|
 |
|
|
|
Issue #171: April 5, 1998
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, Nature Medicine and Reuters.Region nears 15,000th AIDS case
Supreme Court debates HIV disability
Clinton AIDS advisors make demand Shalala's resignation
ACT UP seeks volunteers to DC lobby day
Region nears 15,000th AIDS case
The Philadelphia metropolitan area will reach a tragic milestone sometime over the next few months -- its 15,000th report of a diagnosis of AIDS.Since 1981, 14,586 residents of the Philadelphia region have been formally diagnosed with AIDS. Slightly over seven in ten of these people live in the city, with the remainder distributed among the four suburban Pennsylvania counties surrounding Philadelphia and four southern New Jersey counties.
Almost 1600 people were diagnosed with AIDS in 1997 alone. If the rate of diagnoses continues through this year, this would indicate that the 15,000th case will probably be reported sometime this spring.
The AIDS data, contained in a quarterly report issued in March by the city's AIDS Activities Coordinating Office (AACO), shows that almost 90% of AIDS cases in the region are centered in the region's urban centers -- Philadelphia, Camden and the city of Chester in Delaware County -- and usually in neighborhoods that are predominately African American or Latino.
The AACO report also indicates that most AIDS diagnoses are being determined on the basis of low CD4 blood counts alone, and that a declining number of people are being diagnosed as a result of one of the major marker illnesses related to HIV infection, such as pneumocystis carinii pneumonia (PCP) or wasting syndrome. While about one in four diagnoses was related to PCP in the first fifteen years of the epidemic, only 13% of cases diagnosed over the last twelve months were PCP-related. The change is significant, indicating that while the number of actual AIDS cases continue to rise, the general health of those being diagnosed may be improving.
In analyzing data on Philadelphia city AIDS cases, AACO reported that the number of women contracting AIDS continues to rise in comparison to male cases. While only 16% of all cases reported since 1981 are among women, in 1997 alone, the percentage of women jumped to 24%. Similarly, the concentration of new AIDS cases continues to be centered in the city's communities of color, with almost 80% of all cases reported in 1997 having occurred among people of color.
According to the AACO report, 68% of 1997 cases were among African Americans and 11% were Latino. Only 2 new cases were reported in the Asian and Pacific Islander community, which has suffered only 26 reported cases over the past sixteen years, according to the AACO data.
The city has seen 156 diagnoses of AIDS among children under 13 since 1981, with eighteen reported in the last year. Over 91% of pediatric AIDS cases have occurred among African Americans and Latinos. The largest proportion of AIDS cases have been reported among those in the 30-49 age group (69.8%), with about 18% among those between 20-29 and 10% among those 50 or older.
Among adolescents (13-19), 54 have been diagnosed with AIDS since reporting began in 1981, with only five new cases in 1997. Most teens who have been diagnosed with AIDS are male (32, or 59%), with 22, or 41%, being female. The trend indicates that younger women are contracting AIDS at a faster rate than women as a whole in the region.
The AACO report also showed that the number of AIDS cases among men who have sex with men (MSM) continues to decline as a proportion of total AIDS cases in the city, with MSM comprising only 36.5% of cases reported in 1997, as compared to 69.3% of cases in 1989.
Among gay and bisexual men, the trend toward increasing numbers of cases among African Americans and Latinos continued in 1997, as the number of new cases among white gay and bisexual men continued to decline. In 1997, 61% of sexual minority AIDS cases occurred among African Americans, Latinos or Asians, and 39% occurred among whites.
Supreme Court debates HIV disability
U.S. Supreme Court Justices on Monday questioned whether a woman should be considered as disabled because of HIV-positive status or because she was hindered from reproducing because she chose not to engage in sexual intercourse for ethical reasons.A decision is not expected until the summer. If the Justices rule in the plaintiff's favor, it could affect how physicians care for asymptomatic HIV-infected individuals. Legal experts also say that a decision that inability to reproduce is a disability could have wider implications for insurers.
The justices were considering arguments in a case brought by Sidney Abbott, who sued her dentist, Randon Bragdon. Bragdon, once informed of Abbott's HIV-positive status, said he would treat her only in a hospital setting. Abbott claimed Bragdon violated her rights under the Americans with Disabilities Act (ADA), not only because she was infected with HIV, but also because she could not engage in what she called the "...major life activity..." of reproduction.
Both the U.S. District Court and First U.S. Circuit Court of Appeals upheld Abbott's assertion that she has a physical or mental impairment, that the impairment adversely affects a major life activity, and that the impairment substantially limits her ability to engage in this life activity.
Justice David Souter seemed to agree that sexual intercourse was a major life activity. But he said a moral judgment to not infect others with HIV did not amount to having an irreversible disability. "Why is this moral condition equivalent to the physical condition?" asked Souter. Justice Antonin Scalia said he "...didn't have any problem seeing it as an impairment," but that he could not see how the impairment equated with disabilities such as inability to feed oneself or see.
Bennett Klein, an attorney with Gay & Lesbian Advocates and Defenders who represented Abbott, said the ADA implicitly includes HIV infection as a disability and that congressional drafters of the law also intended for the disease to be considered a disability. The Clinton Administration, through Deputy Solicitor General Lawrence Wallace, supported Klein's assertions, noting that ADA regulations refer to HIV disease specifically as an impairment.
Klein also said that an impairment could be considered a disability if it merely restricted or confined one's ability to engage in a major life activity. Though Abbott was not physically precluded from having intercourse, she was restricted, he argued. Klein also said the dentist was taking unreasonable precautions, given that there had been only 7 "documented" cases of HIV transmission from a patient to a health care worker, according to statistics from the Centers for Disease Control and Prevention.
The justices seemed sympathetic to that viewpoint, with several stating that seven cases out of millions of infections seemed a fairly low risk. But John McCarthy, an attorney for Bragdon, said his client did not consider it an acceptable risk when he saw Abbott in 1994.
McCarthy also argued that, when writing the American Disabilities Act, "Congress did not exclude individuals with HIV disease," but instead narrowly defined what constituted a disability. And, he said, reproduction is not a major daily life activity. And while HIV infection might be an impairment, it did not constitute a disability. "A physical or mental impairment is different from a disability," said McCarthy.
He also claimed that the case could confuse discrimination with disability, noting that Bragdon did offer Abbott care, and that she could have gone elsewhere for treatment if necessary. Chief Justice William Rehnquist agreed, stating, "...discrimination can not amount itself to a disability."
Friends of the court briefs were filed on Bragdon's behalf by the American Dental Association, the Washington-based Equal Employment Advisory Council, and Promina Northwest Health System. Similar briefs were filed on Abbott's behalf by the American Medical Association, more than 100 AIDS advocacy organizations, the Infectious Disease Society of America, the City of Los Angeles, and Sens. Tom Harkin, James Jeffords, and Edward Kennedy.
Justice Sandra Day O'Connor said she found it "curious" that the AMA and ADA were at opposite ends of the spectrum.
Protein suppresses HIV, KS
Until now, researchers have suspected that a substance secreted in the urine of pregnant females -- human chorionic gonadotropin (hCG) -- suppresses Kaposi's sarcoma, an AIDS-related skin and vascular disorder. However, a group of researchers from the Institute of Human Virology at the University of Maryland and elsewhere now report that another urinary factor, which they call hCG-associated factor (HAF), is in fact responsible for this effect. In addition, they found that HAF is also active against HIV, according to the report in the April issue of Nature Medicine.Dr. Robert Gallo and colleagues used techniques to chemically separate hCG and other compounds from the urine of pregnant women. Overall, they found that hCG was not responsible for the antiviral effect, but that there was evidence of "...an as yet unidentified hCG-associated factor (HAF)" that was active against HIV and Kaposi's sarcoma, and that promotes activities involved in bone marrow cell production, according to animal studies.
Thus far, the unknown protein has been partially purified, Gallo said, "...and I think we are getting close to identifying what the material actually is -- it's a small protein, and it's completely separable from hCG."
The finding explains why some preparations of hCG worked against Kaposi's sarcoma and some did not, he said. The anti-Kaposi's sarcoma activity is due to the small protein contaminants present in some hCG preparations, he explained.
"Once it's chemically identified and isolated in pure form, we can reproduce it by recombinant technology and make it in large amounts -- and go back to clinical work," he said. Gallo's team is collaborating closely with Dr. Steven Birken at Columbia University, New York, in purifying HAF, which they hope will be completed within 2 years.
Along with an anti-Kaposi's sarcoma effect, HAF also exhibits a potent antiviral effect against HIV. Although not as potent as protease inhibitors, HAF is nontoxic, Gallo pointed out. Studies indicate that it "...promoted growth of normal bone marrow, unlike a lot of chemotherapy and antiviral therapy."
The unknown substance also appears to suppress the growth of new blood vessels, an activity called angiogenesis that is required for the spread of many cancers.
The actual identity of these active hCG factors is still unknown, according to an editorial by Dr. David T. Scadden of the Harvard Medical School in Boston, Massachusetts.
"The undercurrents to the story thus far suggest that it will unfold with yet another surprising revelation." The addition of HAF "...to the growing number of antiangiogenic compounds will surely contribute to our understanding of angiogenesis and should be useful therapeutically for combating a broad range of malignancies," Scadden concludes.
Clinton AIDS advisors make demand Shalala's resignation
President Clinton's AIDS advisers are expected soon to consider a resolution calling for the resignation of Health and Human Services Secretary Donna Shalala amid debates over the use of federal funds for needle-exchange programs.A congressional moratorium on the use of federal funds for needle exchanges ended on Tuesday, March 31, and Shalala now has the power to decide whether federal funds can be used for the programs. Federal funds can be used as soon as she decides whether the exchange programs help prevent the spread of HIV without encouraging drug use; many scientific studies have shown the programs meet these qualifications.
The Presidential Advisory Counsel on AIDS drafted a resolution calling for Shalala's resignation due to frustration at her lack of impetus to allow the program funding; the full council will vote on the resolution next week.
Clinton's drug policy advisers have strongly opposed support for needle exchange programs.
CDC pushes rapid HIV tests
Increased use of rapid HIV tests, which can be performed within 10 minutes, could significantly increase the number of individuals who learn their HIV serostatus, according to a report by researchers at the Centers for Disease Control and Prevention.Based on this report and a workshop conducted last fall, the Public Health Services (PHS) has altered its HIV testing recommendations. It now recommends that health care providers "...provide preliminary positive test results before confirmation results are available in situations where tested persons benefit."
Publicly funded HIV counseling and testing programs test about 2.5 million of the estimated 25 million individuals tested in the US each year, according to a report in the March 27th issue of the Morbidity and Mortality Weekly Report. However, CDC officials report that in 1996, 26% of the HIV-positive individuals tested at public clinics did not return for their results.
Currently, these publicly funded programs use an antibody test followed by a confirmatory enzyme immunoassay, which often does not have results for 1 or 2 weeks. The use of rapid HIV tests would allow individuals to learn their HIV serostatus in one visit instead of two.
CDC officials used a mathematical model to estimate the number of HIV-positive individuals who would be identified if a rapid HIV test were used. Their findings indicate that the "...use of a rapid test with same-day results for HIV screening in clinical-care settings can substantially improve the delivery of CT [counseling and testing] services." For example, they found that in a 1-year period almost 700,000 additional individuals, including more than 8,000 HIV-positive individuals, would learn their serostatus if rapid testing were used. However, about 8,000 HIV-negative individuals would receive an initial false-positive test result.
The new PHS recommendations are "...based on research demonstrating that persons who receive preliminary results understand the meaning of the result and prefer rapid testing." As more rapid HIV tests become available, the PHS plans to "...re-evaluate algorithms using specific combinations of two or more rapid tests for screening and confirming HIV infection."
ACT UP seeks volunteers to DC lobby day
ACT UP Philadelphia is serving as state-wide coordinating group for AIDS Watch, the annual Spring lobby day on HIV/AIDS issues in Washington, DC.This year, AIDS Watch happens on Sunday, May 3 to Tuesday, May 5. ACT UP Philadelphia is sponsoring a day trip on Tuesday, May 5 and providing transportation from Center City, Philadelphia.
The group can also help arrange transportation for people in other parts of the state.
"We will spend the day talking to our elected officials about the need for continued funding for HIV/AIDS prevention, research and care; lifting the Federal funding ban on syringe exchange; and making research on microbicides and other novel prevention methods a NIH priority," according to Julie Davids, a spokesperson for the group.
To reserve a space, call 731-1844, box 9.
Davids said that for people interested in attending all the days of AIDS Watch, community housing may be available and national organizers have information on hotels. Sunday is a training day, and volunteers will have the opportunity for more lobbying and issue updates on Monday and Tuesday. If interested, call Jean-Michelle Brevelle at (202) 898-0414 x 103 or email "thewonks@aol.com," and say that ACT UP Philadelphia made the referral.
Information on AIDSWATCH '98
If you believe that federal government can and must do more to end the HIV epidemic...
If you believe that people living with or at risk for HIV need full access to quality prevention, care, housing, and research...
If you believe that your voice and your vision can make a difference...
You Belong at AIDSWatch '98!
May 3 - 5, 1998
Washington, DC
What is AIDSWatch '98?
AIDSWatch is the largest annual constituent-based federal HIV/AIDS education and lobbying event in the United States. Every year, hundreds of people living with HIV, their supporters and advocates, come to Washington, DC to educate Congress on the need for increased funding and a strong commitment to federal HIV/AIDS programs for prevention, care and treatment, research, and housing.
AIDSWatch is in its seventh year of providing meaningful opportunities for constituents to meet in person with their federal elected officials to discuss the impact of the HIV epidemic on the lives of real people. Every participant receives a half-day briefing on key issues and training on effective lobbying strategies by experts in the field. The following two days are spent on Capitol Hill meeting with Representatives and Senators and their staff. These face-to-face meetings are one of the most effective ways of influencing our elected officials and are crucial in obtaining increased funding.
Participants at AIDSWatch increase their knowledge of HIV/AIDS issues, and create links with other advocates from across the country to continue their involvement in the policy process in their home congressional districts.
AIDSWatch is a powerful personal experience for all those who participate.
What Does it Cost to Participate?
There is no registration fee or charge for materials. The only costs are those for your travel (airfare, train, bus, etc.), hotel accommodations, food, and ground transportation. In general, and depending upon what region of the country you are traveling from, costs range between $700 - $1,000. A sample budget might look like this: Airfare = $350.00; Hotel (3 nights) = $300.00; Food (3 meals/day) = $ 90.00 ; Ground transportation (includes shuttle to/from airport and Metro around town) = $ 45.00: Total: = $785.00.
A limited number of scholarships will be made available to assist constituents from key congressional districts to attend this important three-day lobbying event. Efforts to make community (no-cost) housing available are also under way.
What Happens After I Register?
You will receive a phone call from the Regional Coordinator for your area, or from the National Coordinator if your area does not have a Regional Coordinator, to discuss your participation and answer any questions you may have. All of your appointments will be scheduled for you, and a trained facilitator will be at each meeting to assist and support you. You will also receive at least one future mailing containing information about hotel accommodations, ground transportation, discounted airfare if available, and a schedule for the event.
To obtain a weekly email version of fastfax, contact with the message: "subscribe" or fill in the box on the fastfax index page.