Russia May Be on the Edge of AIDS Crisis
CDC Wants Routine AIDS Testing
Hepatitis B Vaccination Coverage Among Adults, 2004
Health Agency Targets Pre-Teens with Sexual Information
RUSSIA SAID TO BE ON EDGE OF AIDS CRISIS. Vitaly is the face of Russia's AIDS epidemic, epitomizing many of its most troubling characteristics. "It's considered a dirty disease. People are afraid of it. It's become a joke for many. No one wants to deal with people who are infected," said Vitaly, who asked that his last name not be used because of those fears. Critics say neglect of AIDS victims by authorities and callous treatment by regular Russians are part of a culture of denial that has helped place Russia on the verge of a public health crisis, as AIDS and HIV infections spread. Russia has 334,000 officially registered HIV- or AIDS-infected people. The UNAIDS agency puts the figure at nearly 900,000 and many others say the real number is likely well over a million, around 1 percent of the country's population. The critics also believe the epidemic will deepen amid Russia's decrepit health care system, plummeting health standards, a rising tide of illegal drugs and ubiquitous discrimination.
With hundreds gathering 15May for a major AIDS conference in Moscow, international health experts continue to warn that Russian officials have been too slow to react to a problem quickly moving beyond the traditional core of at-risk people — drug users, gay men and prostitutes — into the wider population.
Without dramatic policy decisions, experts warn, Russia will be overwhelmed. Russia's AIDS/HIV prevalence rate was about 1.1 percent of the population in 2003, according to the United Nations' AIDS program. By comparison, the United States recorded a 0.6 percent rate and France 0.4 percent. The rate for the African country of Botswana was 37.3 percent. Last month, President Vladimir Putin pledged a twentyfold increase in federal funding to fight the disease and the issue tops the agenda for the Group of Eight major industrialized nations summit in St. Petersburg in July. In his annual state-of-the-nation address this month, however, Putin made no mention of the disease, instead focusing on Russia's sharp decline in population… a lack of funding still means only about 10 percent of people who need treatment receive it.
Lyubov Potemina, director of the regional AIDS center, says the number of HIV-infected infants born to infected mothers has been cut dramatically and that more and more people are being tested as a matter of routine. Yet, she says, nearly two-thirds of all new HIV cases last year were due to sexual transmission, a symptom of how the disease is spreading into Russia's heterosexual, non-drug-using population. In another indication of how dire Russia's epidemic is becoming, younger and younger people are becoming infected.
Russia's top AIDS official, Vadim Pokrovsky, says 1 percent of Russia's 18- to 24-year-olds are infected and at least 100 Russians become HIV infected every day. [15May06, By MIKE ECKEL, Saratov, AP, http://www.breitbart.com/news/2006/05/15/D8HKD9T83.html]
CDC WANTS ROUTINE AIDS VIRUS TESTING for adults and teens if doctors follow new U.S. guidelines expected to be issued by this summer. Federal health officials say they'd like HIV testing to be as common as a cholesterol check. The guidelines for voluntary testing would apply to every American ages 13 to 64, according to the proposed plan by the U.S. Centers for Disease control and Prevention. One-quarter of the 1 million Americans with the AIDS virus don't know they are infected, and that group is most responsible for HIV's spread, CDC officials said. "We need to expand access to HIV testing dramatically by making it a routine part of medical care," said the agency's Dr. Kevin Fenton. CDC officials first disclosed the plans at a scientific conference in February. Last week, they said the guidelines should be released in June or July.
The recommendations aren't legally binding, but they influence what doctors do and what health insurance programs cover. Currently, the CDC recommends routine testing for those at high-risk for catching the virus, such as IV drug users and gay men, and for hospitals and certain other institutions serving areas where HIV is common. Under the new guidelines, patients would be tested for HIV as part of a standard battery of tests they receive when they go for urgent or emergency care, or even during a routine physical.
Patients would be allowed to decline the testing. Standardizing HIV testing should reduce the stigma as well as transmission, CDC officials said. Nearly half of new HIV infections are discovered when doctors are trying to diagnose an illness in a patient who has come for care, they noted. The American Medical Association supports the proposed recommendations, said Dr. Nancy Nielsen, a Buffalo, N.Y.-based physician who is speaker of the AMA's House of Delegates. "I'm so happy the CDC is recommending this," she said. "HIV is an infectious disease and it should be treated like any other infectious disease. The fact that it has been treated so differently, I think, in some ways has contributed to the stigma." The new recommendations, as currently drafted, do not require pre-test counseling. They call for post-test counseling to be offered only to patients who test positive. "Doctors should be explicit that 'You're going to be tested,'" said Dr. Tim Mastro, acting director of the CDC's division of HIV/AIDS prevention. [AP, 8May06, http://www.breitbart.com/news/2006/05/08/D8HFULKG0.html, AP, Stobbe; N Valko RN, 9May06]
HEPATITIS B VACCINATION COVERAGE AMONG ADULTS — UNITED STATES, 2004. Hepatitis B virus (HBV) infection is a major cause of cirrhosis and liver cancer in the United States. The Advisory Committee on Immunization Practices (ACIP) has recommended a comprehensive strategy to eliminate HBV transmission, including prevention of perinatal HBV transmission; universal vaccination of infants; catch-up vaccination of unvaccinated children and adolescents; and vaccination of unvaccinated adults at increased risk for infection. The incidence of acute hepatitis B has declined 75%, from 8.5 per 100,000 population in 1990 to 2.1 per 100,000 population in 2004, with the greatest declines (94%) among children and adolescents (1). Incidence remains highest among adults, who accounted for approximately 95% of the estimated 60,000 new infections in 2004. To measure hepatitis B vaccination coverage among adults, data were analyzed from the 2004 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicated that, during 2004, 34.6% of adults aged 18–49 years reported receiving hepatitis B vaccine, including 45.4% of adults at high risk for HBV infection… The same demographic and health-care use characteristics were associated with higher likelihood of vaccination among persons at high risk as among other respondents. In a multivariate model, after controlling for age, sex, education, occupation, and HIV test his
tory, high risk remained a statistically significant predictor (adjusted odds ratio = 1.3) of hepatitis B vaccination.
Reported by: C Weinbaum, MD, K Billah, PhD, EE Mast, MD, Div of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STDs, and Tuberculosis Prevention (proposed), CDC.
The findings in this report suggest that hepatitis B vaccination coverage among adults at high risk, as measured by NHIS, has increased substantially from 30% in 2000 to 45% in 2004 (3). Some of this increase in coverage represents the aging of persons vaccinated as adolescents, reflecting the effect of ACIP recommendations for routine vaccination of adolescents that were first made in 1995 (4). In addition, higher vaccination coverage among persons of all ages at high risk suggests successes vaccinating targeted adults and likely contributed to a decline in hepatitis B incidence. From 2000 to 2004, hepatitis B incidence among adults decreased 27%, from 3.7 to 2.7 per 100,000 population (CDC, unpublished data, 2006). However, hepatitis B vaccination coverage of adults at high risk remained lower than vaccination coverage of children (92%) and adolescents (86%) in 2004 (5), two other age groups included in the ACIP vaccination strategy to eliminate HBV transmission.
The findings in this report are subject to at least four limitations. First, criteria for adults at high risk used in this study might not identify all persons who are at risk for HBV infection, such as persons with multiple sex partners, and might identify persons without risk, such as most persons with hemophilia. Second, the in-person format of the interview might lead to underreporting of risk behaviors. Third, hepatitis B vaccination was based on self-report and was not validated by medical records. Although differences might exist between self-reported vaccination and true vaccination, directional bias is unlikely, so correlates and trends in coverage are likely to reflect true trends. Finally, NHIS excludes all institutionalized persons (e.g., military or incarcerated) among whom both the risk for hepatitis B and vaccination coverage might differ from those of the rest of the population. Despite these limitations, NHIS is the only national survey that collects data related to adult hepatitis B vaccination…
This report is based, in part, on data contributed by S Stokley, MPH, National Center for Immunization and Respiratory Diseases (proposed); A Wasley, PhD, Div of Viral Hepatitis; and N Jain, MD, Div of STD Prevention, National Center for HIV, Viral Hepatitis, STDs, and Tuberculosis Prevention (proposed), CDC.
CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part 1: immunization of infants, children, and adolescents. MMWR 2005;54(No. RR-16):1–33.
National Center for Health Statistics. Data file documentation, National Health Interview Survey, 2004 [machine-readable data file and documentation]. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2004. Available at http://www.cdc.gov/nchs/nhis.htm.
Jain N, Yusuf H, Wortley PM, Euler GL, Walton S, Stokley S. Factors associated with receiving hepatitis B vaccination among high-risk adults in the United States: an analysis of the National Health Interview Survey, 2000. Fam Med 2004;36:480–6.
CDC. Update: recommendations to prevent hepatitis B virus transmission—United States. MMWR 1995;44:574–5.
Stokley S, McCauley M, Fishbein D, Stevenson J. Adolescent vaccination coverage levels: results from the 1997–2003 National Health Interview Survey [Abstract]. Presented at the 40th National Immunization Conference, Atlanta, GA; March 6, 2006. Available at http://cdc.confex.com/cdc/nic2006/techprogram/P10373.HTM.
Williams IT, Boaz K, Openo Kp, et al. Missed opportunities for hepatitis B vaccination in correctional settings, sexually transmitted disease (STD) clinics, and drug treatment programs [Abstract 1031]. Presented at the 43rd Annual Meeting of the Infectious Diseases Society of America, San Francisco, CA; October 5–9, 2005.
Liddicoat RV, Horton NJ, Urban R, Maier E, Christiansen D, Samet JH. Assessing missed opportunities for HIV testing in medical settings. J Gen Intern Med 2004;19:349–56.
CDC. Improving influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among adults aged <65 years at high risk: a report on recommendations of the Task Force on Community Preventive Services. MMWR 2005;54(No. RR-5):1–11.
CDC. Hepatitis B vaccination among high-risk adolescents and adults—San Diego, California, 1998–2001. MMWR 2002;51:618–21.
Advisory Committee on Immunization Practices. Provisional recommendations: Advisory Committee on Immunization Practices (ACIP) voted to approve the following recommendations—October 2005. Atlanta, GA: Advisory Committee on Immunization Practices. Available at http://www.cdc.gov/nip/recs/provisional_recs/hepB_adult.pdf.
* 1) "What are your chances of getting HIV (the virus that causes AIDS)? Would you say high, medium, low, or none?"; 2) "In the past five years, have you had an STD other than HIV or AIDS?"; 3) "Tell me if any of these statements is true for you; do not tell me which statement or statements are true for you; just if any of them are: a) you have hemophilia and have received clotting factor concentrations; b) you are a man who has had sex with other men, even just one time; c) you have taken street drugs by needle, even just one time; d) you have traded sex for money or drugs, even just one time; e) you have tested positive for HIV (the virus that causes AIDS); f) you have had sex (even just one time) with someone who would answer `yes' to any of these statements." [MMWR Weekly May 12, 2006 / 55(18);509-511]
HEALTH AGENCY TARGETS PRE-TEENS WITH SEXUAL INFORMATION. The San Francisco Department of Health has developed a text-messaging service to provide children as young as 12 with "sexual health information" — without their parents' knowledge. The "SexInfo" service allows users to seek sex-related information by using the typical shorthand employed in cell-phone text messaging: "SEXIBFO: reply with code for answrs. 'A1' if ur condom broke 'B2' if u think ur pregnant 'C3' to find out about STDs 'D4' to find out about HIV." [CNSNews.com; Focus on the Family, 12May06, http://www.family.org/cforum/briefs/a0040475.cfm]