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 CATIE, Medicine and Health, Philadelphia Inquirer, and Science.
Richman likely to appoint two as AACO leaders
Tough week for Commission, TPAC
Crixivan to be available in drugstores
Opposition grows to Coburn Act
Richman likely to appoint two as AACO leaders
Philadelphia Health Commissioner Estelle Richman is poised to appoint We The People executive director Joe Cronauer and managed care consultant Patricia Bass as "co-directors" of the health department's AIDS Activities Coordinating Office, according to informed sources.
Cronauer, a person living with HIV who has headed WTP for a year, was granted a leave of absence by the WTP board of directors on April 9th, and Curtis Osborne, currently WTP's Life Center Coordinator, was appointed as the group's new interim executive director. Bass, who formerly worked with the health department's behavioral health managed care company and has been a consultant to AACO on managed care issues since 1996, is a former board member of ActionAIDS.
Cronauer and Bass will replace Jesse Milan, who resigned from the post in February after criticism that minority AIDS services were being largely ignored in the allocation of federal AIDS funding. Richman has taken personal responsibility for the operations of the AIDS office since Milan's resignation.
According to sources, Cronauer will be responsible for managing policy, planning and funding issues for AACO, and Bass will be responsible for internal AACO financial and contract management. Both will report directly to Richman. The structure is very similar to the original organizational plan for AACO developed in 1987, when there was a director and an administrator.
The appointments are expected to be characterized as "interim," while the city seeks permanent officials for the jobs.
Cronauer has also resigned from his position as president of the Philadelphia AIDS Consortium, and has taken a one-year leave of absence from his position on its board of directors. It was unclear whether the new appointment would affect his role as co-chair of the HIV Commission's HIV Prevention Community Planning Group, which develops priorities for city and federal HIV education funding.
The HIV Commission, charged with overseeing the allocation of over $10 million in federal AIDS funds awarded through Title I of the Ryan White CARE Act, had called a special meeting this week to hear from the Philadelphia Health Department on how it was going to accomodate Commission recommendations that it concentrate new funds in underserved communities in Philadelphia and its surrounding counties.
Several weeks ago, an effort by the Commission's African American Caucus to get the Commission to allocate all new federal funding for Philadelphia services to minority organizations failed by one vote on largely racial lines. Instead, the Commission asked the city to develop a plan for distributing the money which takes into account nine "general instructions" that the money be allocated to "services that are targeted to populations heavily impacted by" the epidemic, including minorities, women and children, and to build AIDS service capacity in the eight suburban counties included in the metropolitan area eligible for the funds.
At its meeting on April 9th, however, the Commission members never reached a discussion of the minority issue, and instead rejected an allocations plan for the new funding proposed by city Health Commissioner Estelle Richman which was silent on the city's plan for following the "general instructions." It called for Richman herself to revisit her allocations plan and come to an emergency Commission meeting next week with answers on how the city will reflect the "general instructions" in its allocations process.
The Richman proposal, presented by AIDS Activities Coordinating Office staffers Coleman Terrell, Sallie Feldman and John Cella, sought to allocate all of the funding in certain priorities to suburban counties and southern New Jersey, and use 70% for Philadelphia services.
Suburban and New Jersey representatives severely questioned the city's plan for distributing the funds in their communities, echoing the criticism of minority advocates that the overall priorities adopted by the Commission do not translate neatly into the areas of most desperate need in the suburban areas. Minority advocates had similarly criticized the priorities, stating that the simple application of percentage allocations was not responsive to the areas where the need for new capacity was greatest.
Minority Commission members also criticized Richman's decision to allocate all AIDS case management and case management support funding in suburban areas. They noted that there there are only 13 case managers working for minority organizations in Philadelphia, where there are over 15,000 people of color living with HIV/AIDS.
The discussion was peppered by angry comments from Terrell, who said that AACO staff was too busy to respond to all of the Commission's requirements, and criticism from some Commission members that the Commission's federal mandate was not being respected by the city.
Because of the long debate on the allocations plan, the Commission was unable to discuss how to define a "minority organization" in the funding process. Minority advocates have been unified in their support for using a definition similar to that of the U.S. Centers for Disease Control, which defines a minority organization as one in which most of the board and the executive, administrative and service delivery staff belong to an ethnic or racial minority group, and which has a history of involvement with minority communities.
Curtis Osborne, an African American person with HIV who is expected to become the interim director of We The People this month, said that black PWAs were "frustrated" by the debate. "People of color have a clear consensus on what a minority organization is," he said. "Why don't we have the right to make our own definitions, and why can't [the Commission] simply respect that?"
City officials appear to have rejected the minority groups' proposal, instead distributing a complicated point system that was criticized by Commission members as trivializing the race issue and allowing primarily white organizations to represent themselves as minority groups through mathematical formulas. The Commission's co-chairs have also developed a suggestion on the minority issue, which uses a percentage formula to give preference to minority groups in the application process.
We The People, the largest PWA coalition in the nation and the only one with a predominately African American membership, proposed in a series of recommendations issued last week that agencies which apply for funding, which meet the other required standards in terms of capability and performance, be given preference if they meet a definition similar to the CDC definition. That definition -- "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" -- was also not discussed by the Commission at its meeting.
TPAC director resigns, but...
Meanwhile, Philadelphia AIDS Consortium executive director Larry Hochendoner announced to the TPAC board of directors last week that he would not seek a renewal of his contract when it ends in September, but deeply divided board members were unable to agree to start a search process for a replacement and instead will continue discussions with him.
Hochendoner, who was hired as interim director of TPAC after the forced resignation of Jim Littrell in 1996, has been credited for restoring stability to an organization which was so torn by internal strife and conflicts of interest that city officials removed from it its responsibility to oversee Title I CARE Act funds in 1995. He has also been criticized, however, for what some board members have called confusing financial reports and for making decisions on funding that properly belong to the board as the Title II planning council. TPAC still holds responsibility for oversight of over $4 million in Title II and state AIDS funding for the southeastern Pennsylvania region.
In the summer of 1996, the TPAC board extended what was then a six-month contract with Hochendoner for one year, and passed a resolution to begin the search for a new director in March of this year. However, TPAC president Joe Cronauer informed the board in March that Hochendoner wished to negotiate a renewal to his contract. A deeply divided board, voting 8 to 7 with 4 abstentions, agreed to allow the TPAC officers to try to negotiate an extended arrangement.
By early April, however, no negotiations had been held, and Hochendoner officially submitted a letter of resignation to Cronauer late last week. In announcing his resignation to a TPAC board meeting on April 8th, he said that his primary reasons for resigning were the dysfunction of the board and confusion over the roles of the executive director and the board.
However, after his statement, a motion to begin the search process for a new director failed again, by the same vote as the previous month, 8 to 7 with 7 abstentions. Finally, the board agreed that board members could join a committee to meet with Hochendoner in the next few weeks to see if an arrangement can be found to clarify the issue. According to the board's motion, if an agreement cannot be reached with Hochendoner, the search for a new director will automatically begin at that time.
In other action, the TPAC board affirmed a controversial proposal by Cronauer and Hochendoner to provide about $25,000 in Title II funding to support a special HealthChoices hotline operated by CHOICE, which also runs the city's AIDS hotline. The issue had become controversial because consultation with the planning council is required prior to allocating funding in areas outside the group's formal priorities, and because the hotline has not been actively utilized since its beginning over a month ago, having received only 21 calls. State officials have also expressed concern about using Title II funds for this purpose, although most board members believe that the state will eventually give its approval.
New AIDS therapy proposed
Raising hopes for a new AIDS treatment, U.S. researchers report in Science that they have discovered a way to genetically prevent the formation of a protein needed by HIV to enter some cells.
Scientists at the Naval Medical Research Institute announced that they can prevent T-cells, a prime target of HIV, from making the surface protein CCR5, used as a receptor by the virus. This stops HIV's ability to infect T-cells, Institute researcher Dr. Carl H. June explained. "We know that if you are born without the CCR5 gene, it is very hard to get infected with HIV," he said. "Our work shows that you can artificially induce this immunity by turning off the CCR5 gene in the nucleus of the cell."
Therapies to take advantage of the discovery are far from development, he said.
Crixivan to be available in drugstores
Beginning in May 1997, Merck will expand distribution of indinavir (Crixivan) to pharmacies nationwide. Currently Stadtlanders Pharmacy in Pittsburg is the primary distributor of indinavir.
Merck has sent letters and registration packets to more than 65,000 pharmacies nationwide outlining the new distribution program. Pharmacists will help count and track the number of people taking indinavir to ensure that patients using the drug will have uninterrupted supply for refills.
Paid Prescriptions, a subsidiary of Merck-Medco Managed Care, will administer the new distribution program.
FDA approves delavirdine
The U.S. Food and Drug Administration (FDA) has approved Pharmacia and Upjohn's anti-HIV drug delavirdine (Rescriptor), according to an April 4th announcement.
The approval was based on the results of clinical trials that looked at changes in CD4+ cell counts and viral load measures.
This was the second FDA review of delavirdine. In November 1996, the FDA' s advisory committee on antivirals met to discuss the approval of delavirdine. The 9-member committee was split 4 votes for and 4 votes against approval. The chair of the committee was "unable to vote due to a technicality." The committee has now agreed that delavirdine has at least a short-term effect on HIV.
Delavirdine belongs to a group of drugs known as NNRTIs non-nucleoside reverse transcriptase inhibitors) and is related to another FDA-approved anti-HIV drug called nevirapine. Delavirdine is not a powerful anti-HIV agent and must therefore be used as part of a drug regimen involving other antiretrovirals.
Approval of delavirdine in the United States may hasten the approval process here in Canada.
The wholesale price of delavirdine in the USA is $2,250 per year.
Opposition grows to Coburn Act
The HIV Protection Act, introduced last month by Rep. Tom Coburn (R-OK) and backed by the American Medical Association and conservative groups, is facing opposition from the National Governors' Association, which has joined public health officials, nurses and AIDS activists fighting to defeat the measure.
In a letter to House Commerce health subcommittee Chair Michael Bilirakis (FL), the NGA said the bill (HR 1062), which would cut off federal Medicaid money for states that fail to implement the measure's testing procedures, "unnecessarily places Medicaid funding at risk in order to advance testing requirements of dubious merit." According to the letter, "The cost of implementing the new requirements would be at the expense of the primary prevention activities designed to halt the actual spread of infection." The Association of State and Territorial Health Officials contends that the bill "would cost the states $420 million per year" to implement. Other opponents contend the bill would have no effect on hampering the spread of the virus, and would wipe out funding and local flexibility to operate programs to prevent HIV risk behavior, just as there's evidence that those programs are beginning to reduce AIDS deaths.
The AMA's decision to support the bill has brought protests from others in the medical establishment. Representatives from the American Nurses Association, the Association of State and Territorial Health Officials, the American Public Health Association and the National Alliance of State and Territorial AIDS Directors met with AMA officials earlier this month to register their strong opposition. When asked how the bill could be changed to enlist their support, the groups told the AMA that it wasn't salvageable, according to one lobbyist, quoted in the journal Medicine and Health, who attended the meeting.
Rep. Nancy Pelosi (D-CA) has enlisted 107 cosponsors -- versus Coburn's approximately 70 -- for a separate HIV prevention bill (HR 1219) which would build on existing prevention programs developed through partnerships between state and local health departments, community planning agencies, and federal agencies such as the Centers for Disease Control and Prevention.
TEACH seeks program assistant
Project TEACH (Treatment Education Activists Combatting HIV), an innovative health education program that trains urban people living with HIV/AIDS to act as peer educators and activists, is seeking a full-time "Program Assistant" to TEACH director Julie Davids.
TEACH is a joint project of Philadelphia FIGHT and We The People, which focuses on treatment education, outreach and advocacy. Its training program enrolls HIV+ people who are low income, people of color and active and recovering drug users. Project TEACH Peer Educators work with groups and individuals in health clinics, drug treatment centers, and mental health drop-in facilities.
Responsibiliities for the position include stocking and maintaining the TEACH Resource Center and outreach materials for peer educators, production and updating of presentation kits for peer educators, production of a monthly newsletter, coordination of materials for the peer training program, providing support to the Philadelphia FIGHT Community Advisory Board, and various administrative and clerical tasks.
TEACH is seeking college graduates for the position, although other experience may be counted for those without college degrees. Knowledge of HIV/AIDS treatment, research and social issues and a commitment to working with people living with HIV/AIDS, low-income individuals, people of color, and sexual minorities, is required. People of color and Spanish bilingual candidates strongly encouraged to apply.
TEACH says that skills required for the position include strong organizational and administrative skills; detail oriented; excellent writing and editing skills including writing for audiences of varying literacy levels, proficiency in word processing, desktop publishing, Internet searching, a typing speed of at least 50 wpm, ability to exercise good judgement and confidentiality, ability to work independently and manage multiple projects, and excellent interpersonal skills with diverse populations.
Interested applicants should submit a resume, cover letter and writing sample by May 15th to Julie Davids, Philadelphia FIGHT, 1233 Locust Street, Philadelphia, PA 19107. For further information, contact Julie Davids at 215-985-4448 or jdavids@critpath.org.
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