FASTFAX is available by fax in the 215 and 610 area codes at no cost, or by mail anywhere for $20.00 per year, by calling 215-545-6868, and by E-mail by contacting and type the message SUBSCRIBE in the message section. Sources for some information in this issue include the Baltimore Sun, Washington Post, Lancet, USA Today, Associated Press, Reuters and the Philadelphia Inquirer.
City deaths drop 41% for whites, only 13% for blacks; 3 times more blacks died in 95-96
Protest against mandatory testing set
Needle swaps could have saved 10,000 lives: study
NAC associated with longer survival
3 times as many blacks died in 1995-96
The data showed that 187 whites died from AIDS in 1995 and 110 in 1996. Among African Americans, however, 479 died from AIDS in 1995 and 414 in 1996. Over the 2-year period, three times as many blacks died from AIDS as whites.
The data is consistent with national trends, which showed that AIDS-related deaths among whites dropped by 21%, but only 2% among blacks.
The statistics highlight the complaints of minority AIDS advocates that failure to invest resources in African American community efforts to combat AIDS is having a dire impact on their community. A recent study by the Minority AIDS Project of Philadelphia indicated that almost 80% of local funding for care for people with AIDS was being invested in organizations led by whites, and that this factor has negatively impacted on the ability of minority people with HIV/AIDS to obtain medical care and social services.
In Philadelphia, the drop in AIDS deaths among whites actually began in 1995, when deaths dropped by 7%. AIDS deaths among blacks and Latinos did not begin to drop until last year, according to AACO's report.
AIDS-related deaths among Latinos dropped by 35% last year in Philadelphia. However, Latino AIDS activists cautioned that many Latinos with AIDS return to Puerto Rico and other Central and South American countries as they near death, and their deaths may not be recorded in the Philadelphia death registry.
AACO surveillance supervisor Jim McAnaney is cited in the March 7th Philadelphia Inquirer as saying that the reduction in AIDS mortality "was evenly distributed, with blacks and Latinos experiencing as much of a decline as whites."
However, an independent analysis of the data on behalf of a new African American AIDS coalition, called the African American Community Planning Caucus, determined that deaths were dropping much more quickly for whites than for people of color.
Guy Weston, a former co-chair of the city's HIV Commission and a spokesman for the AACPC, criticized both local and national reports on the decline in AIDS deaths as "obscuring the unique characteristics of the epidemic in the most affected populations."
"In Philadelphia, 71% of the cases reported in 1996 were African Americans," he said in a statement issued by the group. "About 60% of the people living with HIV/AIDS in Philadelphia today are African American. In this context, any report of an epidemiologic trend is incomplete without an analysis by race/ethnicity."
The African American Community Planning Caucus is a new coalition formed by African American people living with HIV disease and five black organizations which provide direct AIDS care services: BEBASHI, The Colours Organization, Ecumenical Information AIDS Resource Center, We The People, and the William J. Craig Memorial Foundation. In releasing its own analysis of the surveillance data, the Caucus also announced that it is preparing, for release late next week, a report which will outline urgent priorities for increasing the capacity of African American AIDS organizations to respond to the epidemic.
Curtis Osborne, Life Center Director of We The People and a person living with HIV, said that the mortality rate data indicates the higher level of urgency in building AIDS services in minority communities. "We already know that African Americans die faster because we tend to be diagnosed later and are more likely not to have access to adequate care," Osborne said. "If African American's don't experience the same reduction in death rates due to lack of access to treatment, we won't experience the benefits of further treatment advances either. We have to recognize these issues and deal with them now if we're serious about fighting AIDS in the African American community. Otherwise we're wasting time."
Joe Cronauer, executive director of We The People, said that "while it's always good news that fewer people are dying, it also means that more people are staying alive -- and they need a comprehensive, culturally competent service system to make sure they stay that way."
The Philadelphia analysis was prompted by a report from the U.S. Centers for Disease Control last week, which indicated that , nationally, U.S. deaths from the disease fell significantly last year for the first time ever.
While deaths from AIDS nationally dropped in all ethnic groups, however, the data shows that improvement is being seen primarily among whites (where deaths dropped by 21%), and hardly at all among African Americans (where the drop was only 2%). Deaths among Latinos dropped by 10%, according to the data.
"Unfortunately, the bad news is that there is not equal access to the continuum of care people with HIV/AIDS require to remain alive and healthy," said Christine Lubinksi of the AIDS Action Council in reaction to the CDC report.
"Thus, as in 1995, AIDS continues to ravage communities of color and women, populations which again represent the fastest growing groups of new AIDS cases," Lubinski continued. According to the CDC, in 1996 African Americans accounted for a larger proportion of AIDS cases (41 percent) than whites for the first time. Additionally, women did not enjoy a decline in AIDS death rates, but instead experienced a 3 percent increase. The proportion of AIDS cases among women also increased so that in 1996 women accounted for 20 percent of newly reported AIDS cases.
According to CDC epidemiologists, the drop in AIDS deaths is due to a reduced number of HIV-positive people who are progressing to the lethal stage of AIDS, and new medical therapies that are "prolonging survival of patients who are already at that stage."
According to the CDC, AIDS deaths fell from 24,900 in the first half of 1995 to 22,000 in the first half of 1996, an overall decline of about 13%.
"This is one of the first bright spots we have seen in this epidemic," said Christopher Portelli, executive director of the National Lesbian and Gay Health Association in Washington. "But we hope it is seen as a call to arms rather than a chance to relax and breathe a sigh of relief."
There was other good news. While the number of people diagnosed with AIDS continues to grow, the growth rate is slowing. In 1995, about 62,200 people were diagnosed, an increase of less than 2 percent over the 61,200 new cases in 1994. The growth rate from 1993 to 1994 was 5 percent.
"We must not relax our efforts," President Clinton said. "In the months and years ahead, we must continue to work together as a nation to further our progress against this deadly epidemic."
The first signs of the drop in AIDS deaths came in January, when New York City reported a 30 percent drop in AIDS deaths in 1996. In Philadelphia, the overall drop for the same period is about 23%.
"I think this speaks to the success of the dual approach of counseling, testing and treating people with HIV," said Patricia Fleming, the CDC's chief of HIV/AIDS reporting and analysis.
The CDC credits better treatment for AIDS patients, including new drugs, and better access to treatment through state and federal programs.
What's still unclear is the impact of a new class of drugs called protease inhibitors. The AIDS death rate leveled off in 1995, before those medicines became widely available.
Not all doctors are sure that AIDS is making an about-face, however.
"In my view, this decline is unfortunately only a lull," said Dr. Irvin S.Y. Chen, director of the AIDS Institute at UCLA. "Not all patients are responding as effectively as the majority of patients. There are some patients for whom the drugs are not effective."
And some advocates point out that AIDS patients, as they live longer, will need more help, not less.
"It's still difficult for a person to walk into a doctor's office and be treated for AIDS," Portelli said. "We are concerned that people will misinterpret this news. We would hope to see more money and support for better access to medical services. New drugs are not all we need."
"Access to health care is a life-and-death matter," said Christine Lubinski, deputy executive director of the AIDS Action Council in Washington. "We are going to continue to urge an increased investment ... because we're finally beginning to see a payoff."
A growing number of people are living with AIDS each year, the CDC said. In June 1996, 223,000 Americans age 13 and older had the disease -- a 10 percent jump from mid-1995 and a 65 percent increase over 1993.
As of December 1996, 581,429 Americans had been diagnosed with AIDS since 1981: 488,300 men, 85,500 women and 7,629 children.
And some new trends are worrying health officials. Blacks accounted for more cases of AIDS than whites for the first time in 1996 -- 41 percent compared to 38 percent. Hispanics accounted for 19 percent, and other races 2 percent.
Also, the proportion of women with AIDS is still increasing. In 1996, women made up 20 percent of new cases. AIDS deaths have not declined among women or heterosexuals.
CDC Director David Satcher said, "We cannot lose sight of the fact that the best way to truly reduce the number of people who die of AIDS is to prevent HIV infection."
Protest against mandatory testing set
Us Women, an ad hoc group of women living with HIV, and ACT UP Philadelphia are sponsoring a demonstration against mandatory HIV testing of pregnant women at a local meeting of the American Medical Association next week.
Last July, the AMA reversed their position on HIV testing of pregnant women and infants. They now say that all pregnant women should be forced to be tested for HIV.
The AMA is coming to Philadelphia for an "Ethics in Medicine" conference on Saturday, March 15. The groups are seeking support for a demonstration that will "Tell the AMA: Mandatory HIV Testing of Pregnant Women or Infants Hurts Women and Children."
The demonstration will begin at 11:30 am with a rally at JFK Plaza (Love Park) across from City Hall (15th&JFK), and continue at 12 noon with a march and picketing at the AMA Conference, which is being held at the Ritz-Carlton Hotel, 16th St. between Market & Chestnut
"It is unethical to force anyone to take an HIV test, and unethical to use AIDS hysteria to control the lives of women," said a statement issued by the two groups. "We know that virtually all pregnant women choose to take the test if they are offered with un-biased counseling. Most experts agree that the threat of mandatory HIV testing will drive some women, already mistrustful of the health care system, even further from care."
"Forced testing is bad public health, the statement continued. "Voluntary strategies are the most effective for getting women and their children into health care and HIV prevention services.
For more information, call 215-731-1844.
Needle swaps could have saved 10,000 lives: study
Calling it an opportunity lost, researchers say that almost 10,000 new cases of HIV infection could have been avoided between 1987 and 1995 if the U.S. had instituted needle exchange programs for intravenous drug users (IDUs).
Two researchers -- Dr. Peter Lurie at the Center for AIDS Prevention Studies at the University of California, San Francisco, and Dr. Ernest Drucker at Montefiore Medical Center in New York -- note that if U.S. policy is not changed, an additional 5,150 to 11,329 preventable HIV infections could occur by the year 2000.
Since 1988, federal law has banned such use of government funds unless it can be shown that needle exchange programs can reduce transmission of HIV and not lead to an increase in illicit drug use.
"In maintaining a ban on national funding for these programs, the USA is unique in the world," write Lurie and Drucker in a report published this week in the British medical journal The Lancet.
Moreover, based on current government estimates of the costs of treating an HIV infection over an individual's lifetime, Lurie and Drucker note that the cost to the U.S. health care system of treating these preventable HIV infections ranges between $224 million and $538 million.
"The failure of the U.S. federal government to initiate a national program of needle exchanges has shifted the emphasis of HIV prevention among IDUs to the states," the authors write, even though "some states have used the federal opposition to justify their own inaction."
However, some states and local communities have "risen to the challenge: Connecticut, Hawaii, Maryland, Massachusetts, New York, and Rhode Island have allocated funds to needle exchange programs," the authors state.
In Connecticut, changes in the needle exchange laws have "led to a 39% reduction in the sharing of syringes."
According to the researchers, most of the 41,000 new cases of HIV infection each year occur among IDUs and their sexual partners and children. "Thus, the prevention of HIV transmission among IDUs should be a cornerstone of any attempt to stem the HIV epidemic in the USA."
In addition, Lurie and Drucker point out that only 15% of the estimated 1.5 million IDUs in the U.S. are in drug treatment on any given day, and that hypochlorite bleach used to disinfect injection equipment is only of limited effectiveness.
Thus, according to the authors, "the provision of sterile syringes to IDUs seems to be the most viable method for reducing the transmission of HIV among active IDUs who continue to inject."
"By revoking laws that ban federal funding for needle exchanges as well as those state laws that impede pharmacy access to sterile syringes, and by educating pharmacists about the importance of selling sterile syringes to IDUs, we can greatly reduce the number of HIV infections that would otherwise occur," the researchers state.
Meanwhile, in Washington, D.C., the Whitman-Walker Clinic has announced that it has received a contract for the city's first large needle-exchange program.
The Lancet article indicated that because drug use plays an especially significant role in the Washington AIDS epidemic, a needle-exchange program would have been particularly beneficial, possibly preventing over 650 infections.
Under the new program, 100,000 sterile syringes will be distributed during the next year from Whitman Walker's site in Anacostia and from four mobile units near areas of high drug activity. Clinic director Jim Graham predicts that the program, along with the use of a new oral HIV test that can be used in city neighborhoods, will begin to control the epidemic among injection drug users.
NAC associated with longer survival
A drug used to treat overdoses of the pain reliever acetaminophen may help AIDS patients live longer, Stanford University researchers report in the Journal of the National Academy of Sciences. The researchers found that patients treated with N-acetylcysteine, or NAC, survived longer than those who did not receive the drug.
NAC has been a popular alternative therapy among people living with HIV for several years, although few studies have confirmed any beneficial effect. The Standard study is among the first to provide concrete data to supports its use by people living with HIV/AIDS.
AIDS Services in Asian Communities is offering paid internships to assist it with program and administrative tasks.
"We're looking for interns to take on real responsibilities in support of our efforts to address the AIDS epidemic in Asian & Pacific Islander communities in the Philadelphia area. Great exposure to AIDS services, advocacy, non-profit management, fund raising, and Asian & Pacific Islander community health and political issues," said a statement issued by the group.
Intern Projects Include: a project to research and assist with the development of a Philadelphia based Asian & Pacific Islander resource directory for health care professionals, agencies, and institutions; a project maintaining the web site of the Asian Language Project, which includes document collection, scanning, cataloging, and integration of multi-lingual AIDS information literature; and assisting in the marketing, recruitment, and retention of volunteers, and with fund raising efforts with foundations and corporations.
Interns are also being sought to provide administrative support to the Program and Administrative Departments. Duties also include database management, budget maintenance, clerical work and the supervision of office volunteers.
Full and part-time internships are available between April 1 to September 31, 1997. Stipend amount varies based on time committed, skills, and enthusiasm. Potential interns must be dedicated, responsible, dependable, and "willing to learn hands-on."
ASIAC said it prefers those who can dedicate more than 2 days a week. Training will be provided.
For more information, contact: Richard Liu, Executive Director, AIDS Services In Asian Communities, 201 South 12th Street, Suite 1R, Philadelphia, PA 19107, (215) 629-1945/(215) 629-1973 fax; e-mail: richliu@critpath.org.
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