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Issue #137: August 10, 1997
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 Boston Globe, Journal of Infectious Diseases, Au Courant.
PWA survey says housing, money remain unmet needs; 40% aren't using protease drugs
Mass. drops need for Medicaid referrals
HealthChoices consumer group to meet
Study questions use of Ritonavir and Crixivan together
HIV Commission seeks planning manager
40% aren't using protease drugs
PWA survey says housing, money remain top priority
A survey of over 1000 people living with HIV disease who are receiving services from the regional AIDS service system says that 1 in 4 of them are unable to obtain the housing they need, and 3 in 10 need emergency financial help they can't get.
The survey also showed that almost 40% of those surveyed are not using protease inhibitors, the drugs which have been credited with extending the lives of thousands of people with AIDS.
The survey was conducted by Basile, Ryan, a Washington AIDS consulting firm, for the Philadelphia HIV Commission, the regional planning body for the allocation of federal AIDS funding. A draft of Basile's initial analysis of the survey data has been presented at several meetings of the HIV Commission over the past few weeks. Further analysis is planned for the final document.
Commission members intend to use the document to help them establish priorities for federal AIDS funding in the coming year.
The written survey was completed by 1069 individuals, almost three times more than originally projected. The sample completing the survey was comprised of 46% African Americans, 16% Latinos, and 38% whites, and about 30% of those responding were women. Official federal estimates of HIV prevalence in Philadelphia say that 61% of those living with HIV/AIDS in the region are African American, 10% Latino, 28% white, and 19% women.
About 38% of the respondents lived in suburban Philadelphia counties, compared to an estimated HIV prevalence in those areas of 29%.
The consultants noted that since respondents received their surveys at locations where AIDS services are provided, it is likely that the needs of people who are not presently served by the AIDS system may not be reflected in the results.
Other significant indications of the results included a finding that 33% of those surveyed did not know their viral load, a basic indicator of HIV progression, including 8% who didn't even know what the term meant. Thirty-eight percent said they were not using protease inhibitors, although some of this number likely includes recently infected individuals who may have access to the drugs but do not choose to take them.
A large majority (76%) of the respondents were either dependent on publicly funded health insurance (Medicaid, Medicare), including 12% who had no insurance at all. Twenty-four percent were on private insurance.
Most respondents (68%) listed AIDS case management as a primary need, while only 9% said they were not using a case manager. Only 47% said that housing was a need for them, while fully 25% said they needed housing and were not able to get it, and 27% said that they had had problems obtaining housing services.
Similarly, in the area of emergency financial assistance, 55% said it was a need for them, and 29% said they could not get the service.
All of the respondents who identified primary health care as a need were able to obtain the service, although 13% said they had difficulty accessing care. Dental care was an exception to this rule: 64% said it was a need, and 20% said they needed the service but can't access it.
The survey indicated that people of color were less likely to know their CD4 counts or viral loads than were whites. Fourteen percent of African Americans and 10% of Latinos did not know their CD4 counts, as opposed to only 4% of whites; 11% of African Americans and 9% of Latinos did not know their viral loads, compared to 3% for whites.
Men who have sex with men were also more likely to know their viral load (77%) versus those who were probably infected through drug use (62%) or heterosexual sex (60%).
Only 56% of African Americans and Latinos reported using protease inhibitors, compared to 71% of whites. This result may be related to the reduction in death rates among people with AIDS in Philadelphia, which shows that deaths rates are dropping among whites at three times the rate they are among blacks.
The study also noted that almost 75% of people of color with HIV/AIDS are on Medicaid or Medicare, while 50% of whites are on public insurance. Among the uninsured, however, there was no difference among the races -- 11% of each racial group reported having no insurance.
Women were also more likely to be on public insurance than men, with 80% of women on public insurance compared to 58% of men.
As would be expected, people with no insurance were more likely to not be using protease inhibitors (49%), compared to over 70% of privately insured people.
The survey also confirmed the belief of those who have claimed that African Americans and Latinos have more difficulty obtaining AIDS services than do whites. In 21 of 25 service categories, a greater percentage of African Americans reported needing services as compared to whites, while Latinos reported needed more services than whites in 20 of 25 categories.
Mass. drops need for Medicaid referrals
In response to a class action suit and concerns about denied services, the Massachusetts Division of Medical Assistance has suspended the requirement that disabled Medicaid recipients and children get approval in advance for therapy and home health services.The controversy which led to the decision mirrors that in Pennsylvania, where many people with HIV/AIDS and other disabled people have complained that they cannot access primary care or home health services because their Medicaid HMOs won't give the prior approval required.
Sharon Torgerson, spokesperson for the medical assistance office, said the "suspension means that disabled recipients who had been denied the services under the April 1 requirement will not have to appeal the denial." She said the decision also means that recipients will not have to receive prior approval from providers for therapy or home health services. Her office has sent out a mass mailing to inform recipients of the change. Laurie Martinelli, executive director of Health Law Advocates, said the reversal "affects an estimated 300 to 500 disabled children in the state's CommonHealth program, an insurance program available to families whose income exceeds Medicaid limits, and hundreds more disabled Medicaid recipients." She said, "We think this is a tremendous victory."
HealthChoices consumer group to meet
The HealthChoices Consumer Advisory Committee, an ad hoc group convened to provide an opportunity for people living with HIV/AIDS to consult with the management of the four Medicaid manager care companies, will meet this coming Friday, August 15th, from 1:00 to 3:00 p.m. at the Philadelphia HIV Commission, 123 South Broad Street, Room 2234.The committee has held four previous meetings with the managed care companies, which have also been attended by representatives of the federal Health Care Financing Administration, which oversees the state program, the Dept. of Public Welfare, which contracts with the companies, and Benova, which is responsible for enrollment in the plans.
For more information, contact Mark Davis at 546-0300, ext. 3644.
Study questions use of Ritonavir and Crixivan together
The findings of in vitro studies indicate that simultaneous administration of saquinavir and indinavir results in "antagonism," according to a multicenter group.The analysis raises questions concerning whether increased antiviral effect can be achieved by the addition of saquinavir to indinavir. It is possible, researchers said, that this drug combination may lead to cross-resistance and increased toxicity. Although the findings do not rule out the use of saquinavir and indinavir together in patients, the in vitro antagonism indicates "...that combining these agents provides antiviral activity less than one would expect were they additive."
Dr. Martin S. Hirsch of Massachusetts General Hospital in Boston and colleagues noted that antagonism between the two drugs appeared to be greater as drug concentrations increased. This is a concern, they point out, because " ... the achievement of higher inhibitory concentrations ... is increasingly the aim of antiretroviral therapy."
HIV Commission seeks planning manager
The Philadelphia HIV Commission is looking for a senior planner to develop, implement and administer regional planning processes for the Philadelphia Unified Planning Team for HIV/AIDS prevention and care services. Responsibilities include designing and conducting surveys, focus groups, and needs assessments; leading in the preparation and revision of the annual Comprehensive HIV Services Plan; and coordinating regional planning group activities.Required qualifications for the position include a Master's degree, (Ph.D. preferred), in public health or administration, with an emphasis on planning. A minimum of three years management experience in public health planning, policy development, and HIV/AIDS services is desired. The position requires excellent analytical, organizational, managerial, writing and speaking (English) skills, and facility with Spanish and Asian language(s) is helpful. The Commission is also looking for someone with "outstanding interpersonal skills and demonstrated sensitivity to diverse communities."
To apply, a letter and resume should be sent to The Philadelphia HIV Commission, 123 South Broad Street, 22nd Floor, Philadelphia, PA 19109.
Meanwhile, the Commission has announced the hiring of an interim Commission Manager, to provide general oversight of its activities until a permanent manager is hired. The temporary position is held by Christopher Bates, the former executive director of the Washington D.C. CARE Consortium, where he managed $5.7 million in Title II Ryan White funding for the city. Bates had held that position since 1991.
Bates is also a founding member of the Gay and Lesbian Anti-Violence Task Force and past treasurer of the D.C. Coalition of Black Gays and Lesbians, and he served on Washington's Title I planning council for six years.
Bates is a native Philadelphians, leaving the city after junior high school.
He replaces Sonia Hunt Gray, who resigned from the manager position several months ago.
ODAAT bans Alive & Kicking!
One Day At A Time, the city's largest network of recovery houses, has banned the distribution of We The People's monthly newsletter, Alive & Kicking!, at its residences and drop-in centers in North, West, and Northwest Philadelphia.Alive & Kicking! is distributed at over 100 sites throughout the region on a monthly basis, in addition to being mailed to almost 5000 subscribers.
Curtis Osborne, executive director of We The People, said that the ban was probably related to A&K!'s report in the August issue which described efforts by the Philadelphia EMA HIV African American Planning Group (PEHAAP) to gain control over almost $4 million utilized by African American AIDS service organizations.
City health commissioner Estelle Richman has "suspended" an earlier plan to divert $200,000 in AIDS funding to PEHAAP to help it with its planning activities and in directing the Minority AIDS Project of Philadelphia (MAPP). Most, but not all, of MAPP member agencies have opposed the funding of PEHAAP and have threatened to pull out of MAPP if Richman goes forward with the plan.
The decision to prevent the distribution of Alive & Kicking! is the second time that an organization has tried to prevent its clients from reading the region's only PWA newspaper. In 1993, then-ActionAIDS executive director Ennes Littrell threw almost 100 issues of A&K! in the trash because it included excerpts of a letter she had written to federal officials opposing the funding of minority AIDS organizations.
Osborne said he was not surprised at ODAAT's action, since it is the only organization which provides AIDS services which has supported PEHAAP's efforts. He blamed ODAAT executive director Steve Pina for the decision. "Steve Pina has made a career of degrading people in recovery and people with AIDS," Osborne said. "It's no surprise to be that he wants to keep them from learning the truth about the PEHAAP scam. We all have known for many years that ODAAT just thinks of its PWA residents as a tool they can use to beat up on the system for more money -- and rarely does ODAAT bother to really educate or empower their people with AIDS to do anything except follow Pina like sheep to the slaughter."
Two months ago, Pina told a meeting of the HIV Commission that he would not permit ODAAT residents with HIV disease to fill out a consumer needs assessment being conducted by the Philadelphia HIV Commission to determine the needs of people living with HIV/AIDS.
ODAAT has been severely criticized in the past for requiring its members to participate in meetings, hearings and demonstrations as a condition of keeping their residence in the program. Others have charged that ODAAT has turned out people who do not have HIV infection to events and claimed that they were suffering from the disease. Still others say that ODAAT rarely informs its residents with HIV on the issues which affect them, and tells them to keep silent at meetings and demonstrations and let Pina and other ODAAT staff do the talking.
Osborne said that We The People would continue to send the organization's newsletter to ODAAT sites, and re-distribute them to other sites if they continue to be refused.
Rally demands Scott ouster
About 150 people, chanting "Bye-bye time for bigots!", demanded the termination of former city AIDS director Richard Scott last week in a raucous rally which traveled from the Health Commissioner's office to the Mayor's office.The demonstration was organized by ACT UP/Philadelphia and supported by African-American activists from One Day At A Time (ODAAT), Blacks Educating Blacks About Sexual Health Issues (BEBASHI), We The People and other AIDS and health services organizations.
Scott was found to have discriminated against four African American employees in the AIDS office by an all-white federal jury several months ago. Eight had sued Scott and the city, and four cases were resolved in Scott's favor while he was found liable for four others.
Scott was appointed at chief of staff to Health Commissioner Estelle Richman after earlier protests over his handling of the city's AIDS office from the African American community. Health department spokesman Jeff Moran has announced that Richman has since re-assigned Scott once again, to "special projects." He continues to draw his $72,000 annual salary.
"The city keeps saying that because he was not found guilty in four cases, everything's okay," said Tyrone Smith, executive director of Unity, Inc., a black gay AIDS group. "But being found as a racist in four cases is enough to still be a racist."
"To those of us living with this disease every day, especially people of color, most issues are simple. You either are helping us to stay alive or you're not," Curtis Osborne, executive director of We The People, told the crowd outside the commissioner's office at 16th and Arch Streets.
"The man we are here to talk about today, Richard Scott, has clearly shown throughout his history as a public official that he is not on our side. He's fought to keep minority AIDS organizations from getting the resources they need, so that he could make it possible for his friends and allies to make more money. He's tried to cut funding for AIDS prevention in minority communities. He's played games with the city's rules and regulations so that he could punish people of color and benefit his own friends. And he's been found guilty, by an all-white jury in a U.S. federal court, of being a racist."
Osborne continued, "We have deep respect for health commissioner Richman, but she's wrong if she thinks it's just politics that leads us to demand that Richard Scott be removed from his position as chief of staff of the health department. Richard Scott stands against the very things which Estelle Richman and Mayor Rendell say they believe in. They need to have the moral courage to tell him he doesn't belong here any more. They need to have the moral courage to let us know, who's side they are really on."
The protesters pasted stickers reading "WHITES ONLY By Order of Richard Scott, Chief of Staff Phila. Health Dept." on buildings, signs and city automobiles over a six-block area during the demonstration.
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