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 CATIE, Washington Post and the Washington Times.
63% of city AIDS cases in poorest neighborhoods
TPAC lapses $125G for viral loads
ASIAC seeks exception to Commission priorities
Poll: worry over AIDS decreasing
Herb seen as decreasing viral load
Group condemns African AZT trials
Clarification: Membership of the HIV Commission
63% of city AIDS cases in poorest neighborhoods
Over six in ten cases of AIDS in Philadelphia have been diagnosed in residents of the city's poorest neighborhoods, according to an analysis of local AIDS surveillance data compared to "median household income" levels reported by the U.S. Census Bureau.
According to the analysis, 63% of AIDS cases diagnosed through December 31, 1996 had occurred in residents of North Philadelphia (31%), South Philadelphia (14%), West Philadelphia (12%), and Kensington (6%). Median annual household incomes for these areas ranged from $15,592 in North Philadelphia to $22,820 in Kensington and lower Northeast Philadelphia.
Most of the AIDS cases reported in these neighborhoods occurred among African Americans.
Areas of the city with higher median incomes had the lowest number of AIDS cases. Only 4% of AIDS cases reported through 1996 had occurred in residents of Chestnut Hill, Roxborough. Manayunk, and Northeast Philadelphia, where median incomes ranged from a low of $32,676 in the Northeast to $38,216 in Chestnut Hill.
Center City Philadelphia, where the vast majority of AIDS medical and social services are located, comprised 10% of AIDS cases through 1996. The median household income for Center City is said by the Census Bureau to be $30,750. The city's Germantown section, where median incomes were reported at $29,888, also held 10% of AIDS cases.
Five percent of city AIDS cases have occurred in the Olney/Oak Lane sections of Philadelphia, where median income is $27,369.
The surveillance data also indicates that the rate of increase in AIDS cases over the last two years has remained relatively stable in all neighborhoods in Philadelphia, with the exception of North Philadelphia, where AIDS diagnoses continue to increase in proportion to the rest of the city. AIDS cases in North Philadelphia comprised 29.5% of all cases prior to 1995, but 34.3% in 1995-1996.
Consistent with national epidemiological data, AIDS cases continued to drop in predominately white areas of Center City and South Philadelphia, which comprised 24.8% of city AIDS cases prior to 1995 and 18.1% in 1995-1996.
Over half of Philadelphia AIDS cases were reported in North, West and Southwest Philadelphia, the target communities of much of almost $3 million in new federal funding for AIDS services being allocated by the city over the next two months.
The data cited was prepared for fastfax by Guy Weston, a member of the Philadelphia HIV Commission and executive director of the Ecumenical Information AIDS Resource Center in North Philadelphia.
CPG delays priority-setting
A six-hour meeting of the Philadelphia HIV Prevention Community Planning Group, scheduled for the purpose of defining percentage allocations for over $3 million in HIV education funding to be distributed through a competitive bidding process later this year, concluded with no action after the group rejected an analysis of data presented by staff of the Philadelphia HIV Commission.
The CPG is a subcommittee of the Commission, and was formed under a federal mandate from the U.S. Centers of Disease Control and Prevention which requires community oversight of CDC's HIV prevention grant to the city health department.
The committee had asked the Commission's CPG staff member, Yoshi Yamasaki, to develop an analysis of how previously-determined population priorities -- that is, populations which would have priority as targets for HIV prevention efforts -- could be translated into specific percentages of the funding that will be available later this year. Committee members said that the report delivered by Yamasaki was inaccurate and confusing, and asked that it be re-done for another meeting of the committee in May.
At the meeting, city HIV/AIDS education director Kevin Green and the new co-director of the city's AIDS Activities Coordinating Office, Joe Cronauer, announced that the city would utilize the CDC's priority for investing HIV prevention dollars in minority communities in its allocation of the funding. Cronauer also said that the city will shortly be issuing a request for proposals for slightly over $200,000 in CDC "supplemental funds," which will be available one-time only and will be allocated only to presently-funded organizations for efforts which must be concluded by the end of this year.
The CPG action in rejecting the Commission analysis was the second time this month that local AIDS planning bodies had rejected a report prepared by city AIDS planners. The HIV Commission itself several weeks ago rejected a proposal for the allocation of new federal direct care dollars, awarded under the Ryan White CARE Act, which had been developed by AACO. Many Commission members at the time stated that AACO had ignored its instructions in preparing the report. A new report was then developed and adopted by the Commission a week later.
TPAC lapses $125G for viral loads
A federal grant to pay for viral load testing for uninsured people living with HIV/AIDS amounting to $125,000 was not spent by the Philadelphia AIDS Consortium prior to its April 1st deadline, according to TPAC sources.
TPAC had also received a second $80,000 viral load grant from the state of Pennsylvania, most of which was spent on the testing by the deadline. According to state welfare department officials, uninsured individuals with incomes of $30,000 or less are now eligible for free viral load testing through the state's Special Pharmaceutical Benefits Program.
The $125,000 grant was awarded to TPAC by the City of Philadelphia utilizing Ryan White CARE Act Title I funding. TPAC had conducted a brief public information campaign late last year to alert the HIV community of the availability of the free testing.
Sources said that TPAC is negotiating to allocate the funding retroactively to a free viral load testing program conducted by North Philadelphia Health Systems, which has suffered a deficit in its program for uninsured individuals.
ASIAC seeks exception to Commission priorities
Echoing complaints from minority and suburban AIDS advocates that the AIDS funding priorities established by the Philadelphia HIV Commission are not consistent with the pressing needs of their communities, AIDS Services in Asian Communities (ASIAC) has asked the city's AIDS Activities Coordinating Office to establish a special new priority category so that it can meet "the most pressing and urgent needs of Asians and Pacific Islanders with HIV/AIDS."
ASIAC executive director Richard Liu, a member of the Commission, said that the eleven service categories included in a request for proposals (RFP) issued by the city covering $3 million in new federal AIDS funding are inconsistent with a community needs assessment conducted by AACO for the Commission earlier this year. According to Liu, that assessment revealed that the most pressing needs of the API communities were in the areas of case management, "care access field specialists, treatment education, information and referral, translation and interpretation services, and capacity building.
Liu said that health commissioner Estelle Richman had promised that at least 5%, or $145,000, of the new AIDS funding would be dedicated to Asian community services, and that this goal could not be met through the service categories defined in the RFP.
Liu wrote that "the existing service system is largely culturally incompatible and linguistically inaccessible to Asians & Pacific Islanders with HIV/AIDS. Simply, the RFP offers us the sail, rudder, and oars to cross a river but assumes that we have a boat to ride on. Even with a makeshift raft with AACO funded sails, rudders, and oars, we will be destined to sink."
Liu requested that AACO develop a special category be developed which combined various service areas in a way which would assure that the funding he said was promised by Richman could be allocated to Asian community organizations.
"Many potential bidders from the Asian & Pacific Islander community will not respond to the RFP because the service categories are largely incompatible for the community's most pressing service needs," Liu wrote. He specifically criticized the $50,000 available for translation and interpretation services, calling it "inadequate" for the Latino, API and deaf communities most needing these services.
While most observers have commended the Commission's general priorities as appropriate on a regional level, the plan has run into opposition in various communities which claim that they are hard to apply in particular areas or subpopulations. Suburban communities, which have been severely under-funded since the epidemic began, have complained that the relatively small amount of funding dedicated to suburban services -- about $450,000 -- is inadequate to build new capacity in the eight Pennsylvania and South Jersey counties surrounding Philadelphia, especially since public health services are already in short supply in those areas. Minority AIDS advocates have noted that the need to build AIDS service capacity in the city's poorest neighborhoods will be done on a haphazard rather than rational basis, because the collective needs of the region -- where medical services are listed highest -- are, they believe, not as urgent as basic social services which allow people living with HIV/AIDS to utilize AIDS services. Minority advocates have expressed particular concern that there are not enough AIDS case managers available outside center city Philadelphia, and that the available funding is inadequate to increase that number with the new funding.
Poll: worry over AIDS decreasing
New research indicates that Americans are less concerned about AIDS and believe that a vaccine against the disease could be developed in the next several years.
According to the new Harris poll, only a little more than 10 percent of those surveyed were "very concerned" about contracting HIV. This figure is about half the rate found in 1991, when the poll was last conducted. In addition, whereas about 66 percent of the country said they thought AIDS was or would become an epidemic, only about 50 percent of the nation believes that now.
Herb seen as decreasing viral load
Traditional Chinese medicine has recipes (mixtures of herbs) for treating various infections, so it should not be surprising that extracts of some of these herbs can shut down production of HIV when tested in lab experiments. One of these herbs, commonly called green chiretta (Andrographis paniculata), is being tested under the brand name AndroVir as a treatment for HIV infection. Researchers are not certain exactly how the herb works but it appears to act differently than drugs such as AZT or protease inhibitors.
In a nine week study on 16 HIV-infected subjects, AndroVir caused half of them to have a 31% increase in CD4+ cell counts and a 38% decrease in the amount of HIV in their blood.
The company testing the compound, Paracelsian, Inc., plans to sell AndroVir as a herbal supplement through the UK-based company East West Herbs. A year's supply of AndroVir is expected to cost about $720. Using revenue from sales of AndroVir, the company hopes to fund further clinical trials.
Paracelsian is also testing another herbal extract for its anticancer activity.
Group condemns African AZT trials
A medical watchdog organization has charged that the U.S. government was sponsoring nine medical studies in the developing world that are unethical because they fail to provide all pregnant women with a drug that could protect their infants from acquiring HIV during childbirth.
The studies seek to learn whether brief use of AZT, or other drugs, will decrease the mother-to-child transmission of HIV. A complicated, three-part treatment with the antiviral drug AZT reduces that transmission by two-thirds, but is viewed by governments and AIDS researchers as far too expensive and cumbersome for the developing world.
The key criticism voiced by the group was that the studies included some HIV-infected women who are being randomly assigned to receive no AZT or other "active" drug anytime during the experiment. In the countries where the studies are being carried out -- mostly nations of West and Central Africa -- AZT is largely unavailable.
"These are as unethical as any experiments we have ever seen since the end of the Second World War," said Sidney Wolfe, director of the Public Citizen Health Research Group, an organization that analyzes research, treatment and public health policy.
"What has happened here is Tuskegee, part two . . . in which even more people will die," said Peter Lurie, an AIDS researcher who assisted Wolfe in analyzing the studies.
Lurie's reference was to the infamous four-decade study in which black Alabama sharecroppers with syphilis were observed and not offered treatment until long after it was widely available.
In a letter distributed to reporters at a news conference, Wolfe asked Donna E. Shalala, Secretary of Health and Human Services, to order researchers to provide all women in the studies with at least some AZT, since that drug has been shown to be more effective than no treatment at all.
Seven of the studies are being funded by the National Institutes of Health (NIH), and two by the Centers for Disease Control and Prevention (CDC).
Various scientists and officials overseeing the experiments, however, said they reached consensus years ago that the experiments criticized by Wolfe were ethical and well-designed. They said it is essential to compare "short-course" AZT treatment to what infected pregnant women in the study countries now are getting -- which is nothing.
All of the studies in question have been approved by research review boards in the United States and the host countries.
"All this debate came up in 1994, and it was felt that the best way to go, and the best interest of the developing world, was to have placebo-controlled trials, where you get accurate data quickly," said Joseph Saba, a research official of UNAIDS, the new AIDS program run by the United Nations, World Health Organization, World Bank, and several other international agencies.
"These studies are attempting to define regimens of treatment that are actually usable in most of the world. They have been put together with extraordinary support and consensus on an international level," said Jack Killen, director of the division of AIDS at the NIH's National Institute of Allergy and Infectious Diseases.
A landmark study, published in 1994, found that the mother-to-child rate of transmission of HIV could by cut from 23 percent to 8 percent if the pregnant woman was given AZT tablets for the last one-third of her pregnancy, intravenous AZT during labor, and if the newborn got the drug for the first six weeks of life. In a more recent study, the transmission rate with treatment dropped to 4.8 percent. The cost of that preventive treatment ranges from $400 to $900.
Because many countries with high prevalence of AIDS are unable to afford that regimen or, in many places, deliver the intravenous medicine even if it were available, many AIDS researchers wondered if a simpler, cheaper, but still effective alternative existed.
The countries include Ivory Coast, Uganda, Tanzania, South Africa, Ethiopia, Burkina Faso, Malawi, and Zimbabwe. In all, more than 12,000 women are involved in the U.S.-funded studies. All participation is voluntary, and the women are counseled on the infection and the details of the study.
In most of the studies, the length of time women take AZT before delivery, as well as the length of time their babies take it after birth, has been shortened. Pills have been substituted for the intravenous dose given during labor. In some of those three treatment intervals, a placebo is given instead of AZT . In most of them, there is one "arm" of the study in which women and babies get only placebo.
At the news conference, Wolfe and Lurie said that about 1,000 babies are likely to become infected with HIV because their mothers are randomly assigned to these all-placebo options. While they said they do not object to studies that give women placebo for some of the intervals, the all-placebo arms are unethical because they, in effect, knowingly give experimental subjects substandard care.
However, Timothy Dondero, of the CDC, said the sort of studies Wolfe and Lurie advocate would not answer the fundamental question: Is any drug treatment better than the treatment women are getting now?
Both Dondero and Saba said that in order to marshal international support and money for HIV testing, counseling and treatment for millions of pregnant women in poor countries, scientists must present unassailable proof of AZT 's effectiveness -- which requires trials that include all-placebo arms.
Further, Saba said, doing studies without all-placebo arms would take far longer, delaying implementation of potentially effective treatment and resulting in far more HIV deaths.
Clarification
In the issue of fastfax dated March 22, 1997, an article on controversies at the Philadelphia HIV Commission incorrectly stated that the majority of the members of the Commission were white. In fact, the sentence was supposed to have indicated that a majority of the Commission members present and voting at the meeting were white.
The federal Ryan White CARE Act requires that the racial composition of the Commission be representative of the HIV/AIDS epidemic in the region.
According to Mick Maurer, co-chair of the Commission, Asian and Pacific Islanders comprise 3.4% of the Commission members; Latinos, 12%; African Americans, 48.3%; and whites, 36.2%.
The U.S. Health Resources and Services Administration, in a report on the racial demographics of the HIV/AIDS epidemic in the region, says that 61% of HIV/AIDS cases in the region are African American, 10% are Latino, 28% are white, and less than 1% are Asian and Pacific Islander.
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