efforts and to oversee a treatment program offering antiretroviral drugs to 10,000 infected adults and 5,000 children. Professor Babatunde Osotimehin, chair of the government's National Action Committee on AIDS, said the adult program is well established, although 10,000 is small compared to the number in need. Nigeria's location on one of Africa's main migration and trade routes, and the dominant role of Christianity and Islam in public life, compound problems of HIV/AIDS control. The Nigerian Red Cross Society said some churches have forced it to amend its ABC of AIDS prevention - abstinence, be faithful, or use a condom - to replace the contraception reference with a call for good conduct. "The problem that we have in Nigeria is mainly cultural," said Dr. Kunle Aderanti, principal health officer for the Nigerian Red Cross. "It's culturally taboo for children to discuss sex with adults - it's taboo even to discuss sex openly." ************************************************************ MEDICAL NEWS ************************************************************ "Adherence to HIV Antiretrovirals Among Persons with Serious Mental Illness" AIDS Patient Care and STDs (04.03) Vol. 17; No. 4: P. 179- 186::Glenn J. Wagner, PhD; David E. Kanouse, PhD; Paul Koegel, PhD; Greer Sullivan, MD, MSPH One drawback to HAART is the need for near-perfect adherence to the regimen. Providers assume that patients with serious mental illness are at an especially high risk for nonadherence. The current study assesses adherence rates to HIV antiretroviral regimens among patients with serious mental illness (schizophrenia, schizoaffective disorder, bipolar depression, and major depression with psychotic features). The study was conducted over a two-week period using electronic monitoring caps and self-reporting in a Los Angeles community-based sample of persons with serious mental illness. Subjects brought their antiretroviral medications to the baseline visit, where they were given a medicine bottle with a microelectronic chip in the cap. Participants dispensed a two- week supply of their most complex medication into the bottle, and researchers told them the chip would record the date and time of each bottle opening. They were instructed to open the bottle containing the selected medication only when preparing to take a dose, and to remove only one dose at a time. Researchers also gathered demographic information (age, gender, ethnicity/race, education, housing accommodations and household composition, employment status, income, and relationship status) and drew blood specimens to be used to perform assays for CD4 count and HIV RNA (PCR) viral load. At the week-two visit, participants turned in their bottle caps and recalled their pill-taking behavior over the previous three days, both HIV and psychotropic medication (if applicable). Researchers asked participants about doses missed and number of days they missed taking their medications over the study period, and questioned them about their adherence strategies. Of the 45 participants who completed the study, mean age was 41, 79 percent were male, 49 percent were Caucasian, 43 percent were African-American, and 9 percent were Latino. Twenty five percent were employed, and education ranged from 23 percent not having completed high school to 25 percent with a college degree. Eighty-one percent were single, 24 percent had unstable or temporary housing, and 66 percent identified as gay or bisexual. The average electronically monitored adherence rate for the sample was 66 percent. Forty percent of the subjects showed at least 90 percent adherence, but nearly a third displayed less than 50 percent adherence. Mean self-reported adherence rates were 92 percent for the entire antiretroviral regimen and 93 percent for the one selected antiretroviral. Self-reported adherence to psychotropics was mildly correlated with self- reported and electronically monitored antiretroviral adherence. The authors pointed out that theirs was the first published study to systematically evaluate adherence to HIV antiretrovirals in persons with serious mental illness. In the study's small sample, the data suggested individuals with serious mental illness are able to adhere to antiretrovirals at levels similar to other HIV populations. "Consequently," the researchers wrote, "mental illness alone is not a reason to defer or deny treatment that is otherwise medically warranted." The authors cautioned, however, that a substantial number of participants displayed poor adherence. "Further work," they concluded, "is needed to identify barriers to adherence that may be unique to persons with serious mental illness, which could then inform the development of interventions to help those struggling with adherence to achieve optimal treatment benefits." ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "Study Finds Many Ignore Warnings on Sex Practices" New York Times (08.09.03)::Richard Pérez-Peña The majority of New Yorkers with multiple sex partners are unaware of their HIV status, and more than 40 percent did not use condoms the last time they had sex, according to what city officials are calling the most comprehensive ever survey of the city's sexual habits. Conducted by the New York City's Department of Health and Mental Hygiene, the study found that people with multiple partners were more likely than others to use condoms and have had a recent HIV test - but not much more. In all, the results call into question the continuing effectiveness of almost two decades of safe sex prevention since the beginning of the AIDS epidemic. A random sampling of 10,000 adult New Yorkers on a wide range of health issues last year provided the data. Although the department has yet to formally release its findings, they were posted on its Web site, www.nyc.gov/health, last week. City Health Commissioner Dr. Thomas R. Frieden said, "...HIV testing needs to be a routine part of medical care. Anyone who's ever had sex, anyone who's ever used IV drugs, needs to know their HIV status," said Frieden. Findings from the study illustrate that higher-risk behavior was not accompanied by a significantly higher rate of condom use. Fifty-eight percent of city residents who had three or more sex partners in the previous year said they used a condom the last time they had sex. Of men who had had sex with men, 45 percent said they used a condom the last time they had sex, compared to 38 percent of other men. Middle-age people were less than half as likely to use a condom as younger adults, suggesting that messages about protected sex have taken root most firmly among those who grew up with them. ************************************************************ NEWS BRIEFS ************************************************************ "Teaching the ABCs" Washington Times (08.08.03)::John McCaslin Harvard anthropologist Edward C. "Ted" Green, a supporter of the "ABCs" - abstinence, be faithful, or use condoms - approach to AIDS prevention, has been appointed to the President's Advisory Council on HIV/AIDS. President Bush, Secretary of State Colin Powell and Paula Dobriansky, undersecretary of state for global affairs, have endorsed abstinence as a means of AIDS prevention, especially in Africa and the Caribbean. But Green, at the forefront of calling attention to the ABCs approach, stressed "it is not 'abstinence only' or 'condoms only.' Both are needed. There is a need for condoms if A and B fail. Some people will never change their behavior." While some high-risk groups like prostitutes are unlikely to change their behavior and need condoms, Green said, Uganda's experience with the "B" approach of monogamous relationships and fidelity in marriage shows that a general population can and will change its behavior. "W. Va. Rape Rate Is One in Nine, Federal Report Says" Associated Press (08.08.03) One in nine women in West Virginia has been raped, according to a report released by CDC. The report's data were gathered from the National Women's Study and the National Violence Against Women Survey, said Keri Kennedy, program manager for the West Virginia Injury Prevention Program in the state Department of Health and Human Resources. "This is the first time we have been able to put these numbers together," said Kennedy. State officials hope the report, "Rape in West Virginia: A Report to the State," will increase awareness of the problem and prevent violence against women. "Understanding the causes of violence against women is an important step in stopping future acts," said state Health and Human Resources Secretary Paul Nusbaum. "Conway Mill Offering Tuberculosis Test to 500 Employees" Associated Press (08.07.03) In Conway, Ark., a Kimberly-Clark employee testing positive for TB has prompted management to offer TB screening to its 500 employees, a plant manager said Thursday. Facility Manager Tim Painter said the company is offering the tests as a precautionary measure and will cover the cost of testing. "We're trying to calm any fears anyone has and answer their questions. We don't know of anybody else who is sick. We're just trying to keep employees informed," said Painter. A plant employee was diagnosed with active TB Monday and the company began testing Tuesday, said Painter. The testing is being offered at the Conway mill and is not mandatory for employees. "AIDS Survival Project Launches Statewide Training Program" Southern Voice (Atlanta) (08.08.03)::Van Gower Atlanta-based AIDS Survival Project has announced the creation of the Positive Action Network, a new Georgia-wide advocacy training group focused on HIV/AIDS. The program's goal is to give advocates the tools to provide information and perspectives to councils, policy-making bodies and health departments on the uniqueness of the HIV and STD epidemics in the South. "We hope to train and activate a new generation of advocates on these issues using their own expertise in areas of importance related to HIV, AIDS and the community as a whole," said ASP Executive Director Jeff Graham. Though the deadline has passed, applications for the program will continue to be accepted through mid-week. For more information, telephone 404-874-7926 ext. 24, or visit www.aidssurvivalproject.org. ************************************************************ The Prevention News Mailing List is maintained by the National Prevention Information Network (NPIN), part of the Centers for Disease Control and Prevention's National Center for HIV, STD and TB Prevention. Regular postings include the Prevention News Update, conference announcements, current funding opportunities, select articles from the Morbidity and Mortality Weekly Report series and announcements about new NPIN products and services. 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