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Issue #238: July 16, 1999
FASTFAX is available by fax in the 215 and 610 area codes at no cost, by mail anywhere for 20.00 per year, by calling 215-545-6868, and on the fastfax index page. Information in fastfax is drawn mostly from secondary sources; people living with HIV/AIDS should share information of interest to them with their primary care provider before making treatment choices. For more information on HIV medications and treatments, contact Kiyoshi Kuromiya of the Critical Path AIDS Project, 215-545-2212 or by email to The presence of the name or image of any individual in fastfax should not be construed as an indication of their HIV status or sexual preference unless specifically stated. Questions or comments should be directed to Editor, fastfax, 425 S. Broad St., Phila., PA 19147-1126 or by email to
In This Issue:
AIDS nursing unit may close by fall
GOP plans major HOPWA funding cut in 2000
Viramune touted as perinatal treatment
Disparities in treatment found in study
Cap on insurance for PWAs upheld
Unexpected deaths found in kids of HIV+ women
Rapid HIV test during labor cuts HIV risk
HAART may 'virtually eliminate' KS risk
Combined vaccine safe, promising
State to audit LA's HOPWA program
FDA renews caution on eating raw sprouts
Well-placed sources at North Philadelphia Health Systems (NPHS) are saying that the hospital, facing losses of over two million dollars in its skilled nursing care unit, is considering closing the facility by late October.
If true, the decision would eliminate the only dedicated nursing homes beds for people with AIDS in the Philadelphia region outside of the city health department's Philadelphia Nursing Home.
Gloria Zankowsky, director of NPHS, told fastfax that while no final decision has been made, the nursing unit's administrator, George Walmsley, has said that the continued losses in its skilled nursing care programs might require that the hospital "get out of the nursing home business."
Girard Medical Center, a division of NPHS, has operated the 18-bed care facility for people with AIDS who need skilled nursing services since 1996. The unit is part of a 54-bed "continuing care" unit at the hospital's 8th Street and Girard Avenue facility.
The decision to consider closing the unit comes despite assurances from the hospital that it would not eliminate the beds if the city or other sources came up with additional funds to reduce its financial losses related to AIDS care. However, sources say, the skilled nursing unit is also suffering huge losses related to its care for the elderly and other patients, and the AIDS funding may not be enough to save the day. The losses result from new Medicaid regulations, implemented in 1994, which reimburse for skilled nursing services according to a complicated "case mix" formula which has made it harder for Medicaid-funded nursing homes to pay their bills.
The city's Philadelphia Nursing Home has provided up to 16 beds specifically for people with AIDS since 1986. fastfax was unable to find any city official who knew how many people with AIDS are currently being served at PNH, or in fact whether there are any PWAs in residence there at all.
Walmsley originally decided to close the AIDS component of the skilled nursing unit, but not the entire skilled facility, late last year, saying that the hospital was being forced to care for people with intensive personal care needs who did not qualify for the state's stringent skilled nursing home reimbursement under the Medicaid program. After a meeting with activists arranged by ACT UP Philadelphia, however, Walmsley had said that if additional aid could be found to either support the costs of the care of these patients, or new options for their discharge were found, the AIDS unit would remain open.
Apparently, however, the nursing unit - which has its own board of directors - is facing such severe economic pressures that even "fixing" the AIDS problem will not be enough to keep it open.
City health commissioner Estelle Richman has proposed a mechanism through which PWAs on the unit who have severe behavioral health problems - usually about a third of the residents - could be supported through funding from the city's Medicaid behavioral health managed care program, Community Behavioral Health (CBH). Girard had told the city that it was the extra cost of caring for PWAs with behavioral problems that was a major factor in the unit's financial crisis.
Richman, working with officials of the AIDS Activities Coordinating Office and community providers, including ActionAIDS, the AIDS Law Project, Calcutta House, the Quaker AIDS Ministry, and We The People, has also developed a plan which is expected to identify funds for eight new "intensive personal care" beds at a new Calcutta facility to open next year.
Activists had believed that the combination of new CBH support and the new Calcutta beds would resolve the problems identified by Walmsley and would keep the AIDS unit open.
However, Zankowsky said that the hospital has been unable to take Richman up on her offer to date because of complicated approvals being sought on the state level. Other sources said that because the new Calcutta program will not be available until next year, officials at the home think that might be too late to help them through their financial crunch.
Richman has also been unable to offer help to alleviate the past losses of the home, now about $ 2 million.
The crisis facing the Girard unit are almost a carbon copy of those which led to the closing of Betak, the region's first independent nursing facility for people with AIDS. Betak, which provided 29 skilled nursing beds and 14 intensive personal care beds, faced numerous financial crises in its five-year run, finally succumbing to the pressure in late 1995. Mercy Health Corporation, which operates the largest Medicaid HMO in the region (Keystone Mercy Health Plan), worked with NPHS to set aside 18 special beds at Girard's continuing care unit at that time in order to assure that skilled nursing care for people with AIDS would continue.
Both Betak and Girard suffer from the failure of Pennsylvania's Dept. of Public Welfare to develop specialized reimbursement rates for nursing and personal care for people with HIV/AIDS. Most other states with large numbers of AIDS cases have developed such rates. During the last financial crisis at Betak in 1995, the state, working with Richman, developed a plan for creating a category of reimbursement for "Special Facilities for AIDS Care" which may have finally alleviated the problem, but the plan was never formally adopted.
While no other specialized AIDS skilled care units, besides Betak and Girard, have ever been attempted in Pennsylvania, specialized personal care homes for people with AIDS - relying largely on Ryan White CARE Act and other public and philanthropic funding - have been able to continue operations, although they all suffer increasing operating deficits every year. Calcutta House, which for over a decade has provided these services in Philadelphia, recently asked the city for financial help to alleviate its growing deficit, and a similar home in Pittsburgh, Corpus Christi House, was forced to close its doors when no extra funding materialized.
David Fair, who led the community effort to create Betak and the advocacy campaign that helped it survive during several financial crises, said that the potential closing of the Girard unit would probably be a much harder decision to overturn. "Girard's problems are worsened by the state's failure to support care for people with AIDS," Fair said, "but the real problem is Gov. Ridge's abandonment of all poor people who need skilled care. If the Republicans in Harrisburg cared about people who are too sick to care for themselves, whatever the reason, we wouldn't be facing this crisis."
Fair said that aggravating the problem this time around is the "relative complacency" of AIDS advocates and planners themselves.
He said that improving AIDS treatments are making "really sick PWAs invisible to the AIDS system, and even advocates. Public health officials, by and large, are managing an AIDS service system for the reasonably healthy, and with the exception of Medicaid, most public dollars are still going to social and support services rather than high-end medical care. So they just don't come across the dying people with AIDS that used to dominate the AIDS planning process. AIDS planning groups seem to treasure their 'process' more than they do the outcomes of what they do - so decisions are made about who lives or dies on the basis of majority votes among the people who have the time to come to thousands of meetings. In the end, people die because they aren't healthy enough to get out of bed to vote."
Fair said that the crises facing very sick PWAs are becoming "invisible" as the system focuses on keeping the already healthy from getting sick in the first place. "But they're still out there. Death rates are going down, but people are still dying. New treatments work, but not for everyone. But it's like we've shuffled off the desperately needy into an attic somewhere, and when it comes time to allocate resources, we forget they're there, or think we're too powerless to do anything about it."
Last month, two committees of the city's Ryan White Title I planning council voted against using Title I funds to help PWAs who needed intensive personal care; the co-chairs of the council said that the group was justified in its decisions because those proposing the funding had not worked enough to educate the group and get the votes to support their position. And a co-director of the city's AIDS office argued against the proposal, despite prior commitments that the city would support the recommendation.
"I don't know that there's enough anger and fear left in the AIDS community to put up the fight it will take to keep these services going," Fair said, noting that the Betak struggle had involved two takeovers, a hunger strike, and serious civil disobedience. "Everybody's an insider now. So it's hard to find people who will risk their positions to voice the concerns of those on the outside."
GOP plans major HOPWA funding cut in 2000
The House and Senate HUD-VA-IA Appropriations Subcommittees are about to mark up the FY2000 appropriations bills, and once again the federal Housing Opportunities for People with AIDS (HOPWA) program could face a severe cut.
Under Republican proposals before the Senate, Philadelphia would lose about half a million dollars from its current $3.85 million annual HOPWA grant, which covers the five southeastern Pennsylvania counties and four counties in southern New Jersey. Under the Republican House proposal, the cut would be in the $300,000 range.
President Clinton has proposed an increase in the HOPWA allocation, which in Philadelphia could mean as much as an additional $200,000.
The impact of a cut on the Philadelphia region could result in a reduction in the number of AIDS housing vouchers available in the region, as well as funding for support services provided to people living with AIDS housing programs and for people supported by the emergency financial assistance program.
Despite about enormous federal budget surpluses, the Appropriations Committees are operating with a $30 billion cut in domestic discretionary programs. The House and Senate leadership are focusing on tax cuts, not on restoring allocations to housing and other vital programs.
The House HUD-VA-IA Appropriations Subcommittee is expected to mark up their FY2000 spending bill on Monday, July 19. The full House Appropriations Committee will likely take that bill up on Friday, July 23. The Senate's HUD-VA-IA Appropriations Subcommittee and full Committee could also take up their FY2000 bill the week of July 19.
If the current funding allocations were spread evenly across all programs under their jurisdictions, the House and Senate HUD-VA-IA Appropriations Subcommittees would cut HUD programs 8% and 13%, respectively.
The 8% and 13% decreases in funding for the Subcommittees represent the minimum HUD cuts. Other programs within the Subcommittees' jurisdiction (veterans, NASA, environmental protection) will not bear the brunt of these cuts, so cuts to HUD will likely be greater.
The Balanced Budget Act of 1997 created the domestic discretionary spending caps. These caps restrict spending for non-entitlement domestic programs like housing. The Balanced Budget Act's pain was not really felt during the past two years. For FY2000, however, the caps will greatly affect spending levels for domestic programs. The caps have already forced allocations to appropriations subcommittees to be $30 billion less than in FY99. Subcommittees with jurisdiction over large domestic discretionary programs have been the hardest hit (i.e., the HUD-VA-IA and the Labor-HHS Subcommittees).
Meanwhile, both the Administration's and Congress's budget offices have reported huge Federal surpluses (upwards of $1 trillion dollars, give or take a few billion). According to the Center on Budget and Policy Priorities, these surpluses would not be at all as large if domestic programs weren't positioned to absorb drastic cuts. The domestic cuts, in effect, are paying for the $700-$900 billion ten-year tax cut packages being shopped around Capitol Hill this month.
Members of Congress can be reached through the Capitol Switchboard at 202/224-3121. (National Low Income Housing Coalition)
Viramune touted as perinatal treatment
Scientists working in Uganda have discovered what they think may be a dramatically more effective way to prevent pregnant women from spreading the AIDS virus to their babies: a drug treatment that costs just $4 per mother and could save up to 1,000 newborns a day.
The drug nevirapine (sold as Viramune) already is widely sold around the world to treat HIV infection. But the new study found it is 47 percent more effective than the therapy now recommended in developing countries for preventing mother-to-baby transmission of HIV.
The discovery, announced by U.S. scientists, could finally boost AIDS prevention among the world's poorest countries because for the first time the nations most afflicted by the AIDS epidemic could afford to buy babies some protection.
"You're talking about the possibility of preventing infection in up to 1,000 babies per day for a cost that is really very minor," said Dr. Anthony Fauci of the U.S. National Institutes of Health, which funded the research. "Now all of a sudden it falls, at least in some countries, within the realm of affordability."
"This research provides real hope that we may be able to protect many of Africa's next generation from the ravages of AIDS," said Uganda's health minister, Crispus Kiyonga, in a statement.
One of the greatest successes in the fight against AIDS is using the drug AZT to lower pregnant women's chances of spreading the virus to their newborns. In the United States and other wealthy countries, infected mothers typically receive five months of AZT, a therapy that cuts in half their babies' risk of infection.
But that treatment can cost more than $1,000, far beyond what developing countries can afford.
Last year, scientists discovered that giving far fewer AZT doses, starting during labor, could protect newborns, although not as effectively as the treatment Americans get. But even that "short-course AZT therapy" was too expensive for many countries.
Nevirapine is a cheaper AIDS drug. Although it works against the same viral target as AZT, it stays in the body for a longer time, crosses the placenta and even gets into breast milk.
U.S. scientists, working with doctors in Uganda, studied 618 mothers. Half got short-course AZT. The other half got a single dose of nevirapine during labor, and their babies got a single dose within three days of birth.
The scientists hoped nevirapine would prove as good as AZT -- but to their surprise, it worked far better. Just 13.1 percent of nevirapine-treated infants became infected with HIV, vs. 25.1 percent of AZT-treated babies.
The United Nations estimates that 1,800 HIV-infected babies are born daily in developing countries. In parts of sub-Saharan Africa, the region hardest-hit by AIDS, up to 30 percent of pregnant women are infected.
Widespread use of nevirapine could prevent between 300,000 and 400,000 babies a year from contracting HIV at birth, the NIH said.
The new study has implications for American women, too: If a woman goes into labor without having had prenatal AZT treatment, doctors could consider giving her nevirapine, Fauci said.
In addition, a study under way of U.S. and European women will attempt to determine whether adding nevirapine to the longer and more expensive AZT therapy that they now take also would work better.
Nevirapine, sold in the United States under the brand name Viramune, appeared safe for infants. But scientists will follow the babies until they're 18 months old, both to look for possible long-term side effects _ and to see whether nevirapine also could protect against HIV in breast milk. Babies born healthy still can become infected through breast-feeding, something no drug so far has prevented. But early data are "highly suggestive" that nevirapine might prove beneficial in breast milk, Fauci said. (Associated Press)
Disparities in treatment found in study
While most AIDS treatment specialists advocate intensive triple drug therapy for HIV/AIDS patients, actual prescribing by physicians and compliance by patients varies widely.
This disparity was discovered in a study recently conducted by researchers at PCS Health Systems, one of the nation's largest pharmacy benefit managers and a wholly owned subsidiary of Rite Aid Corp.
PCS' retrospective study also showed that treatment approaches seem to be improving over time as more doctors become aware of best-practice guidelines. The study indicated that doctors are prescribing the recommended triple drug therapy for new HIV/AIDS patients more often.
"Accurate measurement and tracking of patient compliance and treatment regimens are critical in light of studies showing that patients taking HIV protease inhibitors who do not comply with their prescribed regimen run the risk of developing drug resistance and reactivating the virus," said PCS' Steve Hutchison, Ph.D., lead researcher on the project.
PCS researchers used encrypted, non-identifiable patient data from the company's extensive pharmacy claims database to analyze treatment regimens and determine factors such as estimated length of therapy, patient compliance, switching patterns and concomitant therapy.
Hutchison explained that electronic claims databases allow researchers to measure real-life drug utilization patterns in a natural, real-world setting with less distortion than other methods.
PCS studied two patient groups: one initiating therapy after triple drug therapy was made available but before it was advocated as the treatment of choice, and one initiating therapy after triple drug therapy was advocated by the International AIDS Society. The findings are being considered for publication in The Journal of Acquired Immune Deficiency Syndromes.
The PCS study showed that the incidence of triple drug therapy as an initial treatment regimen for HIV/AIDS patients increased from 37 percent in 1996 to 62 percent in 1997, while the incidence of monotherapy and dual drug therapy during the same period declined to 12 percent and 26 percent, respectively.
The study also found that treatment regimens changed frequently once therapy began, and that many patients did not comply with their prescribed therapies.
"Information of this nature has become increasingly important to the health care system," said Hutchison. "That's because when patients suffering from a chronic disease do not adhere to their treatment regimen, it often results in more complications.
"That, in turn, can result in more frequent visits to the doctor, more hospitalizations, and more lab tests -- ultimately leading to higher overall costs.
"With the rising cost of health care, health plans and providers need accurate information about all aspects of health care delivery," he continued. "Retrospective studies such as this can provide them with important information to ultimately help improve both cost efficiencies and outcomes." (Business Wire)
Cap on insurance for PWAs upheld
The 7th Circuit Court of Appeals in Chicago has overturned a lower court decision and ruled that Mutual of Omaha Insurance Co. did not violate the Americans With Disabilities Act when it placed a lower cap on coverage for AIDS and AIDS-related medical treatment.
The ruling, handed down in early June, said the federal law does not regulate the content of insurance policies. Two Chicago residents who are HIV-positive brought the case against Mutual of Omaha based on the caps in their policies--one limited lifetime benefits for AIDS or AIDS-related medical expenses at up to $25,000, and the other capped coverage at up to $100,000. For other conditions, the policies' limit was $1 million.
Attorneys for the plaintiffs contended the discrepancy was a violation of the Americans With Disabilities Act, which provides that no individual will be discriminated against or excluded from the goods and services provided by a public accommodation because of their disability.
But Mutual of Omaha argued that under the federal act, there is no provision to regulate the terms of insurance policies. The higher court agreed. Company spokesman Jim Nolan said the decision to impose limits is designed to limit risk and lower the rates of policy holders.
The plaintiffs have 14 days to determine if they will ask the court to reconsider its decision. They are also deciding whether to appeal to the U.S. Supreme Court, said Heather Sawyer, attorney for Lambda Legal Defense and Education Fund in Chicago. (Chicago Tribune)
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Unexpected deaths found in kids of HIV+ women
Infants born to HIV-infected women appear to be at increased risk of traumatic or unexpected death, even if they are not vertically infected with HIV, according to a new study published in the July issue of Pediatrics electronic pages.
"A high incidence of sudden, unexplained deaths in infants born to HIV-infected mothers has been noted in several epidemiologic studies," Dr. Thomas J. Starc of Columbia University in New York and colleagues explain.
To further investigate this, Dr. Starc's group evaluated 805 children enrolled in the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection study. The children in this multicenter prospective study were evaluated for immunologic, pulmonary and cardiac function for up to 7 years.
Out of total of 121 deaths, "5 were traumatic or sudden and unexpected and judged by the Mortality Review Committee to be unrelated to HIV infection," they report. "The median age at the time of death was 1.3 months and ranged from 1.2 to 37.8 months."
Trauma was the cause of death in two infants, one of whom had a skull fracture and the other had evidence of battered child syndrome. The third infant died at home of accidental suffocation at 1.2 months and the fourth also died at home unexpectedly at 1.3 months. The fifth child was the victim of an unwitnessed drowning at 37.8 months of age.
Four of these unexpected deaths accounted for 20% of all deaths in the cohort during the first year of life. "It is unlikely that HIV exposure is related directly to the deaths described in this report." However, the physicians point out that "...maternal HIV infection may be a marker for factors that place the child at risk for sudden or traumatic death."
Most of the deaths "occurred within the first few months of life, suggesting that this is a period of increased vulnerability." Dr. Starc's group concludes that "children born to HIV-infected mothers may be more vulnerable than was recognized previously and may be in need of increased social services, especially in early infancy." (Reuters/Pediatrics)
Rapid HIV test during labor cuts HIV risk
Even if a woman has had no prenatal care, a rapid HIV test administered during labor can help reduce the risk of HIV transmission from an infected mother to her child, according to Alabama researchers.
If the results of a new, highly sensitive HIV antibody test are positive, treatment with intravenous AZT (zidovudine) could reduce the risk of mother-to-infant HIV transmission by almost 20%, and save health care dollars, according to physicians at the University of Alabama at Birmingham.
The rapid testing could prevent 183 cases of HIV infection per 100,000 mother-infant pairs, as well as save nearly $58,000 per child. If no treatment was administered, the researchers calculated that there would be 1,275 infected infants per 100,000 mother-infant pairs.
Currently the US Centers for Disease Control and Prevention (CDC) recommends that HIV-infected women begin taking AZT between week 14 and 34 week of pregnancy. However, not all HIV-infected women receive prenatal care, note Drs. Jeffery S. A. Stringer and Dwight J. Rouse in the July issue of Obstetrics and Gynecology.
While early AZT treatment reduces the risk of transmission by roughly 65%, AZT treatment during labor and delivery reduces the risk by at least 18%.
The researchers based their estimates on the assumption on a prevalence of HIV of 5% in the laboring women, as well as the lifetime cost of $103,708 for caring for an infected child. (Reuters/Obstetrics and Gynecology)
HAART may 'virtually eliminate' KS risk
Highly active antiretroviral therapy (HAART) substantially reduces the risk of Kaposi's sarcoma in HIV-infected patients, but a substantial risk of non-Hodgkin's lymphoma persists.
Using data from the Swiss HIV Cohort Study, a large community cohort that includes almost all individuals with HIV infection in Switzerland, a multicenter team led by Dr. Bruno Ledergerber of the University Hospital of Zurich investigated the effects of HAART on the development of AIDS-related conditions.
About 70% of the HIV-infected patients with CD4 T counts below 200 cells per microliter in this prospectively followed cohort were on HAART by the middle of 1997. Dr. Ledergerber's group found that the incidence of all new AIDS-related conditions decreased from 157 events per 1,000 person-years in the period 1992 to 1994, to 35 events per 1,000 person-years in 1997 to 1998.
Overall, the relative risk of the most common AIDS-defining conditions after the introduction of HAART was 0.20. The relative risk for Kaposi's sarcoma was 0.08. "However, no significant trend was evident for non-Hodgkin's lymphoma," the researchers report in the July 3rd issue of the British Medical Journal.
Dr. Ledergerber's group concludes that "...patients cease to be at risk of Kaposi's sarcoma once immune function has been improved by combination therapy." However, those "...with a history of severe immunodeficiency continue to be at risk of non-Hodgkin's lymphoma, despite antiretroviral combination therapy." (Reuters/British Medical Journal)
Combined vaccine safe, promising
An experimental AIDS vaccine that combines two approaches against the deadly virus seems to be doing its job without side-effects, researchers said have announced.
They said they could not tell whether the vaccines were actually preventing infection but said more than 400 volunteers had shown no serious side-effects from the injections and their bodies were mounting the expected protective response against HIV.
Men and women at 14 sites across the United States are getting the dual vaccine, which includes one called ALVAC vCP205 made by Rhone-Poulenc, and another called SF-2 rgp120, made by Chiron.
The ALVAC vaccine is based on a canarypox virus, which does not cause disease in humans and which has been genetically engineered to carry three genes from HIV.
The second vaccine uses a protein from the surface of HIV called gp120.
Both are designed to provide pieces of the virus for the immune system to recognize and mount a response against.
Most of the volunteers are considered at high risk of HIV infection because they inject drugs or engage in unprotected sex with other people at high risk.
Dr. Robert Belshe of St. Louis University said half the volunteers who got ALVAC alone, and 90 percent of those who got both vaccines, developed antibodies that should slow down or stop HIV.
He told a meeting of the International Society for Sexually Transmitted Disease Research in Denver that his team was not able to check whether any of the volunteers actually avoided infection because of the vaccine.
But he said 11 of the 435 became infected -- six of those who got placebo or dummy vaccine, three who got the ALVAC vaccine alone and two who got the combination.
"The current study adds compelling new evidence that large-scale efficacy trials using these or similar vaccines are feasible in communities at risk," the National Institute of Allergies and Infectious Diseases, which helped sponsor the study, said in a statement.
State to audit LA's HOPWA program
California state legislators have directed California's auditor to scrutinize Los Angeles' management of local AIDS housing programs following scathing findings in a similar probe that blamed poor management for a heavy accumulation of unspent funds as a crisis of AIDS homelessness raged in Los Angeles, according to the AIDS Healthcare Foundation (AHF).
The State's Joint Legislative Audits Committee heard testimony in Sacramento from AIDS advocates on a request from State Senator Tom Hayden (D, Los Angeles) to conduct a fiscal and programmatic review of Los Angeles' federally-funded, city run Housing Opportunities for People with AIDS (HOPWA) program. Activist Miki Jackson spoke of $26 million in accumulated unspent funds for the program, even though the city receives under $10 million annually.
"They're sitting on the money while poor people with AIDS can't pay their rent. It's criminal," said Jackson.
According to AHF's Cesar Portillo, "Senator Hayden and Committee Chair Assemblyman Scott Wildman (D, Los Angeles) are leading an effort to finally hold the city accountable for its mismanagement of the program. I think the issue is compelling to those who voted to investigate; Senator Kevin Murray - who provided the deciding vote -- and committee vice chair Senator Richard Alarcon both represent "majority minority" districts, where the escalation of HIV infections among people of color coupled with a the city's lack of housing support is creating a real crisis."
Said Portillo, "This is a life or death issue: People with HIV/AIDS can't stay on complicated anti-viral medications if they have no roof over their heads. That's why the program exists."
In April, Los Angeles City Controller Rick Tuttle issued a blistering report on the program that documented:
-- a significant discrepancy in funds awarded by the federal government and those reported spent and/or allocated by the city's housing department;
-- warned of the threat of lost of federal funds if large amounts of unspent funds continued to accumulate;
-- recommended the transfer of key staff due to serious concerns about lack of planning and oversight.
In a last minute effort to block the audit, a group of local AIDS agencies -- most of whom receive HOPWA funds or sit on a controversial advisory body controlling the funds -- asked that the audit be postponed.
Among other issues, Senator Alarcon specifically asked during the hearing that the percentage of HOPWA funds HOPWA committee members receive be scrutinized.
However, despite the letter, state legislators voted to instruct the Bureau of State Audits to conduct an audit of L.A.'s HOPWA program to:
-- review and evaluate the laws, rules and regulations relevant to the issues;
-- determine the roles and responsibilities of the various entities involved in the HOPWA program and determine whether there are conflicts of interest;
-- review the manner in which the program is managed to determine whether the processes that are in place are efficient and instrumental in achieving the goals of the program;
-- determine the total federal funds received since 1993 and whether the funds were committed and used as required by the federal government;
-- review the city's short- and long-term plans and assess whether they are reasonable and provide the city with an adequate plan to carry out its responsibilities and meet the program's goals and requirements.
"We've demanded an emergency plan of action from the City of Los Angeles since October of last year," said AHF's Portillo. "Since then, the housing bureaucrats denied serious problems with HOPWA, while an untold number of Angelenos with AIDS lived -- and died -- on the streets as money to house them went unspent. We thank the legislators for their action on this audit, and hope it ultimately improves and corrects this well-intended, but poorly-managed program to help people with AIDS in Los Angeles."
FDA renews caution on eating raw sprouts
Because of reports of increasing numbers of illnesses associated with consumption of raw sprouts, the Food and Drug Administration (FDA) is advising all persons to be aware of the risks associated with eating raw sprouts (e.g., alfalfa, clover, radish). Outbreaks have included persons of both genders and all age categories. Those persons who wish to reduce the risk of foodborne illness from sprouts are advised not to eat raw sprouts.
This advice is particularly important for children, the elderly, and persons with weakened immune systems, all of whom are at high risk of developing serious illness due to foodborne disease. People in high risk categories should not eat raw sprouts.
This advisory is updated from a previous health advisory issued August 31, 1998, and is based on additional information from clover and alfalfa sprout- associated salmonellosis outbreaks from January through May 1999. Two outbreaks were associated with clover sprouts: one occurred in California in May and involved approximately 30 cases; a second outbreak in Colorado from March through May involved approximately 70 cases. In addition, from January through March an outbreak of salmonellosis affecting approximately 85 people occurred in Oregon, Washington, and California and was associated with the consumption of alfalfa sprouts
Since 1995, raw sprouts have emerged as a recognized source of foodborne illness in the United States. These illnesses have involved the pathogenic bacteria Salmonella and E. coli O157. Alfalfa and clover sprouts have been involved most often, but all raw sprouts may pose a risk.
The sprout industry has been working in cooperation with government, academia, and other industry segments to enhance the safety of its product. These efforts have focused primarily on seed treatment strategies, good manufacturing practices, and sanitation.
"Despite all these efforts to make raw sprouts safer, we continue to receive reports of illnesses associated with raw sprouts. Consumers need to understand that, at this time, the best way to control this risk is not to eat raw sprouts," said Jane E. Henney, MD, FDA Commissioner.
Although infections with Salmonella and E. coli O157 can cause serious illness, the illness is generally self-limiting in most healthy adults. However, an E.coli O157 infection can lead to hemolytic uremic syndrome with resultant kidney failure or death in children, and equally serious complications in the elderly. Salmonella infections can cause serious illness in children, the elderly and the immune compromised. Healthy persons infected with these bacteria experience diarrhea, nausea, abdominal cramping and fever for several days. FDA offers the following advice to all consumers concerning sprouts: Cook sprouts. This significantly reduces the risk of illness. Check sandwiches and salads purchased at restaurants and delicatessens. These entrees often contain raw sprouts. Consumers who wish to reduce their risk of foodborne illness should specifically request that raw sprouts not be added to their food.
Sprouts grown in the home also present a risk if eaten raw. Many outbreaks have been attributed to contaminated seed. If pathogenic bacteria are present in or on seed, they can grow to high levels during sprouting even under clean conditions.
FDA will closely monitor the safety of sprouts and will take further actions, including the establishment of preventive controls, as necessary to protect consumers.
Consumers who have eaten raw sprouts and are experiencing diarrhea or other symptoms of foodborne infections are advised to consult their health care providers.