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TEXAS HIV/STD E-UPDATE
Information from the Bureau of HIV and STD Prevention,
Texas Department of Health
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IN THIS ISSUE:
-CDC Changes Gonorrhea Treatment Recommendations for MSM
-"Dear Colleague" Letter Urges Comprehensive STD Treatment for MSM
-TDH Changes HIV/STD Educational Materials
-New STD Awareness Poster Available
-Workbook, Web Site Targets Providers Working with HIV+ Clients
-AED Launches HIV/AIDS Anti-Stigma Web Site
-Upcoming Events


CDC CHANGES GONORRHEA TREATMENT RECOMMENDATIONS FOR MSM

Increases in fluoroquinolone-resistant gonorrhea among men who have sex with
men have prompted the Centers for Disease Control and Prevention (CDC) to
change gonorrhea treatment recommendations for some patients.

All men who are diagnosed with gonorrhea and who acknowledge having sex with
other men - whether or not they self-identify as gay or bisexual - should
now receive the injectable antibiotic drug ceftriaxone for treatment instead
of fluoroquinolone antibiotics, including ciprofloxacin (Cipro) and
ofloxaxin.

Fluoroquinolone therapy is used frequently because it is an inexpensive,
oral, and single-dose therapy. However, because of increased prevalence of
fluoroquinolone-resistant gonorrhea in Asia, England, Wales, the Pacific
Islands (including Hawaii), and California, fluoroquinolones are no longer
recommended for treating gonorrhea acquired in those locations. CDC changed
its treatment recommendations based on increases in
fluoroquinolone-resistant gonorrhea among men who have sex with men in
Massachusetts, New York City, and 30 sites surveyed by the Gonococcal
Isolate Surveillance Project (GISP) during 2003.

Most heterosexuals who are diagnosed with gonorrhea can still be treated
with Cipro. However, heterosexual patients who believe their infection is
linked to one of the locations where resistant gonorrhea strains are common
should receive ceftriaxone. Health providers still treating patients with
fluoroquinolone antibiotics should be alert to the possibility of
resistance. Providers should also question patients about their recent
travels in determining treatment.

The full report, "Increases in Fluoroquinolone-Resistant Neisseria
gonorrhoeae Among Men Who Have Sex with Men - United States, 2003, and
Revised Recommendations for Gonorrhea Treatment, 2004," was published in the
April 30 Morbidity and Mortality Weekly Report (2004;53(16):335-338). To
view the report, go to www.cdc.gov/mmwr/preview/mmwrhtml/mm5316a1.htm.


"DEAR COLLEAGUE" LETTER URGES COMPREHENSIVE STD PREVENTION FOR MSM

The CDC has called upon public health programs and private health care
providers to offer comprehensive STD prevention services for sexually active
gay men. In a letter signed by the Directors of the Division of HIV/AIDS
Prevention, the Division of Sexually Transmitted Diseases, the Division of
Immunization Services and the Division of Viral Hepatitis, and released in
March at the National STD Prevention Conference in Philadelphia, the
nation's leading public health experts urge clinicians to consistently
provide all recommended STD prevention services to sexually active gay men.


Men who have sex with men (MSM) are at increased risk for multiple STDs,
including HIV, syphilis, gonorrhea, chlamydia, hepatitis A and hepatitis B.
Numerous reports document high rates of STDs among MSM and suggest a
resurgence in unsafe sexual practices among these men. In 2001 and 2002,
syphilis cases among men increased dramatically in the United States; CDC
estimates that over 40 percent of all cases in 2002 were among MSM. CDC has
also documented syphilis outbreaks among gay men in several cities including
Chicago, Los Angeles, Miami, New York, San Francisco and Seattle.

"The 'Dear Colleague' letter comes at a critical time for state and local
public health officials battling increases in HIV and STD infections among
gay men," said Julie Scofield, Executive Director of the National Alliance
of State and Territorial AIDS Directors (NASTAD). "Leadership from CDC is
essential now to promote integrated preventive and clinical STD services for
gay men at the local level."

The letter points to CDC's 2002 STD Treatment Guidelines, which provide
specific recommendations for STD prevention services that should be provided
for all sexually active gay men and MSM. These services include, at
minimum:
-Annual counseling and testing for HIV;
-Annual screening for syphilis, gonorrhea and chlamydia; and
-Vaccination against hepatitis A and hepatitis B.

"This letter will help us to raise awareness among medical societies,
physicians, community based organizations and advocacy groups about the need
for full implementation of the STD Treatment Guidelines, "said Theresa
Raphael, Executive Director of the National Coalition of STD Directors
(NCSD). "Health providers need to be proactive and diligent in both
identifying and providing comprehensive health care to high risk patients."

NASTAD and NCSD are actively working together to coordinate HIV, STD and
hepatitis prevention efforts for gay men. We urge all stakeholders to work
toward making available the full range of services that gay men need to
protect their health.

NASTAD represents the nation's chief state health agency staff who have
programmatic responsibility for administering AIDS health care, prevention,
education and supportive service programs funded by state and federal
governments.

NCSD represents the Directors of public health sexually transmitted disease
prevention programs in states, large cities/counties and territories of the
United States, and advocates for effective policies, strategies, and
sufficient resources to fight the spreads of sexually transmitted diseases.


Additional information and educational materials on STD prevention among MSM
are available at www.cdc.gov/hepatitis, www.cdc.gov/std and www.cdc.gov/hiv;
information on adult vaccination is available at www.cdc.gov/nip.


TDH CHANGES HIV/STD EDUCATIONAL MATERIALS

Several changes have recently been made to the HIV/STD educational materials
available through the TDH Warehouse. These changes are summarized below.

-TDH Stock No. 4-146, "Women and STDs," is now a bilingual English/Spanish
pamphlet. The Spanish version of this pamphlet (TDH Stock No. 4-146a) has
been deleted
-TDH Stock No. 4-201, "Young People Get HIV," is now a bilingual
English/Spanish pamphlet. The Spanish version of this pamphlet (TDH Stock
No. 4-201a) has been deleted
-TDH Stock No. 4-212, "HIV, AIDS, and Shooting Up," is now a bilingual
English/Spanish pamphlet. The Spanish version of this pamphlet (TDH Stock
No. 4-212a) has been deleted
-TDH Stock No. 6-40, "Sexually Transmitted Disease: Facts to Share" has been
replaced with a new color pamphlet entitled "Facts About STDs"
-TDH Stock No. 6-40a, the Spanish version of "Facts About STDs," has been
added

To order materials from the TDH Warehouse, send a written request with the
TDH stock number, quantity desired, and shipping information to TDH
Warehouse: Literature and Forms, 1100 W. 49th St., Austin TX 78756, or fax
your request to 512-458-7707. The warehouse does not take phone orders, but
you may check on order status by calling 512-458-7761. You may also order
online at www.tdh.state.tx.us/mamd/litcat/default.asp. Up to 500 copies of
each title may be ordered.


NEW STD AWARENESS POSTER AVAILABLE

A new STD awareness poster highlighting the asymptomatic nature of chlamydia
and gonorrhea as well as the availability of urine testing for these
diseases is now available. Produced by the healthcare communications firm
Euro RSCG Worldwide, the glossy color poster measures 14 x 19" and explains
that untreated chlamydia and gonorrhea can led to serious health
complications such as infertility. Samples of the poster can be requested
by contacting Greg Beets, TDH Bureau of HIV and STD Prevention, at
greg.beets@... or 512-490-2500, ext. 2671. To order multiple
copies of the poster, or to order the accompanying gonorrhea and chlamydia
fact sheets, please contact Holli Kolkey, Euro RSCG Worldwide at
holli.kolkey@... or
858-546-4811.


WORKBOOK, WEB SITE TARGETS PROVIDERS WORKING WITH HIV+ CLIENTS

The AIDS Action Foundation has released the Connecting to Care workbook and
Web site for health care providers working with HIV+ clients. The workbook
and Web site feature 17 methodologies that have successfully connected, or
reconnected individuals with "unmet need" to care through medical support
services and client-centered approaches.

Unmet Need - as identified by the HIV/AIDS Bureau of the Health Resources
and Services Administration (HRSA), U.S. Department of Health and Human
Services - refers to persons who are living with HIV and are aware of their
HIV status, but are not receiving regular primary medical care.

The featured methodologies or "activities" utilize both traditional and
innovative approaches to connect individuals to care despite geographic,
economic, cultural and linguistic barriers that may hinder long-term
engagement. The activities range from "Snapshot Viral Load Testing" that
helps clients at health clinics for the homeless obtain a clear picture of
their HIV infection, to "Clinicians Reaching Out" that establishes trust and
demystifies the role of the clinician through their active participation in
the HIV+ community.

The Connecting to Care Web site, which offers English and Spanish versions
of the workbook, can be accessed through www.aidsaction.org.


AED LAUNCHES HIV/AIDS ANTI-STIGMA WEB SITE

The Center on AIDS & Community Health at the Academy for Educational
Development (AEC) created a website to focus on HIV/AIDS-related stigma and
discrimination. This website is one component of an HIV/AIDS Anti-Stigma
Initiative that the Ford Foundation is funding AED to implement.

In Fall 2003, the Ford Foundation awarded AED the largest grant to date to
address HIV/AIDS stigma in the U.S. The Initiative is the first major
program to address HIV/AIDS stigma in the U.S. AED's HIV/AIDS Anti-Stigma
Initiative will examine the impact of HIV/AIDS stigma at the local level by
working with five community-based orgainizations to create strategies to
combat it.

AED recently awarded five nonprofits $180,000 each to develop and implement
18-month programs that will tackle the HIV/AIDS-related stigma in their
communities. The organizations receiving HIV/AIDS anti-stigma grants from
AED are: African Services Committee (New York, NY), Asian & Pacific Islander
Wellness Center (San Francisco, CA), Bienestar Human Services (Los Angeles,
CA), South Carolina African American HIV/AIDS Council (Columbia, SC), and Us
Helping Us (Washington, DC)

AED will disseminate the results of each program to other community-based
organizations in the U.S. and will work with the five funded groups to keep
their projects running.

Accessible at www.hivaidsstigma.org, the website contains detailed
information about the AED/Ford Initiative, profiles of the projects and
contact information for the five grantee organizations, general information
about HIV/AIDS-related stigma and discrimination, and resources for
additional information (including a literature review of recent publications
and links to other sources of information on stigma).

For more information about the anti-stigma website or the HIV/AIDS
Anti-Stigma Initiative, please contact AED at stigma@....


UPCOMING EVENTS

May 25-28, 2004
National Sexual Violence Prevention Conference: Building Leadership and
Commitment to End Sexual Violence, Los Angeles, CA. Sponsored by CDC. Go to
www.cdc.gov/ncipc/2004nsvpc.htm for more information.

May 27-30, 2004
HIV/AIDS 2004: The Social Work Response, Washington, DC. Sponsored by the
Boston College Graduate School of Social Work, National Association of
Social Workers (NASW). For more information, go to
www.bc.edu/schools/gssw/cont-ed/conference/.

June 6-9, 2004
10th Annual Street Outreach Workers Conference, Austin. Sponsored by Texas
HIV Connection in conjunction with the Texas Commission on Alcohol and Drug
Abuse. Call 512-343-9595 for more information.

June 27, 2004
National HIV Testing Day. Sponsored by the National Association of People
with AIDS (NAPWA). For more information, go to www.napwa.org/hivtestinfo/.

August 9-13, 2004
Training Institute in Sexual Health Education (TISHE), Blairstown, NJ.
Sponsored by the Network for Family Life Education at Rutgers University.
For more information, go to www.tishe.org, or contact Nora Gelperin at
norag@..., or 732-445-7929.

November 11-14, 2004
5th Annual National Harm Reduction Conference, New Orleans, LA. Sponsored by
the Harm Reduction Coalition. Go to
www.harmreduction.org/conf2004/index.html, or call 212-213-6376, ext. 15 for
more information.

December 1, 2004
World AIDS Day

December 13-17, 2004
14th Texas HIV/STD Conference, Austin. Sponsored by TDH. A separate clinical
update will be held on December 17-18, 2004 for an additional fee. For more
information, visit www.tdh.state.tx.us/hivstd/conf/2004/default.htm.


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The Texas HIV/STD E-Update mailing list is maintained by the Bureau of HIV
and STD Prevention, Texas Department of Health. To subscribe to or remove
your name from the mailing list, send a message to dan.warr@....

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Back issues of the Texas HIV/STD E-Update going back to 2002 are available
online at the following URL:
www.tdh.state.tx.us/hivstd/pie/e-update/default.htm
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TDH Electronic Publication Number E13-11720
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Texas HIV/STD E-Update
Greg Beets, Editor
Texas Department of Health
HIV/STD Comprehensive Preventive Services Division
1100 West 49th Street
Austin, Texas 78756-3199
Phone: 512-490-2500, ext. 2671
Fax: 512-490-2538
E-mail: greg.beets@...