AIDS Daily Summary July 18, 1995 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, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1995, Information, Inc., Bethesda, MD ************************************************************ "Efforts to Make Blood Products Safer Tied to Competitive Pressures" "Study Finds Americans, Europeans Ill Informed on STDs" Nurturing a New View on Prenatal AIDS Testing" "Gays, AIDS and Oral-Sex Risk" "UCSF Dentists Offer Free Services at the Nation's Biggest Health Fair" "Tuberculosis Knowledge Among New York City Injection Drug Users" "Treatment of HIV-Associated Kaposi's Sarcoma with Paclitaxel" "New AIDS Prevention Volume Highlights Innovative Solutions Used in Last Decade" ************************************************************ "Efforts to Make Blood Products Safer Tied to Competitive Pressures" Philadelphia Inquirer (07/18/95) P. A1; Shaw, Donna According to company documents, executives of Baxter Healthcare Inc. decided in 1979 to expedite the company's virus-killing research for hemophilia blood-clotting products after they learned that a West German firm was close to introducing a clotting drug that was heat-treated to kill the hepatitis virus. The executives then chose to focus on obtaining regulatory approval for a safer product in Germany--where there were 6,000 hemophiliacs, compared to the United State's 20,000. The effort of designing federally approved products for American hemophiliacs should not "in any way slow down or retard progress...in the highest priority project of obtaining Germany registration," wrote David L. Castaldi, president of Baxter's Hyland Therapeutics Division, in a 1982 memo. These documents are part of lawsuit filed in Chicago's U.S. District Court by American hemophiliacs against Baxter, three other drug makers, and the National Hemophilia Foundation. The plaintiffs contend that the companies did not do enough to keep HIV out of their blood products, and that the foundation was too financially dependent on industry to be an effective voice. Last week, the Institute of Medicine said that the companies could have inactivated viruses in blood products sooner, if there had been regulatory or competitive pressure. "Study Finds Americans, Europeans Ill Informed on STDs" Reuters (07/17/95); Melnbardis, Robert According to a new study by the American Social Health Association, most adults in the United States and Europe know little about sexually transmitted diseases (STDs) other than AIDS. The survey of nearly 5,000 adults showed that one-third could not name an STD besides HIV or AIDS. "The public awareness of these infections is very low, and this epidemic in STDs is just smoldering in all of these countries," said Peggy Clarke, association president. Clarke said the survey shows that increasing public awareness of HIV and AIDS have not facilitated open discussions of STDs, noting that embarrassment is the largest factor. Among those who could name an STD other than AIDS, the most frequently cited ones were traditional STDs such as syphilis and gonorrhea. "Nurturing a New View on Prenatal AIDS Testing" Boston Globe (07/16/95) P. 71; Goodman, Ellen The federal study concluding that HIV-infected women who took AZT during pregnancy reduced by two-thirds the risk of HIV transmission to their babies has not only changed the odds of having a healthy baby, but added weight to the importance of HIV testing, writes columnist Ellen Goodman in the Boston Globe. The discovery imposes a special moral obligation on a pregnant woman to be tested for HIV, Goodman contends. However, there is still an ethical dilemma in requiring her to do so. The Centers for Disease Control and Prevention's Dr. Martha Rogers notes that mandating tests only guarantees test results--it does not ensure treatment. The first steps toward testing and treatment should be better counseling, reaching out to women, and getting them into a trusting relationship with medical care--and this is not a relationship that can be built by adversaries or force, Goodman concludes. "Gays, AIDS and Oral-Sex Risk" Philadelphia Inquirer (07/15/95) P. A7; Rotello, Gabriel In an article published in the June issue of Harper's magazine, Walt Odets, a Calif. psychologist and well-known critic of conventional AIDS prevention methods in the gay community, cited a study that appeared to support his claim that oral sex without condoms is "an extremely safe activity." According to Odets, the study followed a cohort of 6,704 gay men in San Francisco and found that "in five years there were precisely two infections that might be attributable to oral sex. This represents a 0.0003 percent risk of HIV transmission over five years." A letter to the editor published in the current issue of Harper's, however, notes that two out of 6,704 actually yields a 0.03 percent risk. Still, Odet's comments leave the impression that only two men became infected with HIV via oral sex in five years--a figure which is low and misleading. The study followed only 675 gay men. In addition, Alan Lifson--who published a study of two of the participants--said, "Our report was simply a case study of two men in whom oral transmission occurred, to indicate that it does, in fact, occur." The best way to way to look at the data, notes cohort director Paul O'Malley, is that at least 3 of the 675 men, or 0.5 percent, were orally infected with HIV. "UCSF Dentists Offer Free Services at the Nation's Biggest Health Fair" Business Wire (07/17/95) "Su Salud" ("Your Health"), the nation's largest all-volunteer health fair, will be held in Stockton, Calif., on July 23. Among the participants will be over 50 members of the University of California's San Francisco (UCSF) Medical School of Dentistry, who will offer free screenings for such conditions as AIDS, oral cancer, tuberculosis, and diabetes. Nelson Artiga, one of the fair's coordinators, said that the UCSF volunteers will donate about $10,000 worth of services this year, providing dental and oral health services. Other volunteer hospitals, universities, and community groups will offer services ranging from cholesterol screenings to pre-natal exams. "Tuberculosis Knowledge Among New York City Injection Drug Users" American Journal of Public Health (07/95) Vol. 85, No. 7, P. 985; Wolfe, Hannah; Marmor, Michael; Maslansky, Robert et al. Between November 1992 and February 1993, as part of a cohort study of HIV infection among injection drug users, Wolfe et al. recruited nearly 500 members of New York City methadone maintenance treatment programs to assess their knowledge of tuberculosis (TB). More than 30 percent of this group reported having tested positive to a tuberculin skin test in the past. Almost all subjects identified TB as an airborne infection, and more than 50 percent also identified possible indirect methods of transmission. Seventy-five percent did not understand the difference between infection and active disease, but those who reported a history of skin test reactivity were two times more likely to comprehend the distinction. A total of 40 percent of those surveyed did not understand the necessity of medication adherence. The majority, however, did understand that TB is potentially fatal, and realized that HIV-infected persons are more susceptible to it. The study's authors concluded that these misunderstandings--which could be the result of faulty TB education and overgeneralization of knowledge about HIV--may contribute to the fear and confusion that hamper TB control efforts "Treatment of HIV-Associated Kaposi's Sarcoma with Paclitaxel" Lancet (07/01/95) Vol. 346, No. 8966, P. 26; Saville, M. Wayne; Lietzau, Jill; Pluda, James M. Saville et al. conducted a phase II trial to determine whether the drug paclitaxel (Taxol), which is active against various carcinomas, is effective against AIDS-related Kaposi's sarcoma (KS). The drug's cellular target is similar to that of vinca alkaloids, which are active against KS. Although none of the 20 patients achieved a complete response, 13 had a partial response. All six of the patients who had received prior systemic treatment responded, as did the five with pulmonary Kaposi's sarcoma. The other six remained stable, while just one progressed. The most common dose-limiting toxic effect was neutropenia. Novel toxic effects included late fevers, rash, and eosinophilia. The authors say their findings suggest that paclitaxel is active against HIV-associated KS, including in those patients with aggressive disease, advanced AIDS, and previous receipt of systemic therapy. "New AIDS Prevention Volume Highlights Innovative Solutions Used in Last Decade" Nation's Health (07/95) Vol. 25, No. 6, P. 24 "AIDS Prevention in the Community: Lessons from the First Decade," edited by Nicholas Freudenberg and Mark Zimmerman, offers case studies on more than 50 AIDS prevention and service programs funded by the Robert Wood Johnson Foundation. Freudenberg says the programs were selected based on the populations they served and on the innovative community-based interventions they provided. The book offers cases studies of such programs as the Hartford Hispanic Health Council, the Los Angeles County Public Health Foundation Condom Promotion and Distribution Project, and the Southeast Network for Youth and Family Services AIDS Prevention for Runaway Youth. The most significant lessons learned, according to Freudenberg, were "the importance of tailoring interventions to particular populations;" including community members in planning and implementing programs; and the need to address life circumstances--such as drug use and poverty--that affect HIV risk.