The CDC HIV/Hepatitis/STD/TB Prevention News Update

MINNESOTA: "Pawlenty Rejects $850,000 for Sex Education"

ZIMBABWE: "Children Crossing Borders in Search of HIV Treatment"

TANZANIA: "Vitamin A Hikes HIV Loads in Breast Milk"

CALIFORNIA: "Counties Cut Back on Fighting Sexually Transmitted Diseases"

CALIFORNIA: "Needle-Exchange Program Offers Resources, Counseling"

GLOBAL: "Global Cash Support to Fight AIDS Is Falling: UN"

UNITED STATES: "Foursquare, MTV to Reward STD Checkups with Badge: Can They Make It Cool?"

MICHIGAN: "Annual AIDS Walk/Run Raises Funds, Awareness"

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MINNESOTA:
"Pawlenty Rejects $850,000 for Sex Education"   back to top
Star Tribune (Minneapolis) , (08.31.2010)   Josephine Marcotty

Experts in adolescent health are dismayed by Gov. Tim Pawlenty’s decision to reject an $850,000 federal teen pregnancy prevention grant that had no strings attached, while approving a $500,000 abstinence-only grant that requires $379,000 in matching state funds.

The state Department of Health wanted to apply for both grants, which were made available through the federal health care overhaul passed in March. Health Commissioner Dr. Sanne Magnan said she did not discuss the grant proposals with Pawlenty, a longtime supporter of abstinence-only education. The governor chose to submit just one application to the federal government, she said.

At a time when the state faces a serious budget crunch and its teen pregnancy and STD rates are higher than the national average, advocates note the rejected grant would have been a no-cost way to provide education on disease prevention and contraception while discouraging teen sexual activity.

“There is no excuse for turning away from this opportunity,” said Michael Resnick, a professor and adolescent health researcher at the University of Minnesota.

A spokesperson for the governor said Pawlenty declined the larger grant because “he is striving to find ways to stop” the implementation of federal health care reform in Minnesota. Both types of grants, however, are funded through the federal overhaul.

At one point, Minnesota was receiving $2 million in federal abstinence-only funds. The state began quietly declining the grants in 2007 after national and state studies largely discounted the approach.

Tom Prichard, head of the Minnesota Family Council, said he supports Pawlenty’s decision. “It’s better to spend no money on sex education if it’s going to have a condom message,” he said. “You are pouring fuel on the fire.”

ZIMBABWE:
"Children Crossing Borders in Search of HIV Treatment"   back to top
Inter Press Service , (08.24.2010)   Ignatius Banda

A quiet migration of HIV-positive children in need of antiretroviral treatment is underway in Zimbabwe. A growing number of families in rural areas are taking their children into Botswana and South Africa in hope of accessing free ARV therapy.

According to some faith-based organizations, the migration is due to long waiting lists for ARVs in Zimbabwe. Though the government offers free treatment, a rigorous vetting process has led to a backlog of patients needing therapy. Of the roughly 160,000 Zimbabwean children with HIV, just one in 16 have access to lifesaving medicines, a UN report found.

Zimbabwean nationals working in South African and Botswana avoid seeking HIV/AIDS treatment because they have no legal status and fear deportation. Under their Millennium Development Goal commitments, however, both nations attempt to provide free health care for all children.

“Some families, after hearing that others have sent their children across the border, have approached us to assist them with going there as well,” said Khumbulani Khaphela, pastor of an evangelical church in rural Plumtree. “This is how desperate the people are to provide treatment for their children.”

“From what we are hearing, it is easy for children with tuberculosis and HIV to be treated in South Africa’s government hospitals,” said Plumtree village elder Josphat Dakamela. “Everybody knows there are no medicines in the country [Zimbabwe] so what is happening here is no surprise.”

The cross-border transporters who have long assisted workers moving to South Africa are now helping sick kids make the passage. “Taking children as young as six to South Africa for treatment is something new,” said Mongameli Sibanda, a transporter. Some are in obviously poor health, he said, giving the journey a new urgency.

TANZANIA:
"Vitamin A Hikes HIV Loads in Breast Milk"   back to top
MedPage Today , (08.30.2010)   Kristina Fiore

In two analyses of HIV-positive mothers in Tanzania, those who took vitamin A and beta-carotene supplements had significantly higher HIV loads in their breast milk than women who did not take them (P=0.02), as well as a higher risk of subclinical mastitis. This inflammatory response leads junctions in the mammary epithelium to open and allow extracellular fluid to flow from plasma to milk; it could thus could explain the higher viral load, said Eduardo Villamor, MD, PhD, of the University of Michigan, a member of both study teams.

“Daily supplementation with these nutrients at the doses tested in the trial should probably not be given to HIV-infected lactating women,” Villamor said.

Both analyses come from a randomized, controlled trial of 1,078 HIV-positive women who received either: vitamin A (5,000 IU) and beta-carotene (30 mg); B-complex vitamins and vitamins C and E; a multivitamin and vitamin A; or placebo.

In a group of 594 women, the proportion of breast milk samples with detectable viral load was significantly higher in those who took regimens with vitamin A and beta-carotene than in the other groups (51.3 percent vs. 44.8 percent, P=0.02). This effect was evident at least six months after birth, when there was a 34 percent increased risk of HIV shedding in milk (relative risk 1.34; 95 percent confidence interval 1.04 to 1.73). No significant differences were noted between women who took multivitamins and those who took the placebo. Breast milk concentrations of beta-carotene were related to increased detectable viral load in milk.

In the second study, the subclinical mastitis of 674 women was assessed by the sodium-to-potassium ratio in breast milk. The researchers noted a 45 percent increased risk of severe subclinical mastitis (P=0.03) in those on vitamin A and beta-carotene, with non-significant trends toward greater risk of moderate subclinical mastitis or any degree of the condition.

Compared to the placebo group, the women receiving multivitamins without vitamin A and beta-carotene had a 33 percent increased risk of subclinical mastitis (P=0.005) and a 75 percent higher risk of severe subclinical mastitis (P=0.0006). A trend toward increased risk for women receiving multivitamins plus vitamin A and beta-carotene was noted but was not significant. For women with CD4+ T-cell counts of 350 or greater, multivitamin use resulted in a 49 percent increased risk of any subclinical mastitis (P=0.006). Multivitamins had no effect on women with lower counts.

Villamor noted that the findings about other vitamins are not particularly concerning, as previous studies have shown them to have beneficial effects. Regarding vitamin A and beta-carotene, however, there are now “strong arguments to consider the implications of supplementation to pregnant or lactating women who are HIV-positive. It does not look like it’s a safe intervention for them.”

“Effect of Vitamin Supplements on HIV Shedding in Breast Milk” was published in the American Journal of Clinical Nutrition (doi: 10.3945/ajcn.2010.29339). “Vitamin Supplementation Increases Risk of Subclinical Mastitis in HIV-Infected Women” was published by the Journal of Nutrition (doi:10.3945/jn.110.122713).

CALIFORNIA:
"Counties Cut Back on Fighting Sexually Transmitted Diseases"   back to top
Sacramento Bee , (08.28.2010)   Carrie Peyton Dahlberg

The recession has led some counties in the Sacramento region to cut back on efforts to contact the partners of newly diagnosed STD patients.

In Sacramento County, the health department has one staff member dedicated to contacting untreated partners. It is a part-time task, so only untreated pregnant women are being contacted as a priority population, said Dr. Glennah Trochet, the county’s public health officer. In fact, physicians are asked to make the first contact; the staffer follows up only with those who cannot be reached.

“Syphilis can be very devastating for a baby,” potentially causing mental disabilities and facial and bone deformities, Trochet said. An infant born to a woman with untreated gonorrhea can develop conjunctivitis, which can cause blindness. Untreated chlamydia in a mother can cause pneumonia in her newborn.

In El Dorado County, contact efforts have been reduced but there are enough staff members to contact everyone. Due to a backlog, however, contacting lower-priority patients takes about two weeks, said Dr. Olivia Kasirye, the county’s public health officer.

Yolo and Placer counties have not made any recent budget-related partner notification cuts.

The 2008 chlamydia rate in Sacramento County was 506 cases per 100,000 population, compared to the state’s rate of 391 per 100,000. The county’s gonorrhea rate that year, 117 cases per 100,000 population, also outpaced the state’s 67 cases per 100,000.

CALIFORNIA:
"Needle-Exchange Program Offers Resources, Counseling"   back to top
Lake County Record-Bee (Lakeport) , (08.27.2010)   Katy Sweeny

The needle-exchange outreach, Any Positive Change (APC), in August celebrated 15 years of service. In addition to home delivery, it provides counseling, resource assistance, treatment referrals, and more, said founder Annina van Voorene.

Visiting clients’ homes provides APC staff a unique opportunity, allowing them to help solve problems they would not otherwise know about. “We know them. They open up to us,” said van Voorene. “We can see the flavor of their lives. It’s an incredible opportunity for education and counseling.”

For example, APC staff can troubleshoot concerns such as clients who do not have running water. They can also teach users the cleanest and safest way to inject to avoid infection. “If only we had a penny for every person who said, ‘You’re the only person who ever treated me with any respect,’” van Voorene noted.

According to van Voorene, Lake County has one of the highest rates of HIV/AIDS among California’s rural counties. From 2002 to 2009, the county logged 60 HIV cases. Between 1998 and 2009, the county recorded 62 AIDS cases, 65 cases of chronic hepatitis B, and 1,611 chronic hepatitis C cases.

APC is funded through grants and does not receive any county or state support, said van Voorene. In 2008, the county Board of Supervisors adopted a resolution authorizing needle exchange. One year later, APC was recognized by the board as a community-based organization, and the group agreed to provide data to Lake County Health Services.

Board Chair Anthony Farrington said he thinks APC is helping reduce the spread of blood-borne disease and would like to see the program have a fixed site offering additional services.

GLOBAL:
"Global Cash Support to Fight AIDS Is Falling: UN"   back to top
Agence France Presse , (09.02.2010)   

The global effort to fight HIV/AIDS is suffering due to the poor economy, UNAIDS Executive Director Michel Sidibe said today in Tokyo. “Governments and donors are second-guessing in terms of their budget and priorities. For the first time in 15 years, we are seeing the global commitment beginning to falter,” Sidibe told a press conference. Simplified, less-expensive treatment plans are needed to save the lives of millions of patients, he said, noting that many in Africa still struggle to access costly care dispensed by highly trained professionals. Sidibe called on Japan to maintain its support for the Global Fund to Fight AIDS, TB and Malaria. He also challenged Tokyo, which recorded 370 new HIV cases last year, to set a goal of no new infections in five years.

UNITED STATES:
"Foursquare, MTV to Reward STD Checkups with Badge: Can They Make It Cool?"   back to top
CBS News , (09.01.2010)   

Foursquare, the smart-phone social networking application that lets users inform others of their whereabouts, has teamed with MTV’s “GYT: Get Yourself Tested” campaign to encourage screening for STDs. Foursquare issues digital “badges” for users who achieve certain goals: Visiting the gym 10 times in a month earns one a “Gym Rat” badge, for example. The new effort will award a “GYT” badge to users who visit a health clinic for STD testing. The idea, organizers say, is to make STD testing as routine as a physical or dental exam. MTV credits GYT, launched in 2009 with the Kaiser Family Foundation, with helping boost the number of young people visiting Planned Parenthood clinics across the country.

MICHIGAN:
"Annual AIDS Walk/Run Raises Funds, Awareness"   back to top
Grand Rapids Press , (08.29.2010)   Monica Scott

Saturday’s 18th annual AIDS Walk/Run in Grand Rapids attracted about 135 registered participants who raised more than $10,000. The event, which had more than a dozen sponsors, helps support the Grand Rapids Red Project, AIDS Inc., Saint Mary’s Health Center, and the Westminster Ryan White Food Pantry. “Events like this are important for getting the word out about the disease and helping break the stigma that surrounds it,” said participant Manita Patel. “HIV/AIDS can be prevented.”