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Issue #228: May 7, 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 American Journal of Obstetrics and Gynecology, CDC AIDS Daily News, New Orleans Times-Picayune, Reuters, San Francisco Examiner, Reuters, Science.
In This Issue:
Drug company pledges $100m for African AIDS efforts
Hybrid virus shows promise in study
Immunex says cancer drug extends AIDS therapy
Americans fear embarrassing MDs with sex questions
HIV+ women need ongoing ob/gyn screening
AIDS activist encouraged Ryan White audit
AIDS Action: another kind of 'audit'
SF bathhouse issue may be on ballot
Less than two weeks after hundreds of demonstrators rallied outside the US pharmaceutical industry's lobbying and trade group headquarters to protest against policies that they say limit access to AIDS drugs in Africa, Bristol-Myers Squibb Company has announced it has committed $100 million over five years to improve the state of HIV/AIDS research and community outreach in South Africa, Botswana, Namibia, Lesotho and Swaziland.
"HIV/AIDS is taking a devastating toll on the people of sub-Saharan Africa, a region accounting for more than four out of five AIDS deaths in the world," said Charles A. Heimbold, Jr., chairman and chief executive officer, Bristol-Myers Squibb Company. "As one of the world's great pharmaceutical companies and a major developer and manufacturer of medicines for the treatment of HIV/AIDS, we feel a moral obligation to take action against this grave situation in a manner consistent with our mission to extend and enhance human life. Our initiative is intended to complement the broader efforts of governments to identify relevant and sustainable programs for the management of HIV/AIDS."
The program, called "Secure the Future: Care and Support for Women and Children with HIV/AIDS," will expand medical research focusing on women and children and provide hard-hit areas with resources to improve community education and patient support.
"The magnitude of the AIDS crisis - particularly in Africa - makes partnerships between the public and private sectors critical if we are to make significant headway in developing effective therapies and helping people in need," said Kofi Annan, Secretary-General of the United Nations. "Through its initiative, Bristol-Myers Squibb is providing a remarkable instance of leadership in creating and sustaining such partnerships. The United Nations, and in particular UNAIDS, is proud to be a part of this historic effort."
UNAIDS Executive Director Peter Piot, M.D., called the program "a significant new development in the global fight against AIDS. With this community-oriented and comprehensive approach, the company has promised a far-reaching commitment - a move that we at UNAIDS hope will be imitated by more multinational companies. Because, in order to win this battle, AIDS must become everyone's business."
"Secure the Future" will be conducted with the participation of governments, UNAIDS, Harvard AIDS Institute, Baylor College of Medicine, Morehouse School of Medicine, the Medical University of Southern Africa (MEDUNSA) and other African schools of medicine.
"Secure the Future demonstrates the potential for public-private partnerships to confront a major health crisis," stated Kenneth E. Weg, vice chairman, Bristol-Myers Squibb. "As a private company, we recognize the need to work in concert with government departments, medical institutions, international organizations and community-based organizations to align the broad range of resources required to address a public health problem of this magnitude." Mr. Weg is leading the development of the project within Bristol-Myers Squibb.
Project plans are comprised of two principal components.
Through research programs, the Bristol-Myers Squibb HIV Research Institute will facilitate development of model programs for the management of HIV/AIDS appropriate for the resource-limited settings of the five participating countries. The company expects this research to generate clinically relevant data that can be used by the African medical community and policymakers to develop a range of practical, cost-effective initiatives.
Additionally, the Institute will facilitate the care of thousands of other people with HIV/AIDS through medical training of African physicians who will be awarded fellowships to be administered by the Baylor College of Medicine. The program also will provide local training to a range of health care professionals. Additionally, fellowships will be awarded to U.S. physicians to teach and help build capacity in the five countries.
Direction for the program will be provided by a Scientific Advisory Board that includes representatives from governments, UNAIDS, Harvard AIDS Institute, and major medical institutions.
The project's "Community Outreach and Education Fund" will help strengthen non-governmental and community-based organizations to address a broad range of pressing social and educational issues facing women and children as a result of the pandemic.
Among the key priorities will be projects that improve the quality of care for the hundreds of thousands of children orphaned by AIDS in the five countries. Other programs will address home-based care and the education of pregnant women and women of child-bearing age about their health and the importance of screening for HIV/AIDS. The Fund will seek innovative ways to reach out to women, such as peer counseling and psychosocial support, and initiatives to help improve the economic and social status of women, such as income-generation programs.
"We will provide guidance to the Community Outreach and Education Fund to improve the prospects for women and children dependent on others for financial and medical support," said Morehouse president Louis W. Sullivan, M.D., a member of the Fund's advisory board.
Fellowships in public health will be administered by the National School of Public Health at MEDUNSA and the Morehouse School of Medicine. These public health professionals will work with community-based organizations to improve their effectiveness.
Hybrid virus shows promise in study
Scientists from Tulane University and New York City have created a hybrid AIDS virus that for the first time lets them closely recreate the human disease in monkeys, which can then undergo experimental treatments.
Even though scientists have long tested potential HIV drugs and vaccines on monkeys, they haven't been able to study HIV directly because it doesn't cause the disease in that species of primates.
Instead, they have had to substitute a viral cousin of HIV that afflicts monkeys. The results have been close to what they might have achieved with HIV, but not as close as researchers would like.
In an attempt to bridge this gap, the Tulane-New York team developed a hybrid with characteristics of both viruses.
Even in monkeys, it triggers an immune-system response that is much closer to what HIV touches off in people, said Dr. Jim Blanchard, a veterinarian at the Tulane Regional Primate Research Center.
Blanchard and four researchers from the Aaron Diamond AIDS Research Center report on their work in the current issue of the journal Science.
This project is the first result of the relationship between Tulane and the New York research center that began last summer when Preston Marx, an Aaron Diamond scientist, moved to the primate center to lead its AIDS research program. He divides his time between the institutions.
The combination virus, known as simian-human immunodeficiency virus, was made by the New Yorkers. Blanchard performed surgery on the monkeys to determine disease progression after infection and the different types of immune responses.
It is the result of years of work with plenty of candidate viruses, Blanchard said. "Sometimes, a virus would infect monkeys but wouldn't cause disease. Some would infect and cause disease but wouldn't mimic HIV."
While it is easy to note when laboratory animals are infected, the real world isn't that orderly. Consequently, Blanchard said, these vaccines and medicines will be administered before, shortly after and long after infection to test their power.
Immunex says cancer drug extends AIDS therapy
Immunex Corp. says that its cancer drug Leukine helps people with HIV stay on their drug cocktails longer without developing resistance to the drugs -- so long as they were started early.
Leukine, which stimulates the immune system, kept the virus suppressed and extended the use of antiretroviral drug cocktails in people with HIV/AIDS patients with low levels of the virus in their bodies, the biotechnology company said in a statement.
The phase three study showed that Leukine also reduced the incidence of all infections and death, Immunex said.
As an immune-based therapy, Leukine acts to block HIV entry into uninfected cells, or even restores cells that have been destroyed by the progression of the disease, Immunex said.
The antiretroviral therapies attack the virus itself.
"Immune-based therapies have the potential to protect the immune system from HIV infection, ensure that infected cells remain susceptible to antiretroviral therapies, and ultimately to reestablish the human immune system's ability to fight HIV infections on its own," said Ann Hayes, M.D., senior vice president of medical development at Immunex.
The six-month randomized study involved 309 patients, out of which 115 patients had viral loads less than the level at which Leukine proved effective.
Of the 57 patients with undetectable levels of the virus, 83 percent of Leukine patients maintained undetectable viral load at 24 weeks, as compared to 54 percent of placebo patients, Immunex said.
The new data suggests that it is possible to extend the time patients can maintain viral suppression and their response to an antiretroviral regimen, the company said.
Immunex said it will review the results of the Leukine phase three trial with the U.S. Food and Drug Administration this spring.
Americans fear embarrassing MDs with sex questions
A recent telephone poll of 500 Americans over age 25 reveals that 85% are willing to discuss sexual problems with their physicians, but many are afraid that their physician would be embarrassed by their questions.
"Men and women said they would not discuss sexual problems with physicians for fear of embarrassing them. Physicians need to detoxify the sexual subject for themselves and learn more about the physiology of normal sexual experiences... This should be taught in medical schools," Dr. Marianne J. Legato of Columbia University College of Physicians & Surgeons in New York said.
The study, entitled "Adult Attitudes towards Sexual Problems," was presented in Washington, DC, at the Gender and Human Sexuality Conference. The Washington, DC-based firm Bennett, Petts & Blumenthal conducted the poll for the Partnership for Women's Health at Columbia University, New York, which Legato directs.
According to the study, 68% of those polled worry that their physicians would be uncomfortable discussing sexual issues, with 75% of women expressing such concern compared with 61% of men. Among younger women, those aged 25 to 44, 85% were concerned that their physician would be uncomfortable talking about sexual problems.
Seventy-six percent of respondents expressed concern that there would be no medical treatment available for their sexual problems.
Most survey respondents (94%) said that sexual relations are important as a person ages. Sixty percent of women and 41% of men disagreed when asked if sexual problems should be a natural part of the aging process.
Survey participants also believed that sexual problems have an impact on a host of medical issues, including depression (91%), emotional stress (93%), poor self-image (88%), and extramarital affairs and marriage breakups (91%).
Among all respondents, 71% agreed that the media provides sufficient information on men's sexual problems, while only 58% said there is enough coverage about disorders affecting female sexual function.
HIV+ women need ongoing ob/gyn screening
There is apparently an increased incidence and prevalence of gynecologic disorders in women in the United States infected with HIV, according to researchers in New York.
Dr. Howard L. Minkoff, of Maimonides Medical Center, and colleagues there and elsewhere in Brooklyn evaluated 292 HIV-infected women and 681 infection-free women for the "...incidence and prevalence of sexually transmitted diseases, viral shedding, findings of Papanicolaou smears, fungal infections, and menstrual disorders."
More than 65% of the HIV-infected women had at least 1 gynecologic disorder, and about one third had more than 1, the research team found. Compared with the controls, HIV-infected women were significantly more likely to have symptomatic candidiasis, infection with oncogenic human papillomavirus, abnormal Pap smears, amenorrhea, syphilis, infection with cytomegalovirus, and genital warts.
Overall, the incidence and prevalence of STDs and oncogenic human papillomavirus infection were greatest in women with CD4 cell counts greater than 500/µL. However, candidiasis, infection with herpes simplex virus, and cytomegalovirus infection were significantly more common in immunocompromised women than in those with more intact immune systems.
"It is clear that CD4+ cell count will not suffice in all circumstances to identify women at risk of having gynecologic disorders," the investigators conclude. "Illicit drugs, and the consequent risk behaviors associated with their use, loom as large as immune status in suggesting which individuals will acquire many of the disorders studied."
Dr. Minkoff's group reminds clinicians to "...institute the type of surveillance that will enable them to document and treat the gynecologic morbidity that occurs progressively more often as HIV disease advances."
According to the Washington Blade, San Francisco AIDS activist Michael Petrelis is among those who called on Congressional Republicans to conduct an extensive audit of how federal AIDS funds awarded through the Ryan White CARE Act are being spent by local communities.
U.S. Representative Tom Coburn (R-OK), House Majority Leader Dick Armey (R-TX) and Commerce Committee Chairman Tom Bliley (R-VA) have sent a letter to the United States General Accounting Office requesting a "performance audit and evaluation of all federal AIDS/HIV programs and services."
"Congress has a moral obligation to those suffering with AIDS/HIV to ensure that the nearly $9 billion directed to federal AIDS programs is spent for purposes for which it is intended," Coburn, a practicing physician, said in a statement. "Over the past five years I have encountered too many instances where federal AIDS/HIV funds have been misused. There have been instances in which AIDS dollars have been used for political campaigns, programs that condone illegal drug use, and programs that fail to fairly distribute funds to women and minorities," he said.
The Blade quotes Petrelis as saying that Coburn's office contacted him last year for suggestions about whether an audit should be requested after Petrelis launched a national media campaign opposing what he called unreasonably high salaries for the directors of AIDS service providing groups in several cities, including San Francisco and D.C.
"There has been numerous examples of abuse of AIDS dollars," Petrelis said. "In some cases, the heads of AIDS groups make more money than their local mayors. An audit is a standard check and balance to see whether these programs are working properly."
Among those who announced support for Coburn's call for the GAO audit are the national gay Republican group, the Log Cabin Republicans, and longtime D.C. AIDS activist Wayne Turner of ACT UP/Washington, D.C. Turner and Jim Driscoll, Log Cabin's national AIDS policy adviser, said that, while they disagree with some of Coburn's positions such as mandatory HIV reporting, they feel an audit of federal AIDS programs has been long overdue.
"Everyone knows of cases where funds have been misused," Turner said. "This will benefit the community."
Meanwhile, officials at the San Francisco AIDS Foundation are puzzled and offended by a letter sent to news organizations on their letterhead claiming the group has slashed executive salaries and made other policy changes.
The letter, purportedly signed by Executive Director Pat Christen, was mailed several weeks ago from San Francisco in envelopes that appear to be from the AIDS Foundation. But the letter is a forgery, Christen said.
"I'm saddened that somebody would feel that this would be a good use of their time," she said.
Christen said she did not know who might have sent the letter. The organization, with more than 100 employees, is about to begin union negotiations. Issues mentioned in the letter, such as the distribution of revenues from the annual AIDS Walk, also have been raised by a few AIDS activists, including Petrelis.
The letter claims Christen makes $200,000 per year, and her salary was to be cut to $90,000 to free more money for subsidies for people with AIDS. But Christen said she made $175,000 per year, an amount in keeping with the heads of AIDS organizations of similar size, and there were no plans to change that.
The letter also claims that henceforth 80 percent of the board of directors and senior management will be made up of people with AIDS or HIV. About 40 percent of the current board of directors is HIV-positive, Christen said, and several members of senior management also are living with the virus. The letter claims none of the top executives has HIV.
Christen said the group didn't plan to take action to find out who had sent the letter.
"It would be a waste of time," she said. "It's a silly distraction to do things like this. There's a lot of important and challenging work to do here."
AIDS Action: another kind of 'audit'
As part of what it calls "an ongoing project to better assess the needs of people and communities affected by the AIDS epidemic," the national AIDS lobbying group AIDS Action has announced that it will launch a study of America's leading AIDS service providers to uncover prevention, care and treatment service trends. Early this summer, AIDS Action will send a comprehensive questionnaire to more than 3,000 AIDS service providers to gather information about populations served, organizational structure, treatment access and kinds of services provided.
"As the epidemic changes, we need a better grasp on how community service providers are changing as well," said AIDS Action executive director Daniel Zingale. "This study will provide key information about today's response to AIDS in America."
AIDS Action has been planning the study for several months, working with its community-based members and policy experts to explore the full range of issues facing AIDS service providers.
Among the areas covered in the questionnaire:
-Breakdown of kinds of services provided
--Administrative and other funding issues
--Professional compensation
--Quality of prevention programs
--Demographics of clients
--Substance abuse treatment
In recent years, the development of new drug therapies, the growth in managed care, and the shifting demographics of the disease have all had a profound impact on AIDS service organizations and the work they perform. In undertaking this study, AIDS Action will assess how service providers are responding to these changes, Zingale said.
"The American people and communities affected by AIDS want a better understanding of how AIDS service organizations are adapting to changes in the epidemic," added Zingale. "This study will provide a comprehensive picture of America's response to the AIDS epidemic today."
The study is expected to take several months to complete, and AIDS Action will release the results as soon as they are available.
SF bathhouse issue may be on ballot
Some gay activists in San Francisco are pushing for city officials to reopen gay bathhouses, which were closed 15 years ago as the rate of HIV infection soared among the city's gay male population.
While the bathhouses have stayed closed, health officials have permitted the opening of sex clubs, where men generally gather in common rooms and staff can check to see if condoms are being used. The sex clubs are not permitted to have private rooms with locked doors.
While Mitchell Katz, the director of the Department of Public Health, notes that such regulations are needed to prevent the spread of HIV, some activists assert the city is being too cautious, noting that other large cities have bathhouses open.
Sponsors of the Sexually Transmitted Disease Reduction Initiative have to gather 10,200 signatures by July 5 to have the measure put on the Nov. 7 ballot. Lee Ann Monfredini, president of San Francisco's Health Commission, notes that while the closure of public bath houses was due to a health emergency, "we still have a health emergency in San Francisco."
Some local AIDS activists have also criticized the measure.
The Health Department reports that as of March 31, San Francisco has recorded 25,976 cases of AIDS, which resulted in 17,814 deaths from the disease.
Chester County AIDS Support Services is seeking a full-time AIDS educator and two part-time staff.
Positions available include HIV/AIDS Prevention Education Specialist, which is the full-time position; a Case Manager Assistant (Bilingual), who will work with the case manager in providing client services, particularly in Spanish-speaking communities; and a part-time Administrative Assistant, who will assist the executive director.
If a suitable candidate is identified, CCASS says that the possibility exists to combine both positions to make one full-time position encompassing both jobs.
To apply, send resume with cover letter and salary requirements by April 30 to Executive Director, CCASS, 1854 E. Lincoln Hwy., Coatesville, PA 19320. No phone calls or faxes will be accepted. The positions will remain open until filled.
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