WMP News and Information

Needle exchange: Public health vs. politics in the District of Colombia

Prosecutor Seeks Lengthy Prison Term for HIV-Infected Woman

Associated Press (07.22.02)

A prosecutor in Compton, Calif., is seeking a felony conviction and a nine-year sentence for a woman who is facing her seventh charge of prostitution since being diagnosed with HIV in 1995. An undercover officer in south Los Angeles arrested Panchita Hall, 46, in April. At the time she was on probation for previous prostitution convictions.

Hall's Superior Court case was postponed Monday for a week. She is charged with felony prostitution, and Deputy District Attorney Lori-Ann Jones said she is seeking the maximum three-year sentence under a 1988 state law that requires prostitutes who are HIV-positive and who have been informed of their blood test results to be charged with a felony upon their second arrest. The prosecutor also wants additional prison time for Hall's four previous convictions, including one that drew a four-year suspended sentence. "It's a very dangerous situation, and the victims don't know it but she does," Jones said.

Since the felony charge for HIV-infected repeat offenses was enacted, tens of thousands of prostitutes have been tested for HIV in Los Angeles County. The first case in 1990 brought a two-year prison sentence for a male prostitute, with 216 other convictions since 1995 for those previously diagnosed with HIV.

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Mistrial Declared in Prostitution Case

Los Angeles Times (08.01.02)

In Los Angeles Wednesday, an impasse was declared in the prostitution trial of an HIV-positive woman after the Superior Court jury reported that it was deadlocked.

Judge Arthur M. Lew dismissed the panel and set Aug. 7 as a pretrial hearing date for Panchita Hall, who will be retried under a 1988 state law that requires convicted prostitutes who have been informed that they are HIV-positive to be charged with a felony upon their next arrest.

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HIV-Infected Woman Charged with Having Unprotected Sex

Associated Press (07.31.02)

Health department officials have charged an HIV-infected woman with having unprotected sex in violation of control measures she agreed to follow, according to court documents.

Virgie Lorraine Mayne Norman, 34, of Gastonia, N.C., was in Gaston County Jail without bond Tuesday night. State law allows county health commissions to establish control measures or rules to prevent the spread of communicable diseases. "This is probably the first time [the charge has been used for HIV]," said District Attorney Mike Lands. "We've had people with tuberculosis who wouldn't take their medication and the Health Department charged them." The warrant states that Norman, "while being infected with HIV, knowingly had sexual intercourse without using condoms in violation of control measures." Norman, who has been charged four times in seven years with prostitution-related charges, declined to comment.

With STDs, Many Still Wind Up Sorry Instead of Safe

Chicago Tribune (07.31.02)
Kevin McKeough

When Anne began having sex with a man she was dating, she insisted on using condoms. After a few weeks, he told her that he'd tested HIV-negative. "Because of that - and this was stupid of me - I had unprotected sex," she recalls. Anne contracted HIV from her boyfriend. "I think it was just his own denial," said Anne.

It's also possible that Anne's boyfriend honestly didn't know he had HIV - which is among the problems that continue to drive up HIV rates despite educational efforts, said Dr. Ronald Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention with the CDC. The same is true for other STDs, other experts say.

Overall, 77 percent of the 440 HIV-positive gay and bisexual men in a CDC study were unaware they were infected. The study surveyed 5,719 men ages 15 to 29 in six major cities. US health officials estimate that 40,000 Americans - including 12,000 women - are infected with HIV each year, with heterosexual sex accounting for one-third of all new cases. In recent years, African-American women accounted for nearly half of the known cases of new infections caused by heterosexual sex, according to the CDC.

"People are a lot less concerned in general about HIV, and as a consequence they're doing less to protect against all [STDs]," says Dr. Martin Gallo, an obstetrician/gynecologist at Good Samaritan Hospital. "There's just a ton of genital warts that are out there," he said. Judith Sutton, a nurse practitioner with Planned Parenthood of Chicago, also reported seeing a large number of patients with genital warts - "HPV [human papillomavirus] is epidemic," she said - and a marked rise in the number of herpes cases.

Sutton recommends that new partners get tested for STDs before they start having sex and repeat the tests six months later. A woman should get a pap smear to check for HPV six months after she and her partner first have sex without a condom so, if detected, it can be treated promptly. In fact, because male condoms don't protect entirely against HPV and herpes, it's advisable to use the female condom, which covers the entire female genital area.

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Congress Issues a Wake-Up Call on Inmate Rape

Detroit Free Press (08.01.02)
Reuters

Lawmakers in both parties yesterday denounced the rape of hundreds of thousands of inmates in US jails and prisons as a national disgrace and a massive abuse of human rights. The victims include pretrial detainees and immigration detainees as well as convicted criminals, Sen. Edward Kennedy (D-Mass.) told the Senate Judiciary Committee. He cited both the "devastating" effects on victims and the "serious consequences for communities," including the spread of HIV and hepatitis C. He said prison officials often fail to take obvious steps to protect inmates.

Kennedy and Sen. Jeff Sessions (R-Ala.) are sponsoring the Prison Rape Reduction Act of 2002. In the House of Representatives, the legislation is sponsored by Reps. Frank Wolf (R-Va.) and Bobby Scott (D-Va.) The act would direct the DOJ to conduct an annual statistical analysis of the frequency and effects of prison rape. It would establish a panel to conduct hearings on systems, prisons and jails where the incidence of rape is high. And it would direct the attorney general to provide information and training for state and local prison authorities on preventing, investigating and punishing rape. The act has broad support in both parties and is backed by a coalition of religious and human rights organizations.

Two million people are held in US prisons and jails. Although there are no definitive data, studies have shown that 10 percent to 22 percent of men and a similar percentage of women are raped each year.

Wendy Patten, US advocacy director for Human Rights Watch, called the situation "a devastating human rights abuse that is widespread." Mental health counselor Robert Dumond told the committee that many prison rape victims experienced post-traumatic stress disorder, anxiety and depression and were at risk of committing suicide.

Sexual and Drug Use Behavior Among Women Who Have Sex with Both Women and Men: Results of a Population-Based Survey

American Journal of Public Health (07.02) Vol. 92; No. 7:1110-1111
Susan Scheer, PhD; Ingrid Peterson, MPH; Kimberly Page-Shafer, PhD, MPH;
Viva Delgado, MPH; Alice Gleghorn, PhD; Juan Ruiz, MD, DrPH; Fred Molitor, PhD; William McFarland, MD, PhD; Jeffrey Klausner, MD, MPH;
and the Young Women's Survey Team

Recent US HIV/AIDS trends suggest a relative increase in HIV infections among women attributed to injection drug use or heterosexual contact. While unknown, the biological risk of female-to-female sexually transmitted HIV is thought to be much lower than the risk of transmission between men and women. Yet studies have shown that some subgroups of women who have sex with women (WSW) exhibit high levels of sexual risk behaviors with men as well as unsafe injection drug use. Thus, if risk assumptions are based on self-reported or presumed sexual identity, possible risks for HIV infection may be underestimated in some subgroups of WSW.

The current study describes sexual and drug use behaviors associated with HIV and other STDs among WSW who responded to a door-to-door population-based survey of women ages 18 to 29. It was conducted between April 1996 and January 1998 among residents of low-income neighborhoods in northern California.

Of 2,457 women, 88 percent reported sex exclusively with men; 7 percent reported sex with men and women; 1 percent reported sex exclusively with women. Of the seven HIV-positive women, four reported only male partners; 2 reported both male and female partners; one reported only female partners. None of the 16 WSW who reported sex exclusively with women reported any injection drug use. Therefore, analyses of risk were limited to those who reported sex with both men and women and those who reported sex exclusively with men.

Compared with women who had sex exclusively with men, women who had sex with men and women were significantly more likely to report past and recent high-risk sexual behavior, including sex with an HIV-positive man; multiple male sex partners; sex with a man who had sex with other men; sex with an injection drug user; trading sex for drugs or money; and anal sex. They were also more likely to report past and recent injection drug use, and they were more likely to have serological markers for hepatitis B and C. Rates for HIV and other STDs did not significantly differ, owing to the small number of these infections.

Rates of sexual and injection drug risk activities exhibited by women who reported sex with both women and men place this group at potentially higher risk of HIV and other STDs than women who were exclusively sexual with either men or women. "Prevention efforts should avoid assumptions based on reported sexual identity and should acknowledge that women who report sex with both women and men may be at increased risk for HIV and other STDs," the authors concluded.

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Zimbabwean Women Very Willing to Use Diaphragms as Potential HIV Prevention Method

AIDS Weekly (08.05.02)

A study of Zimbabwean women who were unable to persuade their male partners to use condoms consistently has found that 98 percent of the women used the diaphragm as an alternative method of contraception and disease prevention, University of California-San Francisco researchers reported at the 14th International AIDS Conference in Barcelona.

"The cervix appears to be a 'hot spot' in terms of susceptibility to HIV. It is also very thin and fragile and has more cells with HIV-specific receptor sites than the vagina. Also, the peristalic contractions of the uterus actually draw fluids up into the upper genital tract - an area that is very susceptible to HIV and other sexually transmitted diseases. This rapid upward movement of the fluid is thought to enhance fertility but also transports HIV and STD-causing pathogens," said principal investigator Nancy Padian, PhD, UCSF professor of obstetrics, gynecology and reproductive services and director of international programs at UCSF's AIDS Research Institute.

Data from observational studies show that protecting the cervix protects against bacterial STDs that can facilitate HIV transmission. And because diaphragms can be used as vehicles to hold spermicides, they may thus increase the effectiveness of new microbicides to prevent HIV transmission, Padian said.

In Zimbabwe, where the study took place, 30 percent of the population is estimated to be HIV-infected. Women first enrolled in a two-month program to teach and encourage male condom use. Women who were unable to negotiate consistent condom use were then enrolled into the diaphragm acceptability phase. Ninety-seven percent of the on-going study's 156 women are married, and 70 percent have had only one partner. Before entering the study, only 1 percent had ever used a diaphragm. Almost all the women used KY Jelly in addition to diaphragms.

"Given the urgent need for HIV prevention methods that a woman can use without her partner knowing about or needing to consent to use, the potential of this existing product can no longer languish unexplored," said Padian, who is also director of the Women's Global Health Imperative at UCSF. Coauthor Tsungai Chipato, MD, said there is "substantial evidence to suggest that protecting the cervix could offer some protection against HIV.... Now that we know they are acceptable [to women], diaphragms need to be tested for efficacy in preventing HIV."

Man Ordered to Receive TB Treatment

Associated Press (07.31.02)

The judge, lawyers, witnesses and court staff all wore masks during a hearing in which a Kanawha County, W.Va., man was committed against his will for treatment of TB. Kanawha County Circuit Judge Irene Berger ruled Tuesday that the threat to public health was too serious and ordered Stephen R. Mitchell of Clendenin into the custody of state health officials.

Mitchell, whose illness isn't considered a severe case, will be treated at Pinecrest Hospital in Beckley until health officials are sure he no longer poses a public health threat. Mitchell was diagnosed with the disease several months ago after an unrelated hospital visit. Dr. J.D. Felson testified that if Mitchell had not missed earlier appointments, he could have been treated on an outpatient basis. Seven West Virginia residents currently are being treated for the disease, state health officials said.

Prisoner Unlocks Hepatitis C Epidemic

Philadelphia Inquirer (07.22.02)
Jennifer Lin; Mark Fazlollah

In 1992 at a state prison infirmary in Pittsburgh, inmate Rob Lassen learned he did not have HIV. But it took four years before Lassen, who was convicted of assault, was told he had tested positive for hepatitis C. The physician who revealed the diagnosis held out little hope for treatment and no explanation of why prison health officials had not told Lassen sooner.

Angry at having his medical results withheld from him and fearful that he would die if he were not treated, Lassen spearheaded a prison-yard investigation of hepatitis C at Rockview prison. How many other inmates knew they had hepatitis C? What was hidden in their files? What had they been told? Could they get treatment?

When Lassen asked for interferon in 1998, prison officials turned him down: They had no policy for treating hepatitis C. When the Food and Drug Administration approved dual drug therapy in June 1998, Lassen began referring other inmates to the infirmary to get blood tests and recorded whether each had been treated - in signed affidavits. Eleven untreated inmates filed grievances with Rockview's medical administrator, promptly landing Lassen in 30 days' solitary confinement for "unauthorized group activity," an infraction making him ineligible for early prison release.

Yet, at the same time, prisoners in eastern Pennsylvania were starting to get treatment. There, Correctional Physician Services Inc. began to use dual hepatitis C therapy on prisoners in 1999. Early in 2000, the Department of Corrections began screening inmates at high risk because of drug abuse, and prisons began offering dual therapy to eligible prisoners. Inmates are also educated about the disease and how it is spread through shared drug paraphernalia, so that the thousands who pass through prisons each year might be less likely to infect others when they get out.

Yet, the improvements came too late for Lassen. After his October 2000 release, he was accepted into a dual-drug interferon clinical trial. It failed, however, to reduce the hepatitis C in his system. As a free man, Lassen appealed the punishment for his hepatitis C activism while incarcerated. In a July 3 hearing before Magistrate Judge J. Andrew Smyser, Lassen accepted the DOC's offer for a settlement of $6,501.

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Prison Rapes Spreading Deadly Diseases

Washington Times (07.26.02)
United Press International

Rape has become so common in US federal and state prisons that it could have deadly consequences for the inmate population as well as the public at large, according to experts. Prison rape has been associated with the spread of diseases such as AIDS and TB. Congress plans to look at the issue this week.

"The AIDS incidence within prisons is alarmingly high," said Pat Nolan, president of Justice Fellowship, which works to reform the criminal justice system. He noted 95 percent of people in prison will eventually be released, so if they contract AIDS or other diseases while incarcerated they will be a tremendous burden to society. A major part of the problem is prison officials who condone rape among inmates, he said, which may be used to punish or control prisoners.

"Rape and HIV in prison is eight to ten times as high as in the general population," said Lara Stemple, executive director of Stop Prison Rape. The people most likely to be raped in prisons are nonviolent and first-time offenders: those most likely to be released into the general population and pose a disease risk, she said. AIDS, herpes and other STDs have been spread in prisons, and hepatitis C is epidemic in certain prisons, Stemple said. One in five men have been sexually assaulted in prison, and one in ten have been raped. Among women inmates, the rate of sexual abuse can be as high as 27 percent in some prisons, and some inmates have become pregnant after being raped by prison guards.

Last month bi-partisan legislation called the Prison Rape Reduction Act was introduced in both the Senate and the House. It would establish a national commission to set standards for reducing and eliminating prison rape. Federal prisons would have to adopt these standards and state prisons could only opt out of them if their state legislature votes not to participate. The Justice Department would be required to conduct an annual review of prison rape to determine where the incidence is unusually high. States with prisons within the worst third would have to
explain their situation before a review panel.

New Drugs Sought for Top Killer of Young Women Worldwide

TB & Outbreaks Week (07.23.02)

Tuberculosis is the number one killer of women of childbearing age worldwide, and the epidemic is growing with the spread of drug-resistant bacteria. Experts attending the 4th World Congress on Tuberculosis in June said that latent TB is a difficult disease to diagnose. In poor countries, women with the disease often aren't diagnosed until severe symptoms appear, they said.

"Many women are diagnosed only after they have become too ill" to care for their families, said Carol Nacy, head of the Sequella Foundation, a group organizing tests for new TB drugs and vaccines. By the time the disease is diagnosed, a patient may have infected 10 to 15 others, Nacy said. Even when women are diagnosed and receive TB drugs, mothers will often give the medicine to their children instead of taking it themselves. "That's one reason TB is the number one killer of women of childbearing age," Nacy said.

About one-third of the human population - roughly 2 billion people - are infected with TB, often in a latent form. But even in that form, the disease can be spread as droplets from sneezing or coughing. About 10 percent of those with a latent infection, some 200 million people, will develop active disease. About 2 million people worldwide die of TB annually, and some estimate that more than 90 million people could succumb to the disease over the next 30 years.

TB is a significant public health problem in developing nations, with China and India accounting for about one-third of all cases worldwide. There were fewer than 16,000 cases of active TB in the United States last year, about half involving recent immigrants.

A combination of drugs, including isoniazid and rifampin, has been shown to cure TB, but medications must be taken every day for six to nine months. Failure to take the full course of drugs encourages the development of drug-resistant strains of TB, which can then be passed from patient to patient. Drug-resistant TB represents about 14 percent of the cases in Estonia and more than 10 percent of those in one province of China. Worldwide, experts estimate that about 4 percent of TB cases involve a bacterium resistant to at least one of the drugs. A report by the US National Institute of Allergy and Infectious Diseases said an outbreak of drug-resistant TB a decade ago in New York City cost almost $1 billion to control. The CDC said drug-resistant cases
of TB have dropped in the United States from 2.7 percent of all cases in 1993 to about 1.2 percent.

The World Health Organization, the National Institutes of Health, the CDC, foundations such as Sequella, and health agencies in many countries are working to control TB through development of new drugs and vaccines, aggressively pushing programs of treatment, and finding new ways to diagnose the disease quickly while it is in its latent form. New cases of TB have declined in countries, including India and China, using directly observed treatment short-course (DOTS), using health care workers to confirm that TB patients take their medications. DOTS is now being used in 148 countries, said Dr. Jong-Wook Lee, head of WHO's TB program. WHO's goal is to identify 70 percent of new TB cases and to cure 85 percent of them, Lee said. "Even in huge countries with a heavy burden of TB it is possible... to achieve very high levels of cure," Lee said.

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Russia on the Brink of AIDS Explosion

San Francisco Chronicle (07.28.02)
Anna Badkhen

Russia is on the brink of a sub-Saharan-type AIDS catastrophe, experts say, and the government is doing next to nothing to avert the disaster. Russia has the world's fastest growing HIV epidemic, UNAIDS reported last month, with a dramatic rise among heterosexuals practicing unsafe sex. If the infection continues at its current rate, of the nation's 146 million people, more than 5 million could have HIV by 2007, said Vadim Pokrovsky, Russia's top AIDS researcher and director of the Center for AIDS Prevention and Treatment.

Russia's government devotes $5 million to HIV treatment annually - a sum that Pokrovsky and other experts say is too small. Pokrovsky said $65 million is needed immediately for programs to prevent and treat HIV.

According to government figures, HIV infections leaped from about 87,000 cases in 2000 to more than 201,000 cases now. Since 1997, the infection rate increased more than 500 percent. UNAIDS estimates there are 700,000 HIV cases. Pokrovsky believes it is closer to 1.4 million. At this rate, between 5 million and 10 million people may be dead from AIDS by 2015, according to estimates by the Center for Strategic and International Studies (CSIS) in Washington.

The Russian health system spends $45 per reported HIV case per year, compared with the $10,000 to $15,000 spent per HIV patient annually in the United States, CSIS reported in February. Many government officials think HIV/AIDS only affects "the scum of the earth," said Alexander Goliusov, head of HIV/AIDS prevention in Russia's Health Ministry. Foundations that fund AIDS prevention programs have appeared in Moscow, St. Petersburg and throughout Russia, but they are usually non-governmental groups existing on shoestring budgets.

Because the virus only appeared in Russia relatively recently, few HIV-positive people have progressed to AIDS so far. Only 2,095 Russians have died of AIDS since the epidemic began, according to official statistics.

Up to 43 percent of people infected in 2001 had no idea how they contracted the disease, according to official figures. Judging by the rate of other STDs, such as syphilis, Pokrovsky said many people who express ignorance about how they contracted HIV probably became infected through unsafe sex. By his calculations, infections attributed to unprotected heterosexual relations grew from 2 percent in 2000 to 15 percent of new diagnoses in the first six months of this year.

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Abstinence, Monogamy and Sex

Lancet (07.13.02) Vol. 360; No. 9327: P. 97

"Perhaps one of the best examples of ideology impeding sound public-health policy is the current US administration's insistence that both US and international sex education programmes promote the view that the only sensible approach to avoiding unwanted pregnancy and sexually transmitted infections is abstinence until marriage, followed by life-long monogamy.

"Since the mid-1990s the USA has poured hundreds of millions of dollars into such programmes, and many cash-strapped public schools have adopted abstinence-only curricula in order to obtain these much needed federal funds. As a result, more candid and frank programmes have been dropped.... In addition, the discussion of contraception in many of these abstinence-only courses often ignores the benefits of different contraceptive methods, emphasising instead their failure rates and side-effects.

"While sexual abstinence - at least until one is old enough and mature enough to engage in healthy sexual relationships - might be advisable, there is little evidence that the abstinence-only approach is effective. Such is the conclusion of several reviews including one conducted by the US Surgeon General in 2001 and another conducted by the Committee on HIV Prevention Strategies in the United States... [which] urged US policymakers to 'eliminate requirements that public funds be used for abstinence-only education, and that states and local school districts
implement and continue to support age-appropriate comprehensive sex education and condom availability programs.' "

"Comprehensive sex-education programmes - sometimes called abstinence-plus - promote abstinence but also recognise that many teenagers are or will soon become sexually active no matter what they are told. ...Comprehensive sex education programmes have been endorsed by almost every major American medical association.... "

"...Denying young people full and accurate information about sex, contraception, and prevention of sexually transmitted diseases not only puts them at needless risk, but also threatens to undermine their trust and respect of some of society's most important institutions: its schools, health system, and government officials. Young people today are exposed to a myriad of influences ranging from their parents and peers to music, film, video, and the Internet. Only if they are provided with all the information they need to make their own decisions will they be able to decide wisely."

Judge Orders Changes in Abstinence Program; Louisiana Group Found to Be Promoting Religion

Washington Post (07.26.02)
Ceci Connolly

US District Judge G. Thomas Porteous Jr. ruled Thursday that Louisiana illegally used federal money to promote religion in its abstinence-only sex education programs, a decision that could jeopardize President Bush's ambitions for expanding the effort nationwide. Porteous ordered the state to stop giving money to individuals or organizations that "convey religious messages or otherwise advance religion" with tax dollars. He said there was ample evidence that many of the groups participating in the Governor's Program on Abstinence (GPA) were "furthering religious objectives."

Using government money to distribute Bibles, stage prayer rallies outside clinics that provide abortions and perform skits with characters that preach Christianity violate the Constitution's separation of church and state, Porteous ruled. GPA head Dan Richey testified last month that the state had stopped subsidizing religious activities, but Porteous replied, "The Court does, however, feel the need to install legal safeguards to ensure the GPA does not fund 'pervasively sectarian' institutions in the future."

Catherine Weiss, director of the American Civil Liberties Union's Reproductive Freedom Project, and James Wagoner, president of Advocates for Youth, which lobbies for broad-based sex education, said the misuse of abstinence money went beyond Louisiana. They called on policymakers to audit abstinence programs, similar to the current federal investigation of other sex education and HIV prevention programs.

Gov. Mike Foster (R) expressed dismay over the decision and said he would review the state's legal options. Bill Pierce, spokesperson for the Department of Health and Human Services, said the administration "remains deeply committed" to both abstinence-only programs and faith-based initiatives.

The suit, filed in May by the ACLU, was the first legal challenge to abstinence-only programs created under the 1996 welfare reform legislation. Bush has asked Congress to extend the $50 million-a-year program and increase other federal abstinence grants from $40 million this year to $73 million next year. Cities, states or organizations that receive the federal grants must use the money to teach abstinence as the only reliable way to prevent pregnancy and STDs. Grant recipients may not discuss contraception except in the context of condom failure rates.

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Senate Panel Passes Budget Bill for District of Columbia

Washington Post (07.26.02)
Spencer S. Hsu

Senate appropriators unanimously approved the District of Columbia's $5.8 billion fiscal 2003 budget Thursday, proposing to end a two-year-old ban on city taxpayer support for drug needle exchange programs. The Senate panel's action sets up a likely rematch of last winter's clash with the House of Representatives, which insisted on placing the restriction in the budget bill and prevailed in final negotiations.

District leaders embraced yesterday's vote as an affirmation of home rule. "This is a grand slam," said Tony Bullock, spokesperson for Mayor Anthony A. Williams (D). Bullock thanked Sen. Mary Landrieu (D-La.) and Rep. Joe Knollenberg (R-Mich.), chairs of the Senate and House Appropriations subcommittees on the District, for seeking to reduce congressional strings in the last two years.

Congress in 1988 prohibited federal support of programs supplying clean needles to intravenous drug users to combat the spread of AIDS, hepatitis and other blood-borne diseases. Two years ago, lawmakers extended the ban in the District to deny local tax support, and effectively shut down the city's sole private program - which distributed several thousand free needles each month - by prohibiting it from operating within 1,000 feet of schools, parks, day-care centers, public housing and other areas with children.

The Senate preserved the ban of federal funds but allows the District to spend locally raised tax dollars. Thirty-five states operate 113 programs, and 38 programs in 17 states receive non-federal government funding. Opponents of the programs say they foster illegal activity and promote drug use as an acceptable lifestyle. Supporters say government health research shows that the programs do not increase drug use but reduce the spread of disease.

The District's AIDS case rate at the end of 2000 was 153 per 100,000 people, ten times the national rate of 14.4 per 100,000. City health officials said last winter that 6,649 residents were known to be living with AIDS and 15,700 others were HIV-positive. "Lives are at stake. It's not just a home rule issue," said Paul E. Strauss (D), a D.C. statehood lobbyist and shadow senator.

India Uses TV Sleuth to Deliver AIDS Message

Chicago Tribune (07.14.02)
Vanessa Gezari

"Jasoos Vijay," or "Detective Vijay," is India's newest fast-paced television detective serial with a twist: The hero is a private investigator who doubles as an AIDS educator. Backed by the national AIDS organization and aired on the country's government-owned TV network, the show represents a new level of acceptance of the threat AIDS poses for India - not just to traditional high-risk groups but to the public at large. It is India's first television drama aimed at teaching ordinary people about the disease.

Launched this month, the show takes viewers to remote villages where Detective Vijay must confirm the purity of brides-to-be, investigate bribery scandals and solve murders and kidnappings while delivering succinct messages about AIDS and sexual health. It runs several times a week during prime time and targets viewers in northern India, where the number of HIV/AIDS cases has so far remained relatively low.

While India's AIDS program has funded non-governmental organizations that work with members of high-risk communities, it has been less willing to throw its weight behind educational initiatives for the public. "The idea that AIDS is affecting regular people - in addition to high-risk groups - is a reality that's just beginning to sink in," said Shaleen Rakesh, a project coordinator with Naz Foundation Trust, a Delhi-based AIDS prevention group. "Detective Vijay" and several other new AIDS-related programs - including a reality show for teenagers - are part of a $6.2 million project funded by Britain's Department for International Development and produced by the charitable arm of BBC World Service.

Filmed on location with cliffhangers at the end of each episode, it is meant to grab the attention of viewers accustomed to a dizzying range of shows and extravagant films. In the first episode, during a murder investigation, a turbaned villager tells Vijay that he has heard AIDS can be spread through mosquito bites. The detective explains that the virus spreads mostly through unprotected sex.

South Africa - Volkswagen Unveils Project to Fight HIV/AIDS

Africa News Service (07.25.02)
Business Day

Volkswagen South Africa this week became the largest employer in the local automotive sector to launch an ambitious program to tackle HIV/AIDS. The program, which will launch next week, involves voluntary testing and is designed both to prevent the spread of the disease and to support infected workers. "The devastating impact of HIV/AIDS is rolling back decades of development progress in Africa and is impacting on every element of our society from teachers, farmers, workers, to managers. All of us are under attack," said company Chief Executive Hans Christian Maergner. "It follows that the motor industry in South Africa is also going to suffer. As more and more people become sick, there will be pressure on families, the workplace, the community and economy." The program was drawn up with help from the German cooperation and development ministry.

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Concern Growing over Teen Health

Newsday (New York City) (07.22.02)
Margaret Ramirez

Lack of funds and fear of a loss of privacy are the two biggest factors that keep New York teenagers from getting the health care they need, according to a new study. The report, by the Citizens' Committee for Children of New York, was released as federal health officials show renewed concern about adolescent health.

Teenagers are at a higher risk of acquiring STDs, according to the CDC. Earlier this month at the 14th International AIDS Conference, CDC officials said half of the 40,000 new HIV infections in the United States occur in people younger than 25.

Researchers interviewed 104 health care providers serving teenagers at clinics and community health centers in New York. A focus group of ten Bronx teens also was queried on its experience with health care. The study found the main barriers to care were concerns about privacy and lack of financial means.

Although a state law guarantees adolescents the right to confidential reproductive health services, 20 percent of clinics nonetheless refused to provide treatment for STDs or gynecological examinations without parental consent. Fees in the clinics varied from free to a sliding scale, with a top fee of $60 per visit. "Teenagers are the largest group of uninsured children," said Tara Sher, lead author of the study. "But even those teens with insurance would tell providers they were uninsured because they were scared of their parents finding out why they went to a clinic." The report suggested:*Hospitals and clinics prominently display their confidentiality policies and hire "adolescent liaisons" to escort teens to their appointments.The city and state create a citywide adolescent health initiative with a phone line and directory of where teens can get services.

The report also found 82 percent of clinics did not offer on-site mental health or gynecological examinations for adolescents. In New York state, adolescent health advocates are pushing legislation that would allow teens to apply on their own for Medicaid to cover services that they are entitled by law to receive without parental consent.

European Union to Step In with More Money for UN Population Fund
After United States Withholds Funds

Associated Press (07.24.02)
Paul Geitner

The European Union will give an extra 32 million euro ($31.8 million) to the UN Population Fund (UNPF) to make up for a US decision to withhold funds earmarked for UN family planning programs, an EU official said Wednesday. Under pressure from social conservatives who oppose abortion, the Bush administration announced Monday that it was withholding $34 million from the UN fund. Officials charged that some of the fund's money goes to Chinese agencies that carry out "coercive programs" involving abortion.

Poul Nielson, EU commissioner for development and humanitarian aid, criticized Bush's stance, calling organizations like the UNPF "part of the solution and not part of the problem" in fighting poverty and AIDS. China denies that its family planning program, which limits most couples to one child, uses forced abortions. The UNPF also denies that its programs support forced abortions.

The additional EU funding was put in the pipeline after President George W. Bush signaled his intentions shortly after taking office last year, the EU official said on condition of anonymity. "That has now gone through the process and been approved" by the 15 EU governments, he said. The new EU money is to be formally announced later Wednesday.

"If it is necessary for others to fill the decency gap in view of recent decisions [in Washington], we will do it," Nielson said in a speech last year. The EU money will fund a program for sexual and reproductive health in 22 developing countries, in conjunction with the UNPF and the International Planned Parenthood Foundation.

Number of Syphilis Cases Triples Since 1999

Herald (Glasgow, Scotland) (07.20.02)
Billy Briggs

Syphilis and other STDs are increasing in Scotland and the rest of the United Kingdom, according to latest figures. Western Scotland has seen a three-fold increase since 1999 in the number of people diagnosed with syphilis, and doctors are also treating more cases of chlamydia and gonorrhea. Ayrshire and Arran Health Board said there had also been a rise in the number of recorded cases in Irvine. In England, a new report revealed a dramatic increase in syphilis cases, with the number of people infected between 1998 and 2000 more than doubling.

Health experts are now calling for a campaign to raise public awareness. "In the year to March 1999 there were seven cases of syphilis in the West of Scotland," said Dr. Andy Winter of the Sandyford Institute in Glasgow. "This rose to 21 between June 2001 and July 2002. Other infections are also on the increase including gonorrhea, which Glasgow has seen an unprecedented rise in since 1995, and also chlamydia," he said.

Commenting on the data released in England, Winter said the figures had risen sharply since the report was written six months ago. "It was only published yesterday and doesn't mention new outbreaks in London and Manchester where cases have gone up to 350 and 280, respectively," said Winter. Health care experts blame the surge in syphilis on complacency and are calling for an urgent review of sex education and awareness campaigns.

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African Patients Push British HIV Figures to New Record

Times (London)(07.15.02)
Anthony Browne

Immigrants from Africa have overtaken homosexual men as the largest group reporting new HIV infections in Britain. Last year 4,163 people were found to have HIV, of whom 1,338 were homosexual and more than 1,500 heterosexuals from Africa. Fewer than 200 cases were attributed to heterosexual sex in Britain.

"The figures show that there were more newly diagnosed cases of HIV among African immigrants than gay men for the first time," said Barry Evans, HIV consultant at the Public Health Laboratory Services center for communicable disease surveillance. The number of African immigrants with HIV has tripled in the past five years from 500 to 1,533 last year, taking the total number of new cases to the highest since testing began in 1985, according to the center.

Of the 22,000 people known to be living with HIV in Britain, more than 5,000 are from Africa, including refugees, students, nurses, others with work permits, and visitors. The Human Rights Act gives overseas visitors with HIV the right to stay and be treated for the rest of their lives if treatment is not available at home.

Callum O'Mahoney, chair of the Association of Genito-Urinary Medicine, said that the trend could spark a new outbreak of HIV among British heterosexuals. "There's a huge potential to spread that wasn't there before, because the number of gays is just not that high: there are far more heterosexuals."

Many HIV specialists are unclear on who they are meant to treat and under what circumstances. Some patients visiting relatives attend clinics, where they are not legally entitled to treatment without first applying to remain in the United Kingdom on compassionate grounds. Doctors have been appealing to the Department of Health for guidance but have been told not to raise the issue because it is too sensitive.
Some countries, such as the United States, Canada and Australia insist on HIV tests before someone is granted permission to immigrate.

Syphilis Rates in Maricopa County Among the Worst in the Nation
Associated Press (07.22.02)

While the rest of the country celebrates record-low syphilis rates, Arizona's most populous county is experiencing the infection at epidemic proportions. Syphilis rates jumped from 709 cases in Maricopa County (Phoenix) in 2000 to 848 cases in 2001. Mother-to-child syphilis rose from 23 cases to 28 during the same period. "It's alarming because the babies are dying," said Douglas Hauth, spokesperson for the Maricopa County Department of Public Health Services. "It's alarming because they don't need to die. And it's alarming because it's so costly," he said.

The Maricopa County Board of Supervisors on Wednesday plans to try to increase STD clinic service fees to $20 per visit, up from $10. Officials hope the fee increase will generate $135,000 to provide faster STD service and supplement HIV testing. If approved, the county's public hearing for the increase will likely be in August.
Jonathan Weisbuch, the county's director of public health, said that during the past few months, several hundred people a week have not been able to get into the STD clinic because it has been so busy. Weisbuch said the fee would be waived for anybody who cannot afford it.

For the past several years, Maricopa Medical Center has had one of the highest rates of congenital syphilis in the country, said Dr. Chris Carey, chair of obstetric/gynecology and women's health at the center. The cases often occur when immigrant women have not received basic public health care. When left untreated in pregnant women, syphilis can result in infant death in up to 40 percent of cases. If the baby does survive, the newborn faces a variety of mental and physical problems. It can cost as much as $10,000 a day to treat the babies, depending on the severity of complications, Hauth said.

Implacable force for family planning

From Asia Harm Reduction Network
The New York Times, 30Jul02
By Barbara Crossette

What a moment for an American to take over the world's largest family planning organization. "We're completely at odds with Bush policy," said Dr. Steven W. Sinding, who becomes director general of the International Planned Parenthood Federation in London this month. Because the federation's agenda includes access to abortion, it receives no American money for any ofits programs in more than 180 countries.

Yet this is a time when millions of people in the third world are clamoring for more contraceptives and health workers are short of condoms to fight the spread of AIDS. On July 22, the administration also ended American support for the United Nations Populations Fund, citing its activities in China, where birth control has been coercive. On that issue, the White House overrode the State Department, which had sent experts to China to look at the fund's programs and found no evidence that American money had been funneled to such programs.

"At a moment when in some ways the priority is shifting from birth control to disease control," Dr. Sinding said, "it's devastating that the resources are not available to these organizations that are the primary channels of service to women in the developing world." In Africa, and possibly Asia, more women than men are being infected with the virus that causes AIDS. Dr. Sinding, 58, has many credentials, including posts as former head of the population office of the United States Agency for International Development, senior population adviser to the World Bank, director of population sciences at the Rockefeller Fund and, most recently, professor at Columbia University's Mailman School of Public Health. He learned the basics at the grass roots in Pakistan, the Philippines and Kenyain.

For full report, see: http://www.nytimes.com

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Marijuana eradication in Hawaii boosts crystal methamphetamine use

The Hawaii Tribune Herald has reported that a National Institute of Drug Abuse study shows that marijuana eradication in Hawaii contributed to an increase in the use of the drug "ice," a smokeable form of methamphetamine. The three year study gathered information from 450 methamphetamine users in Honolulu, San Francisco and San Diego. "It's the first study ever done that interviewed users in the community," said study leader Patricia Morgan. Apparently NIDA never bothered to include key stakeholders in previous efforts, which may explain why the organization is often accused of producing politicized research with predetermined outcomes.

California methamphetamine users were reportedly more likely to snort or inject the drug, while 86 percent of the Hawaii users smoked the crystal form. "The use of ice in Honolulu had led to particularly serious physical and psychological problems and significant social disruption in poor working communities where it replaced marijuana, which had become scarce and expensive due to eradication policies," states the report's executive summary.

The summary noted that the "overwhelming majority" of meth users in Honolulu began using the drug after 1984. The methamphetamine report noted several influences on the "tremendous growth" of ice in Hawaii after 1987. "Residents were both pushed away from pakalolo (marijuana), their staple drug of choice, and pulled toward ice by a well organized marketing campaign by Asian distributors," the report said. "Also, the overwhelming smokeable drug of choice, marijuana or pakalolo, which has been grown and used throughout the islands for many years, became the target of a government eradication campaign. This drove up prices, drastically reduced availability and left locals without their customary, and many would say, relatively benign, smoke."

The Hawaii Tribune Herald presumably used a hard copy of the NIDA report as a basis
for their July 25th article. An electronic version could not be found on the NIDA website.

Drug Policy Alliance eNewsletter: Thursday, August 1, 2002
http://www.drugpolicy.org

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Needle exchange: Public health vs. politics in the District of Colombia

Senate appropriators unanimously approved the District's $5.8 billion fiscal 2003 budget, proposing to end a two-year-old ban on city taxpayer support for drug needle exchange programs. Whether or not science will trump politics remains to be seen. The Senate panel's approval will likely lead to a clash with the House of Representatives, which last year insisted on placing the restriction in the budget bill.

District leaders embraced the Senate's vote as an affirmation of home rule. In 1988 Congress prohibited the District from using federal funds on programs that supply clean needles to intravenous drug users to combat the spread of AIDS, hepatitis and other blood-borne diseases. Two years ago, lawmakers extended the ban to include local tax support. The Senate bill would preserve the ban on federal funds but allow the District to spend locally raised tax dollars.

The District's AIDS case rate at the end of 2000 was 153 per 100,000 people, 10 times the national rate of 14.4 per 100,000. "Lives are at stake. It's not just a home rule issue," said Paul E. Strauss (D), a D.C. statehood lobbyist and shadow senator.

Drug Policy Alliance eNewsletter: Thursday, August 1, 2002
http://www.drugpolicy.org

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