RUSSIA OWNS UP TO HIV

As Russia faces the prospect of an HIV pandemic, the issue of HIV and AIDS has rapidly gone from near obscurity to the top of the political agenda there.¹ In April, President Vladimir Putin allocated $109 million to a national project designed to prevent, diagnose and treat HIV and viral hepatitis. In May, Russia hosted eastern Europes first regional meeting on HIV and AIDS. And at the Group of Eight summit in July, Russia proposed the creation of a regional entity in eastern Europe and Central Asia to promote the development of an HIV vaccine.² These unprecedented initiatives presumably reflect the governments recognition that with knowledge about HIV transmission low among young people, the disease, long seen mainly among young men and injection-drug users in Russia, is poised to begin spreading quickly through the general population. Official figures show 342,000 cases of HIV and AIDS among Russias population of 145 million, but the actual number is thought to be closer to one million.

1. Kmietowicz Z, AIDS in Russia—glasnost arrives at last, BMJ, 2006, 332(7551):1176.

WHEN CAN YOU BE SUED FOR SPREADING HIV?

The California Supreme Court ruled in July that people who transmit HIV to a sexual partner can be sued by the partner—even if they did not actually know that they were infected but there was sufficient information to infer as much.¹ According to the majority opinion, limiting liability to individuals who have been tested for HIV is insufficient, as it may give some people an incentive…to avoid diagnosis and treatment. Two justices sharply disagreed, however, writing that this new standard of liability contradicts state law and policy. Furthermore, one noted, it opens the door for individuals to be drawn into intrusive litigation whenever their current or former sexual partners contract an STD. The case in question concerned an HIV-infected womans lawsuit against her husband, who also has the disease; each blames the other for bringing HIV into their marriage, and the wife is seeking compensation for the husbands infliction of emotional distress and fraud.² The ruling came during the discovery stage, in which she sought to require him to provide highly personal information about his sexual history.

1. Cohen A, An AIDS case tests California law, Washington Post, July 5, 2006, <http://www.washingtonpost.com/ wp-dyn/content/article/2006/07/04/ AR2006070401057.html>, accessed July 11, 2006.

2. Liptak A, People who pass on AIDS virus may be sued, New York Times, July 4, 2006, <http://www.nytimes.com/ 2006/07/04/health/04suit.html?_r=1&oref=slogin>, accessed July 5, 2006. ¹

WHAT YOU NEVER SAW ON GIDGET

Some youngsters learn too early that dating isnt all about carefree time at the beach, the movies or the mall. Nine percent of high school students participating in the 2003 Youth Risk Behavior Survey said that within the last year, a boyfriend or girlfriend had hit, slapped or physically hurt them on purpose.¹ The proportion did not differ between males and females or by grade level. However, it was significantly higher among blacks (14%) than among whites (7%) and Hispanics (9%), and significantly higher among youth whose grades were mostly Cs or lower (11–14%) than among those who did better in school (6–8%). In multivariate analyses, the odds of reporting dating violence were significantly elevated among respondents who were currently sexually active (odds ratio, 2.6), who had attempted suicide in the previous 12 months (3.3), who had drunk heavily on at least one day of the last 30 (1.3) or who had been in at least one fight in the past year (1.7). Primary prevention programs are needed to educate high school students about healthy dating relationship behaviors, and secondary prevention programs should address risk behaviors associated with dating violence victimization, the analysts conclude.

1. Black MC et al., Physical dating violence among high school students—United States, 2003, Morbidity and Mortality Weekly Report, 2006, 55(19):532–535. ¹

NEWBORNS' HOSPITAL STAYS AND THE LAW

The average hospital stay of newborns in California increased significantly after federal and state legislation aimed at reducing the incidence of early discharge went into effect, but some groups of infants appear to have benefited more than others.¹ Between 1991 and 1997, just before the laws were adopted, the average stay declined by about an hour a year; it grew by 10 hours in 1998, by 12 hours in 1999 and by 14 hours in 2000. Increases were particularly large for infants whose mothers had at least a high school education, were aged 35 or older, were white, had not given birth before and delivered by cesarean. Although the laws do not apply to births to women who are covered by Medicaid or have no insurance, the length of stay increased for these groups as well as those with other types of insurance. The odds that an infant would be readmitted to the hospital within 28 days after birth, which also had increased each year from 1991 to 1997, dropped substantially in each of the next three years. No change occurred in the risk that an infant would die by age one. Data limitations preclude inferences of causality.

1. Datar A and Sood N, Impact of postpartum hospital-stay legislation on newborn length of stay, readmission, and mortality in California, Pediatrics, 2006, 118(1):63–72.

A SHOT IN THE ARM FOR ALL PREGNANT WOMEN?

Universal flu vaccination for pregnant women, a strategy that has been recommended by the federal government since 2004, would cost less than treating women who develop the flu during pregnancy, when the risks of complications and hospitalization are particularly high.¹ Analysts estimated the costs of these two scenarios in a decision model that took into account the costs of hospitalization, ambulatory visits for flulike illness, vaccine, over-the-counter medications, treatment of adverse effects of vaccine or medications, and caregiving; flu vaccine was assumed to be 70% effective. The bottom line was that vaccinating all pregnant women aged 18–44 would cost about $50 less per woman than providing treatment once a woman becomes ill with the flu; it also would result in a net gain of 45 hours of perfect health. Noting that fewer than half of obstetricians offer all pregnant women flu vaccinations, the analysts hope that their findings will encourage more to follow the recommendation of universal vaccination for this population.

1. Roberts S et al., Cost-effectiveness of universal influenza vaccination in a pregnant population, Obstetrics & Gynecology, 2006, 107(6):1323–1329.

YOUR TAX DOLLARS AT WORK

Federally funded pregnancy resource centers provide false and misleading information that may frighten women and discourage them from obtaining abortions, according to a report by Democratic staff of the House Government Reform Committee.¹ Staff investigators contacted 23 such centers for information about unintended pregnancy; 20 centers told the callers that abortion increases the risks of breast cancer and infertility, and leads to severe, long-term psychological problems. Although the centers contend that the information provided by their counselors is grounded in research, the studies they rely on are outside the mainstream of medical opinion. The congressional report concludes that the centers approach denies [clients] vital health information, prevents them from making an informed decision, and is not an accepted public health practice. Pregnancy resource centers received little federal money before 2001; since then, they have received $30 million in federal support.

1. Kaufman M, Pregnancy centers found to give false information on abortion, Washington Post, July 18, 2006, p. A8. ¹

GRIM NEWS ON PRETERM BIRTHS

Infants born preterm—before 37 weeks gestation—accounted for 13% of all U.S. births in 2005, according to the Institute of Medicine (IOM).¹ That proportion represents a 30% increase since 1981, and it differs considerably by race and ethnicity: Some 18% of births to black women in 2005 were preterm, compared with 11–12% among Asian, white and Hispanic women. Preterm birth, which can lead to long-term health and developmental problems, exacts a heavy economic toll—$26.2 billion, or $51,600 per infant, a year. Most of the expenditures go to medical care for the infant, but maternal care, early intervention services, special education for children who develop learning disabilities and lost productivity also contribute to the total. The IOM notes that a host of socioeconomic, biological, environmental, and other factors, often in combination, increase a womans chances of preterm delivery. As a result, it urges integrated, multidisciplinary research on the causes and outcomes of preterm birth, to help inform public policy and reduce the incidence of this outcome.

1. The National Academies, Preterm births cost U.S. $26 billion a year; multidisciplinary research effort needed to prevent early births, news release, Washington, DC: The National Academies, July 13, 2006.

IF WOMEN HAD THEIR DRUTHERS

Even for many women who have no menstrual-related health problems, the special monthly visitor is a nuisance. Three-quarters of women interviewed at an Italian gynecology clinic said that their periods interfered with sex, half said that it interfered with their participation in sports and three in 10 said that it interfered with work or their choice of what to wear.¹ If they could have their way, 29% of those surveyed would forgo their period altogether and 28% would reduce the frequency of the cycle (23% to four times, 4% to two times and 1% to once a year). Of those who would prefer to menstruate less than monthly, three-quarters would be willing to take a drug to achieve that effect. The researchers acknowledge that their sample of 270 women was too limited for the findings to be considered widely generalizable; nevertheless, they conclude that many women desire to choose whether and when to bleed.

1. Ferrero S et al., What is the desired menstrual frequency of women without menstrual-related symptoms? Contraception, 73(5):537–541.¹

AIDS TESTING PLAN STIRS CONTROVERSY

With one-quarter of HIV-positive Americans unaware of their infection status, the Centers for Disease Control and Prevention is drafting guidelines recommending that physicians routinely test 13–64-year-olds, regardless of their risk factors—and this proposal is making a lot of people very unhappy.1 Although the test would still be voluntary, the guidelines offer no standards for counseling and permit testing to proceed on the basis of oral consent; furthermore, they do not address the barriers that stand between many HIV- infected people and appropriate care. Opponents of the plan believe that it opens the door for misleading or coercive practices if clinicians do not have or take the time to counsel patients completely and document consent. Advocates of routine testing counter that it could reduce the stigma associated with HIV, as individuals would not have to answer questions about their sexual behavior, and would increase the number of people who know of their HIV status soon enough to seek treatment.

1. Chase M, Plans to expand AIDS testing alarm activists, Wall Street Journal, July 5, 2006, p. A15.