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Risk of AIDS 10 times higher for city's homeless
Groups challenge MAPP performance
DC cuts will raise costs: advocate
MDs challenges marijuana use by PWAs
Inquirer defends Prevention Point
Risk of AIDS 10 times higher for city's homeless
A study conducted for an AIDS housing needs assessment for the Philadelphia Office of Housing and Community Development found that "homeless persons have ten times the risk of having AIDS" as does the general population in Philadelphia.
The study also concluded that Philadelphians with AIDS are three times as likely to have been homeless than the general population.
Conducted by Dennis P. Culhane and Randall Kuhn of the University of Pennsylvania, the report is expected to be formally released soon by OHCD. The study compared data maintained by the AIDS Activities Coordinating Office of people who have been diagnosed with AIDS in Philadelphia with a listing of those who had used the city's homeless shelter services from 1989 to 1995.
Culhane, a nationally-recognized expert on homelessness, said in the report that "Philadelphia is unique among large cities in the US in having a data archive on public shelter utilization," which was begun by Mayor W. Wilson Goode in 1989 for case management and shelter reimbursement purposes. He cautioned that the study only concentrated on people who have stayed in city homeless shelters, which means, he said, that "the rate of 'homelessness' among PWAs will be underestimated, as it will for the overall population in Philadelphia," because it does not count those who don't enter shelters or who use private programs.
Culhane noted that men and people with mental health or substance abuse histories had a greater risk of having AIDS than other homeless individuals. Among people living with AIDS, intravenous drug use, having public or no health insurance, and being African American were associated with a greater risk of being in a shelter.
"The study also confirms that homeless people (or shelter users) represent a very high-risk subpopulation for developing AIDS," Culhane said. "This result is likely due to the role of housing instability in contributing to high risk behaviors (i.e. trading sex and drugs for housing)" as well as substance abuse and mental health problems. He said that "improved access to residential treatment for substance abuse for people who are homeless or at risk of homelessness could reduce the risk for both HIV and homelessness."
The AIDS housing needs assessment was prepared by a team of consultants led by Ellen Alpert, former director of AIDS housing for New York City under Mayor David Dinkins. Other members of the team, in addition to Culhane, were David Fair, former executive director of We The People, and Kimberly Acquaviva, MSW, of the University of Pennsylvania.
Groups challenge MAPP performance
Six groups who receive their public funding through the Minority AIDS Project of Philadelphia have registered a formal complaint about the coalition's advocacy and contract management activities.
The complaint was submitted to Ernest Jones, executive director of the Greater Philadelphia Urban Affairs Coalition, MAPP's parent organization. The organizations involved are AIDS Services in Asian Communities, The Colours Organization, Ecumenical Information AIDS Resource Center, the Gay and Lesbian Latino AIDS Education Initiative, Unity, Inc., and We The People.
In a letter on March 6th, the groups said that there had been "discontent for quite some time" among MAPP member organizations that "MAPP frequently speaks on behalf of a coalition of 21 agencies when, in fact, many of us have few opportunities to contribute to the formulation of positions that are publicly articulated on our behalf." The groups said that MAPP's recent decision to exclude the major African American AIDS service providers and people living with HIV/AIDS from meetings of its AIDS planning group "is only the latest of a series of events."
The groups also said that there is an inherent conflict of interest in the current structure of MAPP. "The fact that many similar agencies rely on GPUAC's expedient system of payment of invoices stifles -- albeit unintentionally -- healthy, open discussion of critical issues." The also raised concerns about "efficiency and competence in the administration of contracts," noting that "invoices and program reports have been lost or misrouted on numerous occasions, in some cases causing delays in payment." They said that their efforts to address these issues with MAPP's administrators "seemed not to be taken seriously."
The letter also criticized the name of MAPP, saying that it implies "some semblance of multiculturalism," but that the staff and leadership of MAPP were all African American. "If [multiculturalism] is the intention, it should be somehow reflected in the staff, leadership, and organizational priority setting process," the groups said. "If that is not the intention...it would not be appropriate for MAPP to purportedly service the interest of 'minority groups' that are not African American."
The letter is not the first time that MAPP has faced criticism from its member organizations. Two years ago, Blacks Educating Blacks About Sexual Health Issues and the William J. Craig Memorial Foundation asked city officials to shift their funding out of MAPP, after a long contract dispute.
MAPP is an outgrowth of the Minority AIDS Coalition, which began to receive Ryan White CARE Act funding in 1993 to administer and coordinate a system of AIDS-related care and prevention services for people of color in the city. Critics have said that MAPP has moved away from it original concept of coordinating services and become primarily a contract management agency, and that only a few agencies have been allowed to participate in its political advocacy agenda. Others have questioned MAPP's use of federal funding for building the capacity of minority AIDS organizations and providing technical assistance to minority groups, saying that most of the funds are utilized for MAPP administrative functions and that technical assistance has not been made available in a coordinated fashion.
Several weeks ago, the Philadelphia EMA HIV African American Planning Group, which was convened by MAPP last year in collaboration with West Philadelphia State Senator Hardy Williams, announced that it was the "recognized planning vehicle for the African American community. However, MAPP administrators and Williams staff physically prevented MAPP member organizations and African American people living with HIV/AIDS from participating in a meeting it called to discuss initiatives for expanding public funding for African American AIDS groups.
PEHAAP was also severely criticized by several black gay AIDS activists for defeating an effort to include the black gay community among its target groups for new AIDS funding.
Guy Weston, a spokesman for the groups, said that they were scheduled to meet with Jones to discuss their concerns on March 14th.
DC cuts will raise costs: advocate
Among the budget cuts called for by the Washington, D.C., financial control board is a $19.3 million reduction from health and human services spending. The cutback is expected to come within weeks, following reductions in other areas, including welfare, day care, emergency aid, and public health.
The newest cuts will profoundly affect people with HIV/AIDS who could lose their home health services, according to a report in the Washington Post. Many people with HIV/AIDS depends on home health aides from the Whitman-Walker Clinic to help them take the medications and fulfill household duties so that they can stay out of the hospital.
Home health care is significantly less expensive than hospital care, and has become an increasingly important mechanism for keeping AIDS care costs down.
Jim Graham, Whitman-Walker's director, says a number of people with HIV/AIDS are currently in hospitals at a cost of $1,000 a day because adequate home care is not available. "We're cutting off money to spend more money," he said.
Dentist loses in HIV lawsuit
A dentist broke federal law by refusing to treat an HIV-positive patient in his office, an appellate court has ruled.
The 1st Circuit U.S. Court of Appeals upheld a lower court ruling that Dr. Randon Bragdon of Bangor, Maine, violated the Americans with Disabilities Act when he refused to fill a cavity for a woman in his office in September 1994.
It is believed to be the first time a federal appeals court has ruled that people who have tested positive for HIV but show no symptoms of the disease are covered under the disabilities act.
AIDS is recognized as a disability under the law.
Bragdon had offered to fill the patient's cavity in a hospital operating room instead of his office. He had a longstanding policy of not treating patients with infectious diseases in his office.
The Boston-based Gay and Lesbian Advocates and Defenders (GLAD) sued on behalf of the patient, Sidney Abbott. She won the case in a lower court, but Bragdon appealed.
"It is an enormous victory for the civil rights of people with HIV," Bennett Klein, director of GLAD's legal project, said of the appeals court ruling.
MDs challenges marijuana use by PWAs
Smoked marijuana is not more medically beneficial than the synthetic form of THC, its active ingredient or other alternative treatments, contend a group of doctors from New York University and Columbia University.
In a letter to the editors of the New York Times, Dr. Gabriel G. Nahas and colleagues claim that the editorial published in the New England Journal of Medicine supporting the medical use of marijuana falsely represented some important facts.
They say it misrepresented the toxic properties of marijuana smoke; falsely implied that smoking marijuana relieves pain; and made unreasonable claims about the benefits of the smoked drug over Marinol, the pill form of THC. The doctors argue that marijuana should not be considered a treatment for terminally ill patients but one of several practices to ease pain.
Inquirer defends Prevention Point
Philadelphia's needle-exchange program should be continued, contends a Philadelphia Inquirer editorial, as long as injection drug users are at risk for contracting HIV.
The editorial was in response to an effort by City Councilmembers Frank Rizzo, Jr. and Joan Krajewski to eliminate funding for Prevention Point Philadelphia (PPP), the only Philadelphia program which exchanges used syringes for clean ones among Philadelphians who use intravenous drugs. The project receive city funding because state and federal regulations prohibit the use of their funds for needle exchange programs.
Numerous recent studies have supported the needle exchange concept, saying that it has reduced levels of HIV transmission among injection drug users. One study projected that over 10,000 new infections would have been prevented if federal and state bans on needle exchange programs and possession of needles had been lifted.
The Inquirer editorial applauded the twelve City Council members who rejected Rizzo's and Krajewski's attempt to suspend the PPP program last month. Although the editors conceded that needle exchanges go against initial moral objections, they note in conclusion that studies have shown that HIV infections decrease when drug users seek clean needles. They also point out that there is no evidence as of yet that needle-exchange programs have increased drug abuse.
While announcing her support for needle exchange programs, federal Health and Human Services Secretary has stopped short of calling for elimination of the federal ban against using federal funds for them.
CCASS seeks new director
Chester County AIDS Support Services, the only AIDS-specific organization in Chester County, has announced that it is looking for a new executive director.
Julie Hazzard, the group's first director, announced her resignation from the post as of May 2nd at a CCASS board meeting this week. Hazzard has built the organization from an all-volunteer operation to one which now employs four staff, who provide case management, AIDS education, children's programs and food services.
Dan Daniel, president of the CCASS board of directors, said that the organization is accepting applications for a new executive director through March 31st. The current salary for the position is $25,000 plus benefits. Interested persons should send their resumes to the Search Committee, CCASS, 1822 Strasburg Road, Glenview Building, Coatesville, PA 19380.
On Positive Health This Week
Frank McClellan, professor of law at Temple University, will discuss the question "Who Can You Trust in Health Care" this week on Positive Health, We The People's weekly TV program for people living with HIV/AIDS. Interviewed by Arnold Jackson and Carol Rogers, McClellan will discuss his work on ethics in medicine and the impact of the Tuskegee experiment on people with HIV facing decisions about AIDS treatments. The program will be broadcast on Tuesday, March 18th, at 7:30 p.m. on WYBE-TV Channel 35.
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