KAISER DAILY HIV/AIDS REPORT
A service of kaisernetwork.org
http://www.kaisernetwork.org/dailyreports/hiv
________________________________________


Thursday, February 5, 2004

ACROSS THE NATION
========================================
1. Georgia Public Health Division Forms Immigrant, Refugee
Advisory Panel on HIV

GLOBAL CHALLENGES
========================================
2. Zimbabwe's Public Health System 'Dissolving,' Running Out of
Medications, Supplies, Including HIV Test Kits

3. Urban Growth, Social Mobility Contributing To Rapid Spread of
HIV in Botswana, NPR Reports

4. Quebec Medical Association Adopts Policy Requiring Doctors To
Disclose HIV Status to Immediate Supervisors

SCIENCE & MEDICINE
========================================
5. Sales of Antiretroviral Drug Fuzeon Lower Than Industry
Analysts Expected

PUBLIC HEALTH & EDUCATION
========================================
6. NPR's 'Tavis Smiley Show' Interviews Columnist About HIV/AIDS
Myths in Black Community

****************************************

ACROSS THE NATION

1. Georgia Public Health Division Forms Immigrant, Refugee
Advisory Panel on HIV

Access this story and related links online:
http://cme.kff.org/Key=1810.Cbr.C.D.HnBCXL

The Georgia Department of Human Resources Division of Public
Health has established a community advisory panel to "help
bridge the cultural gaps" that prevent foreign-born residents
from seeking HIV/AIDS treatment in the state, the Atlanta
Journal-Constitution reports. The council -- the HIV/AIDS
Immigrant/Refugee Advisory Board of Georgia -- stems from a
meeting of more than 24 community and religious leaders during
which participants discussed ways to improve HIV/AIDS education
and treatment programs for immigrants and refugees. The new
board, which is based on a Minnesota program, will serve as a
liaison between immigrant and refugee communities and the state
Division of Public Health. The Minnesota program was established
after health officials determined that HIV infections among
African immigrants and refugees contributed to a 6% increase in
new infections in the state in 2002, according to the
Journal-Constitution. Dr. Luke Shouse, a medical epidemiologist
with the state public health division, said that many immigrants
and refugees do not know their HIV status and are not aware of
available medical care. In addition, undocumented immigrants and
refugees are often afraid to seek medical care out of fear of
deportation. Cultural issues and HIV-related stigma also
contribute to their reluctance to seek medical care, the
Journal-Constitution reports. Currently, there are no estimates
of HIV/AIDS prevalence among Georgia's immigrant and refugee
populations. Shouse said that state health officials have tried
to estimate prevalence rates by using data on the HIV/AIDS rates
in immigrants' and refugees' countries of origin. However, state
and local protocols determine whether country-of-origin
information is requested on AIDS reporting forms and in many
cases, people from Africa or the Caribbean are classified as
"African-American" or "black, non-Hispanic," according to the
Journal-Constitution (Poole, Atlanta Journal-Constitution, 2/4).

GLOBAL CHALLENGES

2. Zimbabwe's Public Health System 'Dissolving,' Running Out of
Medications, Supplies, Including HIV Test Kits

Access this story and related links online:
http://cme.kff.org/Key=1810.Cbr.D.D.HwXj0x

The New York Times on Thursday profiled Zimbabwe's health care
system, which "like the rest of [the country's] economic and
social fabric ... is dissolving." With the economy in "free
fall," Zimbabwe is "desperately short of even basic drugs and
medical equipment," which is forcing a "once robust" health care
system "close to ruin" and is taking a "human toll," according
to the Times. For example, in a country where 25% of the
population is HIV-positive, nurses at Parirenyatwa Hospital in
the capital city Harare said that there have been no HIV test
kits since November (Wines, New York Times, 2/5). About 3,000
Zimbabweans die of AIDS-related diseases each week, and more
than 700,000 children in the country have been orphaned by the
disease (Kaiser Daily HIV/AIDS Report, 12/10/03). In addition,
Zimbabwe's infant mortality rate rose 15% between 1999 and 2002,
compared with nearby Malawi, which saw a 5% decrease over the
same period, and South Africa, where the infant mortality rate
has remained constant. Over the last decade, the infant
mortality rate has increased from 57 deaths for every 1,000 live
births in 1994 to 76 deaths for every 1,000 live births in 2004,
according to the Times. Zimbabwe's maternal mortality rate also
has increased from four deaths for every 1,000 live births to
seven deaths for every 1,000 live births. One medical
professional in Harare -- speaking on the condition of anonymity
-- said, "Basically, the health care system is collapsing on
itself right now. There's an exodus of health care professionals
from this country. And most of the rural health structures have
been left under the supervision of nurses' aides who have
nothing to treat patients with" (New York Times, 2/5).

3. Urban Growth, Social Mobility Contributing To Rapid Spread of
HIV in Botswana, NPR Reports

Access this story and related links online:
http://cme.kff.org/Key=1810.Cbr.F.D.HvQmHl

The development of Botswana's infrastructure, including
transportation, urban growth and social mobility, has
contributed to the rapid spread of HIV in the country, NPR's
"All Things Considered" reports. With 38% of the adult
population in Botswana estimated to be HIV-positive, the country
has the highest HIV prevalence in the world. Part of Botswana's
problem is the country's location in Southern Africa, which is
"the heart of the global AIDS pandemic," NPR reports. In
addition, the country's well-developed highways serve as
"arteries for goods and diseases" across the continent, and the
"economic boom" following the discovery of diamond deposits in
the country also has contributed to the spread of HIV, NPR
reports. The segment includes comments from Tsetsele Fantan,
project leader for the African Comprehensive HIV/AIDS
Partnerships; Michael Cassell, a behavior change adviser for the
Botswanan government; and Ebu Tyoor, an HIV researcher at the
Botswana-Harvard AIDS Institute Partnership for HIV Research and
Education (Beaubien, "All Things Considered," NPR, 2/4).

The complete segment is available online in RealPlayer.

4. Quebec Medical Association Adopts Policy Requiring Doctors To
Disclose HIV Status to Immediate Supervisors

Access this story and related links online:
http://cme.kff.org/Key=1810.Cbr.G.D.HqNxzw

The Quebec Medical Association has adopted a policy requiring
HIV-positive doctors to disclose their status to employers, Dr.
Andre Senikas of the association said on Wednesday, CP/Yahoo!
News reports (Levesque, CP/Yahoo! News, 2/4). The policy comes
after the Sainte-Justine Children's Hospital disclosed two weeks
ago that Dr. Maria Di Lorenzo -- who operated on more than 2,600
patients before her death on Aug. 16, 2003 -- was HIV-positive.
Di Lorenzo in 1991 informed her immediate supervisor of her
HIV-positive status, and a committee was formed to determine
what medical work she could perform. However, the hospital had
no written follow-ups on Di Lorenzo after 1996. Although Di
Lorenzo's immediate supervisor was aware of her HIV-positive
status, the hospital administration said that it was unaware of
her status until a few weeks ago and that Di Lorenzo continued
to operate on patients until her death (Kaiser Daily HIV/AIDS
Report, 1/26). Under the new policy, all HIV-positive physicians
must inform their immediate supervisors of their status and meet
with a committee of experts to develop an internal policy. The
policy must include provisions for tracking the doctors over
many years, including regular updates as technology changes.
Each policy must take into account the risks of the procedures
performed by the physician and must develop specific
precautions. The Quebec Medical Association, which is a division
of the Canadian Medical Association, has 7,000 members
(CP/Yahoo! News, 2/4).

Hospital Tests 1,500 Former Patients

Since Sainte-Justine Hospital made public Di Lorenzo's
HIV-positive status, the hospital has performed HIV tests on
more than 1,500 people on whom she operated between 1990 and
2003, the Canadian Press reports (Canadian Press, 2/3). Hospital
officials have said the chance that any children contracted HIV
from operations is extremely small (Kaiser Daily HIV/AIDS
Report, 1/26). The hospital sent registered letters to the
families of 2,614 patients on whom the doctor operated, and more
than 11,500 people have called the hospital since Di Lorenzo's
status was announced. The hospital was unsure how it would
notify patients whom it has been unable to contact thus far,
according to the Canadian Press. Hospital spokesperson Sylvie
Tessier said that she was unable to disclose the results of the
tests because of doctor-patient confidentiality laws, the
Canadian Press reports. However, some news reports have quoted
hospital officials as saying that no patients have tested
positive (Canadian Press, 2/3). Because this is the first time a
hospital has conducted a "callback campaign" after discovering
that an HIV-positive surgeon operated on children, hospital
directors are planning a peer review of the process for
publication in a medical journal, Tessier said. Lawyer
Jean-Pierre Menard is investigating the possibility of filing a
class-action lawsuit on behalf of 40 of the affected families,
according to the Montreal Gazette (Bruemmer, Montreal Gazette,
2/4).

SCIENCE & MEDICINE

5. Sales of Antiretroviral Drug Fuzeon Lower Than Industry
Analysts Expected

Access this story and related links online:
http://cme.kff.org/Key=1810.Cbr.H.D.JWNk7W

Sales of the antiretroviral drug Fuzeon, which was jointly
developed by Swiss drug maker Roche and U.S. biotechnology
company Trimeris, have been "slower ... than many industry
analysts expected," the Raleigh News & Observer reports
(Vollmer, Raleigh News & Observer, 2/4). Fuzeon, which is in a
class of drugs called fusion inhibitors, has encountered
resistance from doctors and patients because of its high cost
and injection delivery method. The drug costs about $20,000 per
patient per year. The drug is designed for HIV/AIDS patients who
have failed to respond to other medications (Kaiser Daily
HIV/AIDS Report, 1/7). Although Fuzeon is considered to be
"revolutionary" in HIV treatment, some doctors and patients have
been "turned off" to it, and more patients than expected have
dropped the therapy, according to the News & Observer. Sales of
the drug rose from 7,300 one-month supply kits in the third
quarter of 2003 to 9,000 kits in the fourth quarter of 2003, but
the patient drop-out rate was 25% -- about twice as high as some
analysts had predicted. Roche has planned a Fuzeon education
campaign for doctors, nurses and patients, as well as
post-marketing studies comparing the drug to other
antiretrovirals, the News & Observer reports. The initiatives
could boost sales of Fuzeon in six to nine months, Dr. David
Boucher, an analyst at investment company CE Unterberg Towbin,
said (Raleigh News & Observer, 2/4). Roche on Wednesday said it
would not change sales forecasts for Fuzeon, despite
disappointing sales (Reuters, 2/4).

PUBLIC HEALTH & EDUCATION

6. NPR's 'Tavis Smiley Show' Interviews Columnist About HIV/AIDS
Myths in Black Community

Access this story and related links online:
http://cme.kff.org/Key=1810.Cbr.J.D.JP52Pg

In anticipation of National Black HIV/AIDS Awareness Day on
Feb. 7, NPR's "Tavis Smiley Show" on Wednesday discussed with
Dr. Ian Smith, a columnist for Men's Health and the New York
Daily News, myths surrounding HIV/AIDS in the black community.
According to Smith, HIV/AIDS prevention campaigns are negatively
affected by myths that the disease is curable and does not have
"the deadly impact that it once had" because many young black
people have witnessed a "huge revolution" in HIV-related
treatments. Smith said that HIV/AIDS education and awareness
must be refocused to reach those people most at risk for HIV
infection. In addition, Smith said that the stigma from the
early 1980s that HIV/AIDS is a "white, gay disease" persists in
the black community. "It is now a disease of everyone and every
age," Smith said, adding that until black people in the United
States "get beyond" the stigma, "it's going to be hard to get
people to go in and be honest and upfront about the testing."
Smith also said that the number of HIV cases among individuals
ages 50 and older are "increasing rapidly" because some people
do not understand that HIV is "not an age disease" and because
some physicians do not ask patients in this age range about
their sexual behaviors or offer them HIV tests (Smiley, "Tavis
Smiley Show," NPR, 2/4).

The complete segment is available online in RealPlayer.

________________________________________

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