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Commission votes down spending new funds for minority groups
Survey says 41% of PWAs can't afford housing
Ritonavir approved for kids with HIV
With less than half of the Commission members present, ten white members voted against the resolution, with eight black members voting for it. One white member also voted for the caucus motion. Most of the African Americans voting for the motion were people living with HIV/AIDS. The vote reinforced the racial division of the Commission membership, which in January defeated by one vote the election of an African American as its co-chair. The vote left no people of color in leadership positions at the Commission, although one of its committees later elected a black co-chair after one of the white co-chairs resigned in protest.
The majority of the Commission members are white, even though federal law requires that its composition be based on the demographics of the local epidemic. Over 71% of people living with HIV/AIDS in the region are people of color, according to the federal Health Resources and Services Administration (HRSA).
The caucus motion called for the Commission to suspend a proposal from the city's AIDS Activities Coordinating Office (AACO) to allocate most of the new funding -- amounting to slightly over $3 million in two Ryan White CARE Act Title I awards -- to existing AIDS service organizations, and set aside over $1 million for "one-time" expenditures on activities which would not be carried forward past next March.
Noting that the Commission had previously passed a comprehensive AIDS plan which called for "ensur[ing] that the resources that come into this region follow the path of the virus as it changes and develops, and mov[ing] resources into minority communities that are hardest hit by the epidemic," the caucus members charged that the AACO plan would shore up services that they claim do not adequately serve African Americans and prevent serious efforts to enhance the capacity of minority organizations to provide services.
The defeated resolution called for a delay in developing an allocations process until a "rational discussion" of how to use the new funds to building minority community capacity could be held.
The Commission also ruled out of order a motion to develop a competitive bidding process for the entire $14 million pool of CARE Act funding available to the region. Many advocates have complained that in each of the seven years the CARE Act has been providing money to the region for AIDS services, no attempt has been made to evaluate the quality of the services or to ask existing groups to compete with new initiatives for the money. This "hold harmless" policy has been targeted by minority AIDS groups as the primary mechanism by which the city guarantees that minority AIDS services cannot be expanded, since a larger portion of available dollars is set aside each year for existing groups.
James McCann, the HRSA official responsible for monitoring the city's expenditures of Ryan White money, told the African American Caucus on Tuesday that his agency encouraged cities to hold competitions for CARE Act funds periodically. "This is not an entitlement program," McCann said. "The only way to make sure you're doing things right is to be able to change things when you need to."
According to a recent report released by the Minority AIDS Project of Philadelphia, over 70% of federal AIDS funds are allocated to groups which are not based in minority communities.
In a highly contentious meeting reminiscent of the most dysfunctional days of the now-defunct Title I planning council operated by The Philadelphia AIDS Consortium, most of the Commission's African American members walked out of the meeting after their defeat.
The remaining members of the Commission eventually passed a motion giving the city two weeks to revisit its proposal and develop a strategy for using that funds that honors its "general instructions" on priorities for CARE Act funding. These instructions include a recommendation that the city "contract services that are targeted to populations heavily impacted by" the epidemic. The instructions also require that "services to women, infants and children" are supported by a percentage of the funding at least equal to the percentage of total AIDS cases reported in those populations. About 16% of AIDS cases in the city are women, and almost 73% of the women with AIDS are black or Latino. Almost 80% of children with AIDS are children of color. They also require that the city assure that federal AIDS funds are allocated fairly throughout the nine-county Philadelphia region, which includes the five southeastern Pennsylvania counties and four counties in southern New Jersey.
Prior to the Commission debate, an ad hoc coalition of African American people living with HIV/AIDS and five black AIDS service organizations also called on city health commissioner Estelle Richman to prevent AACO from implementing its plan. The organizations involved included BEBASHI, Colours, Ecumenical Information AIDS Resource Center, We The People and the Craig Foundation.
"The plan developed by AACO...will make it almost impossible for meaningful efforts to be made this year in enhancing the capacity of minority AIDS service organizations to meet the desperate needs of our community," the group said. "In effect, following this allocations plan -- given the likelihood that new funding in the amounts available this year are greater than they will be in future years -- actually guarantees that the existing framework of services and agencies will continue unchanged for the foreseeable future, and will make it even more difficult, if not impossible, to ever be able to expand capacity in minority organizations to serve minority people with HIV/AIDS, without significantly reducing funding for existing groups."
It called on Richman to "suspend [AACO's] actions until a reasonable discussion can take place about ways in which this funding can be allocated with the priority of enhancing minority community capacity as a fundamental principle."
The group also submitted to Richman an early draft of a proposal, being developed under the leadership of members of We The People, to recommend priorities for capacity building in the African American community. It noted that its draft plan was unfinished and had not yet been able to receive the input of many other African American service providers or consumers, but that "We share it with you now in its unfinished state in the hope you will understand that we are making a legitimate effort to define the need for new capacity in the African American community and that we have concrete strategies for building that capacity. But our efforts will be for naught if the funding is allocated according to inappropriate standards in the meantime."
Federal guidelines say that individuals and families should be classified as "housing needy" if they spend more than a third of their monthly income on housing costs.
The study, conducted as part of a local AIDS housing needs assessment conducted under contract to the Philadelphia Office of Housing and Community Development, highlighted increased levels of poverty and homelessness as the epidemic expands rapidly in communities of color in Philadelphia.
Among African Americans, according to the survey, 63% reported incomes of $6,000 or less, while 27% of whites earned at that level. Among Latinos, 50% earned less than $6,000 per year.
The report also found that 44% of PWAs responding to the survey had either lived in a homeless shelter over the prior year, or had lived "night-to-night" with friends or family. Both categories are considered "homeless" under federal and local definitions. Respondents to the survey were "17 times more likely than individuals in the general population to be currently homeless," the report said. A second study, which compared city shelter admissions with the AIDS registry kept by the Philadelphia Health Department, said that on average, people with AIDS were ten times more likely to be homeless than the general population, and homeless people were three times more likely to have AIDS than the general population.
Race also plays a role in homelessness among PWAs, according to the report, especially among those who are very ill. "Among severely symptomatic respondents, African Americans are seven times more likely to be homeless than Caucasians," the analysis reported.
The analysis of the survey was conducted by Kimberly Acquaviva and Dennis Culhane of the University of Pennsylvania. The OHCD housing needs assessment is expected to be formally released this spring.
Ritonavir approved for kids with HIV
Abbott Laboratories has received clearance from the U.S. Food and Drug Administration (FDA) for the use of Norvir, a protease inhibitor, in children with HIV and AIDS.
Norvir is one of the first of currently marketed protease inhibitors to receive FDA clearance for use in children with HIV and AIDS. The drug is one of the first-generation protease inhibitors that has been shown to have a positive impact in the lives of AIDS patients. Norvir was cleared for marketing for adult use on March 1, 1996.
The dosing recommendation for Norvir in children (age 2-16) is based primarily on pharmacokinetic and safety data from an ongoing Phase I/II study being conducted by a team of scientists at the HIV and AIDS Malignancy Branch of the National Cancer Institute, in collaboration with Abbott Laboratories.
Currently, researchers have enrolled 51 HIV-infected children with either no prior therapy, progressive disease, or toxicity to another antiretroviral regimen. The use of Norvir was evaluated in the 44 children who had completed at least four weeks of treatment as of Sep. 30, 1996. Norvir was given alone for the first 12 weeks, then in combination with zidovudine and/or didanosine.
The recommended dosage of Norvir in children, in combination with nucleoside analogues, is 400 mg/m2, twice daily, and should not exceed 600 mg, twice daily.
The starting dose is 250 mg/m2, twice daily, which should be titrated to 400 mg/m2. The evaluation of the antiviral effect of Norvir in children is ongoing.
In HIV-infected patients age 2-16 years, the adverse event profile was similar to that seen during clinical trials and post-marketing experience in adults. The most common adverse events in adults include nausea, diarrhea, vomiting, asthenia and taste disturbance. Safety of Norvir in children below age 2 has not been established. Norvir should not be used in combination with highly metabolized medications known to cause "serious or life-threatening adverse events," the company said.
HIV "Prevention" Act is back
A controversial bill calling for a wide variety of what the AIDS Action Council calls "coercive" actions against people with HIV/AIDS was reintroduced in Congress on March 12th by Rep. Tom Coburn (R-OK).
The bill, called the HIV Prevention Act of 1997, has 72 co-sponsors, and requires the federal government to keep a list of all people who test positive for HIV, and requires states to change their laws to follow the bills provisions or be cut out of the federal Medicaid program.
Nationally, 53% of adults and 90% of children living with AIDS rely on Medicaid to receive basic health care services.
The Coburn bill specifically provides that states can pass Coburn-required laws or regulations that violate current requirements of the Ryan White CARE Act and still get CARE Act funds. The Ryan White CARE Act requires states to meet certain requirements in order to receive Ryan White dollars, such as having laws protecting confidentiality. The Coburn bill would render these and all other protections of the Ryan White CARE Act "meaningless," according to the Council.
The Coburn bill includes provisions that allow medical professionals to refuse treatment to any individual who has not been tested for HIV, instead of encouraging medical professionals to talk to their patients about HIV, counsel them about risk reduction, and encourage patients to be tested voluntarily. "It also places these professionals at greater risk by not encouraging them to use universal precautions, the only practice that really protects them from accidental exposure to HIV and other blood-borne diseases," the Council said.
The bill also mandates that all states report names of HIV-positive individuals to the CDC to create a federal partner notification program, despite the fact that all states already have partner notification programs. States would be required to provide detailed "information" about everyone who tests positive to the CDC to be "shared" between states to track partners nationally.
It also requires states to implement new complicated and confusing processes for HIV testing of accused sexual offenders, even though the Crime Control Act of 1994 already provides for testing of sex offenders in federal court and at least 44 states and D.C. have laws explicitly providing for HIV tests in sexual offense cases. The Coburn bill does not give victims control over whether or not testing occurs nor does it require that the victim be given counseling, testing or care. It also compromises the victim's confidentiality by requiring disclosure of the defendant's test results to practically every attorney involved in the case, as well as the public health department.
The Coburn bill includes several other "test and report" provisions dealing with everything from funeral homes to adoption agencies, all of which are state-law issues and none of which have previously been subject to federal oversight.
"Many of the policies advocated in the Coburn bill have explicitly been rejected as ineffective and prohibitively expensive by medical, public health and prevention experts nationwide," the Council said. "Others are unnecessary and confusing variations of current law. And the Coburn bill as a whole will just tie the hands of states and communities already implementing real prevention programs and practices to stop the spread of HIV locally.
AIDS Action Council lobbyists said that it is unclear how quickly this bill will move in the House, but that its passage becomes more likely as co-sponsors sign on. Many right-wing religious and women's groups have made passage of the bill one of their highest priorities for this Congress. The Council encourages the bill's opponents to be vocal to their local representatives in Congress to counter the impact of the highly-organized right-wing groups.
For more information, call the AIDS Action Council at 202-986-1300.
We The People on the radio
We The People, which currently publishes two newsletters and broadcasts a weekly television program for people living with HIV/AIDS, moved into radio this week with a new weekly program on WPEB-FM, located at 88.1 on the dial. The neighborhood station reaches primarily residents of West and Southwest Philadelphia. Sr. Atikah Bey, the station's director, offered the free air time to WTP earlier this year.
The new program will be broadcast every Tuesday from 1-3 p.m., and is hosted by WTP Life Center Coordinator Curtis Osborne and WTP Housing Counselor Melody Walker. For more information, call 215-545-6868.
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.
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