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 Journal of AIDS and Human Retrovirology, Reuters, and the Washington Times.
We The People releases plan for minority AIDS services
WTP gets go-ahead on new housing project
City to increase number of AIDS housing vouchers
AMA endorses right-wing HIV Act
Maternal smoking raises fetal HIV risk
Fair not "expert" in AACO case
WTP releases plan for minority AIDS services
We The People, the region's primarily African American coalition of people living with HIV/AIDS, has issued a 59-page report outlining a plan for increasing the capacity of the African American community to deliver AIDS services in sixteen areas, ranging from primary medical care services to AIDS planning.
The report, developed over a six-week planning process involving members of We The People and leading African American AIDS service agencies, recommends that most of the $3 million increased awarded to the Philadelphia area under the federal Ryan White CARE Act be concentrated on AIDS service agencies staffed and operated by people of color.
"We The People, the nation's largest regional coalition of people living with HIV disease and AIDS, has always held to and practiced the belief that we ourselves as PWAs know what we need to stay alive, and how our services need to be provided to us, better than anyone else knows," the report says. "We have suffered too long from a system which allocates at least seven out of every ten dollars it gets to services which are not part of our cultural or community reality, or which force us to fit into their realities if we want to live."
The report, called The Time to Act is Now!, contains 68 individual recommendations on how services can become more sensitive to the needs of African American people with HIV/AIDS, and where public funding should be directed to build a system of care in minority communities. Joseph Cronauer, executive director of We The People, said that a separate report on HIV prevention and education services is currently being prepared.
The We The People report comes as the Philadelphia HIV Commission and the Philadelphia AIDS Consortium debate how to use newly-awarded federal AIDS funding. African American advocates on the HIV Commission, which is responsible for allocating almost $13 million in federal funds, have been defeated in most of their attempts to enforce a priority for the new funding which would require that it be used to support minority organizations providing AIDS services.
The AIDS Consortium, which allocates about $3 million in federal and state funds, has built in a priority for minority organizations in the distribution of about $400,000 in new funding it will award this year, with little controversy.
In addition to its specific service and funding recommendations, the report provides an analysis of AIDS epidemiologic and HIV prevalence data to support its contention that the needs of African American people living with HIV disease should be pre-eminent at this point of the AIDS crisis. It also emphasizes the importance of ensuring the "cultural competence" of all AIDS service organizations, and calls for public health agencies and funders to enforce specific standards and staff training requirements in that area.
The report also calls for the city and to adopt a definition of "minority organization" which is consistent with the federal guideline used by the U.S. Centers for Disease Control. That definition requires that a majority of the Board of Directors of the agency be comprised of the minority community to which services are targeted; a majority of the executive, management and service delivery staff be comprised of the minority community to which services are targeted; and that the agency have a proven history of involvement with the minority community being targeted.
"Only this definition truly defines an organization which has incorporated the kind of cultural competence and involvement with minority communities that building minority capacity requires," the report states.
An eight-member writing team produced the analysis and the recommendations, including Cronauer, WTP members Paul Gray, Curtis Osborne and Roy Hayes, Michael Hinson, executive director of The Colours Organization, Gary Bell, executive director of BEBASHI, Guy Weston, executive director of the Ecumenical Information AIDS Resource Center, and David Fair, former director of We The People.
Copies of the report are being distributed to members of the HIV Commission and the AIDS Consortium. An draft of the report had earlier been provided to city health commissioner Estelle Richman, who is currently operating the city's AIDS office while she develops a plan for new leadership of the office.
WTP gets go-ahead on new housing project
We The People's three-year old plan for developing a 25-unit apartment complex for people disabled by AIDS in West Philadelphia got its final go-ahead this week, as the Pennsylvania Housing Finance Agency (PHFA) awarded almost $220,000 in "tax credits" which add the final component to the financing of the project.
The project involves renovating a property near 49th and Marlton Streets in the city's Parkside section of West Philadelphia into 25 one-bedroom apartment units. Individuals admitted to the program must be disabled according to Social Security Administration regulations, and will pay rent at a rate not to exceed 30% of their monthly income.
A study soon to be released by the city's Office of Housing and Community Development said that over 41% of people with HIV/AIDS in the Philadelphia region spend over half their monthly income on rent, and that 13% spend over 70% of their income on rent. More than half of people with HIV/AIDS in the region reported annual incomes of less than $6,000.
The West Philadelphia project will cost approximately $1.8 million, most of which was raised by former We The People executive director David Fair, with the tax credits obtained by WTP's development partner, Pennrose Properties.
The project was originally planned for location in South Philadelphia, but a new site was obtained after objections to the original location were raised by members of the South of South Neighbors Association.
The West Philadelphia program is the second housing project operated by We The People. Its Lombard Street Community opened last December. The two projects are the only AIDS housing programs in the region operated directly by people living with HIV/AIDS themselves.
City to increase number of AIDS vouchers
With waiting lists sometimes surpassing 100 people and waiting times approaching a year, the Philadelphia Office of Housing and Community Development announced late last month that it is increasing the availability of rental assistance "slots" specifically directed to people living with HIV/AIDS.
The announcement came as OHCD issued a "request for proposals," asking for organizations to apply for funding to support rental assistance, emergency housing payments and housing counseling services for people living with HIV/AIDS in southeastern Pennsylvania and southern New Jersey. The funding, totaling over $1.6 million, is awarded to the city under the federal Housing Opportunities for People with AIDS (HOPWA) program.
The new slots are being offered in response to a recommendation of the OHCD AIDS housing needs assessment, which suggested that new slots be created each year consistent with the number of people on the voucher waiting list, as long as funding is available to do so.
The recommendations were developed by David Fair, then-chair of the city's AIDS Housing Task Force, and Ellen Alpert, a New York consultant who directed the needs assessment.
About 125 new rental assistance slots will be available once proposals are evaluated, according to Scott M. Wilds, an aide to OHCD director John Kromer. Rental assistance vouchers pay an average of two-thirds of the monthly rent for people with HIV/AIDS who meet certain medical and income guidelines. Homeless people and people who are living in unstable circumstances are given preference for access to the slots, which are administered by the health department's AIDS Activities Coordinating Office.
In addition to the new slots, existing rental assistance slots currently administered by the Tenants Rental Assistance Corporation, are also subject to competition in the new funding cycle. TRAC co-chairperson David Fair said that TRAC will seek to continue to manage its existing slots and possibly expand the number of slots it controls. "We're hopeful that we will gain some new partners in this effort in this funding round," Fair, who formerly chaired the city's AIDS Housing Task Force, said. "It's especially critical that more rental assistance vouchers be made available in the suburbs and in hard-hit areas in low-income towns and cities outside Philadelphia," he said.
OHCD is also seeking a location for a new hospice/personal care program for people with AIDS in the region. State welfare officials have promised to support the new program with a $415,000 annual grant formerly utilized by Betak, the AIDS nursing facility which officially closed earlier this year. Residents of Betak were transferred to personal care homes and a special AIDS nursing unit at St. Joseph's Hospital in Philadelphia operated by Mercy Health Services.
AMA endorses right-wing HIV Act
The American Medical Association and conservative family groups have put their support behind the HIV Prevention Act of 1997, which threatens states with a cut-off of their Medicaid funding unless they report the names of all people with HIV to the federal government, allows doctors to refuse care to patients who won't be tested for HIV, and mandates forced partner notification and other disclosure measures.
Sponsored by Rep. Tom Coburn (R-Okla.), the bill "would refocus public health efforts on HIV prevention by using public health techniques designed for communicable diseases," said Dr. P. John Seward, executive vice president of the AMA. According to Gary L. Bauer, president of the Family Research Council, the bill would treat HIV "as what it is: a deadly health threat, not a political issue."
The bill, called the HIV Prevention Act of 1997, has 72 co-sponsors.
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," according to the AIDS Action Council.
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.
Maternal smoking raises fetal HIV risk
Women infected HIV who smoke during pregnancy are more likely than non-smokers to pass the virus on to their babies, a study has found.
The study, by researchers at Thomas Jefferson University and the New York state health department, found that one-third of the women in the study who smoked and did not take virus-fighting drugs passed the HIV virus on to their child.
Ordinarily, the risk of passing on the virus from pregnant mother to child is about one in four, although this can be reduced to about one in 10 if an HIV-infected mother takes anti-retroviral drugs such as AZT, according to most studies.
The smoking study was reported in the April issue of Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology.
Lead researcher Dr. Barbara Turner, a medical professor at Thomas Jefferson, said in a release that nicotine in cigarettes is toxic to blood vessels and can promote premature rupture of membranes surrounding a fetus.
"Our study shows that smoking may be especially dangerous for HIV-positive pregnant women, because its effects may increase the baby's exposure to blood and other maternal secretions that contain the virus during delivery," she said.
The study was based on an analysis of 901 HIV-infected New York state residents receiving health assistance, and their babies born between 1988 and 1990.
Turner said drugs that fight HIV might eliminate the effects of smoking on transmission of the virus, "but smoking is still associated with low birthweight babies and poor birth outcomes for this very vulnerable population."
Fair not "expert" in AACO case
U.S. District Court Judge Louis Bechtle has ruled that former We The People executive director David Fair will not be characterized as an "expert" if he testifies in the racial discrimination case filed by eight African American employees against Richard Scott, former director of the city's AIDS Activities Coordinating Office.
Affirming that Fair's "expertise...is vast in other fields," Bechtle said that it did not extend to the strict employment issues being debated in the federal lawsuit. Bechtle had previously disallowed issues related to AIDS funding or discrimination in city AIDS funding decisions, which were the subject of "expert testimony" Fair had been asked by the plaintiffs in the case to submit to the court last October.
Bechtle, who has also removed the city as a defendant in the case, said that the upcoming trial in the case would only be permitted to focus on specific hiring and related employment actions made by Scott during his eighteen months as the city's top AIDS official.
Fair is the founder and first director of the AIDS office. "Maybe Mr. Fair would have done things differently than Mr. Scott," Bechtle said, "but I just don't believe his expertise, which is vast in other fields, can assist the jury on these employment decisions."
Clifford Boardman, the attorney for the eight plaintiffs, said he might appeal Bechtle's decision. He said that he still intends to call Fair on whether it was inappropriate for Scott to remove responsibility for HIV prevention from a career AACO employee who was African American and give the position to "a white person with little or no experience." Boardman referred to Kevin Green, who was the white man appointed by Scott to direct AACO's prevention efforts after only a few months as a "provisional" city employee, as "the ally he [Scott] needed to make sure the money kept flowing to white groups."
Fair said he was unconcerned at the judge's action. "I never characterized myself as an expert in city employment procedures," he said. "The attempt to call me an 'expert' on those issues was a legal tactic of the plaintiffs and not my concern. While I agree with the plaintiffs that there is a direct relationship between what Richard did with AIDS funding is related to his personnel actions, I am not particularly well informed about specific personnel actions other than what Richard himself and the plaintiffs have told me."
Fair is also scheduled to be called as a witness in another race discrimination case against the city, involving the claim of former AACO minority initiatives director Cecil Hankins that he was illegally passed over for promotion to AACO director so that Scott could get the job.
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