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Issue #243: August 20, 1999
FASTFAX is available by fax in the 215 and 610 area codes at no cost, by mail anywhere for 20.00 per year, by calling 215-545-6868, and on the fastfax index page. Information in fastfax is drawn mostly from secondary sources; people living with HIV/AIDS should share information of interest to them with their primary care provider before making treatment choices. For more information on HIV medications and treatments, contact Kiyoshi Kuromiya of the Critical Path AIDS Project, 215-545-2212 or by email to The presence of the name or image of any individual in fastfax should not be construed as an indication of their HIV status or sexual preference unless specifically stated. Questions or comments should be directed to Editor, fastfax, 425 S. Broad St., Phila., PA 19147-1126 or by email to
In This Issue:
Study shows odds of getting HIV infection
Researchers say microbicide increases HIV risk
Cell "teamwork" may explain delays in HIV symptoms
Police arrest AIDS outreach worker
Man arrested for AIDS cure claims
One-third of world population infected with TB
Alleged murderers of HIV+ women released
HIV-positive doctor jailed for sex with wife
WHO official: West owes AIDS apology to Africa
Just how risky is risky sex in the era of AIDS?
The San Francisco Department of Public Health has just released a study that calculates the odds, and to those who understand the arcane numbers, the results are surprising and troubling.
Showing for the first time the mathematical risk of HIV infection in a variety of circumstances, the study of 1,583 men suggests that AIDS remains a difficult disease to contract but that steps taken by some men to lower their risk are not as effective as some have hoped.
"It is really important for people to have information in making decisions about their sexual risks," said Susan Buchbinder, an epidemiologist with the city health department and senior author of the report.
Each time an uninfected man engages in unprotected receptive anal intercourse with an HIV-positive partner, for example, chances are 1 in 120 that he will become infected with the AIDS virus.
Oral sex, often seen as a safe alternative to anal sex in the gay community, poses a small but significant risk of infection. Each contact poses about 1-in-2,500 chance that an exchange of semen from an HIV-infected partner will transmit the disease. Those odds are not as favorable as commonly thought.
"We're not talking thousands of times less risky. We're talking about 10 times less risky," said Buchbinder.
But the study also hints that even disciplined use of a condom may offer less protection than previously thought. Among the 49 men in the study group who became infected, only half reported having unprotected sex with a partner who was either HIV positive or not known to be uninfected. That suggests that half of those infected were practicing some form of "safer" sex -- use of a condom or oral sex.
Most provocative was a preliminary finding that among men who had receptive anal intercourse with an HIV-infected partner those who used condoms were only one-third less likely to contract the virus than those who used no condoms at all.
"The data tell us that, when you have receptive anal intercourse, you are at greater risk, regardless of whether you reported using a condom," said Buchbinder.
But the epidemiologist cautioned that her computer models did not have enough statistical power to draw conclusions about the safety of condom use. The data could be skewed by subjects who reported using a condom but in fact did not, or by men whose condoms broke or slipped off without their knowing it. "It is something that definitely needs confirmation," she said.
AIDS prevention experts said the study is useful and supports much of what they had always believed.
"We've always said that oral sex is lower risk but not risk-free," said Dan Wohlfeiler, a researcher at the University of California at Berkeley School of Public Health.
In a previous role as director of education programs for the Stop AIDS Project in San Francisco, Wohlfeiler said, the single question asked most of him was what are the odds of transmission in oral sex.
"The odds may be 1 in 2,000," said Wohlfeiler, "but if you have 10,000 going on at any one time, someone is going to draw that unlucky card."
The study makes clear that there are varying levels of risk of HIV infection, depending on the type of sexual acts performed, the health status of the partner, and the use of condoms.
Buchbinder points out that the study has implications for doctors making decisions about whether to prescribe a short course of antiviral drugs to men who had unsafe sex with partner they did not know -- a preventive step sometimes compared to the "morning-after pill."
The study found that the chances of a man becoming infected from a single incident of unsafe sex with a partner who was not known to be HIV-negative was 1 in 370 -- comparable to the risk of becoming infected by an accidental needle stick from an HIV-infected patient.
Current practice is to place a health care worker stuck by such a needle on the same preventive antiviral therapy. If the risks are similar, Buchbinder reasons, then doctors should not hesitate to prescribe the same medicines to men who fear they have been infected by a partner of unknown HIV-status.
The study also found that the risk of HIV infection is lower among men who practice insertive anal intercourse. The risk of infection for a man who practices unprotected insertive anal sex on an HIV-infected partner is 1 in 1,666 per contact.
Earlier studies have found that women who have unprotected vaginal intercourse with an HIV-infected partner run a risk of infection of between 1 in 1,000 and 1 in 2,000 each time they have sex.
Buchbinder stressed that the findings cannot be applied as a guide for each individual -- rather they show how a group of individuals might fare on average. In fact, the study found that individual infection rates varied widely -- some subjects were infected by as few as one or two risky encounters, while others remained uninfected after hundreds of high- risk sex acts.
And while the lower-risk practices of unprotected sex -- exchange of semen in oral sex, or insertive anal intercourse -- offer a low risk of infection, Buchbinder warned the danger remains real. "If you do it often enough, you are increasing your risk," she said. (San Francisco Chronicle)
The use of nonoxynol-9 appears to be associated with an increase in minor lesions and self-reported side effects, according to the results of a South African study of commercial sex workers.
The presence of the lesions is believed by researchers to increase the risk of contracting HIV among women who experience them.
Also, the microbicide - which is has become a common component of most condoms distributed by AIDS prevention efforts -- increases the rate of HIV-1 shedding compared with placebo.
The latest study supports the results of several others conducted over the past several years indicating that while nonoxynol-9 may be effective at preventing pregnancy, its usefulness as an HIV preventative is severely limited. This is among the first studies, however, which indicates that the substance may pose a danger to some women as well.
About 50% of female sex workers in South Africa are HIV-positive, but intervention strategies targeted to this group have been lacking, Dr. Roxana Rustomjee of the University of Natal in Congella and her associates, who conducted the latest study, point out. Female sex workers who work at long distance truck stops in Africa and have clients who refuse to use condoms are particularly vulnerable, they said.
Dr. Rustomjee's group therefore focused on this group of women to see if the use of nonoxynol-9 film was a safe and acceptable intervention.
Twenty women enrolled in the trial received a 72 mg nonoxynol-9 film and a glycerine-containing film (placebo) that was packaged in the same manner. Fourteen of the 20 participants were HIV-positive at baseline.
Overall, the nonoxynol-9 film was acceptable to the study participants, they report in the August 20th issue of AIDS. Dr. Rustomjee's group observed "no statistically significant differences between the two treatment groups for genital lesions, reported side effects, and viral load." However, when compared with placebo, use of the nonoxynol-9 film was associated with more "clinically detected genital lesions (six out of eight versus two out of eight) and self-reported side effects (five out of eight versus three out of eight)."
In addition, they found that "HIV shedding was correlated with the presence of incident vaginal or cervical lesions."
Dr. Rustomjee's team believes these clinical effects associated with nonoxynol-9 film use bring into "question the potential narrow margin of safety for this product," and that phase II trials will need to address this concern. (Reuters/AIDS)
Cell "teamwork" may explain delays in HIV symptoms
n a discovery that helps explain why some HIV-positive people take longer to develop AIDS than others, Spanish scientists report that some structures in cells appear to cooperate to form a defense against HIV.
In the research, Dr. Carlos Martinez-A. and colleagues at the Universidad Autonoma de Madrid, Spain, focused on a group of molecules called chemokines, which play a role in alerting the immune system when an infection enters the body. When chemokines attach themselves to structures called chemokine receptors on the surface of white blood cells, they trigger the immune system to fight the infection.
Although the receptors usually help to protect the body, certain types allow HIV to enter immune-system cells.
But, according to a report in the August 19th issue of Nature, in some people, chemokine receptors work together to prevent HIV from infecting cells.
Once a receptor binds with a chemokine, it usually links up with another receptor of the same type. But in laboratory tests, Martinez-A. and his colleagues found that a mutant receptor called CCR2V64I can link up with CCR5 or CXCR4 receptors, which are HIV's pathways into cells. This unusual bond prevents HIV from entering cells by way of these receptors, according to the report.
The finding may explain why HIV-positive people with the CCR2V64I mutation tend to develop AIDS later than those without it, the researchers note.
The discovery may have practical implications, such as the development of drugs that prevent HIV infection or delay the development of AIDS by encouraging receptors to block HIV's entry into cells, Martinez-A. said. (Reuters/Nature)
Police arrest AIDS outreach worker
A transgendered AIDS outreach worker has been arrested for the second time in the past two months for "obstructing a highway" while she was distributing condoms and AIDS information to transgendered sex workers in Philadelphia's 13th Street corridor.
The area, which has been known for high levels of prostitution, both gay and straight, for several decades, is a central location for AIDS education activities by a number of Philadelphia AIDS service organizations.
Outreach workers from the Youth Health Empowerment Project (YHEP) and other street outreach groups have also reported harassment by police as they conduct their work.
The transgendered worker, employed by ActionAIDS, told Au Courant, a weekly Philadelphia gay newspaper, that she was wearing a badge indicating that she was an outreach worker when she was arrested.
Joan Curran, deputy director of ActionAIDS, said the two arrests had led her to suspend the organization's street outreach activities.
"I cannot send them out, I cannot distribution condoms, I cannot effectively stop the spread of HIV until I have a meeting" with police officials," Curran told Au Courant. "The police are arresting people because of the way they look, making an assumption - if they look this way, they must act a certain way."
Police officials said they would "welcome" a meeting to discuss the issue. (Au Courant)
Man arrested for AIDS cure claims
A convicted murderer who heads a Nevada company has been arrested on securities fraud charges after his company made several recent announcements claiming to have developed a cure for AIDS, prosecutors announced this month. And the federal Securities and Exchange Commission (SEC) has filed false claims charges against his company.
Alfred Flores, 49, president of New Technologies & Concepts Inc., was arrested in New York, and the SEC charges were filed in Las Vegas, his company's headquarters. The false claims sent the price of stock in New Technologies' parent company, Uniprime Capital Acceptance Inc., to soar from $1 a share to nearly $8 a share, prosecutors said.
The complaint alleged that New Technologies issued three news releases on Uniprime's Web site describing "Plasma Plus."
On June 16, the company said Flores had "conducted tests on patients in Madrid which have shown complete reversal from the immune system of the HIV infection, with no reintroduction of the virus after a period of almost 18 months."
A July 19 news release said "Plasma Plus" had proven 100 percent successful in eliminating the presence of HIV in patients, the complaint said.
If convicted, Flores could face a maximum of 10 years in prison and a fine of $1 million.
Flores, 45, was the president of New Technologies & Concepts Inc., which he founded in May 1999 with the assistance of Uniprime, the 70 percent owner of the subsidiary.
The SEC halted trading in Uniprime shares July 21 when it questioned Uniprime's early HIV claims and could not get a reply. Since Aug. 4, when the halt expired, some 800,000 Uniprime shares have traded in the secondary market, it said, and Uniprime has raised nearly $500,000 in private placements.
A receptionist who answered the telephone at Uniprime said its executives were in meetings and were not available to respond to calls.
The U.S. Attorney's office said Flores had an extensive criminal record, including a 1984 conviction for conspiracy to commit financially-motivated murder, for which he had served nine years.
According to the SEC, Uniprime issued a press release June 16 claiming that Flores was an honors graduate of the University of Madrid, a researcher in immunology at his own laboratory in Lisbon, Portugal, in addition to his claim to have tested the anti-HIV "Plasma Plus" on patients in Spain.
In fact, according to the SEC and the U.S. Attorney, Flores never attended the University of Madrid, had no official recognition from the Spanish government and the patients and doctors named had never heard of him.
Prosecutors and investigators said Flores was in jail in Colorado on the murder conspiracy charge at the time he supposedly was conducting his research.
The SEC said it was freezing the company's assets and seeking a permanent injunction against it. If convicted, Flores would face a maximum sentence of 10 years and a fine of $1 million. (Associated Press/Bloomberg News)
One-third of world population infected with TB
A total of 1.86 billion people, or 32% of the world population, is infected with the bacteria that causes tuberculosis, according to the World Health Organization (WHO).
"The global burden of tuberculosis remains enormous," WHO researchers write in a report published in The Journal of the American Medical Association.
In 1997, nearly 8 million new cases of tuberculosis occurred, 1.87 million people died from the disease and existing cases of disease numbered 16.2 million. Although nearly 2 billion people were infected with the tuberculosis bacteria, most people who are infected do not become ill.
Eighty percent of tuberculosis cases are found in 22 countries, and more than half are found in just five countries, including India, China, Indonesia, Bangladesh and Pakistan.
Africa is also hit hard by the disease, with 9 out of 10 countries with the highest incident rates per capita located on that continent, according to the report.
What's more, Africa has the highest proportion of people infected with both TB and HIV (1.2%). Overall, 32% of people in Africa with tuberculosis were also HIV-positive.
"I am very hopeful that this article will stimulate better TB surveillance," said lead study author Dr. Christopher Dye in an interview with Reuters Health. "We are throwing down a clear challenge to countries -- especially in the developing world -- to provide better information about the scale of the TB epidemic, and the measures they are taking to control it," he said.
"Better measurement means better awareness, and that is almost bound to lead to better control," he said.
Until now, the most recent data on tuberculosis were from 1990, and did not include information on individual countries.
The latest figures "are the fullest and most up-to-date assessment we can currently make of TB burden by country, by region, and globally," write Dye and colleagues with the WHO Global Surveillance and Monitoring Project.
The average case fatality rate was 23% in 1997, but "it exceeded 50% in some African countries with high HIV rates," the researchers add. (Reuters/Journal of the American Medical Association)
Alleged murderers of HIV+ women released
In what AIDS activists blasted as a setback to an AIDS-awareness campaign, police in Johannesburg, South Africa, said this month charges have been dropped against four youths suspected of killing an AIDS activist after she publicly disclosed she was HIV positive.
Gugu Dlamini, a 36-year-old volunteer field worker for the National Association of People Living With HIV and AIDS, was fatally beaten after publicly disclosing her illness on radio and TV at a gathering on World AIDS Day.
Police arrested four youths in January and later released them into the custody of their parents. Police Director Bala Naidoo confirmed the charges have been dropped, but said they might be reinstated.
Activists accused authorities of laxness in bringing Dlamini's killers to justice and said it was sending the wrong message.
"When a person is murdered for being open about her HIV status and you allow murderers to get away with it, what does that say to (other people with HIV/AIDS)," Mark Heywood of the AIDS Law Project was quoted as saying in The Sunday Independent, a Johannesburg newspaper.
The Dec. 1 beating occurred in a town in KwaZulu-Natal province, where an estimated 20 to 30 percent of the population has HIV or AIDS. Despite the high infection rate, those who are known to be infected are generally shunned, so they often try to keep their illness secret.
The government is attempting to boost AIDS awareness and condom use in a country where an estimated 3.6 million South Africans-- or 8.6 percent of the total population -- are infected with HIV or AIDS.
In a telephone interview, Naidoo denied the Dlamini case was being given short shrift.
"The charges have been provisionally withdrawn pending a further investigation by a special unit,'' he said, adding that authorities were giving the case ``priority." (Xinhua/Associated Press)
HIV-positive doctor jailed for sex with wife
An HIV-positive former doctor was jailed in Australia on Friday for at least three years for having sex with his wife despite knowing he was infected.
Christopher Dirckze, 43, was sentenced to four years and two months by a Melbourne court for endangering his wife's life by having unprotected sex, the Australian news agency AAP reported.
"For an extended period the accused made no attempt to protect his wife from the risk of infection although he himself was infected and he continued to engage in unsafe sexual practices with at least one other partner," judge Graham Anderson told the court.
Dirckze, who had pleaded guilty to a charge of placing his wife in danger of serious injury, found out he was HIV- positive in 1994.
He then began a relationship with a woman whom he married in February 1996, shortly before the birth of their child. The couple separated in March 1997.
"At no time before March 1997 was the accused's wife aware that he had been diagnosed as HIV positive and at no time had he told her," the judge said.
In a statement tendered to the court Mrs Dirckze wrote of the "fairy tale" life she believed she was living until she discovered her husband had a homosexual lover with full-blown AIDS.
In the statement she said: "My husband knew he was infected with the HIV virus in 1994, courted me in the same year, conceived a child with me, married me and continued to put my life at risk every time we had sex. He knew all along, he was a medical doctor by profession."
Neither the mother nor her baby girl have tested positive.
Dirckze was struck off the Victoria state medical register in August 1997. (Reuters)
WHO official: West owes AIDS apology to Africa
As new evidence suggests that the first person to die of AIDS could have been in the United States of America in the early 1960s, the Western world should apologize to Africans for wrongfully blaming them for the scourge, a WHO official has said.
Ebrahim Samba, regional director for Africa of the World Health Organization (WHO), told the Daily Herald that the Center For Disease Control in Atlanta, the United States, had proof that the first patient died between 1961 and 1962 of a "rare disease".
The person's tissues were kept and revisited recently. HIV immuno bodies were found in the frozen tissues, the Herald reported.
"All the bad things are said to emerge from Africa, while all the good come from the West. The West should, therefore, send a letter of apology to Africa for being wrongfully blamed," said Samba. (Xinhua/Comtex)