Crypto warning issued after heavy rains
Coalition sponsors City Hall vigil on HealthChoices
HIV Commission adopts 97 AIDS plan
CNN airs program on protease inhibitors
HMOs seek higher rates in NY, DC
In 1995, when the Philadelphia Health Department finally confirmed that evidence of crytosporidium had been found in city tap water, AIDS advocates, led by Critical Path AIDS Project director Kiyoshi Kuromiya, have demanded that the city conduct an information campaign to alert people living with HIV/AIDS and other immune system disorders of ways to protect themselves from infection with the sometimes deadly bacteria.
"Since the Las Vegas cryptosporidiosis outbreak in 1995, we have known that careful monitoring of water did not necessarily provide protection for PWAs against this protozoa, a potentially deadly contaminant of water for those with compromised immune systems," Kuromiya said last week.
"Las Vegas water was well within all quality control standards for turbidity, coliform counts, and there was no cryptosporidium detectible in the water. Yet 80 persons, primarily PWAs, were infected with this diarrheal disease. In the 1994, outbreak in Milwaukee over 400,000 persons were infected and over 100 persons died. Although healthy individuals also contract crypto, it is a self-limiting disease in those individuals lasting for four or five days and characterized by severe diarrhea, averaging 19 stools a day in the Milwaukee epidemic," Kuromiya said.
We The People joined Critical Path in the winter of 1995 in demanding that the city make sure that the PWA community be fully informed of crypto risks, and conduct an ongoing campaign to educate PWAs and others about the importance of avoiding the use of tap water for drinking, cooking, and other household chores, as well as the need to be especially careful in other areas, such as avoiding getting water in the mouth while showering. WTP asked that the city fund a major citywide effort through alerts, newspaper ads, mailings and brochures, as well as support of PWA educators to reach out to the community at support groups, AIDS organizations, and other events.
At the time, the city's health department limited its effort to a three-page alert faxed and mailed to area AIDS service organizations. The Philadelphia Water Department included a version of the alert in water bills, which were sent to city residents who own homes or apartment buildings.
Over 22,000 people residing in the Philadelphia area are believed to be infected with HIV.
"Although the city of Philadelphia's year-old Cryptosporidium Panel has not committed to an ongoing alert system to warn consumers, particularly PWAs, when danger of cryptosporidium contamination of the city's tap water is high, it is vital that the following information be communicated to the PWA community," Kuromiya said in an alert issued by Critical Path.
During the winter of 1995, Critical Path Project warned the Department of Public Health of Philadelphia that the group was aware of a water-borne outbreak of cryptosporidium in Philadelphia in August of 1994. One doctor with a large HIV practice had 14 cases in a two-week period of time. Critical Path believed that it was possible that the outbreak was the result of a record rainfall on July 14, 1994 which overtaxed the city's water facilities. "The Health Department adamantly insisted for over a year that they could not confirm that such an outbreak took place and pointed to other transmission routes, such as sexual transmission ("rimming" or inadequate cleansing)," Kuromiya said. "Eventually in early 1996, the city health and water officials formed a Cryptosporidium Technical Review Committee to look into the issue of cryptosporidium in the water supply -- which had become a national issue, with boil-water alerts being declared in Washington DC, New York City and elsewhere."
Kuromiya, a member of the panel, pointed out using the City Health Department's own graphs, the rate of cryptosporidium cases in the city showed an obvious anomalous peak during August of 1994 which suggested a water-borne outbreak.
"During the current record rainfall and flooding (since December 12th), conditions for a cryptosporidium outbreak are high," Kuromiya said. "PWAs and others with compromised immune systems are advised by Critical Path to take the following steps: Do not drink tap water (or drinks made from tap water or ice cubes made from tap water). Do not swallow water when showering or bathing or brushing your teeth. Use only water filtered to NSF-53 standard or to an absolute 1-micron filter (such as the Pur filter available at department stores for about $50). Or use distilled water or water brought to a rolling boil for 5 minutes."
Kuromiya said that PWAs should use one of the bottled spring waters listed in an Office of Environmental Engineering memo ("Revised List of Bottled Water--Cryptosporidium Free," December 4, 1996)--a copy of the memo is available from Critical Path (545-2212). Distilled waters are acceptable or spring waters micro filtered to an absolute 1-micron rate, which include: Aqua Penn Spring Water, Cloister, ACME, IGA, Arctic, Deer Park, Ephrata Diamond, Great Bear, Deer Park, Poland Spring Distilled, Thorofare, Keystone, Lehigh Valley Natural Spring Water, A & P Markets, Appalachian Spring Water, Montco (Thriftway), Shop N Bag (Thriftway), Wissahickon Mountain Spring Water, all available in the Philadelphia area.
The Ad Hoc Coalition on HealthChoices will ask Mayor Rendell to demand from the White House that people with AIDS be exempted from the new Medicaid managed care plan, to begin in southeastern Pennsylvania on February 1st, at a City Hall Candle Light Vigil on Monday, December 30th, at 5:00 p.m.
More information on the vigil is available from the Minority AIDS Coalition (215-851-1936) and from ACT UP Philadelphia, (215-731-1844).
The Health Care Financing Administration is expected to decide whether or not to allow Pennsylvania to institute HealthChoices by January 1, 1997.
HealthChoices is the state's mandatory Medicaid managed care program that will enroll some 13,000 people with HIV/AIDS. Officials have acknowledged that there are problems with the program and recently postponed enrollment by four weeks.
ACT UP's Kate Krauss, who has been organizing against the program as it is presently constructed since her arrival in Philadelphia earlier this year, said, "The Department of Public Welfare knows there are huge problems with HealthChoices - the program is a social experiment that will gamble with the health of thousands of people. One month won't mean a thing if there are still no safeguards in Health Choices to protect people with HIV."
Several weeks ago, the Ad Hoc Coalition on Health Choices, a coalition of people living with HIV/AIDS, activists and service providers, published the results of a survey demonstrating that none of the four contracted HMOs in the program could provide HIV-positive callers with a list of HIV-experienced doctors. Another recent survey showed that the HMOs were completely unprepared to address the needs of callers who did not speak English.
On December 10, 26 people, including the executive directors of thirteen local AIDS organizations, were arrested outside the offices of the Health Care Financing Administration to protest the program, in a demonstration organized by ACT UP.
The Ad Hoc Coalition on Health Choices wants the state to delay enrollment of people with HIV until it is clear that there are enough HIV-experienced physicians to care for them and a minimum standard of care is established for their treatment. In addition, activists want the state to develop a credible definition of the term "HIV specialist" so that doctors considered specialists are indeed competent providers for people with HIV. Finally, the groups demand that HMOs must provide services in the languages their clients speak, not just English.
A study published this year in the New England Journal of Medicine showed that people with HIV-experienced doctors lived almost twice as long after AIDS diagnosis as those with inexperienced doctors.
HIV
Commission adopts 97 AIDS plan
The Philadelphia EMA HIV Commission has adopted a plan for Ryan White CARE Act funded AIDS services in southeastern Pennsylvania and southern New Jersey which calls for a dramatic increase in funding for AIDS services in the African American community, the group hardest hit by the local AIDS epidemic.
The Commission sets priorities for the allocation of over $7 million in Ryan White Title I CARE Act funding for the region. The Philadelphia AIDS Consortium, which fulfills the same role for the Act's Title II funding, is set to take action on the plan next month.
According to the city's AIDS Activities Coordinating Office, almost 70% of AIDS cases reported in the last twelve months have occurred in the African American community. The federal Health Resources and Services Administration, which administers the Ryan White program, has projected that HIV prevalence -- the number of HIV/AIDS cases in a specific population compared to the total number of people in that population -- is 850 times higher for African Americans than it is among whites.
Among men who have sex with men, almost 63% of cases in the last year were diagnosed in African Americans, as were over 68% of heterosexual cases. 75% of pediatric cases, and over 71% of cases diagnosed among women, were African American, according to the report.
Similarly high proportions of cases have been diagnosed in the city's Latino community, including over 14% of cases among women and 6% of cases among men who have sex with men.
The 1997 AIDS plan calls for the continuation of a project begun in 1993 to build capacity of minority AIDS services organizations, led by the Minority AIDS Project of Philadelphia (MAPP). "Despite many accomplishments, insufficient resources have prevented MAPP from implementing the best strategies for the African American community, and to fully coordinate a comprehensive AIDS service delivery system," the plan admits.
The plan also calls for funding of a Philadelphia EMA HIV/AIDS African American Planning Group "to augment planning for the African American community." The provision is seen by minority advocates as the only way to assure that the needs of the African American community are addressed, after years of complaints by minority AIDS advocates that the existing Ryan White planning process has marginalized them and refused to respond to their needs.
The plan also calls for the current MAPP budget for services, coordination and capacity building to be doubled, "at minimum," and for oversight of the increased funding to be the responsibility of the new planning group, which is drawn from the membership of the 8th District Task Force. The Task Force was convened by State Sen. Hardy Williams, who for many years was the chair of the state legislature's Health and Welfare Committee when the Democrats controlled that State Senate.
The decision to double MAPP funding means that almost all new Ryan White funding coming to the Philadelphia area will be allocated to MAPP services. It may also mean the re-allocation of funding for some existing programs to meet the plan's targets.
The planning group is in the process of developing a detailed plan for the allocation of the funding, which takes effect March 1st.
Project TEACH (Treatment Education Activists Combating HIV), is an innovative health education program which trains urban people living with HIV/AIDS to act as peer educators and activists in the under-served communities hardest hit by the AIDS pandemic -- low-income communities and communities of color. TEACH focuses not only on prevention but treatment education, outreach and advocacy.
TEACH coordinator Julie Davids has announced that the group is looking for part or full time interns for all or part of 1997. Davids said that these are probably going to be volunteer positions, although the group may be able to find some stipends for the summer. "However, these internships offer invaluable experience doing real work to save lives," she said.
TEACH needs people with writing, researching and administrative skills to help develop program materials, Davids said. Interns must be dependable and capable of independent work. Hours are flexible, and some work can be done off-site.
TEACH is co-sponsored by two organizations: Philadelphia FIGHT conducts community-based clinical trials on promising therapies for HIV/AIDS and associated infections, and offers a range of treatment education programs to affected communities. We The People Living with HIV/AIDS is the region's largest group representing people with HIV/AIDS. It is one of the few in the nation comprised of low-income people of color, and provides a wide spectrum of practical support services.
The TEACH training program teaches people living with HIV -- all low income, most African American and recovering drug users -- the basics of secondary prevention and methods of communicating this information to others living with HIV. Topics include staying healthy when you are HIV positive through assertive use of health care, pharmaceutical and complementary therapies, prevention and early treatment of infections, nutrition, clinical trials, stress reduction and peer support. Retention rates for the program are excellent, averaging 87.5% to date. Graduates of Project TEACH participate in a peer education program, speaking to groups and individuals in health clinics, drug treatment centers, and mental health drop-in facilities.
Graduates have also founded an Activist Committee that includes TEACH graduates, new
applicants and friends who are living with HIV. Public transportation tokens are provided for all
events and assignments, and TEACH is able to provide lunch at most of its meetings and programs.
For more information, please contact Julie Davids, Project Director, at 215-985-4448 or
On Sunday, December 22, CNN will broadcast an hour-long documentary on protease inhibitors, which are being hailed as the most promising treatment breakthrough for AIDS since the epidemic began.
The CNN program will look at the development of these new anti-HIV drugs and how they have worked, and not worked. for people living with HIV disease. The program features interviews with people living with HIV/AIDS who are taking the drugs.
The program airs at 9:00 p.m. EST.
Most private HMOs in the Albany, NY, area have filed requests with the state Insurance Department to increase rates for 1997, "reversing a trend over the last several years in which the plans attempted to keep rates flat in an increasingly competitive and price-sensitive market," according to Capital District Business Review.
Medicaid HMOs, on which most Philadelphia area people living with HIV/AIDS depend for their primary medical care, are usually unable to increase their rates because they are forced to accept whatever "capitation" rate is allowed for them under their state contracts. Advocates have raised concerns that as HMO rates in the private sector increase, the Medicaid components of the plan will become even less profitable, and service cuts or withdrawal from Medicaid may be the only options available to the HMOs.
Philadelphia AIDS advocates have joined with area HMOs in demanding that Governor Ridge guarantee that capitation levels in the new HealthChoices Medicaid managed care networks -- which all people eligible for Medicaid are being forced to join by February 1st -- be high enough to assure that a quality standard of AIDS care is available and that expensive AIDS drugs and treatment can be provided.
Over 60% of Medicaid-eligible Philadelphians already participate in Medicaid managed care. One major company, QualMed, already has pulled out of the state's HealthChoices plan because it did not believe it could operate under the low rates.
The Capital District Business Review reported that "employer demands and competitive pressures" are at the root of the rate increases. Under insurance reforms that went into effect in January 1996, HMOs only need approval from the state Insurance Department for rate increases over 10%.
In light of $10 to $12 million in year-end losses, Albany-based Capital District Physicians' Health Plan (CDPHP) "is implementing stringent cost controls -- and raising its rates despite employers' desires," the article said. The plan is requesting 4.4% to 9.9% increases for small groups and 1.3% to 6.6% for large groups. It has also requested an average 19.3% increase on its prescription drug plans.
William Cushing, CDPHP marketing director, said, "We have to dip into our reserves, and we don't like doing that." CDPHP has suffered losses totaling $8.9 million through September 30 of this year; revenue during the same period totaled $225.7 million.
Cushing added that "[w]hile conceding that CDPHP is concerned about losing some competitive edge ... other area HMOs are raising their rates, too. ... If everyone was having a banner year, I would be more concerned about (CDPHP's rate increases)."
Other HMOs are also planning increases in the new year, the report said. Meanwhile, in Washington, a report in the Washington Business Journal says that "area employers can expect to pay more for health insurance next year as most major [HMOs] raise premiums to boost sagging revenue."
"The expected increases come after several years of virtually no premium hikes -- the result of HMOs' fierce competition for new members. But now the fight for market share has taken a back seat to the need to offset lower profits and rising medical costs," the report said.