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Issue #215: February 5, 1999
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 articles in this issue include Associated Press, Journal of AIDS and Human Retrovirology, Kaiser Daily HIV/AIDS Report, Morbidity and Mortality Weekly Report, New England Journal of Medicine, New York Times, Reuters.
Blacks may have genetic risk of HIV infection
Only half of PWAs getting treatment: study
C-section + AZT halves perinatal HIV risk: study
Evidence grows that babies may inherit resistant strains
Clinton: small increase in 2000 AIDS funding
Rally supports call for Rite Aid investigation
Endangered chimp said to be source of HIV
Gurian appointed acting state health secretary
Ridge budget increases SPBP, holds line on other AIDS funding
HIV+ hygienist sues Valley Forge dental firm
SF gay risk behavior continues to rise
HIV stays in syringes for four weeks
Whitman uses right-wing study to combat needle exchange
42% of US adults have had HIV test
PPP shifts needle exchange site
Blacks may have genetic risk of HIV infection
by Laurie Garrett, Newsday
About 20 percent of African-Americans carry a genetic mutation that puts them at six times greater risk than whites of being infected with HIV once they're exposed to the disease, New York scientists said at the 6th Conference on Retroviruses and Opportunistic Infections.
Researchers reporting at the conference also found disturbing levels of drug-resistant viruses being passed from person to person worldwide, and differences in survival rates within the United States based on access to health insurance.
The new gene mutation was announced by Dr. Leon Kostrikis and John Moore of the Aaron Diamond AIDS Research Center in Manhattan. In an interview, Moore said the defect is related to a cell receptor - called ccR5 - that's used as an entryway for HIV.
Although some Caucasians have mutations that protect them from infection by eliminating their ccR5 receptors, the beneficial mutation has not been seen in people of African descent. Sadly, Moore said, the reverse has now been determined: About 20 percent of African-descendant Americans carry the 356-T mutation, which somehow (the biological details are yet undetermined) manipulates their ccR5 receptors in a way that makes them highly vulnerable to HIV.
Preliminary results of further study indicate that the mutation is also widespread in West Africa, the researchers said.
Kostrikis found the 356-T mutation through genetic analysis of 1,500 babies born to HIV-positive mothers: About 250 of the babies were also HIV-positive. And the majority of those who were infected were black and had the 356-T mutation.
Dr. Victoria Johnson, of the University of Alabama, addressed the issue of drug-resistant HIV by describing a case in which a baby was born infected with a strong strain of HIV that was highly resistant to two key drugs and mildly resistant to six more, essentially leaving the child untreatable.
The mother's HIV was highly multi-drug resistant as a result of her eight years of sporadic treatment. Johnson said the case argues against a long-held hypothesis that highly mutated, drug-resistant viruses might be weak, having given up their lethal characteristics in exchange for drug resistance.
Several surveys presented at the conference also suggested that the odds of sexually acquiring a drug-resistant form of HIV in the United States may be around 10 percent.
For instance, Dr. Daniel Boden of Aaron Diamond studied HIV found in 70 new-infected people, 55 of them New Yorkers. Overall, he said, 11.4 percent of them were infected with drug-resistant forms of the virus, which, "clearly compromises treatment."
But Boden's boss, Dr. David Ho, cautioned in an interview that "we don't know the impact of those mutations on subsequent treatment," so it would be premature to conclude whether this finding is cause for concern.
While drug resistance is most likely to appear where anti-HIV medicines are in widespread use, an analysis offered at the conference found that the disease can - even in the absence of any such drugs - become naturally resistant to protease inhibitors.
Dr. Danuta Pieniazek of the Federal Centers for Disease Control and Prevention in Atlanta, carried out genetic analysis of more than 300 viruses from 17 countries, including some in Africa, Latin America and Asia where protease inhibitors are not available. She discovered that up to 85 percent of all HIV may have genes that make the individual virus strains more or less resistant to certain drugs. For instance, one wild strain found in the Ivory Coast in Africa and another from Brazil were naturally cross-resistant to all protease inhibitors, she said.
"The public health implications are that there is a certain background of naturally occurring mutations," said Dr. Harold Jaffe of the CDC. "Those vary around the world, and may mean that drug therapies need to be tailored to local gene profiles." © Copyright 1999, Newsday Inc.
Only about half of all people infected with HIV in the United States are getting treatment, and one-third of those are not getting the preferred antiviral cocktail treatment, researchers have reported.
But they said more study is needed to find out who is slipping through the cracks -- and why.
"Half of all adults with HIV infection are not getting regular care," Dr. Samuel Bozzette of the California think tank RAND, told reporters at the 6th International Conference on Retroviruses and Opportunistic Infections.
Bozzette, who also works at the University of California at San Diego, headed up a survey known as the HIV Cost and Services Utilization Study, which polled about 160 doctors across the country. "We find 335,000 people (with HIV infection) in care," he said.
The Centers for Disease Control and Prevention (CDC) estimates that about 600,000 Americans -- and possibly up to 900,000 -- are living with HIV infection.
"But we are comparing an estimate with an estimate," Bozzette said. "What we are saying is 'a lot'."
As part of the survey, 2,200 patients were asked whether they were getting treatment -- notably the cocktail of powerful drugs that has been shown to hold the virus at bay.
They found that a third of the patients were not getting the therapy -- 65 percent were either getting no drugs, or a smaller dose of just one or two drugs.
"It is apparent that underserved populations -- minorities, the poor, people with public insurance -- do not have the same access to good, regular outpatient care and indicated pharmaceuticals," Bozzette said. A survey conducted by the San Francisco Department of Health found that among 513 HIV-positive individuals, 42 percent were not currently taking appropriate medications, citing lack of health insurance as the cause.
But Bozzette said the health care system is probably only partly to blame. "There is a little hint that patient attitudes have an effect on whether drugs are prescribed or adhered to."
Apparently, some patients believe the drugs are useless, or do not want to face the issue. "I think a lot of patients are fleeing care. They know they are positive but then they just kind of ignore it," Bozzette said.
And some people do not know they are infected.
"It seems to us that a lot of people with early disease who are in care come into care for some other reason," he said.
Last month, Bozzette's team reported that the cost of providing the drug cocktail -- known as highly active antiretroviral therapy, or HAART -- is less than commonly believed, about $20,000 a year per patient.
The largest, most comprehensive analysis of its kind has found that pregnant women infected with HIV can reduce the risk of transmitting the virus to their infants by about 50 percent if they deliver by elective caesarean section -- before they have gone into labor and before their membranes have ruptured, according to a study led by a researcher at the National Institute of Child Health and Human Development (NICHD).
The article describing the study will be published in the April 1, 1999 issue of The New England Journal of Medicine. Because of the study's immediate potential in reducing HIV transmission, however, the journal's editors decided to release the article early.
"This finding can prevent needless suffering and loss of life," said NICHD director Duane Alexander. "A c-section presents risks to the mother, so each case must be evaluated individually -- but this fact is striking: c-sections cut mother-to-child HIV transmission by at least 50 percent." In the study, an individual patient data meta analysis, elective caesarean section was defined as caesarean section performed before rupture of the membranes and before the beginning of labor. The main analysis included 8,533 mother and child pairs from five European and 10 North American studies, said the study's leader, Jennifer Read, a medical officer with NICHD's pediatric, adolescent and maternal AIDS branch.
HIV-infected women who were breast feeding their infants were not included in this study, to rule out the possibility of the virus being transmitted via breast milk.
The mothers who took part in the studies were divided into four groups: those who had elective caesarean section; those who had a caesarean section after rupture of membranes and/or after labor began; those who delivered vaginally with assistance from forceps or vacuum suction; and those who delivered vaginally with neither forceps nor vacuum suction.
The main analysis compared the likelihood of HIV infection among 857 children whose mothers delivered by elective caesarean section to that of 7,676 children whose mothers delivered by other modes of delivery. The likelihood of mother-infant transmission of HIV was decreased by approximately 50 percent among children whose mothers delivered by elective caesarean section.
The results were essentially unchanged when other factors were taken into consideration, including: receipt of antiretroviral drugs by the mother and child; how advanced the mother's HIV-related disease was; and the infant's birth weight.
Of the 5,944 mothers who did not receive AZT or other antiretroviral drugs during pregnancy and during labor and whose children did not receive such drugs during the first few weeks of life, 10.4 percent of the mothers who delivered by elective c-section transmitted the virus to their infants, as compared to 19 percent of the women who delivered by the other modes of delivery. Of the 1,451 mothers who did receive antiretroviral drugs during pregnancy and during labor and whose children received such drugs during the first few weeks of life, two percent of those who delivered by elective c-section transmitted the virus to their infants, as compared to 7.3 percent who delivered by other means.
HIV-infected women had a decreased likelihood of transmitting the virus with elective caesarean section as compared with other modes of delivery, Dr. Read said. She added the potential benefit of elective caesarean section with regard to decreasing the transmission of HIV from mother to child must be weighed against the possibility of increased post-operative infections and other problems among HIV-infected women.
Previous studies of the potential benefit of caesarean delivery in reducing HIV transmission from mother to infant had produced conflicting results, probably due to the smaller numbers of patients in some of the studies and the combining of caesarean deliveries performed both before and after labor began or after rupture of membranes had occurred. Obtaining the original data, combining the studies to increase the numbers and separating elective caesareans from others, provided the clear-cut results in this meta-analysis.
The results "suggest a potential role for elective caesarean section as an additional intervention to decrease mother-child HIV transmission, irrespective of concomitant receipt or lack of receipt of AZT prophylaxis," Dr. Read said.
In a related report, United Nations investigators, who are conducting the largest clinical trial to date of vertical transmission of HIV, told attendees at the 6th Conference on Retroviruses and Opportunistic Infections that a single week of AZT (zidovudine), initiated at delivery to both HIV-infected mother and newborn, reduces vertical HIV transmission risk by 37%.
Dr. Peter Piot, executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS), observed that the conventional regimen involves three to four weeks of zidovudine given before birth and immediately afterwards.
Researchers presented data on 1,357 participants in the UNAIDS Perinatal Transmission (PETRA) Trial who were involved in three treatment protocols. Residents of five urban centers in South Africa, Uganda and Tanzania received either zidovudine and lamivudine or placebo initiated at 36 weeks gestation and continued into the postpartum period, initiated at delivery and administered for one week to both mother and child or given during labor and delivery only. The investigators measured transmission rates six weeks after birth.
Transmission was not reduced in mothers who received zidovudine and lamivudine only during labor and delivery. Transmission was reduced 37% in mothers and infants who received a week of zidovudine and 3TC (lamivudine) beginning at delivery. Treatment initiated at the 36th week of pregnancy and continuing after birth reduced vertical transmission rates by 50%.
UNAIDS Director of Policy Dr. Awa Coll-Seck said in a UN press release announcing the results that "it is vital to develop a range of prevention options for mother-to-child transmission so that countries can cater to women living in different real-life situations ...We hope that as more data are gathered, more public health officials and donors will see the value of investing in mother-to-child transmission programs in the countries hardest hit by the AIDS epidemic."
UN officials note that prevention programs are particularly important in light of the evidence that about one third of cases of vertical HIV transmission occur through breast-feeding, but that, in developing countries, the "...risk of [the] infant dying if not breast-fed could be even greater than the risk of transmitting HIV infection through breast milk."
Glaxo Wellcome announced last year that it would lower the price of zidovudine for the prevention of vertical HIV transmission.
Doctors trying to find ways to prevent the transmission of HIV to babies have reported some disturbing news -- some babies are inheriting drug-resistant infections.
While drug treatment during pregnancy can greatly reduce the risk that a mother will infect her baby -- those babies that do get infected may be saddled with a strain that is especially hard to treat, the researchers said.
And public health officials said they were worried by one report suggesting the drugs themselves could, in very rare cases, cause fatal disease in babies.
The experts made their report at the Conference on Retroviruses and Opportunistic Infections.
In the United States the standard regime of taking AZT before birth, during labor and giving it to the baby afterward reduces transmission by two-thirds.
But HIV is known to evolve rapidly, and can very quickly become resistant to drugs.
Robert Colgrove of Beth Israel Deaconess Medical Center at Harvard University and colleagues were checking to see if, when this regime fails, mothers can pass on drug-resistant virus to their babies. They found that 53 percent of babies born with HIV infection eventually became resistant to drugs.
The longer their mothers had taken AZT while pregnant, the more likely the babies were to develop mutations, Colgrove told the conference.
"I think it's a cause for concern," Colgrove said. "But given the known efficacy of AZT, I certainly wouldn't advise anyone to stop taking it."
But he predicts that as more women take HIV drugs to protect both themselves and their babies, more cases of resistance will pop up. That means the children will have limited options when it comes to taking drug cocktails to control their infections.
Victoria Johnson of the University of Alabama at Birmingham described one especially severe case of a baby who inherited resistance to more than one drug.
Her mother had been infected with HIV for years and had taken many different drugs, both before and during her pregnancy. Like many patients, she sometimes stopped taking the drugs and switched frequently - something that has been shown to help the virus become resistant. "This particular mother basically did her own thing in terms of antiretroviral (anti-HIV) therapy," Johnson said.
The baby was given AZT as soon as she was born, but was HIV-positive when first tested at a few weeks old. Her strain of the virus was already resistant to three drugs at that point -- and within a few months became resistant to even more.
In a third report, Stephane Blanche and colleagues at the French medical research institute INSERM told of two babies given two HIV drugs -- Glaxo's 3TC and AZT -- to prevent infection from their mothers.
They were among more than 1,000 children tracked as part of another study on using two drugs to prevent HIV transmission. But these two died of an extremely rare disease caused by genetic damage to the mitochondrial DNA -- which is found in the cell body rather than in the nucleus with the genes.
One died at 11 months and one died at 13 months, both from severe brain damage.
Blanche told the meeting that there was no proof the drugs caused the damage. But he said there was also no evidence the babies had inherited abnormalities, and HIV drugs are known to cause mitochondrial damage.
Dr. Kevin DeCock, of the Centers for Disease Control and Prevention (CDC) in Atlanta, called the findings "worrying" and said his agency was looking "urgently" into data on women in the United States who had taken or were taking the two drugs.
But the CDC's Dr. Martha Rogers said the CDC did not know of any such cases. She said women should not stop taking the drugs because they both prevent transmission of a known deadly disease and protect the women themselves.
Clinton: small increase for AIDS programs in 2000
resident Clinton includes several HIV/AIDS-related funding increases in his $1.7 trillion FY 2000 budget proposal, in addition to the previously announced proposal to extend Medicaid and Medicare coverage to HIV-positive and other disabled individuals returning to work. The increases are minor, however, and have drawn criticism from AIDS advocates who had hoped Clinton would build on last year's major increases in funding for AIDS programs.
While overall funding for the Ryan White CARE Act increases by 7 percent, or $100 million, the increase for the Title I program - which provides the bulk of funding for Philadelphia area programs - is only $16 million nationally. Funding for Title II programs, which supports AIDS programs in each of the 50 states, increases by $45 million.
Clinton's proposal increases funding for AIDS Drug Assistance Programs, including Pennsylvania's Special Pharmaceuticals Benefits Program, by $35 million.
Increases for Title III and Title IV Ryan White programs total $38 million, and the dental reimbursement program increases by only $200,000. No funding increase is being requested for AIDS education and training centers, such as the one operated locally by Hahnemann Hospital.
An additional $130 million would fund Early Intervention Service programs targeted to minority communities. Philadelphia's access to this funding may be hampered by the resistance of members of the Philadelphia HIV Commission to agreeing on a definition of agencies that could qualify for the funding, with historically black and Latino community groups pressing for a concentration of the funds in their efforts while historically white providers want a more flexible definition.
NIH funding for HIV/AIDS research would be increased by $35 million -- about 2% -- bringing the total budget to $1.8 billion. The funding will go to develop an HIV vaccine and cheaper, simpler drugs with fewer side effects, according to Health and Human Services Secretary Donna Shalala.
In the area of HIV/AIDS prevention, funding for the U.S. Centers for Disease Control includes a $35 million provision for community demonstration projects aimed at reducing racial and ethnic disparities in HIV infections and five other diseases from which minorities suffer disproportionately. The Public Health and Social Services Emergency Fund would receive $50 million to address the AIDS crisis in minority communities through prevention and treatment.
AIDS Action Executive Director Daniel Zingale blasted Clinton's budget for "flat federal prevention funding for the fourth year in a row as well as an anemic 2% increase for substance abuse treatment programs," according to the Kaiser Daily HIV/AIDS Report. He added, "Where President Clinton fights to protect young people from smoking, he stands paralyzed in the fight to protect them from HIV." Zingale added that the $100 million increase for the Ryan White CARE Act was "far below" the $261 million increase Congress approved last year.
The National Health Council was also "disappointed" with Clinton's proposed increase in NIH funding, asserting that the 2% increase in HIV research funding is "a significant decrease from last year's historic 15% increase."
Rally supports call for Rite Aid investigation
Advocates and people with HIV/AIDS rallied on January 29th to protest Rite Aid's purchase of PCS, a pharmacy benefits management firm.
In a press conference held at the Philadelphia offices of the Department of Justice, HealthChoices consumers, activists and HIV/AIDS service providers demanded that the Department's Anti-Trust Division launch an investigation into the January 22 sale. The press conference was called by the Working Group on HealthChoices and HIV, a coalition of forty-five service provider and advocacy organizations that addresses problems that people living with HIV/AIDS have with HealthChoices, Southeastern Pennsylvania's Medicaid managed care plan.
The sale, approved by the Federal Trade Commission, gives Rite Aid control over the 50 million prescription plan members now enrolled in PCS in addition to the 4 million already enrolled in Rite Aid's own pharmacy benefits manager (PBM), Eagle Managed Care. Rite Aid also handles pharmacy access for civil service employees in Philadelphia, many of whom have reported problems similar to those experienced by people on HealthChoices.
Sources said that city health commissioner Estelle Richman intends to publicly announce that she, too, has had problems getting prescriptions filled accurately at her local Rite Aid.
"We phoned, faxed and wrote to the Federal Trade Commission's Bureau of Competition imploring them to look at how destructive Rite Aid's virtual monopoly over prescription drug access already is for people on HealthChoices in our region," Anna Forbes, staff to the Working Group declared today. "Medical Assistance recipients in our region are already forced to enroll in a HealthChoices HMO," she explained. "Now 100% of them will also be forced to use a prescription plan controlled by Rite Aid since all four of the HealthChoices HMOs use either Eagle Managed Care or PCS as their PBM."
"Prescription access problems occur when a Medicaid HMO hires a PBM owned by a pharmacy chain," Forbes added. "The PBM has a clear conflict of interest. Now, unless the Anti-Trust Division intervenes with an investigation, Rite Aid holds the pharmacy purse strings for everyone in HealthChoices."
The rally and press conference featured consumers' accounts of problems encountered with Rite Aid-controlled prescription plans -- problems that have resulted in people doing without the medications they needed to prevent complications of HIV/AIDS, psychiatric crisis and control blood pressure.
Forbes reported that the Federal Trade Commission approved Rite Aid's purchase of PCS even though, according to FTC litigators, an FTC investigation of alleged "conduct violations" is ongoing.
Joan Curran, Associate Executive Director of ActionAIDS, said that such difficulties are not unusual. "We hear from clients regularly whose prescriptions have been denied outright, who have received undocumented under-fills or who are forced to spend a huge amount of time and energy going from the pharmacy to the doctor to the HMO and back again just trying to get access to the meds they need to stay alive. They are confused and angry. Some just give up and have huge gaps in their medication regimens after a pharmacist tells them that the PBM refused to OK their prescriptions. Interruptions in treatment can be deadly for a person struggling to live with HIV, heart disease or any number of other chronic diseases. When I think of what's happening already, and then think of Rite Aid getting 50 million more prescription plan members on top of the 4 million already in Eagle Managed Care, it makes me furious. These are indigent people with chronic illness speaking here today. For them, access to pharmacy is now so severely curtailed that it is potentially life-threatening," she concluded.
Following the press conference, Working Group representatives met with Bob Connally, Chief of the Anti-Trust Division's Philadelphia Branch, to formally request that they initiate a post-merger investigation into Rite Aid's purchase of PCS on the grounds that it is anti-competitive and that, based on the experience of consumers in the Delaware Valley, it is likely to endanger the welfare of the 50 million prescription plan members now served by PCS, especially those who will not have access to other, non-Rite Aid-controlled, prescription plans.
Endangered chimp said to be source of HIV
A study supported by the National Institute of Allergy and Infectious Diseases (NIAID) reports that the origin of HIV has been found in a subspecies of chimpanzees native to west equatorial Africa.
Beatrice H. Hahn, M.D., of the University of Alabama at Birmingham, led the international team of investigators. They describe their findings in the February 4 issue of Nature, and Dr. Hahn presented the study details on the opening night of the 6th Conference on Retroviruses and Opportunistic Infections in Chicago.
The type of chimpanzee implicated in first spreading HIV to humans -- who are not believed to get sick from the virus -- is an endangered species, which is likely to complicate efforts to conduct further studies which might benefit HIV treatment in humans.
"This is an important finding with significant potential," notes Anthony S. Fauci, M.D., NIAID director. "We now have chimpanzee isolates of simian immunodeficiency virus [SIVcpz] that have been shown by careful molecular analysis to be closely related to HIV-1. Furthermore, this virus infects a primate species that is 98 percent related to humans. This may allow us -- if done carefully and in collaboration with primatologists working to protect this endangered species -- to study infected chimpanzees in the wild to find out why these animals don't get sick, information that may help us better protect humans from developing AIDS."
Until now, HIV's origin had been unclear. Although most scientists suspected that the virus descended from a primate species, only three chimpanzees infected with viruses related to HIV had been documented, and one of these viruses correlated only weakly with HIV.
When Dr. Hahn and her collaborators recently identified a fourth chimpanzee infected with SIVcpz, they decided to use this opportunity to carefully examine all four viruses and the animals from which they were derived. With sophisticated genetic techniques, they analyzed the four SIVcpz isolates and compared them with various HIV-1 viruses taken from humans. They also determined the subspecies identity of the chimpanzees: three belonged to a subspecies native to west equatorial Africa, Pan troglodytes troglodytes. The fourth, the chimpanzee infected with a virus most unlike HIV, belonged to an east African subspecies known as Pan troglodytes schweinfurthii.
As it turns out, the three isolates from the Pan troglodytes troglodytes chimpanzees strongly resemble the different subgroups of HIV, namely groups M (responsible for the pandemic), N and O (both found only in west equatorial Africa). Their investigation also revealed that some of the viruses resulted from genetic recombination in the chimpanzees before they infected humans.
Their other significant find, Dr. Fauci notes, is that the natural habitat of these chimpanzees directly coincides with the pattern of the HIV epidemic in this area of Africa. Putting all these pieces of the puzzle together, Dr. Hahn and her colleagues conclude that Pan troglodytes troglodytes is the natural reservoir of HIV and has been the source of at least three independent occurrences of cross-species virus transmission events from chimpanzees to humans.
The authors believe that HIV was introduced into the human population when hunters became exposed to infected blood. Furthermore, they speculate that humans might still be at risk for cross-species transmission because the bushmeat trade -- the hunting and killing of chimpanzees and other endangered animals for human consumption -- is still common practice in west equatorial Africa.
This new report suggests that preserving the wild chimpanzee populations will be crucial for further carefully designed studies to better understand how cross-species virus transmission occurs and how infected chimpanzees resist disease, studies that in turn may lead to new strategies for designing HIV drugs and vaccines.
Gurian appointed acting state health secretary
Gov. Tom Ridge has appointed Gary Gurian, who formerly headed Montgomery County's health department, as Acting Secretary of Health, replacing Health Secretary Daniel F. Hoffmann, whose resignation became effective February 1.
"Gary Gurian has worked tirelessly as Deputy Secretary for Public Health Programs over the last four years and will do a fine job managing this critical agency during this transition," Gov. Ridge said.
Gurian will serve as Acting Secretary until Gov. Ridge nominates his new Health Secretary.
As Deputy Secretary for Public Health Programs since August 1995, Gurian directed the administration, coordination and planning for programs statewide through the bureaus of Communicable Diseases; Chronic Disease and Injury Prevention; Drug and Alcohol Programs; and Family Health and Community Health Systems.
He previously served as Director of Health at the Montgomery County Health Department for five years. He directed the development and administration of all public health programs and services in Pennsylvania's third-largest county. During his tenure in Montgomery County, Gurian had a tense relationship with AIDS advocates, most of whom felt the then-fledgling department was unwilling to work with them on developing a county-wide strategy to combat HIV/AIDS.
Gurian also served as director of health for the Allentown Health Bureau from March 1980 to December 1990. He served in a number of field and administrative positions for the Illinois Department of Public Health from June 1974 to March 1980. Prior to that, he served for one year with the Peoria County Health Department in Illinois.
Ridge budget increases SPBP, holds line on other AIDS funding
Governor Ridge's FY 2000 state budget proposes an increase of over $1.7 million for the Pennsylvania's AIDS drug assistance program, but provides no new money for AIDS education and service programs, according to Bruce Flannery, executive director of the Pennsylvania Coalition of AIDS Service Organizations (PCASO).
Flannery said that the increase for the Special Pharmaceuticals Benefits Program (SPBP), Pennsylvania's version of the federal AIDS drug assistance program, amounts to over 16 percent, raising the state funds available for low-income and uninsured people with HIV/AIDS to over $12.6 million. Additional funding is added to SPBP from the state's Ryan White grant.
Pennsylvania's AIDS drug assistance program supports prescription drug costs for individuals making $30,000 per year or less who do not have insurance to pay for the drugs. PWAs with families to support are able to make more money per year, according to a sliding scale, and still qualify for the program. Most of the approved AIDS medications, including protease inhibitors and non-nucleoside reverse transcriptase inhibitors, are covered in the Pennsylvania program, which is among the most comprehensive in the nation.
Flannery said that while state officials used a sophisticated pharmacoeconomic model to project the funding needed to meet demand for SPBP resources, "the number of folks using SPBP has and continues to grow dramatically, and as we move ahead, no one is really certain what costs will look like a new drugs are introduced."
"The good news is that DPW and the Governor's office has made every effort to keep the program running and accessible to all qualified persons with HIV," Flannery said.
Noting that SPBP continues to pay for Clozaril for the treatment of schizophrenia in addition to the 65 or so AIDS drugs covered, Flannery expressed concern that trying to cover both AIDS and mental illness prescription drugs may ultimately weaken the program for both constituencies.
"The bad news is that as the program continues to share it's state-generated resources with mental health patients. Unfortunately, SPBP might soon be forced to pay for a variety of psychoactive meds in the pipeline, which would likely make a bad situation worse. We feel strongly that it is a disservice to both PWAs and those living with mental illness to force them to 'compete' for the same resources. The state should break the programs apart and fund each program adequately," he said.
Flannery said that the state health department's funding for HIV prevention and care programs, called the "106" program after its budget line number, gets no funding increase in Ridge's new budget proposal. Current funding for these programs is $6.528 million. "This is distressing," Flannery said, "in light of the growth of caseloads as mortality decreases, and the fact that Pennsylvania's care and prevention efforts have not been made a the priority I think they need to be."
Flannery said that PCASO has called on the Governor and health department to work with affected communities to better assess needs, as well as plan and coordinate resources to fill gaps, meet real needs and target prevention efforts and strategies on communities at greatest risk.
"We will also work to try to secure additional resources to fill gaps for next year," Flannery said.
Hearings on HIV reporting scheduled
Meanwhile, acting on a recommendation from Philadelphia health commissioner Estelle Richman and the city's AIDS Activities Coordinating Office, the state health department has announced that it will hold a series of public hearings throughout the state over the next few months to get public views on how it should implement a new HIV reporting policy for Pennsylvania.
The Philadelphia Board of Health has recommended to the state that it implement a "unique identifier" system, rather than actual names, once it requires that new HIV infections be reported to state health officials. The Allegheny County Board of Health, which oversees public health services in Pittsburgh and surrounding areas, is expected to endorse a coded reporting system as well.
Federal officials have asked each state to initiate HIV reporting systems this year, and while they have said they will support any kind of reporting programs, they have also clearly indicated their preference for names reporting systems. Most advocates and people with HIV/AIDS have opposed names reporting, saying that it risks confidentiality violations and may discourage some people from getting tested.
Anna Forbes, a Philadelphia activist who is nationally recognized as an expert on the reporting issue, said that it will be important for AIDS activists, AIDS service organizations, and public health experts to speak out in favor of code reporting in the upcoming state hearings. "If the state Dept. of Health goes away from the hearings with the message that only Philadelphia and Pittsburgh object to mandatory name reporting and that the rest of the state couldn't care less, it will obviously reduce the odds of them doing the right thing when they make their decision," she told fastfax.
The schedule of the hearings was not available to fastfax at press time, but will be published next week.
HIV+ hygienist sues Valley Forge dental firm
An Atlanta dental hygienist has charged in a lawsuit that he was illegally fired after his employer learned he had tested positive for HIV.
The Lambda Legal Defense and Education Fund filed the lawsuit in U.S. District Court in Atlanta on behalf of hygienist Spencer Waddell, 35.
"There is a simple answer to concerns about HIV in the health care setting -- use gloves, masks, sterilized instruments," Lambda attorney Stephen Scarborough told Reuters, which originally carried the story. "It is well established that as long as appropriate precautions are taken, the risk is so small as to be negligible."
The lawsuit was filed against Valley Forge Dental Associates, which manages a dental clinic in Riverdale, Georgia, about 20 miles (35 km) south of Atlanta.
The suit alleged the dental group illegally fired Waddell because it feared patients would object to being treated by someone with HIV.
"A rampant epidemic of irrational fear threatens the careers of many health care professionals who have HIV," Scarborough said. "This case aims to replace bias and fear with science as the basis for health care employment decisions."
Waddell, who is HIV-positive but does not have AIDS, began working for the dental practice in January 1996. Scarborough said his employer learned of his HIV status in September 1997, when it received a call from his doctor, who is not named in the lawsuit.
"They found out when his personal physician called them," Scarborough said. "That's why they fired him. We have somebody who is fully qualified and capable of providing dental service. He is fully able to work, and in fact is working in a dental office at this time."
The lawsuit alleged Valley Forge immediately placed Waddell on a leave of absence. He was later offered a lower-paying, non-clinical job and fired when he refused to accept it, the lawsuit said.
A spokeswoman at Valley Forge Dental Associates' headquarters in King of Prussia told Reuters no one from the company was available to comment on the lawsuit.
SF gay risk behavior continues to rise
A trend toward an increase in unsafe sexual behavior among men who have sex with men in the San Francisco area, and a subsequent increased risk of HIV infection, is highlighted in a report from the Centers for Disease Control and Prevention (CDC).
Between 1994 and 1997 there have been "significant increases" in self-reports of unprotected anal intercourse among men who have sex with men, as well as significant increases in the rates of rectal gonorrhea in San Francisco, CDC officials report. During this time interval, the rates of unprotected anal intercourse rose from 30.4% to 39.2%.
The percentage of men who reported having unprotected anal intercourse with multiple partners also increased from 23.6% in 1994 to 33.3% in 1997. Rates of rectal gonorrhea in men seen at STD clinics in San Francisco also rose steeply, from 21% to 38%, which reverses a 3-year declining trend.
The highest rates of both unsafe sex and gonorrhea occurred among men between the ages of 26- and 29-years old. And the number of self-reports of unprotected intercourse increased dramatically among these younger men.
"Because the prevalence of HIV infection among [men who have sex with men] in San Francisco is high, small increases in unsafe behaviors in this population may result in increases in HIV infection incidence," CDC officials point out.
These data "...suggest that the substantial reduction in sexual risk behaviors among [men who have sex with men] and the decreases in rectal gonorrhea during the 1980s and early 1990s cannot be assumed to be maintained indefinitely," CDC researchers write in the January 29th issue of the Morbidity and Mortality Weekly Report.
A perception of lower risk of HIV infection, along with the availability of highly active antiretroviral therapy, "may lead to misunderstandings and complacency toward safe-sex messages." Therefore, targeted HIV and STD prevention programs, along with community-based outreach "...remain crucial to reach these populations."
HIV stays in syringes for four weeks
HIV recovered from syringes can remain viable for 4 weeks or longer, according to a multicenter group. This has especially important implications for syringe exchange programs "because not only do these programs provide new, sterile injection equipment, but they also remove from circulation potentially infectious needles and syringes," Dr. Nadia Abdala of Yale University and her New Haven, Connecticut-based colleagues reported.
In the January 1st issue of the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, they determined the duration of survival of HIV in used syringes. Specifically, they used a microculture assay to detect the viability and duration of survival of HIV in the blood that typically remains in syringes of injection drug users.
"Using this assay and modeling the worse-case situation for syringe sharing, we have recovered viable, proliferating HIV from syringes that have been maintained at room temperature for periods in excess of 4 weeks," they report.
They also found that the volume of blood in the syringe, along with the titer of HIV in the blood, determined whether or not viable HIV was recovered.
Dr. Abdala's group feels that these "...findings have implications in the design of public health recommendations for preventing the spread of HIV among drug injectors." HIV-contaminated syringes are potentially infectious for prolonged periods, which highlights the importance of targeted interventions to encourage the disposal of used syringes and to reduce the practice of syringe sharing.
Whitman uses right-wing study to combat needle exchange
Despite solid scientific evidence that syringe exchange programs reduce the spread of HIV and do not encourage drug use, New Jersey's Gov. Christine Todd Whitman points to a study by the right-wing Heritage Foundation as her evidence against syringe exchanges, according to an article in the New York Times. While the nation's most prestigious health and medical institutions have endorsed needle exchange programs, Whitman claims these studies are "dubious, at best."
"Whitman's opposition to syringe exchange is fueling an HIV epidemic in New Jersey," said Ethan Nadelmann, JD, Ph.D., drug policy expert and director of the Lindesmith Center, which has reported that the lack of needle exchange in the state has led to thousands of new infections. "New Jersey now has the nation's highest rate of HIV infection among women and children. She is simply playing politics with people's lives."
As Whitman nears the end of her term in 2001, Diana McCague, a syringe exchange activist, told the Times, "It's unfortunate that the government's own statistics show that four people will be infected by injection-related HIV every day between now and then. That's 4,400 people between now and the end of her term."
In 1998, Whitman's appointed Attorney General, Peter G. Verniero, released a study that was critical of needle exchange programs. Whitman frequently refers to this study when defending her opposition to syringe exchange. However, the Times reports that one of the sources for the study was the right-wing Heritage Foundation, which also advocated conversion to Christianity as a cure for drug addiction.
Numerous scientific studies have concluded that needle exchange programs dramatically reduce the spread of HIV and do not encourage drug use. Needle exchange programs are supported by the American Medical Association, the National Academy of Sciences, the Centers for Disease Control and Prevention, the American Public Health Association, the American Bar Association and the U.S. Conference of Mayors as well as other prestigious medical, professional and public health organizations.
42% of US adults have had HIV test
About 42% of adults in the US have been tested for HIV, either voluntarily or to obtain insurance, enter the military or for their job, according to a survey conducted by the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.
However, the rate of testing varied widely from state to state, and -- not surprisingly -- tends to be higher in states with a high rate of AIDS cases.
For example, only 26% of adults in South Dakota said they had been tested for HIV compared with 60% of those in Washington, DC, which had the highest AIDS rate.
In most states, men were more likely than women to have undergone an HIV test. But women were more likely to have had the test voluntarily.
Overall, about 22% of those tested had the test for personal or health reasons, with the bulk of tests part of job or insurance requirements.
The telephone survey, conducted in 1996, included 97,006 people between 18 and 65 in all 50 states and the District of Columbia.
"HIV testing can help reach at-risk person with counseling and other prevention services and link infected persons with needed health care services," according to the CDC. The federal agency notes that "not all persons need to be tested for HIV." Testing is recommended for all people with risk factors for the disease, and in specific situations such as pregnancy or in tissue donation.
"Prevention programs should be structured to increase the proportion of at-risk persons who receive HIV-testing services," advise CDC experts.
PPP shifts syringe exchange site
Prevention Point Philadelphia, the city's syringe exchange HIV prevention program, will be moving its Saturday morning needle exchange and service referral site on February 13th, 1999 to its Center at 333 West Girard Avenue.
The time will remain the same - 10:30 a.m. to 12:30 p.m. 333 West Girard is a yellow, three story row house with a blue door, right across the street from the Kentucky Fried Chicken; the closest intersection is 4th and Girard.
PPP director Julie Parr said, "This will be a temporary situation until we find a more permanent home for our Saturday morning needle exchange site. We are looking for a place in the Kensington area where we could do the exchange indoors." She said that PPP will continue to provide HIV testing and medical care at the Saturday site.
Parr is asking outreach workers and AIDS service organizations who refer people to the needle exchange take the time to get new schedules, or cross out the old location and replace it with the new one on existing material. For more information, call PPP at 215-787-0112.
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