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Issue #209: December 25, 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 wtp@critpath.org and type the message SUBSCRIBE in the message section. Sources for some articles in this issue include Associated Press, Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, Nature Reuters Health Information Service, United Press International, Washington Blade.
Region wins $2m increase in Title I funds
Most PWAs not getting standard care
Emergency grant system finally consolidated
PI dose can be reduced by adding NNRTI: company
Thymus may help immune recovery
Clinton council condemns lack of followup on vaccine
43 million Americans without health insurance
California to revisit code reporting; DC going to names
Straight men lead in new STD/HIV cases
TPAC asks AACO for water filter funding
LA settles $1.2m lawsuit by AIDS agency
"Portraits of Women" set for AIDS Library
ActionAIDS seeks fundraising staff
AIDS Library improves web site
Vegetarianism and HIV: Making It Work
After several years of stagnant or decreased levels of funding for its Ryan White CARE Act Title I program, the AIDS Activities Coordinating Office (AACO) has announced that it will receive a $2 million increase in federal funding under the program for 1999.
The allocation to the Philadelphia eligible metropolitan area, which includes southeastern Pennsylvania and southern New Jersey, will be $16,011,451 in 1999, according to Joe Cronauer and Patricia Bass, co-directors of AACO.
The new funding will be distributed across the region, and Cronauer said that AIDS service programs in each of the three major geographic areas of the region - the city of Philadelphia, Philadelphia's Pennsylvania suburbs, and four counties in South Jersey - will each see an increase in dollars invested in direct services.
Cronauer cautioned that funding levels for each of the specific service categories funded under Ryan White, which range from primary medical care to food programs, have not yet been finally determined. He said, however, that it was likely that a significant portion of the increased funding will be dedicated to enhancing primary medical care services for poor and uninsured people with HIV disease, as well as for direct services which encourage adherence to medical treatments and continuation in primary medical care.
The Philadelphia HIV Commission, which sets priorities for the use of Title I funds every year, has increased its emphasis on supporting primary medical care over the past several years, as HIV medical treatments have proven more promising for some PWAs. The Health Resources and Services Administration (HRSA), the federal agency which administers Ryan White CARE Act funds, has also increased its emphasis on programs providing or supporting direct medical care in its "guidance" issued annually to local government applicants for the funds.
The Philadelphia funding is part of a $479 million pool apportioned by HRSA to 50 eligible metropolitan areas around the nation to support AIDS care services for low-income individuals and families." Forty-seven of those metropolitan areas, including Philadelphia, also received funding from a special allocation recommended by the Congressional Black Caucus (CBC) to enhance direct AIDS care to "areas with high numbers of affected African American and Hispanic populations." Philadelphia's allocation under the CBC initiative for 1999 is approximately $206,000. mercado de divisas
The funding is awarded based on the number of living AIDS cases in a metropolitan area, as well as a review of an annual competitive application.
"These grants place funds where they are needed most, so that hard-hit communities can provide people affected with HIV/AIDS the critical services they need," said Donna E. Shalala, Health and Human Services Secretary for the Clinton Administration, in announcing the awards.
"Our initiative with the Congressional Black Caucus further helps us mobilize a long-term, comprehensive response to the severe and ongoing HIV/AIDS crisis in racial and ethnic minority communities, particularly among African Americans and Hispanics."
Title I grants provide essential HIV/AIDS health care and a wide range of support services to those who lack or are only partially protected by health insurance, including physician visits, case management, assistance in obtaining medications, home-based and hospice care, substance abuse and mental health services and other related services. To qualify for Title I funding, an EMA must have a population of at least 500,000 and have reported more than 2,000 AIDS cases in the most recent five calendar years.
"The demographic impact of HIV/AIDS is changing, as growing numbers of African Americans and Hispanics need HIV/AIDS primary care and support services," said Claude Earl Fox, M.D., M.P.H., administrator of HRSA. "These funds allow us to broaden our overall effort to bring added resources to more than 1,300 HIV care providers in communities where the majority of their clients are African American and Hispanic."
Other HRSA-administered CARE Act programs fund HIV/AIDS services in states and eligible U.S. territories (Title II); provide support to public and nonprofit organizations for outpatient early intervention services and planning grants (Title III); fund special programs for improving access to care for women, youth, adolescents and families (Title IV); demonstrate and evaluate innovative models of care for historically underserved populations (Special Projects of National Significance Program); oversee a regional network for educating and training AIDS care providers (AIDS Education and Training Centers Program); and provide reimbursement for uncompensated costs in treating dental patients with HIV (HIV/AIDS Dental Reimbursement Program). Title II also supports the AIDS Drug Assistance Program (ADAP), which helps support the cost of medications that prolong and improve the quality of life for uninsured individuals and others unable to pay. sofia airport transfer
Since FY 1991, the Clinton Administration has awarded close to $6.4 billion in CARE Act funds. It is estimated that more than 400,000 individuals affected by HIV/AIDS access CARE Act services each year.
Most of the people in the United States infected with HIV are not receiving regular medical treatment, according to a study published in the New England Journal of Medicine.
Based on interviews with 2,864 HIV-infected patients in a nationwide survey done in early 1996, the research concludes that the cost of providing that treatment is less than commonly believed -- about $20,000 a year per patient.
"It is deeply disturbing that up to two-thirds of persons with HIV infection are not getting regular care and that even fewer are getting the new multi-drug therapy" that can suppress HIV to undetectable levels in the blood, said Dr. Samuel Bozzette of the California think tank RAND who is chief author of the study.
"The data explode the widespread belief that care for the HIV-infected is extraordinarily costly," he said.
Although Bozzette acknowledged that AIDS is "a large and growing burden" for health insurers and the government, he said the findings show that "HIV care is less expensive than care for many other serious diseases" such as heart and kidney diseases.
"The real crisis in paying for HIV care is not its cost, but rather how to finance it," Bozzette said.
Until now, "the cost is commonly believed to be $60,000 to $70,000 a year," said Peter Erbland of the AIDS Action Committee in Boston. But those estimates may have been skewed by the days "when people would go to the hospital with full blown AIDS."
The multi-drug treatment, colloquially called the AIDS cocktail, is allowing people with HIV to live better for longer.
"For people with HIV with no symptoms or minor symptoms, it's a lot easier to treat earlier and treat longer, and the intensive stuff is at the end," Erbland said.
The Centers for Disease Control and Prevention has estimated that between 650,000 and 900,000 Americans are infected with HIV. Bozzette and his team calculated that only 292,000 to 372,000 of them saw a doctor at least once during a six-month period, which was the definition of regular medical care.
The reason is that "some people aren't tested (for HIV), some people flee care, or they don't have appropriate access to care, and underfinancing has to be part of that," Bozzette said.
Erbland said it was a question of educating providers as well as people with HIV.
"Doctors who don't treat a lot of HIV cases may not know, for instance, that regular checkups for testing viral load or looking for minor infections that may become life-threatening are important for prevention," he said.
On the other hand, the survey also suggests that when patients are receiving regular care, the medical community is adapting rapidly when new HIV treatments appear.
At the beginning of 1996 only 16 percent of patients were getting the "AIDS cocktail". Yet by the end of that year the number had risen to 55 percent.
"That's really encouraging to see that highly effective therapies did diffuse quickly to people under care," said Bozzette.
The survey found that 20 percent of people with HIV have no health insurance; 29 percent are covered by Medicaid, the federal program for the poor; and 19 percent had their treatment covered by Medicare.
Acting on a three-year old recommendation from its joint housing committee, the AIDS Activities Coordinating Office (AACO) and the Philadelphia AIDS Consortium (TPAC) have announced that they will merge their AIDS emergency grants program -- which together total over $825,000 -- into one program accessible to all people with HIV throughout the region.
The Philadelphia Office of Housing and Community Development (OHCD) is also likely to participate in the consolidated program, but will not make a final decision until the cost of the new program is determined and assurances of continued supportive services for recipients are in place.
AACO is responsible for overseeing Ryan White CARE Act Title I funding for "direct emergency financial assistance" to PWAs in the nine counties of southeastern Pennsylvania and southern New Jersey; OHCD administers funds for emergency housing assistance in the nine counties allocated through the Housing Opportunities for People with AIDS (HOPWA) program. TPAC manages a fund, awarded through Title II of the CARE Act, which is limited to people with HIV in the five-counties of southeastern Pennsylvania.
AACO estimates that at least 1600 people living with HIV/AIDS in the region receive assistance from the funds, usually for housing-related needs, although Ryan White funds are made available for some medical costs and other emergency expenses.
The announcement of the consolidated program was made in separate statements by AACO co-director Joe Cronauer - who was among those who recommended the approach several years ago - and TPAC executive director Larry Hochendoner.
Cronauer said that the three funders will sponsor a bidder's conference early next year to identify an agency that will be responsible for issuing emergency payments. He said that every AIDS service agency in the region will be eligible for submitting applications for the funds on behalf of their clients, which will be sent to the successful bidder for payment once they are approved.
Individual PWAs not receiving services from an AIDS service organization will also be able to apply, although the agencies recommend that applicants receive assistance from a case manager or social worker to make sure that all appropriate documentation is correct before an application is submitted.
Each of the funding streams applies slightly different rules and eligibility requirements to consumers seeking to access the funds.
Historically, these funds have been distributed to a variety of case management and community organizations. The AIDS Housing Task Force, an advisory body to the agencies, recommended in 1995 that a new system of coordination of the funds be implemented because of varying eligibility requirements among the different community groups, the greater complexity for consumers in finding emergency assistance because agencies did not always publicize availability of the funds beyond their own clients, and because the cost of administering the program was higher than necessary because each of the groups needed to cover their own overhead costs. The Task Force also noted that the involvement of so many different agencies in distribution of the funds sometimes led to consumers applying for more grants than they were eligible for, since there was no way to keep a central record that would avoid duplication and abuse of the program.
The Task Force recommendations were eventually included in a Housing Needs Assessment supported by OHCD in 1996 and adopted by the HIV Commission's Housing Committee, which succeeded the Task Force as the region's advisory body on emergency assistance and housing programs.
TPAC was the first of the three agencies to seek to consolidate the program, deciding over the past year to distribute the emergency assistance funds from its own offices rather than through community groups.
"This is the first system-wide collaborative service for consumers in this region," TPAC said in a statement.
The new program will likely mirror the procedures put in place by TPAC in administering its Title II emergency grant program, and follow a practice piloted by We The People in allocating emergency grants under the LifeSavers Emergency Fund, the oldest and largest emergency grant program in the region. In 1996, recognizing that cash flow problems often led to long delays in making payments under the LifeSavers program, WTP entered into an arrangement with the Tenants Rental Assistance Program (TRAC) - which also managed the city's AIDS housing voucher programs - to have payments made by TRAC, with later reimbursement by WTP once the AIDS funding agencies eventually reimbursed the funds. Since the arrangement with TRAC was established, the LifeSavers program has been able to make payments within five days of most applications.
The new consolidated system is likely to be modeled on the same practice, with applications being submitted through the network of AIDS service providers and processed and paid through a central office maintained by AACO, TPAC and OHCD.
"This is a clear instance of a practical working partnership that benefits the consumer," said Hochendoner, director of TPAC. "The collaborative efforts of Title I and II in the EMA's Case Management Coordination Project, which provides uniform trainings for Title I and II funded case managers, has been working smoothly over the past few years."
Scott Wilds, who oversees the HOPWA emergency assistance program for OHCD, told fastfax that OHCD's final decision on participation in the new arrangement will depend on the administrative cost charged by the agency selected to distributing the funds, and on firm assurances that PWAs getting help receive appropriate financial and housing counseling.
"We want to ensure that consumers continue to receive some form of housing counseling related to the HOPWA funds and that HOPWA funds are not simply paid out without some counseling or similar supportive services being offered," he said.
The addition of the non-nucleoside reverse transcriptase inhibitor (NNRTI) delavirdine (Rescriptor) to an antiretroviral regimen that includes zidovudine (AZT) and a protease inhibitor allows for a dose reduction of the protease inhibitor, without jeopardizing viral suppression, according a Pharmacia & Upjohn press release.
Officials at the New Jersey company added that research findings suggest that regimens containing their NNRTI permit a simpler dosing schedule.
The interim results of two open label studies were reported at the International Conference on the Discovery and Clinical Development of Antiretroviral Therapies in St. Thomas, US Virgin Islands.
In the first study, 44 HIV-positive patients received delavirdine, zidovudine and indinavir (Crixivan), or lamivudine (3TC), zidovudine and indinavir (control arm). At 24 weeks, patients who received triple combination therapy with delavirdine and lower doses of indinavir achieved levels of viral suppression comparable to those in the control group, according to principal investigator Dr. Jeffrey Goodgame of the Central Florida Research Initiative in Altamont Springs.
In the second study, twice daily dosing of delavirdine and nelfinavir (Viracept) were given in triple or quadruple drug combinations. The findings "suggest that twice-daily dosing of [Rescriptor] (600 mg) in combination with nelfinavir (1,250 mg) plus d4T and/or ddI may result in a rapid and significant decrease in viral load within 4 weeks of initiating therapy," the release continued.
Delavirdine has the unusual characteristic of increasing drug levels of protease inhibitor, Dr. Goodgame said. It is that activity that makes the dosing simpler and actually allows dose reduction in certain instances. And the "bottom line" is that significant viral suppression is obtained with this combination as well, he continued.
"The interesting thing is that everybody's been trying to salvage proteases because of the side effects," he continued. "Now by actually reducing the quantity of drug, we may actually be reducing side effects."
The drug regimens with the lower protease inhibitor doses were very well tolerated. "We were very pleased with the outcome, Dr. Goodgame added, "and most patients did extremely well." (RHIS)
HIV-positive adults who respond to antiviral drugs show increased activity in the thymus gland, according to a recent study published in Nature. The finding suggests that the thymus -- found in the chest and most active in infancy and childhood -- can contribute to recovery of the immune system in HIV-infected adults.
The thymus produces T-cells early in life, but shrinks in size and is normally almost undetectable in an adult. It was previously thought to be of marginal importance to the adult immune system.
"Up until recently it wasn't clear whether the adult thymus was even functioning," study lead author Dr. Richard A. Koup of the University of Texas Southwestern Medical Center in Dallas said. "What this study shows is that, indeed, even into adulthood... the thymus is functioning. It is probably functioning at reduced capacity, but it is still producing new T cells."
Koup, Dr. Daniel C. Douek and colleagues found that HIV infection suppresses thymic function, but treating HIV infection with highly effective antiretroviral therapy (HAART) is associated with increased T-cell output by the thymus, according to a report in the December 17th issue of Nature.
"So the thymus is hopefully going to be involved in the immune restoration that occurs in patients treated with HAART," Koup said.
The researchers made the discovery by distinguishing between T cells newly produced by the immune system and long-lived T cells that may have been circulating in the blood system for years. This was accomplished by measuring TRECs (short for "T-cell receptor rearrangement excision circles"), circular bits of DNA that are generated as T cells are produced.
In all but one HIV-infected person the researchers studied, there was a rise in TRECs after the subjects began HAART, sometimes within 4 to 16 weeks of treatment.
"Now that we can measure thymus output, we may be able to develop therapies that will increase the output of the thymus," Koup said.
Koup also suggested that continued thymic output may lead to recovery of immune function in HIV-positive patients. "If the thymus is continuing to put out new T cells, then it should be able to put out new T cells that are programmed to have some of the specificities which may have been lost," he said.
But several things still need to be determined, Koup added. One is the degree of function of the adult thymus, relative to the infant thymus. And based upon that "we need to know how long it will take to reconstitute the immune system after it's been depleted."
President Clinton's AIDS advisory council has scolded him for insufficiently following up his grandly announced plan to develop an AIDS vaccine within 10 years.
In turn, Clinton warned that 2000 will be tight budget year for AIDS research but he endorsed the council's proposal for a national media campaign to promote voluntary testing for HIV.
"It has been 19 months to the day since your announcement of the vaccine goal and a director of the vaccine center at NIH has not yet been appointed," Helen Miramontes, a member of the president's HIV/AIDS advisory council, told Clinton in a meeting in the Cabinet Room while the House of Representatives was debating articles of impeachment against the President.
She said just one preliminary vaccine meeting has been convened at the National Institutes of Health since Clinton, in a 1997 commencement address, invoked the legacy of John F. Kennedy's 1960s race to the moon and set a 10-year target for developing an AIDS vaccine.
"When President Kennedy announced that we were going to put a man on the moon, he appointed a person within the White House to oversee this endeavor," Miramontes said, asking Clinton to add a vaccine coordinator to the staff of the Office of National AIDS Policy.
Clinton responded with a vote of confidence in the office's director, Sandy Thurman, and with a promise that a vaccine director at NIH "is about to be appointed."
The council requested additional AIDS research and treatment funds in his fiscal 2000 budget, particularly for an initiative targeting minority populations.
"This budget year will be more difficult than the last one because we got such big increases in everything last time and because of the global economy kind of slowing down," Clinton responded. "But we'll do the best we can."
Dr. Scott Hitt, the council's chairman, told Clinton that 300,000 Americans do not know they are infected with HIV. "And contrary to your own stated goals, we are not decreasing the numbers of new people infected," Hitt said.
Clinton promised to work on creating a public/private outreach campaign to lessen the stigma of HIV testing. "It offers the promise of sort of getting by the divisive arguments of the past and actually doing something. I like it," he said.
He also said he would consider asking Vice President Al Gore, in his ongoing discussions with the pharmaceutical industry, to press for price cuts on HIV-related drugs. (AP)
Despite a "booming economy," the number of Americans without health insurance climbed to 43.2 million last year, nearly one in every six persons, according to a report issued by the Universal Health Care Action Network, a Cleveland advocacy group.
The number of uninsured was up 1.5 million from 41.7 million in 1996, equivalent to 125,000 people losing coverage every month, according to data issued by the U.S. Census Bureau in September.
"Sixteen percent of Americans are without insurance," said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard. "What's startling is the magnitude of the increase when the economy was booming."
Nearly 11 million people in families with incomes between $30,000 and $60,000 were uninsured in 1997, as well as 5.8 million in families with incomes over $60,000. The uninsurance rate for Hispanics (which have the highest rate of uninsurance) climbed from 33.6% to 34.2%.
"These may be the best of times for the economy, but they are the worst of times for health care," noted Dr. David Himmelstein of Harvard. "Uninsurance is rising - even people with coverage often can't get the care they need, and costs will double in the next decade. It's time to reopen debate over national health insurance."
Outgoing California Gov. Pete Wilson vetoed a bill this year that would have required the use of codes in the reporting of HIV cases, but the legislation has been reintroduced after the election of a Democratic governor and the issuances of new federal guidelines on HIV reporting by the U.S. Centers for Disease Control and Prevention.
Assemblywoman Carole Migden, D-San Francisco, announced its reintroduction today-- two weeks before Wilson is succeeded by Democrat Gray Davis.
Migden says new guidelines from the Center for Disease Control urge states to go beyond the reporting of AIDS cases to track people infected with HIV. While the CDC guidelines recommend the use of names in HIV reporting, her bill would authorize an identification system that uses a cryptic code to report HIV cases to local health departments while keeping patients' names confidential.
Migden says federal officials are offering to help states develop HIV reporting systems that conceal the names of patients by assigning them numbers. She says the idea is to improve data collection while protecting patients' privacy.
Several other states have used to the coded reporting system or are developing it. Pennsylvania's Health Dept. has not yet announced whether it will use names or codes in its HIV reporting program, although both the Pittsburgh and Philadelphia boards of health are considering recommendations in support of code reporting.
Others have adopted name-based systems and rejected coded identifiers on grounds that they make it too difficult to find the partners of people with HIV.
Present law in California requires that an AIDS diagnosis, but not HIV infection itself, be reported to local health departments by name.
The Washington Blade has reported that the District of Columbia is moving toward requiring names reporting because a code-based system would be too complicated and expensive to implement for the cash-starved local government.
As in Pennsylvania, however, health officials - who are ultimately responsible to the Congress - said they will conduct a review of unique identifier systems before making a final determination. The district's policies can be subjected to congressional action, and most activists believe that since the CDC has encouraged names-based reporting, it is unlikely that DC will act independently.
"There will be reporting. We must go into HIV reporting. That's not even a question anymore," Ronald Lewis, director of the district's Agency for HIV/AIDS, told the Blade. "We must move to HIV reporting to have a better sense of where the epidemic is going in our community."
"When we listen to CDC, when we listen to surveillance experts ... they do not see unique identifiers as a real option," Lewis added. Lewis was also quoted as being concerned that regions that do not act consistently with CDC reporting guidelines will not be able to effectively complete for CDC grant funds for HIV education and prevention services.
"You just end up the big loser," he said.
The Blade reported that while Virginia, which borders DC, will continue with its names reporting system, Maryland will also continue with its unique-identifier-based system, "despite prior CDC criticism that it does not provide thorough information." Solomon told the Blade that the CDC's study of Maryland's four-year-old system occurred too early on to provide an accurate analysis, and that the department's own more recent study shows the system is wholly adequate, she said.
Ron Simmons of Us Helping Us, one of the leading black AIDS organizations in the DC area, told the Blade that "The idea of having a name reported may make some folks stay away from testing."
"Black people have had more than enough [negative] experience with the health system in this country. It won't go away just because Ron Simmons and Us Helping Us says it is OK."
The majority of new cases of HIV infection in individuals attending a sexually transmitted disease (STD) clinic in the US are among heterosexual men, according to researchers from the Centers for Disease Control and Prevention (CDC).
In the December 15th issue of the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, Dr. Hillard Weinstock and colleagues report the findings of a 12-STD clinic study conducted in 7 US cities. They reviewed the records of all patients who initially tested negative for HIV infection and who were retested at least once during the study period, which was from 1991 through 1996.
The investigators found that a total of 286 individuals HIV seroconverted during the study period. Of these individuals, 53% were heterosexual men and 28% were women.
A key factor in HIV risk among heterosexuals appears to be drug use. "Multivariate analyses showed that drug use was associated with HIV seroconversion only among heterosexuals," they report.
However, they also found that men who have sex with men, and younger men in particular, still have the greatest risk of HIV infection. The researchers estimated that 1 in 47 gay or bisexual men in the STD clinic population seroconvert each year.
Dr. Weinstock's group points out that these data are important in determining the type of HIV prevention interventions that may have the greatest impact. Gay and bisexual men, especially younger men, should continue to be targeted. They also urge that clinicians assess sexually active heterosexuals for drug use and that modification of drug-use behavior "should be accepted as a vital part of STD and HIV control."
The Philadelphia AIDS Consortium's program which distributes water filters to people with HIV has run out of filters, and TPAC is asking the city's AIDS Activities Coordinating Office (AACO) to find funding to keep the project alive.
The program was initiated to alleviate fears of infection with cryptosporidium, a potentially life threatening bacteria which was found in the city water supply several years ago. City water quality officials say that they have largely eliminated the risk of crypto infection from the city's water, although water quality in some suburban areas continues to be questioned.
Health Commissioner Estelle Richman, in a letter to TPAC in late December, said that the city is considering distributing water filters through its own program early next year, depending on the availability of funding. AACO ran a similar program last year. Richman suggested that since TPAC has "underspending" of its Ryan White Title II dollars, it might consider using some of those funds to support its own program.
Richman also said that if AACO resumes its program, it will distribute the filters through a project which can reach the largest number of consumers at the least cost.
No cases of AIDS-related cryptosporidiosis have been reported in Philadelphia through September 30th, according to AACO, and only five cases were reported for the corresponding period of last year. Since January of 1990, 105 people with AIDS in the city have developed cryptosporidiosis, according to a recent AACO report.
Each year, between 50 and 1,200 people die in the United States from water-borne diseases, largely from microbes, and 200,000 to 1.3 million are made ill, according to the federal Centers for Disease Control and Prevention. Elevated levels of mercury and radium have been found recently in some area water wells.
Last year, according to the Philadelphia Inquirer, 39 public water systems in Pennsylvania issued 70 "boil water" advisories because of unhealthy levels of bacteria in drinking water. And in New Jersey, 7 percent of community water systems exceeded state standards for such cancer-causing contaminants as solvents, degreasers and gasoline components, according to state compliance reports.
Public water supplies are treated and tested regularly. And the overwhelming majority provide safe water: Water systems serving more than 98 percent of the people receiving public water in Pennsylvania met all federal and state health standards last year, according to state compliance reports. In New Jersey, the number was 92 percent.
But even though the risk of water-borne infection is low, its impact on people with HIV and other immune-weakening illness can be fatal.
Cryptosporidium, a microscopic, disease-causing parasite, is generally spread through human or animal fecal matter. It causes the disease cryptosporidiosis, a common (the CDC estimates 80 percent of Americans have had it) disease which causes diarrhea, cramps and flu-like symptoms and can kill people with weak immune systems, such as the very young, the elderly, and PWAs. In 1993, in the largest outbreak of waterborne disease in the United States, cryptosporidium got into Milwaukee's water supply when heavy rains overwhelmed the city's water-treatment system. The disease killed about 50 people and sickened 400,000 others.
Cryptosporidium is resistant to chlorination, so the best general treatment is filtration. Large water utilities are required to test water sources monthly for the bacteria, but there is no mandatory treatment. This has led for demands that special efforts be made to help people with AIDS filter their own water at their homes through the use of water filters.
According to Richard Gliniak, a PWA who serves on the TPAC Board of Directors and who proposed the program initially, TPAC allocated $40,000 for the program for the period from July of 1998 to June of 1999, but funds have already been exhausted. Gliniak told the Philadelphia Gay News that TPAC will be unable to authorize new funds for the program until next July.
Nurit Shein, executive director of Philadelphia Community Health Alternatives, which distributes the filters, said that almost 300 filters were distributed by November at the agency. She told PGN that PCHA is no longer accepting applications for the program.
"It's just common sense for the city to help out," Gliniak told PGN. "It's in everybody's best interest to help as many people as possible avoid crypto [infection]."
"We think that people with HIV should consider not drinking tap water, because we know what's in the water," Shein said. "It's very important for every person with HIV or AIDS to have one of these water filters."
Joanne Dahme, a spokeswoman for the Philadelphia Water Department, told PGN that Philadelphia's tap water is generally safe. She said people with health problems should contact their physicians for advice about drinking tap water.
"We really have top-quality water in Philadelphia," Dahme said. "We're looking for crypto all the time, and we don't find it [in tap water] very often."
A crypto scare erupted in Philadelphia's AIDS community in 1997, when indications that cryptosporidium "oocysts" were present in the city's water supply became public. Dahme told PGN that the test results were not definitive, however.
Warren Hunt, operations director for We The People, told PGN that there is a critical need for more water filters for low-income PWAs.
"Most of the people with HIV or AIDS in this city are scared to death of drinking the tap water," he said. "And their fears are realistic."
While unable to find additional funds for its water filter program, the TPAC Board has allocated an additional $10,000 to increase the salary of its executive director, Larry Hochendoner. Several Board sources told fastfax that Hochendoner, who has suggested he may be leaving TPAC in the coming year, told the Board that he would have to resign in early 1999 unless the additional funding was added to his contract.
The Los Angeles County Board of Supervisors has approved a motion that completes a $1.2 million out-of-court settlement to legal action on free speech rights and corruption in contracting brought against it by the nation's largest HIV organization, AIDS Healthcare Foundation (AHF).
"This marks the end of a bitter era of confrontation, and instead ushers in a hopeful time for our patients," said AHF President Michael Weinstein. "Instead of fighting the County in court and in the press, in 1999 we can focus our combined strength on offering life-saving medical care for needy, HIV-infected Angelenos."
The Supervisors today adopted a contract amendment that completes a complex joint settlement on contentious funding and free-speech issues. AHF had sued the County for infringing on its free speech rights by slashing its funding in reaction to public protests against County AIDS policy.
The amendment restores residential care funding for people with AIDS that had been cut through a competitive bid process that both Supervisor Zev Yaroslavsky and AIDS Healthcare Foundation decried as corrupt. The settlement also frees AHF from financial liability for a dispute in pharmacy billings.
"This is a genuine compromise, a real settlement," said Weinstein. "Neither side walks away with everything it wanted, but offers enough to move forward and not look back."
AHF had filed suit in state court this past February seeking damages and protection from government retribution for advocacy on behalf of its patients (AHF vs. County of Los Angeles, et al BC 185623). According to the lawsuit, County officials slashed the agency's funds in retribution for a series of public protests against government funding cuts to AIDS services. The suit sought general and compensatory damages of $5 million.
The settlement also ends a funding dispute over AHF's participation in a federal drug discounting program. AHF had been invited by the federal government to participate in its "340B" program, which allows charitable organizations to purchase prescription drugs from manufacturers at deep discounts. The program regulations also allows such organizations to bill the government for the drugs at a higher rate, so long as the "profit" expands services provided by the charitable organization.
AHF said it complied with both the spirit and letter of the program. The County, however, publicly described the practice as "over billing." In the settlement, the County relinquishes its claim to the allegedly "over billed" funds.
"The County acknowledges through this part of the settlement that we were never in the wrong," said Weinstein. "In fact, participation in 340B is now mandatory in order to participate in some federal funding," said Weinstein.
Additionally, the settlement resolves AHF's legal disputes with the County over misconduct by the County's HIV Commission and the County's competitive bid contracting process.
In June of 1996, the County's appointed HIV Commission passed a series of motions opposing AHF's demonstrations and singled out the agency for investigation of its contracts. In violation of the state's open meetings law, no public notice was given that the agenda would include discussion about AHF and the actions were taken in absentia.
During the previous months, AHF had organized protests criticizing County elected and appointed officials for shortfalls in federal AIDS grants. AHF blasted the County for failing to lobby the federal government for increased funds to meet growing demands for HIV- related medical care.
"Some agencies disagreed with our strategy, while others joined us in the demonstrations," said AHF Director of Government Affairs Cesar Portillo. "However, agencies that compete against us for funds also sit on the County's HIV Commission - and in 1996, they used their votes on the commission to punish us for our aggressive public policy statements," said Portillo.
During the meeting, which was audio-taped as per County policy, commissioners are quoted admitting that they were "fed up" with AHF's advocacy and were acting out of "revenge."
According to the suit, when the commissioner who chaired that meeting was then hired to run the County's AIDS Programs Office, and AHF's residential funding was soon slashed by $700,000. The suit alleged that other commissioners inappropriately interfered in the competitive bidding process for residential funds to reduce AHF's funding.
AHF serves over 5,000 Greater Los Angeles patients regardless of their ability to pay at 4 out-patient health care centers, 2 residential facilities; the WomensCare Center; through Positive Healthcare, the first AIDS specific managed care program in the nation; and through AHF's Research Division, and through AHF's Treatment=Life Division featuring the WEHO Lounge, a coffee house/HIV testing and information center.
River Huston will read and show slides from her photo-essay book, A Positive Life: Portraits of Women Living with HIV, at the AIDS Library at 1211 Chestnut Street, 7th Floor, on January 14th at 6:30 p.m. Light food and refreshments will be served beginning at 6 p.m.
Through candid interviews and original photographs by Mary Berridge, Ms. Huston details the endless emotional and physical struggles of life with HIV, a disease that provokes anger, hatred, and denial, yet somehow inspires equal measures of compassion, faith and humility. In the book, the women share their disappointments with failed treatments, the hope of new drugs and alternative therapies, and the pride of personal triumphs.
For more information, call Jenny Pierce at 215-575-1110, ext. 128.
The AIDS Library has announced that it brought up its live, interactive web site at http://www.ain.org/library/home.asp on World AIDS Day.
The library's web site provides accurate and current HIV/AIDS information to people affected by HIV in the Philadelphia area.
The web site includes a section on HIV Community Resources, a searchable database of HIV/AIDS services in the region; Online Publications, linking to HIV/AIDS publications on the web; Fact Sheets about the latest information on drugs and opportunistic infections; and a Library Catalog of the library's audio tape, book, pamphlet and video collections.
Lee Arnold, AIDS Information Network board member and a librarian himself, said that the web site "is a fantastic resource. In one session, you can find out what materials the library holds, get fact sheets on treatments and conditions, access online publications, and use a database of community resources searchable by name, location or services."
For more information, visit the web page at the address above or call 215-575-1110, ext. 2.
ActionAIDS development department is looking for a Development Associate, which it describes as a "motivated, responsible, team player with excellent organization, writing, and communications skills."
The basic function of the position is to provide coordination of grants management, writing of grants, press releases, newsletters, etc., and coordination of special events.
An undergraduate degree is desirable, and computer literacy is required. Experience in grant writing and coordinating special events a plus, but not required.
ActionAIDS executive director Kevin Conare said that the organization is seeking candidates with fresh perspectives and from different backgrounds. ActionAIDS offers a supportive work environment and full benefits. People of color, women, people with disabilities, sexual minorities and people living with AIDS or HIV encouraged to apply.
Applicants should forward letter of interest along with resume to: ActionAIDS - Human Resources, 1216 Arch St., 4th floor, Philadelphia, PA 19107, Fax # (215) 864-693
A free breakfast for people living with HIV, their caregivers and AIDS service professionals
Special Guest: Patricia Lindstrom, RD
WHAT: Breakfast and Discussion
WHEN: Friday, January 22, 1999
8:30 - 10:00 a.m.
WHERE: MANNA
12 s. 23rd Street (enter on Ranstead)
Center City Philadelphia
RSVP: By January 20th to 215-496-2662.
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