From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CDC Summary 1/20/93
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 13
Organization: unspecified
Date: Fri, 22 Jan 93 22:02:12 PST

                        AIDS Daily Summary 
                         January 20, 1993  
 The Centers for Disease Control and Prevention (CDC) National AIDS  
Clearinghouse makes available the following information as a public  
service only. Providing this information does not constitute endorsement  
by the CDC, the CDC Clearinghouse, or any other organization.  
Reproduction of this text is encouraged; however, copies may not be  
sold. Copyright 1992, Information, Inc., Bethesda, MD  
------------------------------------------------------------------------ 
 "AIDS Enters the Office" Financial Times (01/20/93), P. 8  (Harrison,  
Barbara) 
     Although a few American companies have instituted AIDS education  
campaigns, most firms lag behind in establishing any anti-AIDS efforts.   
Approximately 1 million Americans are HIV-positive, making AIDS the  
second leading cause of death for men aged 25-44 and the sixth leading  
cause for women aged 25-44.  This age group accounts for more than 50  
percent of the U.S. workforce.  More than two-thirds of companies with  
between 2,500-5,000 employees and about one in 12 companies with fewer  
than 500 employees have had a worker with HIV or AIDS.  Therefore, the  
Centers for Disease Control has established a "Business Responds to AIDS  
" program.  The agency has prepared a manager's kit and a labor leader's  
kit to give step-by-step guidelines on how to develop an HIV/AIDS policy  
and an education program.  The kits make recommendations regarding  
health insurance issues, in addition to counseling and educational  
services.  It also includes a section on what the Americans with  
Disabilities Act means to companies. It says that companies cannot deny  
an HIV-positive individual a job because insurance costs may increase.   
Also, job applicants cannot be forced to undergo an HIV test.  And firms  
cannot  release workers with HIV or AIDS if they are able to perform the   
"essential functions" of a job given "reasonable accommodation"  to  
their disability.  Digital Equipment Corporation was one of  the  
corporate pioneers which established an AIDS education  program in 1987.   
Paul Ross, Digital's manager of its HIV/AIDS  program, feels that  
allaying the fears of infected and uninfected alike is crucial to avoid  
workplace problems.  
------------------------------------------------------------------------ 
"Europe Starts to Face HIV Issue" Financial Times (01/20/93), P. 8   
(Abrahams, Paul et al.) 
     European-based companies have been slow to deal with AIDS in the   
workplace, as opposed to their U.S. counterparts.  A primary  reason is  
that the disease has spread more slowly in Europe than  North America.   
For example, 3,995 people in the U.K. have died  of AIDS since 1982.   
Most of the firms that have addressed the  problem early have been  
branches of U.S. multinationals or  U.K.-based groups with subsidiaries  
in Africa and Asia.  Glenys  Rowe, an independent consultant on HIV and  
AIDS implications for  businesses, says that more businesses are now  
beginning to face  the issue.  Approximately half of the companies that  
contemplate  adopting an anti-HIV policy do not do so, but incorporate  
the  issue into existing health policies.  They fear that a specific   
policy would lead to discrimination.  Rowe said that one of the  most  
promising programs is the launch of the U.K. Corporate HIV + AIDS  
Project.  It's goal is to produce a number of briefing  sheets on  
various policy issues when considering the impact of  HIV and AIDS on  
businesses.  The French Agency for the Fight  against AIDS recently  
surveyed more than 1,000 company personnel  directors and found that one  
in 10 firms had HIV-positive  workers.  A total of one in four companies  
had implemented  prevention programs.  However, the 80 percent of  
companies which  had not already established any program said they saw  
no reason  to do so in the future.  Evidence suggests that the risk are   
minimal for heterosexuals who do not inject drugs, do not visit   
brothels, and do not holiday in Thailand  and other "sex-tourist" hot- 
spots.  Recent figures state that homosexual/bisexual men  comprise 65  
percent of new AIDS cases and IV-drug users account  for 15 percent.  
------------------------------------------------------------------------ 
"Young Men Dominate AIDS Victims in Singapore" Reuters (01/16/93) 
     Singapore--Most new AIDS cases in Singapore occur among young men  
who had sex with prostitutes, and an additional 55 people were  found to  
be infected with HIV last year, the Health Ministry  reports.  The  
Sunday Times newspaper quoted ministry figures as  demonstrating that  
three out of four of all Singaporean AIDS  patients were single and four  
out of five were between the ages  of 20 and 39.  Among the 55 new HIV- 
positive individuals--49 men  and six women--about 70 percent contracted  
HIV through  heterosexual relations with prostitutes and 96 percent  
through  sexual contact.  In 1991, there were 42 newly detected HIV  
cases, and 17 in 1990.  According to the Health Ministry, 37   
Singaporeans died of AIDS as of January 1 and there were 158  other  
people found to be infected with HIV.  The number of  foreigners  
infected with HIV increased from 28 in 1991 to 61 in  1992.  
------------------------------------------------------------------------ 
"AIDS Prevention" Associated Press (01/16/93)  (Kennedy, Dana) 
     New York--After the federal government announced that it would  cut  
state funds for AIDS prevention, a New York outreach worker  began to  
worry about where teenage prostitutes in Times Square  will get condoms.   
Ines Robledo, who works with Streetwork, a  drop-in center that provides  
AIDS counseling to homeless  teenagers and some adults, said, "They're  
going to give up hope  without us."  She said they are more concerned  
about where they  are going to sleep and eat, rather than whether they  
are going to infect others or themselves.  Federal officials recently  
revealed that Congress has allotted only $129 million for grants to  
states for AIDS prevention this year, compared with $143.7 million last   
year and $159 million in 1991.  Terri Lewis, director of the AIDS and  
Adolescent Network, said, "This is the most appalling thing  the  
government has done in the history of this epidemic.  Many  centers are  
going to close down, which means people won't get the services they need  
and more and more people will get infected."   One prostitute said that  
many men won't use condoms and a lot of  prostitutes won't dispute it.   
Monay Johnson, a 24-year-old  transvestite prostitute, said he tries to  
use condoms with  customers but often is to tired.  He added that when  
he is using  crack he usually forgets about it altogether.  Streetwork  
is part of Victim Services Agency, and its budget for fiscal year 1993  
is just over $1 million--including about $170,000 from the federal   
government, said Marin Gazzaniga, a Victims Services spokeswoman. The  
remainder comes from a combination of state, city, and  private funds.  
------------------------------------------------------------------------ 
"One of Six in Zimbabwe has AIDS Virus--Study" Reuters (01/18/93) 
     Harare--Nearly 1.5 million residents of Zimbabwe, a sixth of the   
country's population, have contracted HIV, according to a survey   
published on Monday.  The survey, commissioned by the Commercial   
Farmers' Union, said Zimbabwe's economy could experience a lack  of  
skilled labor if infection rates continued at present levels.  Zimbabwe  
has 40,000 confirmed AIDS cases reported in a population of 10.2  
million.  
------------------------------------------------------------------------ 
"AIDS Education" Associated Press (01/18/93)  (Neergaard, Lauran) 
     Atlanta--Parents and school systems nationwide are debating about  
how to educate students about AIDS and at what age.  John Kappers of the  
National Association of People with AIDS, said, "This has  polarized  
people because they think it's a morality issue.  If  they could see  
someone dying of this disease, they would see the  immorality in not  
teaching about it."  The debate has occurred in New York regarding what  
to teach in each grade which stalled the  state from implementing AIDS  
education in the nation's largest  school district until five years  
after lawmakers mandated it in  1987.  Also, the Michigan Board of  
Education rejected a proposed  wait-until-marriage approach.  In South  
Carolina, some parents  are requesting that lawmakers stop the Education  
Department from  using "AIDS-Buster" kits--equipped with a rubber model  
of a penis for condom demonstrations--with high risk teens in pregnancy   
clinics and juvenile shelters.  But the most recent controversy  has  
emerged in Georgia, where hundreds of parents are protesting  a state  
plan to increase sex and AIDS education.  Georgia  students get anywhere  
from two days to a few weeks of sex  education in high school; the class  
is often an elective.  The  governor vetoed a bill last year that would  
have curbed the  courses and asked the state Board of Education to  
strengthen the  curriculum.  The school board suggested that fifth- 
graders be  taught "some of the ways to prevent the spread of  
communicable  diseases."  Critics say that suggests that students would  
get  explicit lessons on anal and oral sex and condoms--educators   
vehemently deny it.  Georgia has about 6,000 AIDS cases--ranking   
seventh in the nation--along with at least 16,400 HIV infections.  
------------------------------------------------------------------------ 
"TMP/SMX Prophylaxis for Toxoplasmic Encephalitis" American Pharmacy  
(01/93) Vol. NS33, NO. 1, P. 87   (Covington, Timothy R. and Hurd, Peter  
D.) 
     Low doses of trimethoprim-sulfamethoxazole (TMP-SMX) appear to be  
more effective prophylaxis against toxoplasmic encephalitis when   
compared to pentamidine in AIDS patients with a history of  Pneumocystis  
carinii pneumonia (PCP), according to a study  conducted by A. Carr et  
al. published in the Annals of Internal  Medicine.  Toxoplasmic  
encephalitis is a frequently occurring  neurologic complication of HIV  
infection with early mortality as  high as 16 percent and residual  
neurological impairment of 40-50  percent.  The study analyzes the  
efficacy of low-dose TMP-SMX as  primary prophylaxis against toxoplasmic  
encephalitis versus  pentamidine in HIV-positive patients with a history  
of PCP.  A  total of 60 patients received TMP-SMX during the three-year  
study period, and 95 received pentamidine as secondary prophylaxis   
against PCP.  None of the 60 patients in the TMP-SMX group and no  
patients in the seronegative for Toxoplasma gondii developed   
toxoplasmic encephalitis.  In the pentamidine-treated group, 12  of 36  
seropositive patients developed toxoplasmic encephalitis.   No cases of  
toxoplasmic encephalitis developed during the  observation period.  The  
median time to develop PCP in the 12  seropositive patients in the  
pentamidine-treated group was 460  days.  Low-dose TMP-SMX offers the  
advantage of being simple,  convenient, and safe and it may protect an  
AIDS patient from  developing both toxoplasmic encephalitis and PCP, the  
researchers conclude.  
------------------------------------------------------------------------ 
"Corticosteroids for HIV Esophageal Ulcerations" American Pharmacy  
(01/93) Vol. NS33, No. 1, P. 87   (Covington, Timothy R. and Hurd, Peter  
D.) 
     Oral corticosteroid therapy is effective when used to treat  HIV- 
related esophageal ulcerations, write C.M. Wilcox and D.A.  Schwartz in  
a study featured in the American Journal of Medicine. The study assesses  
the safety and efficacy of oral prednisone  therapy in managing HIV- 
associated idiopathic esophageal  ulcerations.  Esophageal ulceration  
was confirmed by clinical,  endoscopic, and pathologic criteria in HIV- 
positive individuals.  Prednisone was administered to 12 patients at an  
oral dose of 40  mg per day, tapering 10 mg per week, for a total of one  
month of  therapy.  Endoscopy was performed within one week of  
completion  of therapy.  The mean duration of esophageal symptoms was  
found  to be 2.9 weeks.  A total of 10 of the 12 patients receiving the   
steroid had AIDS.  Also, 11 of the 12 patients had complete  relief of  
symptoms, usually in the first week of therapy.  The  study revealed  
that the oral steroid regimen was well-tolerated.  Mild asymptomatic  
Candida esophagitis was detected in the  patients on follow-up  
endoscopy.  No systemic opportunistic  infections were documented during  
or within one month of the  completion of therapy.  The researchers  
conclude that controlled  studies should be conducted to determine  
optimal dose and  duration of therapy and ultimate safety and efficacy.  
------------------------------------------------------------------------ 
"Noticeboard: Didanosine and ACTG 116A" Lancet (01/09/93) Vol. 341, No.  
8837, P. 109 
     The National Institutes of Allergy and Infectious Diseases has   
released findings from a study by the AIDS Clinical Trials group  that  
addresses whether duration of previous AZT therapy  influences the  
efficacy of didanosine.  The trial (ACTG 116A)  comprised the second  
part of a study that analyzed the efficacy  and toxicity of didanosine  
in patients with AIDS, AIDS-related  complex, or asymptomatic HIV  
infection.  Of the patients who had  not taken AZT before, didanosine  
was less effective than AZT at  preventing progression of HIV disease to  
a new AIDS-related  illness.  In patients who had received 8-16 weeks of  
AZT,  didanosine was the more effective drug.  A total of 119 patients   
who took 8 or fewer weeks of AZT had inconclusive data.  Patients  
receiving low-dose didanosine had fewer episodes of pancreatitis, the  
most serious side-effect of didanosine therapy, than those  receiving  
the higher dose.  Last year, the results from the first part (ACTG  
116B/117) of the study protocol were published.  Kahn  et al. discovered  
that low-dose didanosine postponed progression  of HIV disease in  
patients with ARC and asymptomatic HIV  infection who had received AZT  
for at least 16 weeks.  The  subjects in the ACTG trial differed from  
those in the Alpha  trial, in which patients were intolerant of AZT.   
The results  that show 500 mg/day didanosine (400 mg/day in tablet form)  
is  safer than the higher dose, and that it is more effective than  AZT  
in patients who have received 8-16 weeks of AZT, support its  use in  
urgently needed studies of alternating vs. simultaneous  nucleoside  
analog regimens and in trials combining nucleosides  with other drug  
categories.  

Newsgroups: sci.med.aids