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 Journal of AIDS and Retrovirology, Journal of Virology, Philadelphia Daily News, Philadelphia Inquirer, Reuters, Washington Post.
Women at higher HIV risk than thought
Feds say 461,000 are HIV+ in US
Syphilis in US near all-time low
Reuters restricts access to AIDS articles
Richman aide guilty of race bias
Law Project sets insurance workshops
Women at higher HIV risk than thought
HIV can infect many different types of tissues in the female reproductive system, suggesting that women may be at greater risk of infection than previously thought.
About 70% of all new HIV cases in the U.S. are thought to be due to heterosexual contact, and women are at greater risk of contracting the disease from men -- rather than vice versa. The virus is thought to gain access to the body through immune system cells in the vagina and cervix, through microscopic tears in the skin or via lesions from other sexually transmitted disease.
Now, a new study has found that not only can cells lining the vagina and cervix be infected, but tissue in the uterus and fallopian tubes are vulnerable as well, according to the report in the May issue of the Journal of Virology.
"Our findings suggest that efforts to control heterosexual transmission of HIV-1 should include protection at all sites, not just the lower reproductive tract," said lead study author Alexandra Howell, an immunologist in the HIV Research Laboratory at the Department of Veterans Affairs in White River Junction, Vermont. The study was a collaboration with researchers at Dartmouth Medical School in Lebanon, New Hampshire.
The test tube studies also showed that the cells do not necessarily have to carry the CD4 surface marker -- a molecule thought to be necessary for the virus to infect the cells.
"These findings are the first to report infectivity of normal female reproductive tract tissues and demonstrate that HIV can infect cells in the upper reproductive tract," the authors wrote.
Howell and colleagues examined a variety of female reproductive tissues from 26 women undergoing hysterectomy, and the ability of five different strains of HIV to infect the tissue in laboratory culture.
The study indicates that "the entire reproductive tract is potentially a target for HIV uptake and systemic spread," Howell wrote.
"Others have suggested that blood contact from the vaginal trauma of sexual intercourse, or lesions within the vaginal canal or cervix resulting from sexually transmitted diseases, are a portal of entry for HIV," the authors concluded. "Our findings suggest that if HIV travels the length of the reproductive tract, then free virus and/or cell-associated virus present in semen may infect at any site along the tract independently of lesions or sites of trauma."
Feds say 461,000 are HIV+ in US
The prevalence of HIV infection among men and women in the US is 0.32%, or about 461,000 persons, according to government epidemiologists. They report population-based prevalence estimates in an update of the third National Health and Nutrition Examination Survey (NHANES III), published in the April issue of the Journal of the Acquired Immune Deficiency Syndrome and Retrovirology.
The projection is significantly lower than the over one million cases of HIV infection which have informally been claimed by federal officials in recent years.
Dr. Geraldine M. McQuillan of the National Center for Health Statistics in Hyattsville, Maryland, and co-investigators combined six years of NHANES data--from 1988 through 1994--with previously published statistics to improve the precision of their estimates. The study included 11,203 individuals from 18 to 59 years of age, who were anonymously tested for HIV, and reflects data for persons residing in households. Some individuals at high risk for HIV infection, prisoners and homeless persons not living in shelters were not in included in the study. "NHANES III is the only population-based national survey covering both men and women that provides an estimate of HIV prevalence," the authors explain.
Dr. McQuillan's group found that 59 individuals were positive for antibodies to HIV, which yielded the weighted prevalence estimate of 0.32%. Overall, "[m]en were four times more likely to be infected than women." When broken down by race and ethnicity, the figures show that "...black and Mexican-American men [were] three times more likely to be infected than women, compared with white men, who were six times more likely to be HIV positive than white women."
Data were used to examine the association between drug use and HIV prevalence, and indicated that "[b]lack women who used cocaine were 12 times more likely to be HIV positive compared with all tested black women."
Syphilis in US near all-time low
No new cases of syphilis were reported in more than 70 percent of U.S. counties last year, but many locations had more than their share of infections. The Centers for Disease Control and Prevention, therefore, is concentrating on areas where the disease is still prevalent, including Washington, D.C.; Baltimore, MD; and Richmond, VA.
The CDC's Judith N. Wasserheit notes, "[Syphilis] has been eliminated from several industrialized countries and it's now at such low levels and so concentrated in the United States that it could be eliminated here as well." According to the CDC, there were 4.4 cases of syphilis per 100,000 Americans in 1996, close to the record low of 3.9 cases per 100,000 attained in 1956 and 1957. The most new cases of any county were recorded in the Baltimore area, a combination of the city of Baltimore and Baltimore County, which had 629 new cases and 91 cases per 100,000. Washington, D.C., ranked No. 19 in the country, with 114 new cases and a rate of 20.6 per 100,000, while Richmond came in at No. 35, with 66 new cases and a rate of 33.3 per 100,000.
CMV web site offered
Partnership in Vision (PIV), a collaboration of leading AIDS practitioners, advocates and vision specialists, has announced the premiere of its World Wide Web site (http://www.piv.org). The site is designed as a comprehensive educational resource for people with, and at risk for, cytomegalovirus (CMV) retinitis and other ocular manifestations of AIDS.
The PIV web site offers facts about CMV retinitis, highlights of recent scientific conferences and information about available therapies for CMV retinitis. It also includes a guide to low vision resources available for people who have experienced a loss of vision. For people with low vision, the web site offers the option of selecting a high-contrast setting, to provide easier viewing.
Educational materials developed by the Partnership in Vision will be made available on the site. The PIV web site also provides on-line access and user download to "Questions and Answers About CMV Retinitis," a new counseling tool that features answers to commonly asked questions about CMV retinitis and its management.
PIV is the first multidisciplinary group of healthcare professionals dedicated to educating the medical community, and people with HIV/AIDS, about cytomegalovirus (CMV) retinitis and other ocular manifestations of AIDS. The partnership is funded by an unrestricted educational grant from Gilead Sciences, Inc., of Foster City, California.
For additional information, visit the PIV web site at http://www.piv.org, or call the PIV toll-free number at (800) 981-9402.
Reuters restricts access to AIDS articles
Reuters Health Information Service, an international news agency which has been a main source of current AIDS treatment information for people with HIV and their medical providers, has announced that it will no longer allow free access to its daily news feed for AEGIS, the nation's largest e-mail AIDS information service.
AEGIS (AIDS Education Global Information Service) was given permission several years ago by Reuters to re-distribute the news agency's AIDS-related news articles on a daily basis to thousands of people on its free e-mail address list, on its bulletin board, and through a web site. Researchers, advocates and individual people living with HIV/AIDS have utilized AEGIS for almost ten years to access full-length reports on research studies and other medical and political AIDS news. Reuters reports have been highly valued by individual PWAs who are unable to gain access to medical journals or who are intimidated by the technical jargon of many journal articles.
Sister Mary Elizabeth, a Roman Catholic nun who has managed the AEGIS service since its beginnings in the late 1980s, said that Reuters has informed her that it will charge a fee for use of the articles amounting to $1500 per month for three articles a day. AEGIS cannot afford the fee, she said.
Internet-connected AIDS activists have been conducting an email campaign to Reuters asking that the reconsider their decision.
Ted Kirk, a We The People board member and former co-chair of the Philadelphia HIV Commission, wrote Reuters that "As a person living with AIDS, I am distressed your organization has decided to withdrawal its support of the AIDS pandemic by not allowing any AIDS information to be transmitted via its feed. The millions of people who rely on vital information about treatment and consumer groups throughout the world is needed. Your service provided that link. Since your removal of the service - and the absence of an explanation -- leads me only to be what already been said so many time about corporations. You simply don't care enough even to transmit information which can help save lives!"
"How can a few extra seconds of transmission time compare to the thousands of lives that may be helped by doctors throughout the world who had access to AEGIS. Many, many consumer groups will lose touch with what is happening to each other without AEGIS -- in my mind the balance of these vital issues and lives does 'cost' the few seconds it must take to transmit. Your decision is cold and callous."
Kiyoshi Kuromiya, director of the Critical Path AIDS Project, the Philadelphia-based Internet AIDS information service, told Reuters that "Many of the people (and organizations) who read and use this information are on disability or serve persons with limited incomes and have no way of accessing potentially life-saving information other than through Sister Mary Elizabeth's service. You do a great disservice to our community of desperately ill persons who need this fast breaking information on research and treatments. Reuters New Media's image and standing in the general public is damaged severely by this ill-considered decision and things will get much worse if you persist in this indefensible business decision. You have nothing to lose and much to gain restoring this public service."
Marijuana may reduce immunity
The major active ingredient in marijuana may reduce resistance to infection, according to laboratory studies.
Experiments with mice reveal that exposure to marijuana's psychoactive component, THC (tetrahydrocannabinol), increased the animals' susceptibility to the bacteria that causes Legionnaire's disease.
Artificial THC likewise decreased the animals' immunity to infection. The artificial form of THC is sometimes used as an alternative to marijuana.
For 10 years, University of South Florida researchers in Tampa, headed by Dr. Herman Friedman, chairman of medical microbiology and immunology, have been investigating marijuana's effects on the immune system. Recently, their government-funded studies have focused on determining the molecular basis for these effects.
"We learned that THC increases the susceptibility of mice to an opportunistic bacterial infection that a normal, healthy person would resist," Friedman adds. "This Legionella organism causes major infections in people whose immunity (is) compromised, including people with AIDS, older individuals, and people being treated with chemicals to prevent organ graft (transplant) rejection."
In the experiments, mice infected with a dose of Legionella that their immune systems would ordinarily defeat became susceptible to infection when also treated with THC. The animals also developed increased tissue levels of cytokines -- molecules that promote inflammation. The mice also showed decreased T-cell activity -- cells that play an important role in the immune response.
But mice treated with marijuana's non-psychoactive cannabinoids (cannabidiol or cannabinol) prior to being exposed to low-doses of Legionella did not show similar susceptibility to the infection. And when given these marijuana components at three to four times the concentration of THC, mice "showed only slight or insignificant enhancement of susceptibility to Legionella," Friedman says.
The researcher notes that both THC and its synthetic version produced high levels of pro-inflammatory cytokines, "but the non-psychoactive cannabinoids did not."
Friedman says the findings offer new insight into how marijuana may depress the immune system, and may have implications for marijuana use by people whose immune systems are already compromised.
Meanwhile, Drs. Eric A. Voth and Richard H. Schwartz of The International Drug Strategy Institute in Topeka, Kansas, and the Fairfax Hospital in Falls Church, Virginia, report that evidence supports the selective use of pure THC preparations to treat nausea associated with cancer chemotherapy and to stimulate appetite.
In their review of research published between 1975 and 1996, the investigators found that both purified THC and marijuana have toxic effects, especially after long-term use. However, they did not determine if the adverse effects were stronger, or more serious, in patients treated with pure THC compared with those treated with marijuana.
There was no evidence in support of using crude marijuana in place of THC, since purified THC is already available as a prescription medication, according to the authors. Further, Drs. Voth and Schwartz conclude that crude marijuana does not qualify as a medicine and remains a controlled Schedule I drug.
Richman aide guilty of race bias
Richard Scott, chief of staff to Health Commissioner Estelle Richman, has been found guilty in federal court of racial discrimination in his treatment of four African American employee's of the city's AIDS Activities Coordinating Office (AACO) while he was director of the agency.
Scott, who also chairs the board of directors of Thrift for AIDS, was AACO director for eighteen months in 1993 and 1994. He was promoted to the position of chief of staff in late 1994 by Richman, after months of complaints by minority AIDS organization that he was resistant to supporting AIDS efforts in communities of color. Richman moved Scott out of the AACO post when an AACO staffer inadvertently released the names and HIV status of members of the city's HIV prevention planning group at a public meeting in late 1994.
The all-white jury said that Scott discriminated against James Roberts, Linda Robb, Valorie Burks and Terrance Young in a re-structuring of AACO which reduced their responsibilities and shifted them to lesser-qualified whites. Roberts, who is now executive director of the Minority AIDS Project of Philadelphia, had been director of AIDS education for AACO; Robb, who has since transferred to another health department agency, was director of AACO's Agency Services Unit. Young and Burks were program analysts responsible for supervising various city AIDS contracts; Burks remains at AACO while Young has transferred to the Office of Maternal and Child Health.
U.S. District Court Judge Louis Bechtle had previously removed the city as a defendant in the case, ruling out the possibility that the plaintiffs could be returned to their former positions or receive back pay. The jury was restricted to awarding punitive damages to Scott, ruling that he must pay the four plaintiffs $26,000. Five other claims of discrimination by Scott leveled by other AACO staff were dismissed.
Bechtle also refused to allow testimony regarding other complaints about racial bias by Scott in his supervision of AIDS funding awarded by the city during his term as director.
Richman told the Philadelphia Inquirer that she was "disappointed" in the verdict and relieved that "only nominal damages were awarded by the jury." Richman testified during the trial on Scott's behalf, saying that the personnel changes were based on strengthening its performance rather than for personal or racially-motivated reasons. She had no comment to the media on whether the federal finding would impact on Scott's position as her chief of staff.
Court records indicate that Scott has served as chief of staff in an "acting" capacity for over two years, while continuing to formally be listed in the city civil service registry as AACO director. Scott is paid $74,000 a year in the new post.
Kevin Feeley, spokesman for Mayor Rendell, said that no disciplinary action was planned as a result of the verdict. He told the Daily News that the city was "disappointed that this split decision came down showing that there was a conclusion that there was discrimination. We don't believe that that occurred or that it is a fair conclusion to draw from the facts of the case."
Meanwhile, City Councilman Michael Nutter has criticized the city for refusing to hold Scott accountable for his actions while AACO director, calling it a "knee-jerk reaction of defending Mr. Scott," according to the Daily News. "It seems to me that when an all-white federal jury find for African American plaintiffs against a white defendant, then the evidence must have been compelling."
"I think there's personal damage to the credibility of the person and if no action is taken from a disciplinary nature, then the verdict also impacts on the agency."
Boardman, the plaintiff's attorney, called the verdict "a total victory." He said, "one of the highest-ranking city Health Department officials was convicted of bring a racist...A convicted racist should not have any authority over the public health of African American citizens."
Both sides in the court case estimate their legal costs associated with the case at over $300,000 each. Clifford Boardman, attorney for the plaintiffs, told the Philadelphia Daily News that he intends to sue again to recover legal expenses. The city is expected to cover the costs of Scott's defense.
Scott's legal troubles don't end with this verdict. Another former AACO staffer, Cecil Hankins, has also filed suit in federal court saying that Scott and former health commissioner Robert Ross violated civil service rules in evaluating his own application to be AACO director before Scott was appointed. The Hankins case is expected to go to trial in late June.
Law Project sets insurance workshops
The AIDS Law Project of Pennsylvania has scheduled two insurance seminars for Wednesday, June 11th, to answer questions from people living with HIV/AIDS and their friends and families about health insurance, COBRA benefits, life insurance, and Social Security.
The daytime session of the workshop will be held from 11 a.m. to 1 p.m., and the evening version from 6 p.m. to 8 p.m. Both seminars will be held at the Law Project's Philadelphia office, 1211 Chestnut Street, Suite 1200.
To register or to obtain further information, call 215-587-9377.
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