(Circulation. 2001;103:e9011.)
© 2001 American Heart Association, Inc.
Cardiovascular News
Over the next 2 years, US hospitals can expect to see depressed margins or profits, said the credit rating agency Fitch in a report released January 22, 2001. According to the AHA News Now, which is published on the Internet by the American Hospital Association, the credit rating agency said hospitals will need at least 2 years to recover from low reimbursements from the federal government in the Medicare and Medicaid programs.
Escalating personnel and supply costs are expected to contribute to hospital losses, said the agency in its report. The chronic nursing shortage is expected to continue unabated and strain the abilities of hospitals to operate effectively. As hospitals make more use of nurses hired from temporary agencies, they will see their operating costs continue to grow because such nurses cost at least twice as much as nurses employed by the hospital. The report, Default Implications for Hospitals and Health Care Systems, can be found on the firm’s website at http://www.fitchratings.com/corporate/reports/report.cfm?rpt_id=115341.
Medicare Begins Pilot Prescription Drug Program in Mine Workers Union
In a 3-year experimental program, retired members of the United Mine Workers of America, who receive health benefits from a Medicare-underwritten retirement fund, will be reimbursed 27% of the costs of an existing prescription drug program. The program, which is slated to begin July 1, 2001, is still in the planning stages, said spokespersons for the US Department of Health and Human Services (HHS).
HHS personnel said that although the trial was announced on the last day of the Clinton administration, they did not think that the incoming Bush administration would rescind it. "We approved it because we thought it would provide Congress with good information," HHS spokeswoman Melissa Skolfield told the Associated Press.
Food and Drug Administration Considers Expanding Blood Restrictions
The US Food and Drug Administration is considering banning blood donations from people who have spent >10 years in France, Portugal, and Ireland since 1980—fallout from the growing epidemic of bovine spongiform encephalopathy in Europe. The agency’s committee on Transmissible Spongiform Encephalopathies recommended on January 19, 2001, that the ban be extended.
Blood banks already ask US donors whether they have recently
spent at least 6 months in Britain, where the first cases of "mad
cow" disease first appeared in animals and then people. Blood
donations from people who have traveled to or resided in the United
Kingdom for 
6 months between 1980 and 1996 are not used.
Although it has not definitely been proven that the disease is transmitted by blood, animal experiments have pointed to blood as a possible transmissible agent. Bovine spongiform encephalopathy causes symptoms similar to those of Creutzfeldt-Jakob disease, a fatal, degenerative nerve disorder.
Rising HIV Rates in Western World Concern Infectious Disease Experts
Both New York City and San Francisco are reporting increases in HIV cases, a situation that has the nation’s infectious disease experts on guard. In both cities, those most at risk were young, gay, and members of racial or ethnic minorities.
In a survey of 542 gay New Yorkers aged 23 to 29 years that was conducted by the New York City Department of Health, 2% of white gay men were positive for HIV. In contrast, 14% of Hispanics and 33% of blacks in the age group were HIV-positive, according to a report in the January 25, 2001 issue of the newspaper Newsday. The newspaper reported estimates that as many as 4.5% to 6.3% of young gay men were becoming infected in the city each year.
"I think it is a disaster," Ronald Johnson, associate director of the city’s Gay Men’s Health Crisis, told Newsday. "I suspect that New York may have a bigger problem than in other cities."
However, in San Francisco, a study released January 24, 2000 showed that the rate of newly reported HIV cases among that city’s gay men had more than doubled since 1997 and was continuing to climb steeply, according to the San Francisco Chronicle. According to the Chronicle, the report estimates the infection rate in the city at 2.2%, up from 1.04% in 1997. The newspaper called the climb in infection rates "an alarming reversal." Because of an aggressive education and outreach effort, San Francisco, one of the cities hardest hit in the early days of the AIDS epidemic, had stabilized its rate of new infections during the late 1980s and early 1990s.
Willi McFarland, an epidemiologist with the San Francisco Department of Public Health, told the Chronicle, "We’re now on the upswing of a rebound epidemic, although it’s not nearly what we were seeing in the late 1970s and 1980s." Rising rates among San Francisco gay men have been of concern for a number of years. However, this study is the first to quantify such a dramatic increase. Experts in AIDS prevention have speculated that a new generation of young gay men do not remember the spectre of the AIDS epidemic that attacked this community in past decades and have returned to risky sexual practices. Those risky practices have put them at increased risk of developing HIV infections. There is also fear that improved treatment of HIV has made some people complacent about the possibility of contracting the disease.
Robert Janssen, director of the division of HIV/AIDS prevention at the federal Centers for Disease Control and Prevention in Atlanta, said the new figures have rung alarm bells at the federal level because of fears that the entire country could go the way of San Francisco. He told the Chronicle that federal officials would meet in February to discuss the new trends.
However, the United States was not alone in concern about surging HIV infections. The British Broadcasting Corporation (BBC) reported on January 25, 2001 that public health experts in the United Kingdom expected a record number of new HIV diagnoses in 2000.
New data from the Public Health Services Laboratory indicated that 2868 new cases of the disease were reported in 2000, but the agency said more cases are expected to be reported later. The BBC said that >20 000 adults are infected with HIV in the United Kingdom. There were 1315 heterosexual cases of the disease in 2000, the public health officials told the BBC, with most of those people contracting the disease while visiting sub-Saharan Africa.
Again, public health officials said that younger people are not as affected by safe sex messages as were those in earlier generations. They called for greater attention to AIDS prevention efforts.
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