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Issue #153: November 30, 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 Clinical Infectious Diseases, Housing Works, Reuters, Sexually Transmitted Diseases.
Changes recommended for emergency needs funds
Court restrains NY AIDS housing cuts
UN doubles estimate of AIDS cases
Penn data challenges AZT use for KS
CMV acquired sexually by HIV+ men
Changes recommended for emergency needs funds
The Philadelphia HIV Commission's Housing Committee has issued new recommendations for the management of emergency needs funds for people living with HIV/AIDS in the region.The recommendations were developed at the request of the Commission's Care Committee, which is responsible for giving direction to the city's AIDS Activities Coordinating Office (AACO) on principles and procedures for allocations of federal Ryan White CARE Act Title I funding. The committee has also asked the city's Office of Housing and Community Development (OHCD) and The Philadelphia AIDS Consortium (TPAC) to consider the recommendations. OHCD manages emergency needs funding provided under the Housing Opportunities for People with AIDS (HOPWA) program, and TPAC manages Ryan White CARE Act Title II funding.
The recommendations were developed through a process led by David Fair, who developed the emergency financial assistance program for people with HIV/AIDS in 1994 and until recently served as the Housing Committee's acting co-chair. Fair created the LifeSavers Emergency Fund, the largest direct financial assistance program in the region, which allocates over $250,000 in such funds annually.
The committee's recommendations were based on two discussions sponsored by the committee and the recommendations of the Philadelphia EMA AIDS Housing Needs Assessment, which Fair and others prepared in 1996.
The committee commended recent efforts by the three funders to better coordinate what are called "direct emergency assistance" programs over the past year, noting that the groups have developed a common application form, improved provider understanding of eligibility requirements, and enhanced communication and collaboration between and among the various agencies providing direct emergency financial assistance. It recommended that "routine" meetings of all emergency assistance providers "should be convened on at least a quarterly basis to discuss issues, encourage collaboration, and address problems which may arise from time to time in the implementation of these programs." The Housing Committee volunteered to act as convener of these meetings if requested.
The recommendations said that it is important for funders to "approach the provision of emergency assistance as a 'system' which is an essential component of the HIV/AIDS continuum of care in the region, rather than as distinct programs of particular providers. All providers of these services should follow the same procedures and have the same rules for access, eligibility, and allowable funding." The committee said that greater efforts need to be made to assure that applicants are aware of which agencies can provide emergency financial assistance and that any PWA can apply to any of the agencies for help, whether or not they are clients of the agency.
The committee also recommended that the funders should investigate the feasibility of establishing a central database for emergency financial assistance information, to assure that eligibility procedures are implemented responsibly, limit the potential for abuse of the services, and garner ongoing and critical information for the evaluation and improvement of the programs.
The committee also noted that not all agencies participating in the system of emergency financial assistance are following the same rules and procedures with regard to determining eligibility or the maximum amount of assistance available. It said that "unnecessarily conflicting rules: apply between Ryan White and HOPWA funders with regard to how many applications an individual consumer may make for emergency assistance under their programs and the maximum amount available during a specific time period.
"The Committee believes that these variations result in confusion and are themselves an access barrier for consumers requiring this assistance, making it unnecessarily difficult and more complicated for a consumer to access these services in an emergency situation and for providers to respond to their need," the report said.
The committee recommended that all agencies providing emergency financial assistance, regardless of funding source, should allow the same maximum amount of assistance available from the funding source. At the present time, this maximum is $750.00 per year. "No agency or contract should permit setting a maximum available amount of assistance for consumers applying to that agency which is lower than that allowed by the funder for other agencies or consumers." At least one agency, Congreso, has limited its emergency grants to $500 per year, in order to be able to provide more grants and serve more clients.
The committee recommended that a process for evaluating "actual utilization of emergency assistance programs, and data on needs unmet through current regulations and procedures" needs to be developed to determine what the formal maximum grant amount should be.
The report also said that while Ryan White-funded emergency assistance established a maximum amount available throughout a contract year, regardless of the number of times a consumer may apply, HOPWA-funded emergency assistance, while allowing the same maximum total amount, allows only one application per consumer per contract year. "These conflicting regulations," the committee noted, "are unnecessary and increase complexity for both consumers and providers in meeting emergency needs.
"Implementation of these conflicting requirements has, in practice, become an access barrier for consumers needing these services and providers seeking to meet their need," the report said.
The committee recommended that the provision of HOPWA emergency assistance funds limiting the right of a consumer to only one application per year, regardless of amount, should be removed immediately. "Consumers applying for HOPWA emergency assistance should be permitted to apply for these funds as often as necessary, and to receive the maximum amount allowable per individual per contract year," the report said.
The committee also reviewed reports from agencies providing emergency financial assistance that their ability to respond on an emergency basis to requests for assistance is significantly hampered by delays in reimbursements from funders for these expenses. It said that special procedures for assuring adequate cash flow in the system of emergency financial assistance are required to assure that this service meets its objectives and is truly responsive to the emergency needs of consumers. "Unlike other publicly-funded HIV/AIDS services, most (but obviously not all of which are personnel-related), the service provided in this category is money, and because of the nature of this service, extraordinary attention to assure that the service is actually available when needed is required of both funders and agencies."
In other business, the Housing Committee elected two formal co-chairs at its meeting of November 25th, after operating for most of the past year with acting chairs. Zahira Soto, an AIDS educator from Congreso, and Albert Barrett, former Member Services Director at We The People -- both people living with HIV -- were elected at the meeting. Their election represents the first time that the committee, which had its origins in the AIDS Housing Task Force, which provided oversight to AIDS housing programs from 1992 to 1996, has been led by two consumer representatives.
Court restrains NY AIDS housing cuts
New York State Supreme Court Justice Emily Jane Goodman has granted a temporary restraining order compelling New York City's Human Resources Administration (HRA) to stop damaging housing programs operated by Housing Works, New York's largest provider of AIDS housing services, and to restore benefits lost by program residents as a result of the city's actions.
Under the terms of the order, HRA must pay rents necessary to prevent evictions from Housing Works' AIDS Scattered Site Housing Program, stop interfering with Housing Works' leases with landlords, and to immediately restore food stamps to Housing Works' residents who lost them as a consequence of HRA's tortious interference.
Housing Works, Inc., together with persons with HIV/AIDS housed by the group, has filed a class action suit against the HRA, charging that the Republican Mayor Rudy Giuliani, who has frequently condemned the group's advocacy efforts, "is engaged in a conspiracy to strip Housing Works of apartment leases that are for housing people with AIDS."
The plaintiffs seek an injunction to prevent eviction and require the City to restore rent benefits and food stamps that the City's actions have denied to sick and disabled people with AIDS.
For over six years, Housing Works has leased apartments as part of a city contract to house people with HIV and AIDS, and now holds leases on 180 apartments under this program. Giuliani let the contract lapse last June 30, even while personnel from the HRA repeatedly promised to extend the contract and reimburse Housing Works for rents as they came due, according to the organization.
"These misleading promises were part of a calculated and orchestrated attack on Housing Works," the group said in a statement. Housing Works said that the actions put the organization into default on its rents. The group said that HRA had also been "falsely informing clients that Housing Works was abandoning the program and their apartment leases."
Housing Works' Co-Executive Director, Charles King, said, "They can't shut us up, so they are trying to shut us down." He dismissed any suggestion that the organization would moderate its activist political stance.
Richard Emery, the organization's attorney, said that "The high-handed machinations of the Giuliani Administration are trampling on the well-established rights of this humanitarian non-profit organization and people with AIDS. The people are threatened with living in the streets. Once again, in order to force the Mayor to uphold the law, citizens have to go to Court."
The lawsuit seeks immediate restoration of clients' benefits, payment of rental arrears to prevent the eviction of the persons with HIV/AIDS and their families housed in the program, and other injunctive relief, as well as damages for "past, current, and continuing civil rights violations, fraud, tortious interference with contractual relations and contractual performance, promissory estoppel, breach of contract, and unjust enrichment." In addition to the City of New York and the Human Resources Administration, defendants named in the suit are HRA Commissioner Lilliam Barrios-Paoli and Deputy Commissioner Gregory Caldwell.
King noted that this summer, ACORN, another non-profit organization that has protested the Mayor's workfare and housing policies, was removed from two multimillion dollar housing development projects. "The Giuliani Administration's willingness to punish its critics financially is proving to be effective. Fewer non-profit agencies with City contracts are now willing to engage in strong advocacy or openly support the Mayor's targets."
Housing Works, Inc. was founded in 1990, and in seven years has become the nation's largest minority-led, not-for-profit provider of housing, supportive services and advocacy for homeless and formerly homeless people with HIV and AIDS. Housing Works currently provides supportive housing to over 1,000 women, men and children living with HIV and AIDS in New York City, and provides a range of supportive services to over 5,000 people living with HIV and AIDS.
UN doubles estimate of AIDS cases
AIDS cases soared worldwide to 30 million adults and children in 1997 with researchers saying they had grossly underestimated the rate of infection, now at about 16,000 a day.The sharp climb -- from 22.6 million people in 1996 -- is due to new methods of collecting data as well as an actual 19 percent increase in the results, said a report by UNAIDS, a joint program of U.N. specialized agencies, released in November.
But the increase, the survey said, is still 19 percent in 1997 over 1996 for all people infected with HIV or AIDS, even when the new reporting methods are taken into account.
"We are now realizing that rates of HIV transmission have been grossly underestimated -- particularly in sub-Saharan Africa, where the bulk of infections have been concentrated," said Dr Peter Piot, executive director of UNAIDS.
"If current transmission rates hold steady, by the year 2000, the number of people living with HIV or AIDS will soar to 40 million," he said.
In 1997 alone, people who became infected for the first time swelled from 3.1 million children and adults to 5.8 million, an actual increase of 9 percent, according to the new estimates.
The report said that some 2.3 million people died of AIDS in 1997 -- a 50 percent increase over 1996. Nearly half those deaths were women and 460,000 were children under 15. For children, the report estimates that 1,600 under 15 are infected with HIV every day compared to 1,000 children a day last year.
The new figures show that the number of people estimated to be living with HIV or AIDS include 20.6 million in sub-Saharan Africa, 6 million in South and Southeast Asia and 1.3 million in Latin America and 530,000 in Western Europe.
The worst affected is sub-Sahara Africa where HIV cases increased by an alarming 7.4 percent among people between 15 and 49 years of age.
In contrast the rate of new AIDS cases is expected to drop about 30 percent in Western Europe in 1997, with only Portugal and Greece still showing substantial rises.
And new figures from the United States indicate the rate of AIDS will drop by 11 percent in 1997 after decreasing 6 percent last year.
The survey, however, still pointed to many countries in the world where reporting was faulty or non-existent, making it unclear how long the new estimates would be valid.
Among the 30 million people currently living with HIV, most of them have no idea they are infected, particularly in the developing world where the epidemic is concentrated.
HIV testing in many countries is done mostly for purposes of surveillance rather than treatment, which is scarce. Few people have any hope of treatment, so they feel little incentive to get tested, the report said.
Southern African continues to be the worst affected area. South Africa estimated 2.4 million of its citizens were living with HIV. Botswana figures have doubled and Zimbabwe estimates the infection as high as one in every five adults.
Uganda, the first country in Africa to institute a far-reaching AIDS prevention program, has shown some results with rates dropping about a fifth in 1997 compared to the previous year, particularly among younger age groups practicing safer sex.
Penn data challenges AZT use for KS
Although the results of randomized trials indicate that AZT (zidovudine, Retrovir) may prevent Kaposi's sarcoma (KS) in people with AIDS, new data reported in the November issue of the journal Clinical Infectious Diseases suggests this may not be the case.Dr. Marshall M. Joffe of the University of Pennsylvania School of Medicine in Philadelphia and colleagues there and elsewhere used data collected in the Multicenter AIDS Cohort Study (MACS) to examine the effects of AZT use on the subsequent incidence of KS.
In reviewing data collected on almost 5,000 men enrolled in MACS, the researchers found that "...Zidovudine use has little effect on the incidence of KS." This finding contrasts with reports from clinical trials indicating that zidovudine may reduce the incidence by approximately one-third. Dr. Joffe and others suggest that these trials were limited by low statistical power and heterogeneity, and that their positive findings may be due to chance.
The authors note that the new data are not necessarily inconsistent with prior reports, but that "...there is room for further work."
CMV acquired sexually by HIV+ men
New data underscore the importance of sexual factors in the acquisition of cytomegalovirus (CMV) infection in HIV-infected men.Although the sexual route of transmission of CMV has been well-characterized in HIV-positive women, the importance of sexual factors in the transmission of CMV in HIV-infected men is poorly documented. To remedy this inconsistency, researchers in France tested a prospective cohort of 723 HIV-infected men for CMV-seropositivity, and compared these results with a survey of prediagnosis sexual behaviors.
Dr. Nicolas Carre of the Hopital du Kremlin-Bicetre and colleagues there and elsewhere report in the November issue of Sexually Transmitted Diseases that "...several factors linked to sexual behavior, especially routine condom use, were related to the presence of CMV antibodies..." in this cohort.
For example, age, homosexuality, history of sexually transmitted diseases, and multiple sexual partners were all significantly positively correlated with CMV seropositivity. On the other hand, reports of routine condom use during the 6 months prior to HIV diagnosis were associated with a 60% reduced risk of seropositivity; occasional condom use reduced the risk by 50%, although this association was of "borderline significance."
The French team concludes that CMV appears to be "...mainly acquired through sexual contacts in HIV-seropositive men." Therefore, "[s]exually active, HIV-seropositive people not infected with CMV would be well advised to use condoms systematically to reduce the risk of potentially sight- and life-threatening CMV diseases."
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