Issue #121: April 20, 1997

FASTFAX is available by fax in the 215 and 610 area codes at no cost, by mail anywhere for $20.00 per year, by calling 215-545-6868, and by and typing SUBSCRIBE in the message. Sources for some information in this issue include the Associated Press, Reuters NewsMedia, and the Washington Times..

New AIDS funding will target minorities, suburbs

After months of debate and controversy, the Philadelphia HIV Commission has instructed the city of Philadelphia to concentrate most of almost $3 million in new federal AIDS funding to organizations in minority communities and Philadelphia's suburbs.

Both suburban areas and communities of color -- which health commissioner Estelle Richman defined as African American, Asian/Pacific Islander, and Latino -- were deemed by the Commission as underserved and as a priority for the investment of the new funding.

"It was determined by a collaboration between AACO and the Commission that these geographic areas and communities of color are the areas of greatest need at this point," said Joe Cronauer, the newly-appointed interim co-director of the AIDS Activities Coordinating Office.

In determining awards of Ryan White Formula funds, the federal government calculates the number of cases in heavily impacted "metropolitan areas" as defined by the US Census Bureau. Although the Philadelphia metropolitan area includes adjacent counties in Pennsylvania and New Jersey that comprise about 30% of the area's population, funding to these areas has never been any more than about 16%.

The decision came after several stormy meetings at which attempts to pass resolutions which would assure that minority AIDS organizations, most of which have received little new funding from public sources since 1993, were defeated by one-vote margins along largely racial lines. However, at its April 16th meeting, all 21 voting members of the 60-member Commission adopted a proposal from city health commissioner Estelle Richman which targets most of the funding being allocated in the city to minority neighborhoods, particularly North and West Philadelphia, which have the highest concentrations of AIDS cases. Eight Commission members abstained from the vote.

According to federal statistics, over 70% of Philadelphia's HIV population are people of color, although almost 80% of the current funding is used to support organizations which do not meet federal definitions as "minority organizations."

After long debate, the Commission also adopted a definition of "minority provider" proposed by We The People in a report issued in early April on the need for more minority-led AIDS services. That definition defines a minority organization as one in which the majority of the board and direct service staff of the organization are members of the minority group to which the services are targeted, and one which has a proven history of working in the target community, and includes stipulations for cultural competence and cultural appropriateness.

Representatives of various communities of color also expressed optimism concerning the new funding plan.

"I think that by establishing such a definition, we are moving closer to confronting the very difficult public health decisions that we have to make." said Michael Hinson, a new appointee to the commission who heads the Colours Organization.

Richard Liu, Executive director of AIDS Services in Asian Communities, echoed Hinson's optimism. "Given that we have just completed a six month, seventy one page needs assessment of Asian Pacific Islanders with HIV/AIDS, there is a clear indication that targeted services for this population is needed. I just hope that we can reach communities such as ours with the limited funds we have to work with."

This was the third attempt by the commission to endorse a plan to distribute these funds. On March 19th, the commission charged the health department to bring back the proposal of how to "equitably distribute new funding" based on "existing recommendations and general instructions to the grantee." A special meeting called on April 9, 1997 to answer this charge ended without resolution when AACO staff were unable to answer pertinent questions.

"This is a thousand percent improvement over last week," said Guy Weston, a former Commission co-chair who severely criticized the city's first presentation. . There was clearly a level of detail from the Commissioner and her staff that has not been provided to the finance committee or the full commission last week.

The $2,921,402 budget proposal was endorsed after intense questioning, but without the contention which has lately typified most Commission meetings. However, when the commission began to review a series of proposed definitions of 'minority provider," many commissioners began to ask questions expressing concern that definitions may impact unfairly on agencies that have a long history of serving minority populations.

The definition adopted by the Commission recognizes that minority providers may not be available in certain service categories or geographic areas. Rob Capone, WTP Education Director who made the motion to adopt the definition, said he was pleased with the result. "I think we can really build capacity in minority communities with this approach. It won't be just a line item on the budget."

However, many commissioners appeared confused or frustrated over the proposed definition, and asked why sexual minorities and women were excluded from the proposed definition. Dorothy Mann, Executive Director of the Family Planning Council immediately proposed a similar motion that requires the Resource Allocations Advisory Committee, an independent review panel which advises the health commissioner on AIDS funding allocations, to consider similar criteria for female representation among the Board, administrative, and service delivery staff of organizations applying for funds to provide services to women. The motion passed.

In an interview after the meeting, Weston expressed disappointment in the reactions of his colleagues. "I find it extremely sad that in 1997, in an eligible metropolitan area where three fourths of the people living with HIV/AIDS are African American, Asian Pacific Islander, or Latino, that individuals who plan health services that affect peoples lives can be so far out of touch with rudimentary public health concepts. This is Public Health 101: We've identified significant health status disparities in our community and have chosen to implement this targeted initiative to begin to bridge the gap. Sometimes I wonder if people really appreciate the magnitude of disparity."

In Philadelphia, the AIDS case rate per 100,000 people is 168 cases per 100,000 Latinos and 139 cases per 100,000 African Americans, compared to 33 cases per 100,000 Whites.

"If we look at this graph in the CPG Prevention Plan, we'll see that while the case rate in Whites has remained relatively stable for the last several years (with the exception of the impact of the 1993 change in the case definition), the rate in African Americans and Latinos began skyrocketing ten years ago and hasn't stopped to take a breath. This is not meant to trivialize the reality of the pain of those 33. It's just that 168 is five times 33, and resources should be apportioned with appropriate consideration of these factors.

"We know that the widely acclaimed decline in AIDS related deaths was not equally distributed," Weston continued. "41% in Whites, 13% in African Americans. We know that one-third of the AIDS cases in Philadelphia have been diagnosed in a cluster of north Philadelphia zip codes that, is almost exclusively African American and Latino in population, makes up 1/6 of the city's population, and where HIV/AIDS are services are few and far between."

Weston, who directs a North Philadelphia coalition of churches responding to AIDS called the Ecumenical Information AIDS Resource Center, said it was appropriate to use race and ethnicity as a focal point for targeted initiatives.

"Race/ethnicity is the only variable that captures all of the sociocultutal and socioeconomic factors that account for health disparities such as these," he said. "This is by no means unique to HIV/AIDS. The same disparities occur in heart disease, liver disease, diabetes, cancer...the list goes on. When we analyze data by other variables such as economic status or risk group, disparities don't necessarily disappear. None of these disparities appear if we look at data by sexual orientation or gender alone. About 85 % of women and 94-5% of children with HIV/AIDS are African American or Latino In other words, race/ethnicity is a what we call a "marker" for underlying cultural and economic factors that affect health. Socioeconomic status is associated with premature sickness and death. Unemployment, poverty and illiteracy are associated with decreased access to health education, and health prevention and care services. African Americans and Latinos are represented disproportionately in lower income brackets. You know the rest of the story."

Weston said that the intense controversy which developed in the Commission and at AACO in the past few months could have been avoided.

"I hope that the next time we have such a discussion, that someone has the forethought to give a broader scope of background information, in terms of the purpose and context of the definition as well as various logical exceptions to the rule. For example, we spent an inordinate amount of time talking about how such a definition might apply to city health clinics and whether the Board of Health or city council would be considered the governing body that would need to meet some minority representation goals. The answer was simple. Government bodies are typically not subject to such definitions. The discussion should have stopped there.

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Richman confirms AACO appointments

Philadelphia Health Commissioner Estelle Richman has confirmed the appointment of Joe Cronauer, current executive director of We The People, and Patricia Bass, a health department consultant and former board member of ActionAIDS, as "interim co-directors" of the city's AIDS Activities Coordinating Office.

Bass, who already consults with AACO on managed care issues, will be responsible for contract administration and fiscal management of the AIDS office, while Cronauer will be responsible for planning and policy issues. Cronauer will begin his duties formally on April 28th.

Cronauer has been executive director of We The People since last April. He was granted a leave of absence by the WTP board of Directors on April 9th to take on the new AACO duties for at least one year. He also resigned his position at president of the Philadelphia AIDS Consortium and has taken a one-year leave of absence from his membership on that organization's board of directors.

Prior to his appointment as WTP's executive director, Cronauer, a person living with HIV, had served as WTP's Education Director and as a counselor.

The We The People board of directors has also announced that it has appointed Curtis Osborne, also a person living with HIV, as interim executive director during Cronauer's term at AACO. Osborne has served as WTP's Life Center Coordinator since last July, and previously worked as WTP's housing counseling. Prior to coming to We The People, he worked as a mental health services supervisor at Intercommunity Action, a Roxborough mental health agency, as well as an active volunteer on We The People's Positive Voices Outreach Team.

Osborne will be the first African American PWA to hold the top post at We The People, whose membership is primarily African American.

Osborne's successor as Life Center Coordinator is Melody Walker, who was promoted to the position from her current role as WTP's housing counselor. Recruitment is currently underway to replace Walker, as well as to fill the new position of Crisis Intervention Case Manager.

The WTP board has also asked AACO to provide financial assistance to the organization to allow it to obtain fiscal and administrative help during Cronauer's absence, since the appointment of Cronauer to the AACO post was unexpected and the organization had little time to prepare for the shift in duties. We The People currently holds almost thirty city and state contracts for a wide range of AIDS services, totaling over $1.5 million annually.

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Ride sponsors fined $134,000

ActionAIDS, the AIDS Information Network, Philadelphia Community Health Alternatives and Pallotta and Associates will pay a $134,000 fine to the state of Pennsylvania to settle the claim of the state attorney general that last year's AIDS Ride violated state fundraising laws.

The AIDS Ride, a highly controversial fundraising event developed by Pallotta and Associates, a California for-profit public relations firm, raised only $324,000 for distribution to AIDS service organizations last summer. Almost $1.5 million of the donations made for the event were used to cover expenses and pay the Ride's organizers.

Pallotta and the three groups had promised supporters that 60% of the Ride's proceeds would help people with AIDS, but less than 20% actually went for that purpose.

State officials said that Pallotta had never registered with the state as a fundraiser and that two of the groups -- AIN and PCHA -- were not registered as charitable organizations in Pennsylvania at the time of the event. The agreement allowed the groups to settle the claims without having to admit wrongdoing or suffer a court trial on the state's complaints.

According to the Pennsylvania attorney general's office, Pallotta will pay $110,000 of the fine, and each of the three groups will pay $8,000. The attorney general's office said that about $113,000 of the funds collected through the fines will be re-distributed to AIDS service organizations.

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Company offers life insurance to PWAs

An Illinois life insurance company has announced it is offering first-of-its kind policies to HIV-positive people, and has reported it is receiving many calls from potential buyers.

News of the life insurance policies for HIV carriers offered by Guarantee Trust Life Insurance Co. had created a surge of calls to the suburban Chicago company, vice president of product development Jeff Burman told Reuters Newsmedia.

So far, about four applications were pending. The policies will initially be offered only in Illinois to gauge demand, then be offered nationally, Burman said.

A $25,000 policy for a non-smoking, 30-year-old man with the virus will cost about $300 per month, about six times the premium for a similar person without the virus.

The privately held insurer already provides coverage to more than one million people, including some with liver ailments, diabetes and other serious health problems.

"Extending coverage to qualified HIV positive individuals is a natural outgrowth of an acquired expertise in providing insurance on a sound business basis to individuals with severe health impairments," the insurer's president, Richard Holson III, said in a statement.

The move recognized the advances in treatments for AIDS patients, including "cocktails" of various drugs that have been shown to stave off symptoms of AIDS in infected people for years.

The insurer, which will provide policies worth up to $250,000, will offer the coverage only to those infected with the virus through sexual contact or accidental needle sticks. It said those who contracted the disease from intravenous drug use or from blood transfusions carried unacceptable risks.

Most AIDS advocates are cheering the company's decision.

"I'm certainly amazed that the insurance industry is starting to recognize that there is some real hope out there for people living with this disease," said Javier Salazar, a lobbyist for Washington-based AIDS Action.

"From a life insurance risk perspective, we believe many otherwise healthy HIV-positive individuals are more appropriately viewed as having a treatable chronic illness rather than a terminal disease," company president Holson said.

State Farm and Allstate, two of the nation's largest insurers, said they have no plans to offer life insurance to HIV-positive individuals.

"The reasoning is, those who are HIV-positive are infected with a disease that is associated with high health costs and early death," said Murray Payne, spokesman for State Farm. "The underlying principle is the same for anyone with any other serious life-threatening disease."

Salazar of AIDS Action noted the cost would be prohibitively high for most people.

"Paying for what you need to stay alive is hard enough already," he noted. "Shelling out $300 a month for life insurance on top of that is a benefit that few people would be able to access."

Those who qualify must be under 49, have certain levels of the virus and infection-fighting T-cells and not have full-blown AIDS.

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Experimental drug shows promise

An experimental AIDS drug being developed by Gilead Sciences Inc has been shown to drive down viral levels by more than 90 percent in the first eight days of treatment in clinical trials, the company has announced.

Although Gilead has yet to test the drug for sustained periods of time in humans, it said that based on the rapid pace at which it reduced the virus in the short-term trial, as well as further success in longer trials in animals, it was hopeful it could eventually achieve more than 99 percent viral reduction.

The drug, known as anti-retroviral PMPA, belongs to a class of compounds known as nucleotide analogues, which block HIV from replicating.

While it is similar to some of the most widely used AIDS drugs like AZT, PMPA targets a wider area of the virus, reducing the risk that it can develop a resistance, Gilead said.

"Based on mathematical models of how the virus replicates, you would not be able to do much better than (90 percent) reduction in viral load in a single week, regardless of how many therapies or the potencies of the drugs," said Dr. Howard Jaffe, senior vice president of drug development at Gilead.

"But based on the animal data and the slope of the decline in the eight-day test on humans, we have every reason to believe it would continue to drive down viral levels if used over a longer term."

While many doctors have successfully lowered their patients' viral load by more than 99 percent using the celebrated three-drug cocktail, Gilead's findings could potentially achieve the same results with a lighter drug regimen.

Jaffe said the Gilead drug would need to be taken only once a day, and preliminary results showed it was well tolerated with no significant side effects except nausea.

Jaffe said Gilead also tested a vaginal gel form of the drug in animals, which was found to block the spread of the virus during sexual activity. It plans to begin similar studies in humans later this year in collaboration with the National Institutes of Health.

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N. Dakota to imprison "suspected" HIV carriers

Making North Dakota the first state to confine people suspected of having HIV, Governor Edward Schafer has signed a controversial measure that gives judges the power to detain a person without a hearing, and force that person to take a blood test for HIV.

The American Civil Liberties Union, which is considering a legal challenge, said the law serves no public health purpose, and is a serious violation of due process and the Fourth Amendment's guarantee against unreasonable searches and seizures.

"This law is way over the top," said Keith D. Elston, executive director of the ACLU of the Dakotas. "It completely violates people's most basic rights, while addressing none of the health concerns raised."

Under the measure, a person who believes that another individual has "significantly" exposed them to blood may secure a state court order confining that individual for up to five days, during which time a judge can rule on whether to order a HIV test.

The legislation specifies a "person" as a police officer, firefighter, emergency medical technician, health care worker or a patient -- in other words, practically anyone could be detained. The law also allows a person to be imprisoned even though no criminal charges have been filed.

"This measure gives courts the unprecedented power to jail doctors, patients and ordinary citizens for something as unsubstantiated as a hunch," said Matt Coles, director of the ACLU's National AIDS Project.

"Even people accused of the most heinous crimes are jailed only after some official has determined there is probable cause," Coles said. "Then they are entitled to a fair hearing within a couple of days. Surely, the possibility that someone has HIV is not a reason to disregard basic due process."

The law also provides no guidance to courts on how the results of the forced HIV test will be kept confidential, raising important questions about individual privacy, according to the ACLU.

The controversy stemmed from an incident in Minot, North Dakota where a police officer was exposed to blood during an emergency call. The officer later noticed a scratch on his forearm and requested the subject to be tested for HIV. The subject tested positive, but the officer has not.

"The only way that officers and others can know if they haven't been infected is to get tested themselves," Coles said. "While it may satisfy our curiosity to know the other person's HIV status, those results don't tell us anything about our own health."

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New "czar" advocates for needle exchange

Citing "strong scientific evidence" that needle-exchange programs help reduce the spread of HIV, President Clinton's new AIDS czar has pledged to attempt to remove the political controversy from the debate over federal funding for the programs.

Following her appointment at the White House in early April, Sandra L. Thurman, former director of AID Atlanta, said "the best thing is to follow the science," referring to a new report from the Department of Health and Human Services that favors needle exchanges. While she did not promise to ask the president to lift the ban on federal funding for needle-exchange programs, Thurman noted that she would recommend that the president act on the scientific evidence available. Of his new appointee, Clinton said, "She's worked on the front lines of the AIDS epidemic for more than a decade. She's been an advocate and a catalyst at the state, local, and national levels."

Unlike other AIDS czars, Thurman will have an office inside the White House complex, a move long sought by AIDS activists who said the office holders were too far away from the president to have any influence.

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EIARC sponsors second church AIDS conference

President Clinton's spiritual advisor Dr. Anthony Campolo, Dr. Elaine Daniels of the federal DHS AIDS Policy Office, Black preacher Rev. Jeremiah Wright Jr, and locally renowned Latino AIDS advocate Father "Butch" Gamarra will lead the deliberations at Churches Respond: A Call To Care, a conference sponsored by the Ecumenical Information AIDS Resource Center which will take place at the Adams Mark Hotel on June 13 and 14, 1997.

"We like to do this as an annual training and networking opportunity for church leaders and HIV/AIDS service providers who are interested in collaborating to address the HIV/AIDS epidemic in their communities," said Guy Weston, Conference Director.

Weston said that the conference will have four major focuses: New challenges to the church in the wake of life extending treatments; Continued dialogue on theological issues that affect church involvement in AIDS ministry; Issues unique to heavily impacted populations; and Utilizing our common bond of faith to move from divisive rhetoric to collaborative action.

In addition to plenary sessions on these and other topics, the conference will offer a complete array of workshops, including basic AIDS education, a "how to" workshop for AIDS organizations wishing to work with churches, and a pastoral counseling seminar. Special feature workshops include a presentation of the role of Faith Communities in health promotion and disease prevention, facilitated by the CDC's Faith Initiatives Coordinator Qairo Ali, and a discussion of AIDS in the developing world in the context of "oversees missions." This workshop will be presented by Dr. Jacob Gayle of the United Nations Agency for International Development. A special workshop for mothers will feature Dorothy Beam, mother of the late Joseph Beam and two other local mothers to be announced.

Weston said that he was particularly excited about examining new challenges to churches in the wake of life extending treatments. "Recent reports from national and local health officials indicated a grave disparity between whites and people of color in the decline of AIDS related mortality," he said. "Although much of this disparity is attributed to socioeconomic issues such as health care access, it is clear that we can also address this issue through indigenous community treatment education efforts. Many churches have health programs that address blood pressure and blood sugar. We can help to make this blood infection a chronic manageable illness by using this same approach. We can also encourage politically active churches to support politicians that understand these issues."

Referring to what has been termed the "Lazarus Syndrome", Weston said that the advent of new treatments also creates an emotional "roller coaster" for individuals who have experienced dramatic improvements after thinking they were close to death. Pastoral counseling must adjust to these new realities, he said. "It is not merely grief and death and dying issues", he said.

Weston said that he expects to announce co-sponsorship by two local clergy coalitions within the next several days. The conference is also being co-sponsored by the Pennsylvania AIDS Education and Training Center at Allegheny University. There will be a registration fee of $50.00. A limited number of scholarships will be available for persons with HIV and their caregivers or family members.

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