June03-3-1

Study Looks at HIV-Positive Men in China

Fri Jun 20, 2:57 AM ET

NEW YORK (Reuters Health) - Public health experts estimate that roughly three percent of Beijing's gay and bisexual male population is infected with HIV, according to a new report.

"Our data suggest that there is low but significant HIV-1 prevalence in men who have sex with men in Beijing," the authors write in the June 21st issue of The Lancet.

"However, in view of high rates of unprotected sex in such men, HIV-infection rates will continue to rise unless prevention measures are implemented," they add.

Few studies have been conducted in China to determine the prevalence of HIV infection among gay and bisexual men, according to the report.

Since experts estimate that between 2 and 8 million Chinese men have sexual relations with men, many believe that HIV infection rates in this population could play an important role in the spread of the virus.

In the current study, Dr. Kyung-Hee Choi of the University of California, San Francisco and colleagues interviewed 481 men in Beijing who said they had sex with men. All of the men also got an HIV test.

Of the group, 15 men, or 3.1 percent, were infected with HIV, and nearly half of the group noted that they had had unprotected anal sex with a man in the previous six months, and 22 percent had unprotected anal or vaginal sex with a woman during that same time.

In addition, the researchers found that men older than 39 were 4.5 times more likely to be infected with the virus compared with younger men. Since older men were much more likely to have been married, the authors express concern that these men may "contribute to the sexual transmission of HIV to heterosexually active adults."

"Efforts are urgently needed to prevent further spread of infection both in these men and to their heterosexual partners," the authors conclude.

The United Nations estimates that between 800,000 and 1.5 million people in China were infected with HIV at the end of 2001, and the number could grow to 10 million by 2010 if swift action to control the spread of the disease is not taken.

SOURCE: The Lancet 2003;361:2125-2126.

Many Women Don't Discuss STDs with Partners, Docs

NEW YORK (Reuters Health) - Although one in three new cases of HIV in the U.S. occur among women, many women feel too embarrassed to discuss sexually transmitted diseases (STDs) with their doctors or sex partners, new survey findings show.

This "sexual silence" can lead to ignorance about sexual health issues, Dr. Hilda Hutcherson, of Columbia University in New York, said during a Tuesday media briefing jointly held by the survey sponsors, the Henry J. Kaiser Family Foundation and SELF magazine.

Indeed, more than 80 percent of the 800 women surveyed did not know that one third of new HIV cases occur among women, or that one quarter of Americans are likely to get an STD -- many of which are symptomless -- at some point in their life.

Sixty percent of the 18 to 49 year-olds surveyed were also unaware that women are more susceptible to STDs than men and up to 65 percent did not know that an STD can lead to liver damage and an increased risk for HIV or cancer. Most women were aware that STDs can also lead to infertility and pregnancy complications.

Currently, an estimated 65 million people in the U.S. are living with an incurable sexually transmitted disease, and approximately 15 million men and women in the U.S. develop a new STD each year, experts say.

Still, about half of women in the U.S. have never discussed HIV/AIDS or any other STD with their doctor, according to the survey. Fifteen percent say they have deliberately withheld information about their sexual health from their doctors, and 14 percent said their doctor didn't need to know such information.

In her current practice as a gynecologist, Hutcherson said the most common reasons her patients give for their lack of communication about sexual health issues are embarrassment, guilt and shame.

The same was true of the women surveyed. Nearly 90 percent said they were embarrassed to discuss sexual health issues with their partner, and a similar proportion said they worried what their partner would think of them. Sixty-nine percent said their partner didn't need to know and almost half said they believed women shouldn't talk about such things.

Some women fear their partners may think they're promiscuous, Hutcherson said, citing the example of one woman who said, "he might think I've been around the block a few times."

But the "truth of the matter" is that women can die from their lack of knowledge about STDs, Hutcherson said.

Dr. Vanessa Cullins, also present during the briefing, added that women -- and their doctors who may also feel uncomfortable discussing sexual health issues -- need to get past their feelings of embarrassment so they can take charge of their "reproductive destiny." Cullins is vice president of medical affairs for Planned Parenthood Federation of America.

In other findings, up to 64 percent of women said they had ever been tested for HIV or other STDs. However, 15 percent to 20 percent incorrectly believed that such testing was a routine part of their gynecological examination.

For example, 40 percent of women surveyed said the Pap smear, which tests for abnormal cells that can lead to cervical cancer, also tests for STDs, and nearly 10 percent believed it was a test for HIV/AIDS or pregnancy. Cervical cancer is usually caused by the sexually transmitted human papillomavirus (HPV), but the Pap smear does not directly test for the virus.

In general, Cullins said, doctors do not conduct a battery of STD tests on their patients. She added that women should help guide their doctors, by telling them if they think they should be tested for a few different STDs.

What it all boils down to, Hutcherson said, is the "individual responsibility of each woman." They need to demand answers from their doctors and demand proper treatment, she said.

The Kaiser Family Foundation/Self National Survey of Women on their Sexual Health was conducted via telephone from December 10, 2002 until January 19, 2003. The margin of error is plus or minus 3.6 percent and may be larger in some subsets of women included in the survey.

Researchers Have New Theory on Origin of AIDS Virus

They believe the simian precursor to the AIDS virus was created in chimps that ate two kinds of monkeys with
different but related viruses, red-capped mangabeys and spot-nosed guenons.

They made the deduction by sequencing the genes of the simian immunodeficiency viruses in chimpanzees and 30
monkey species and then compiling "family trees" to see which were most closely related.

The study, done jointly by researchers at the University of Nottingham, the University of Alabama at Birmingham, Duke University, Tulane University and the University of Montpellier in France, appears today in the journal
Science.

The conclusion is important, said Dr. Beatrice Hahn, a University of Alabama at Birmingham virologist and one of
the authors, "because it shows that chimpanzees acquired their virus exactly the same way humans did, by hunting
bushmeat." Neither chimps nor monkeys get sick from it.

Unlike the other great apes, chimpanzees are formidable hunters. Troops of males often work together; some chase
monkeys through forest canopies while others wait in nearby trees to swat their prey off branches, and yet others
follow on the ground, leaping on fallen monkeys and battering them to death.

Hunting males tear their catches limb from limb and eat them on the spot, share the carcasses or trade them to
females for sex, so blood-to-blood contact from "open cuts or chomping on bones" is easy to imagine, one researcher said.

The prevailing theory about the origin of H.I.V. is that somewhere in central Africa, probably between 1910 and
1950, a chimpanzee hunter picked up its virus by cutting himself while butchering a carcass. The simian virus then
mutated into H.I.V. and spread among humans, mostly through sex.

However, "a lot of people just don't buy this and say it was polio vaccine or dirty needles or tattooing or crazy
tribal practices," Dr. Hahn said. "This shows the flaw in their argument."

Experts not connected with the study said they found it plausible. Dr. Ronald Desrosiers, a professor of genetics
at Harvard Medical School, said it "looks like it makes sense" and demonstrates how easily diseases transfer
between species.

Another expert, Edward Hooper, argued in a 1999 book, (Little, Brown), that a chimpanzee virus passed into humans when an experimental oral polio vaccine was grown in a medium containing chimpanzee cells and used in parts of the former Belgian Congo in 1957 to 1960. He called the study "reasonably plausible, though based on limited data."

"I have no problem with the idea that chimps got it by eating other monkeys," he said.

Scientists believe two monkey viruses were involved because the virus from guenons (Cercopithecus nictitans) was
closest in the part of the genome that contains the code for the virus's protein envelope, while the virus from the
mangabey (Cercocebus torquatus) was closest in a different segment.

There is no way to know when the two viruses merged inside one chimpanzee. "It could have been hundreds of years ago or tens of thousands of years ago," Dr. Hahn said.

Chimp virus has been found in two subspecies found in central Africa known as troglodytes and schweinfurthii, but
not yet in the westernmost subspecies, known as verus, nor in a related species found south of the Congo River, the hairier bonobo or pygmy chimpanzee.

The virus's failure to spread to all chimpanzees before they diversified into subspecies suggests that it is
relatively new, researchers said. Subspecies have been separated for eons by large rivers like the Congo and the
Ubangi, since chimps cannot cross water.

A related study of the virus in wild chimpanzees by many of the same authors, scheduled to appear in the Journal of
Virology next month, shows that it is much less common than in monkeys and the rate varies from region to region and troop to troop. None of the chimps studied in Uganda's Kibale National Park were infected. An estimated 13 percent of those in Tanzania's Gombe National Park were.

By contrast, 50 to 90 percent of most adult monkeys are infected with their versions, said Dr. Paul M. Sharp, a
professor of genetics at the University of Nottingham.

Because wild chimpanzees, which grow nearly six feet tall, can easily kill humans, getting blood samples is dangerous, so researchers watch chimps closely enough to be able to test their feces and urine.

It is still unclear exactly how chimpanzees infect each other and why the disease isn't more rampant among them,
since they have many sexual partners and fight frequently, often biting each other, which in rare human cases has
passed the virus.

Nursing is surely one route, Dr. Hahn said, because some chimps captured in infancy are infected.

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