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Issue #227: April 30, 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 Chicago Tribune, Congress Daily, Nature Medicine, New England Journal of Medicine, Philadelphia Inquirer, Reuters, Science, United Press International.
In This Issue:
Congress may extend Medicaid to HIV+ people
Names reporting condemned at Philadelphia hearing
PCP treatment can stop if HAART is effective: study
'Latent' HIV lasts a lifetime: study
Bill on medical privacy proposed
HIV vaccine promising in monkeys
Protein may be key to treating Kaposi's
Protest highlights drug access problems in Africa
AACO staffer charges reverse discrimination
Ridge nominates Medicaid official as health secretary
Statscript installs new HIV management system
Congress may extend Medicaid to HIV+ people
A bill that would expand Medicaid coverage to low-income, HIV-positive individuals before they develop symptoms of AIDS has been introduced in both the House and Senate in Washington.
The legislation would enhance Medicaid benefits that today are only usually available when a person is disabled by their HIV infection or develops AIDS. Vice President Al Gore called for similar legislation last year but his effort petered out before it could advance in the Congress.
If passed, the legislation could assure health insurance coverage to the majority of low-income people living with HIV infection today, who often do not have enough money for private insurance and have not been sick enough to qualify for Medicaid coverage for disabled people.
The Early Treatment for HIV Act was introduced by House Democratic Leader Richard Gephardt (D-MO), Representative Nancy Pelosi (D-CA) and Senator Robert Torricelli (D-NJ). Under the bill, states would have the option to expand their Medicaid programs to provide coverage.
Senator Torricelli said of the bill in a press release, "It is a real step toward improving the quality of life for thousands of low-income people with HIV. The legislation eliminates the glaring flaw in the Medicaid program by allowing access to vital medical services."
Fifty-nine members of the House have signed on as cosponsors of the bill, and, earlier this month, the Presidential Advisory Council on HIV/AIDS wrote to President Clinton to urge his active support of the legislation.
The sponsors of the bill noted that the Department of Health and Human Services has recommended the use of antiretroviral therapy before the development of symptoms of AIDS. Medicaid currently does not define individuals with early infection as disabled, and many low-income HIV-positive patients therefore cannot receive drugs or HIV-related healthcare through the program.
Representative Pelosi said, "It is imperative that our government healthcare programs catch up with the recommendations of government healthcare experts."
AIDS Action, a Washington, DC-based advocacy group, strongly endorsed the legislation. Executive Director Daniel Zingale said, "Today, an entire class of Americans is denied access to drugs and care that prevent full-blown AIDS until they develop full-blown AIDS. If automobile safety regulations followed the current model, air bags would only be required in cars that have already crashed."
AIDS Action noted that President Clinton's fiscal year 2000 budget proposal included a $300 million demonstration project to partially enact the plan.
In an interview with Reuters Health on Wednesday, Zingale said that the plan was launched at an AIDS Action event in April 1997 and was immediately endorsed by Vice President Gore, who was attending the event. He said that the group and Vice President Gore were optimistic at the time that the Medicaid program would be modernized to include the change in a relatively short amount of time.
However, he said that the plan was "bogged down in debate about cost neutrality." He added that the plan would save not only lives but "dollars in the long-run, because you would avoid so many people getting to the most expensive late stages of the disease."
Zingale said that he was optimistic that the bill would be passed and approved by the president and that polls that AIDS Action had conducted among members of Congress showed "overwhelming support" for the bill. He said that he supports the state-federal partnership that would occur under this plan, because it gives the state a stake in the plan.
In some cases, it might not make sense, according to Zingale, to make wholesale changes in a state Medicaid program, because it might not be the most efficient way to cover the cost for those in need. He said that rural states, in particular, might find a way to cover everyone without making changes to the Medicaid program.
"In one fell swoop, this would raise the entire national standard of care and even out the disparity in the level of services and availability of treatments across the country," said Craig E. Thompson, executive director of AIDS Project Los Angeles, on the announcement of the legislation.
The measures will face a tough battle in Congress, where balanced-budget requirements make any program expansion difficult.
An aide to Florida Republican Michael Bilirakis, chairman of the House subcommittee that would first consider Pelosi's bill, said Bilirakis was sympathetic to the bill's intent but needed more information about the costs and, more important, what would have to be cut to provide the additional care.
Several studies presented at the World AIDS Conference in Geneva, Switzerland, last year suggested that the expansion of Medicaid to HIV+ people, while costlier at the front end, could provide substantial savings over time by reducing hospitalizations and secondary illnesses.
Using a computer model to estimate the number of HIV patients by stage of illness and type of insurance they receive, James G. Kahn of the AIDS Research Institute at the University of California, San Francisco, determined that more than 37,000 low-income people would enroll in the expanded Medicaid program over five years, resulting in 15,000 fewer AIDS diagnoses and 5,000 fewer AIDS deaths.
A plan providing drugs and outpatient care would cost about $300 million over those five years, Kahn said.
Names reporting condemned at Philadelphia hearing
The Philadelphia hearing on Pennsylvania's plans to implement an HIV reporting mechanism later this year heard from almost 30 people last week - almost all in support of HIV reporting but opposed to the collection of names and other identifying information as part of the project.
Close to 100 people attended the hearings, sometimes loudly applauding activists who threatened to aggressively oppose any state effort to require names as part of the HIV reporting system.
Anna Forbes, a local activist who has achieved a national reputation as a proponent of the use of "unique identifiers" rather than names for HIV reporting, told several state health department officials at the Children's Hospital hearing that "Pennsylvania would be in good company if it decided to pursue the UI option." She noted that Maryland, Illinois, Massachusetts and Hawaii are already using or preparing to use unique identifiers in their reporting systems.
Forbes said that "people with HIV/AIDS, drug users in recovery, women with terminated pregnancies and people with mental illness are protected from the threat of stigmatization by the use of UI systems.
Bruce Flannery, executive director of the Pennsylvania Coalition of AIDS Service Organizations, told the panel that there is broad-based opposition to names reporting throughout the state.
"There's been a groundswell of opposition to reporting names," Flannery said. "Even in parts of the state where it's risky for people to publicly identify themselves as having the virus, people have been coming to these hearings and sacrificing their own privacy in order to plead with the state not to require names. Their major concern is that others with HIV, especially folks in high risk populations, will stay away from testing and care out of fear that their names will get out."
Flannery noted that the Philadelphia Board of Health, the Philadelphia Health Department, and a committee of the Allegheny County Health Department have also endorsed a non-name, coded system for HIV reports.
Kevin Conare, executive director of ActionAIDS, the largest AIDS service agency in the state, said that his agency's 2500 clients have emphasized the importance of protecting their privacy when obtaining AIDS services. "It took years to get clients to feel comfortable coming to a space in their own communities," Conare said. "We were able to do this by respecting their need for confidentiality."
Conare said that "People get into care by being able to trust providers in their communities, not by being reported. If you take away our ability to keep our clients' confidentiality, you strip us of our ability to gain their trust. Please do not do this."
Conare challenged those who equate HIV name reporting with similar requirements for those who contract sexually-transmitted diseases and tuberculosis, calling such comparisons "misleading."
"HIV disease is a communicable disease, that is hard to get, that has a slow progression of symptoms, and that is not curable, but requires years of complicated drug regimens to manage. It cannot be compared to STD'S which can often be controlled through one time or very time-limited interventions. It cannot be compared to TB, which is air borne and can also be controlled through 3-6 month interventions."
A person with AIDS, Conare said that if Pennsylvania had required names reporting when he tested positive for HIV, he may have delayed seeking treatment.
"I only got tested because it was anonymous," he said. "It took me a year to get into care. Today I am very open about my status. I am grateful that I was able to get to that point on my terms and when I wanted. Names reporting would have only made it take longer and I would have waited until I was sick."
Larry Frankel, executive director of the American Civil Liberties Union of Pennsylvania, told the panel that the ACLU's national office recently conducted an intensive analysis of the HIV reporting issue. "We have found that the existing evidence demonstrates that name-based reporting is a counterproductive public health measure that will cause individuals to avoid HIV testing," Frankel said. "One study found that more than 60% of individuals tested anonymously would not have undergone testing if their names would have been reported to public health officials. Other studies have found that individuals are much more likely to voluntarily test for HIV, if the testing is anonymous because those individuals believe that they can control the dissemination of their test results."
Paul Davis of ACT UP Philadelphia said that "Names reporting does not mean that more people with HIV are somehow detected." He noted that "the CDC still considers there to be tens of thousands more people with HIV in NJ than the state's list of names holds. Mandatory names reporting does not detect a single additional person with AIDS. Unique Identifiers might find a few hundred extra people around the state. Names reporting has been shown to decrease the numbers. State owned lists of names will not magically create new waves of individuals suddenly willing to come forward and get tested."
Noting that the state has argued that names reporting, which is preferred by the national Centers for Disease Control, is important in the competition for federal AIDS dollars and might result in additional funds being allocated to AIDS services in Pennsylvania.
But "names reporting will not mean more funding for cash strapped agencies," Davis said. "It does not mean one single penny. An increase in the state budget would. Governor Ridge has flat funded [the state HIV budget] this year, in spite of increasing case loads.
"Tracking isn't treatment," Davis said. "Making lists isn't prevention. Collecting names isn't a cure."
David Fair, former director of the city's AIDS Activities Coordinating Office and of We The People Living with AIDS/HIV, told the panel that a system utilizing codes and seroprevalence studies would prove superior to simply recording names to define the HIV epidemic in Pennsylvania.
"Even with names reporting," Fair said, "the feds are going to have to develop some kind of formula to extrapolate those numbers to try to define what the real epidemic is -- putting us in the ironic situation where having actual names turns out not to mean much except as just another piece of inadequate data on which to go back to making the educated guesses we've been making for so long.
"Names data, then, won't be a whole lot better than seroprevalence data -- and might even be less reliable as a basis for making projections, given the fact that many more people than today will avoid being tested until their disease is advanced."
Fair said that those who minimize the risk of confidentiality violations, claiming that there have been few so far in the epidemic, do not understand the environment in which HIV name reporting is being proposed.
"When we have U.S. Congressmen threatening federal legislation to make having sex a crime for a person with HIV, I start to wonder whether it's a good idea for them to have names and addresses of the people they think of as potential felons," he said. "When we have local school districts refusing to allow children with HIV to go to school -- often refusing admission on the basis of rumor rather than information legally available to them -- it makes me nervous that some local homophobe or AIDS-phobic council member might suddenly make it legal for you to turn over the names."
Fair continued that "The bottom line is that even though it's unlikely that, today, simply reporting names is going to produce all sorts of discrimination and abuse and threats to the quality of life of people with HIV -- it could, someday. It's within the realm of reason. It's not that far-fetched. Watch our legislature in action on your cable TV and tell me you think these guys will always do the right thing.
" Remember, it was only ten years ago that quarantining people with HIV was still considered as potentially sound public health practice. It was only two weeks ago, in the Midwest, that a man with TB was put in jail because he wasn't careful enough about making sure he did not infect anyone else. It was only two days ago that a mother in Oregon was told, by government, that she couldn't breast-feed her child because she might put her child at risk -- and if the child got infected, that she could be indicted for murder.
"Whatever your opinion of those actions, what they mean is that when a government has the name of a person with HIV, it's possible that someone in that government will use that name in some punitive fashion, rightly or wrongly. And in a free society, should we even take the chance?"
HIV+ people who are taking combination antiretroviral drugs and have CD4 cell counts of 200 or higher can safely stop taking drugs to prevent Pneumocystis carinii pneumonia (PCP), a common and often life-threatening infection seen in people with HIV/AIDS, researchers have reported.
The findings of a new study, reported by Dr. Hansjakob Furrer of Inselspital Bern in Switzerland and colleagues in the April 29th issue of The New England Journal of Medicine, complement those from a similar study published in January.
In the Swiss study, 262 subjects who were on combination antiretroviral therapy were monitored for PCP and another opportunistic infection, toxoplasmic encephalitis, following discontinuation of PCP-preventing drugs. PCP is a pneumonia caused by a parasitic infection, and toxoplasmic encephalitis is a central nervous system infection that can result in brain abscesses and convulsions.
Over a period of about 11 months, there were no cases of PCP, toxoplasmic encephalitis, or AIDS-defining illness in any of the patients studied.
These findings "suggest that combination antiretroviral therapy induces a clinically significant restoration of immunity against P. carinii," the authors concluded.
They estimate that fewer than 2% of this group of HIV-positive patients are likely to develop PCP, far fewer than the estimated 6% rate expected in patients not taking highly active antiretroviral therapy (HAART). PCP was once the leading killer of people with HIV disease.
"This is really good news for the patients," said Furrer in a statement, "because each time we can leave out the antibiotics, it means many less pill for the patients (to take)."
However, they warn that there is still a risk of PCP in patients who have already been exposed to the infection, and advise these patients should continue to take prophylaxis against the infection. (UPI) AIDS patients see lower pneumonia risk.
Furrer said that when CD4 cell counts drop below 200, the risk of PCP rises to 10 to 20 percent a year; below 100 CD4 cells, the risk increases to 40 percent a year. His patients had CD4-positive counts between 200 and 500 cells, putting them at about a 6 percent yearly risk of PCP.
"We had more than 300 patients who were eligible to drop PCP prophylaxis in our group, but many decided they weren't willing to take the risk that PCP would return," Furrer told United Press International.
He said the study's main results are:
- Patients were able to reduce taking medication. "Most of the time, people living with HIV have to add about two pills to their daily regimen every year," he said. "This study will allow them to reduce the number of pills." PCP prophylaxis required three to seven pills a week.
"There is a great psychological boost to these patients knowing they can safely stop taking some medication," Furrer said.
- That the CD4 cells that rebound with patients on treatment with protease inhibitors and other antiretroviral medication are functioning cells.
"We have debated whether these rebounding CD4 cells really work to protect the body, whether they are functioning cells," said Furrer. "Our work would indicate that these are real cells and they represent a functioning reconstitution of the immune system," he said.
Furrer's study is consistent with an earlier finding in a smaller group of patients treated by Dutch doctors. Furrer said, "As far as we are concerned, we are now practically certain that fewer than 2 percent of our patients are likely to develop PCP."
Furrer presented preliminary data on his study at the World AIDS Conference in Geneva last year.
In an accompanying editorial in the journal, Dr. Henry Masur of the National Institutes of Health, Bethesda, Md., and Dr. Jonathan Kaplan of the Centers for Disease Control and Prevention, Atlanta, wrote: "The report by Furrer and colleagues offers gratifying evidence that immune reconstitution resulting from highly active antiretroviral therapy may allow some patients to discontinue primary prophylaxis against PCP."
The doctors said further studies should attempt to define the risk of discontinuing the medication in other infected populations. Furrer said his group is continuing to perform such studies.
Furrer noted, however, that the possibility of PCP resurfacing more than a year after the prophylactic treatment has been discontinued cannot be entirely excluded. He further said the findings do not apply to patients who have previously had PCP.
In 1995, researchers at Johns Hopkins discovered that HIV evades anti-viral drugs by hiding in the immune system, infecting T cells, and then going to sleep, or turning off.
In the May issue of Nature Medicine, the same team reports this silent infection persists for a lifetime.
"This doesn't mean a cure for HIV is impossible, but it is an obstacle," says Robert Siliciano, M.D., Ph.D., senior author on the report. "And it emphasizes that patients need to stay on their medication, possibly for the rest of their lives."
However, not all news from the study was bleak. The study patients, who kept to their strict drug regimens under supervision from physicians at the Johns Hopkins Moore HIV Clinic, all had undetectable levels of HIV in their blood and no signs of AIDS.
"The good news is that patients who comply with their therapy are able to keep the virus suppressed for long periods," says Joel Gallant, M.D., who directs the Moore Clinic. "We have assumed that therapy for HIV patients would have to be long-term or even lifelong. This study suggests that is still the case. But the study also suggests that HIV-infected patients can still live long, healthy lives without symptoms, provided they are rigorous about taking their medications."
When taken as prescribed, combination therapy (the so-called "drug cocktails") of older anti-HIV drugs like AZT and newer protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs), reduces the amount of circulating virus to undetectable levels in most patients. The immune system remains relatively healthy and the collection of diseases that signal AIDS is staved off.
But the latent form of HIV can wait out even decades of anti-HIV therapy. First, it integrates its genetic code into the DNA of dormant, or resting, T cells. While the cells are in their resting phase, the HIV genes inside them remain switched off a silent infection. When the dormant cells are reactivated, say by a simple infection like the flu, the HIV genes reemerge, co-opting the cell machinery to make millions of copies of the virus.
Anti-HIV medication suppresses this flood of virus. But without medication to stop it, the virus can replicate out of control, eventually causing AIDS.
"We've seen patients without detectable virus in their blood come off their medication, and within a few weeks or months they experience a rebound, with high levels of virus in their blood", says Gallant. "Now we know that this reservoir of dormant T cells is responsible."
To measure how long the reservoir survives, the team followed 34 patients for two years, periodically drawing blood samples. Using a sophisticated cell-sorting technique developed at Hopkins, they siphoned off the dormant T cells that carried HIV genes and counted them. They found the number of silently infected cells remained stable, or declined very little. A statistical projection showed the reservoir lasting 60 years or more.
Siliciano added that because so few T cells only one in one million harbor the silent infection, they are impossible to detect without extremely precise methods. In the Nature Medicine article the team reports finding the infected T cells in 32 of 34 patients. Since writing the article, they have found silently infected cells in the other two patients.
The study was funded by the National Institute of Allergy and Infectious Diseases.
A U.S. Senate bill setting federal rules to protect the privacy of medical records was introduced Monday, one of several such measures being considered as a deadline approaches for Congress to act on the issue.
Sen. Robert Bennett (R-Utah) said his bill would create a uniform federal law that would supersede a patchwork of state laws. There are 35 states with medical confidentiality laws, including Illinois, some of which conflict with each other, he said.
The law would not interfere with authorized medical researchers' access to patient records, which is crucial for medical advances and therapeutic breakthroughs, Bennett said. "If the access to medical records for research is shut off in the name of confidentiality, we will in fact damage health care," he said.
Bennett's medical privacy bill, like others that have been introduced during this session of Congress, is an attempt to beat an August deadline set by the Healthcare Insurance Portability and Accountability Act. That 1996 law, also known as Kennedy-Kassebaum after its bipartisan sponsors, Sen. Edward Kennedy (D-Mass.) and then-Sen. Nancy Kassebaum (R-Kan.), was meant to help workers who switch jobs keep their insurance.
Kennedy-Kassebaum envisioned the electronic transfer of medical records as families moved. Thus it required Congress to pass a law by Aug. 21 to safeguard the confidentiality of medical records as they became ever more mobile. Should Congress fail to act in time, Kennedy-Kassebaum called for the administration to create and put into effect comprehensive privacy standards.
"I don't run into any legislator in either body who says having this done in the executive is a good idea," Bennett said. "On a constitutional basis, if we're going to pre-empt state law, the Congress ought to do it. We should not get into the habit of having the executive branch by executive order wipe away state legislation."
"Sometimes those who are strongly in favor of patients' rights and confidentiality don't realize that in their effort to achieve that laudable goal, they might in fact draw legislation that would shut off the research that [some] people have benefitted from and that others need so badly," Bennett said.
A medical privacy bill Bennett introduced several years ago did not make it into law. The pre-emption of state laws is the major difference between his bill and two others.
At a congressional hearing, Sen. Patrick Leahy (D-VT) testified that Bennett's bill "makes room for the many possible future threats to medical privacy that we may not anticipate today." He added, "As medical and information technology moves forward into the next century, we must maintain the public's right to meet future technological challenges to privacy with stronger medical privacy laws closer to home."
With regard to access by law enforcement officials, both bills, in addition to Sen. Kennedy's (D-MA) legislation, would impede law enforcement officials' efforts to combat healthcare fraud and other crime, Justice Department officials said.
Each of the bills would require law enforcement authorities to obtain a court order, subpoena, or at least some third-party permission before personal medical information could be released.
Bennett said that while "appropriate checks within the system" would be necessary, "There are times when, in the course of their duty, that law enforcement authorities need access to medical records."
An experimental vaccine that combines genes from HIV and SIV, followed by a booster shot with a pox virus carrying the same genes, appears to protect monkeys from infection with a combination immunodeficiency virus.
The experimental treatment "holds very high promise for a preventive vaccine," said Dr. Harriet L. Robinson of the Yerkes Regional Primate Research Center in Atlanta, Georgia.
While monkeys given the vaccine still became infected with a virus that combined both HIV and SIV (the monkey version of HIV), the vaccine helped contain the virus for up to 62 weeks, according to the report in the May issue of Nature Medicine.
The monkeys given the vaccine had undetectable levels of virus in the blood compared with unvaccinated monkeys that had high levels of virus. There were a total of 32 animals in the trial, with 4 animals in each of the 8 groups.
"The protocols all combined DNA priming (of the immune system) with either protein or recombinant pox virus boosting," Robinson said, "and differed in their ability to raise neutralizing antibody and cell-mediated immune responses."
"We got our best and most long-lasting protection in the group that received intradermal DNA prime followed by recombinant pox virus boost," she said.
Robinson's group is currently beginning another macaque trial in which they will further develop the vaccinations that led to the most favorable protection in this trial. "We're also getting ready to try to take the protocol into humans, although that will take time... at least a year," she said.
A team of Harvard researchers suggests that blocking the action of a particular protein may stop cell-to-cell spread of the herpesvirus linked to Kaposi's sarcoma, a common complication of AIDS.
The finding may lead to treatments that stop or slow spread of the herpesvirus, called human herpesvirus-8.
Kaposi's sarcoma, a condition in which malignant purple or dark brown tumors appear on the skin, can be extremely aggressive in AIDS patients. The tumors have also been found in elderly Mediterranean men, but they develop at a slower rate in these patients, the authors note.
In their report, published in the April 23rd issue of Science, the investigators note that DNA from Kaposi's sarcoma-associated herpesvirus (KSHV) is found in almost all Kaposi's sarcoma lesions.
The researchers report that their study shows that a protein called latency-associated nuclear antigen (LANA) is also found in tumors infected with KSHV.
The team of researchers, led by Mary E. Ballestas of Harvard Medical School, Boston, Massachusetts, found that LANA works to connect viral DNA to the infected cell's chromosomes during cell division, thus helping KSHV to enter new tumor cells. The team speculates that strategies that block this process could be useful in preventing and treating diseases caused by the virus.
"Although additional work is necessary to further define the molecular mechanisms by which LANA mediates (passage of viral DNA from cell-to-cell), strategies that interfere with the functions of LANA described here could be useful in... preventing or treating KSHV-associated diseases," Ballestas and colleagues concluded.
Hundreds of demonstrators rallied outside the US pharmaceutical industry's lobbying and trade group headquarters on April 21st to protest against policies that they say limit access to AIDS drugs in Africa.
Chanting, waving signs, and in some cases defying police, AIDS activists and environmental and trade groups demonstrated in favor of legislation sponsored by Rep. Jesse Jackson Jr., an Illinois Democrat. Jackson's bill would forbid the Clinton Administration to retaliate against any African country that tried to use certain trade provisions, namely, compulsory licensing and parallel imports, to obtain cheaper AIDS drugs.
Approximately 22.5 million people in Africa are infected with HIV or have AIDS.
The United States needs to "give African governments and African corporations an opportunity to produce medicines that will be widely distributed among the people of sub-Saharan Africa so (they) can live," Jackson told supporters gathered in a downtown park during lunch hour.
Health and consumer groups have criticized the Clinton Administration for pressuring developing countries on behalf of drug companies to abandon trade approaches that could help them obtain cheaper medications. Drug makers and US officials say that the trade powers these countries might use violate patent rights and would hurt the companies' ability to invest in future AIDS drugs.
Compulsory licensing, legal under World Trade Organization rules, allows countries to grant a local company authority to make cheaper, generic versions of drugs even while the products are still protected by patents. In addition, parallel imports let countries buy drugs through third parties at lower prices.
The trade powers have become a rallying point for AIDS groups that say the gap is growing between those who can afford medications and those who cannot. Carrying signs reading "Human Rights, Not Corporate Rights" and "Just Say No to Drug Lobbyists," demonstrators marched through city streets to the offices of the Pharmaceutical Research and Manufacturers of America, the trade association for brand-name drug makers.
"We're not going to allow our president and vice president to bully and harass and kill people in Africa," Julie Davids of ACT-UP Philadelphia told the rally.
E-mail discussion group announced
Discussion and exchange of information and experiences has recently begun on AF-AIDS - a new regional HIV/AIDS information email forum for Africa (in English and French). Over 850 people and organizations working in or with African Nations in the response to the epidemic have already joined the forum.
Each day members discuss current HIV/AIDS issues and share their experiences about what works and what does not in response to the epidemic, as well as news from the regions and forthcoming events such as conferences and workshops. The forum is also linked to a similar initiative among over 1600 people working on HIV in Asia, so that the two regions can benefit from each others experience and knowledge.
AF-AIDS can be joined by sending an email to: with the word 'join' in the subject line. Participants are automatically sent each days messages free of charge. The group is also available on the web at http://www.hivnet.ch:8000/af-aids/tdm.
In an ironic twist on the decade-long history of staff disputes that has plagued the city's AIDS Activities Coordinating Office (AACO), a white male employee has sued AACO and various city officials claiming that he has been discriminated against because he is a white, heterosexual male.
Only last year, a federal jury found that former AACO director Richard Scott had been guilty of race-based discrimination by denying promotions and other personnel benefits to several African American AACO employees.
The most recent suit was also filed in U.S. District Court, and names, in addition to the city itself, Health Commissioner Estelle Richman, city personnel director Linda Seyda, Health Department personnel director Joseph McNally, Bruce Davidson, a former Health Department physician in its Tuberculosis Control Unit, former AACO director Jesse Milan, and current AACO co-directors Patricia Bass and Joseph Cronauer, as defendants. The individuals named are being sued both as city officials and as private citizens.
The complainant, Philip DiBartolo, who works in the AACO epidemiology unit, claims that his civil rights have been "intentionally" violated by the officials named in the suit in a series of incidents dating back to 1994.
DiBartolo said that in 1994, Davidson, then director of the TB Control Unit, refused to use him as a supervisor and instead hired non-union contractors to perform duties that he should have been assigned. He also charges that Davidson sought to hire a personal friend for a position in his unit, and that DiBartolo was reassigned to AACO's Prison Unit "in retaliation for reporting the hiring of contract employees to the union."
In 1995, DiBartolo says, he applied for a civil service position as "Health Services Program Manager," a high-level supervisory position. He claims that in order to "bypass" him for the promotion, Jesse Milan, then AACO director, appointed Jennifer Kolker, who now works in the health commissioner's office, to the position, even though she was not a civil service employee. Milan is identified in the federal complaint as a "gay African American."
DiBartolo also charged that in October, 1995, Milan assigned him to a position in AACO's Housing Unit as "another lateral move to deny [him] advancement." He said that he was denied the opportunity to apply for promotions on several other occasions as well. DiBartolo also claims he was unfairly penalized by several of his health department supervisors because he had "supplied...information which was instrumental" to the eight African American employees who successfully sued Scott and the city in the previous racial discrimination case.
In papers filed with the federal court, DiBartolo describes what he believes is a pattern of discrimination against heterosexual white men in favor of gay people, people of color and women. He charges that AACO co-directors Patricia Bass, an African American woman, and Joseph Cronauer, a gay white man, "were not qualified and/or less qualified than [DiBartolo] because they did not have a master's degree or three (3) years manager experience," as required by the position.
Cronauer served for several years as both We The People's Education Director and eventually as its Executive Director, and previously worked as a manager for a local food service company. Bass has held a variety of management positions, including being the first administrator of the city's Medicaid managed care program, Community Behavioral Health.
DiBartolo also criticizes the appointment of Coleman Terrell, a person with HIV disease who is also a gay white man, to a position managing AACO's planning activities.
DiBartolo charges that Bass and Cronauer, while telling him that there was no money for his promotion demands, "hired contract employees, gay black and white males and females in an effort to bypass Plaintiff, the civil service commission, and the collective bargaining agreement." He says that since 1992, the city has "engaged in a pattern and practice of discriminating against [him] on the basis of [his] race, white, and sexual orientation, heterosexual."
Calling the city's action "sexual favoritism" and "sexual harassment," DiBartolo says that since last July, AACO has employed "five gay, minority or female individuals" to positions for which he is qualified. Among the positions cited are one formerly held by former We The People executive director Curtis Osborne, an African American gay man who is living with HIV disease, and "grant application writers," including David Fair, also a former WTP director who is a gay white man.
DiBartolo's complaint says that he has "suffered humiliation, the loss of self-esteem and a painful dimunition of his inability (sic) to provide himself and his family with the earned rewards of excellence in his chosen profession." He also says he has "suffered a severe stigmatization of his reputation, loss of professional status in the community and severe mental anguish."
DiBartolo's lawyers, Mark Frost and Gregg Zeff, say in their federal complaint that they are seeking a determination by the court that the city has violated DiBartolo's rights under the first and fourteenth amendment to the U.S. Constitution, the Civil Rights Act of 1871, the Pennsylvania Human Relations Act, and rights protected under the Pennsylvania state constitution, as well as breach of contract. They said they are seeking also financial damages "in an amount appropriate under the circumstances."
Neither the city solicitor's office nor the health department would comment on the suit.
Pennsylvania Gov. Tom Ridge has nominated Robert S. Zimmerman, currently deputy secretary for Medical Assistance Programs for the Department of Public Welfare, as his new Secretary of Health.
Zimmerman served as acting secretary in the early days of the Ridge Administration.
"During his nearly 30-year career at the departments of Health and Public Welfare, Bob Zimmerman has shown that he knows and understands the health-care needs of Pennsylvania's 12 million citizens, and that he knows how to assure that government responds to those needs effectively and efficiently," said Gov. Ridge. "He is ideally suited to lead the Department of Health at an important time for health care in Pennsylvania - as we face the challenges of a changing health-care market and changing health-care needs for Pennsylvanians."
Zimmerman succeeds former Health Secretary Daniel F. Hoffmann, who resigned in January, and Gary Gurian, former health director for Montgomery County, who has been acting secretary since Hoffman's resignation.
Gurian will return to his previous post as Deputy Secretary for Public Health Programs.
"Today, all aspects of health care are undergoing rapid and significant change," Zimmerman said. "In that climate, the role of the Department of Health in assessing health, promoting sound health policy and practices, and assuring the quality of health care to all Pennsylvanians is more important than ever. I believe this climate presents new opportunities for the Department of Health to work in conjunction with the administration, the department's sister agencies, the General Assembly and constituent groups to address these vital issues in new and creative ways."
The Disease Early Warning System (DEWS), which helps monitor the progress of HIV-infected patients, has been installed in 11 Statscript pharmacies in 9 cities nationwide, officials at Chronimed Inc. has announced.
"All of Chronimed's 29 Statscript pharmacies will have the system installed by the end of the calendar year," according to a press release from the Minneapolis, Minnesota-based company. The DEWS allows pharmacists to monitor individualized regimens of HIV-infected patients who fill prescriptions at their pharmacies.
Using this system, the pharmacists can report HIV-infected patients' compliance patterns, laboratory data, current medications and nutritional needs to the patients' physicians. In addition, the Statscript HIV-certified pharmacists can also make clinical evaluations and subsequent recommendations.
"This system represents Chronimed's first step in establishing a real-time, electronic linkage between providers responsible for the care of persons with HIV/AIDS," Maury Taylor, Chronimed CEO said. "Allowing a patient's medical provider and pharmacist to review complex treatment results in an easy-to-read, consolidated format ensures these Statscript patients receive the best care in the industry."
The service can be provided for only a "minimal incremental cost" through the use of "our secure network connections created by the Internet," Taylor continued.
Dr. Henry F. Blissenbach, Chronimed's president and chief operating officer, added that the new "system embodies Chronimed's vision that integrating care is the most effective way to manage chronic diseases. Too often, a patient's care is fragmented with lab results recorded one place, office visits somewhere else and pharmaceutical usage data in yet another location." The DEWS can pull all of this information together, he said, and should improve quality of life while reducing costs.
Statscript's Philadelphia pharmacy is located at 1117 Locust Street. Maria Walsh, the pharmacist, can be reach by calling (215) 627-2800.
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