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Issue #241: August 6, 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:
Marlton Residences finally a reality
Under threat, HMA changes nutritional supplement policy
Merck to test vaccine on people
Ethnic bias delays HIV diagnoses in women
Study confirms viral load affects perinatal transmission
'Low-risk' gay sex may drive HIV spread
AIDS Library moves to new home
Marlton Residences, We The People's second AIDS housing project, was formally opened by Mayor Ed Rendell and a group representing AIDS service organizations, community groups and neighbors on Wednesday, five years after planning began for the 15-unit apartment building in West Philadelphia's Parkside neighborhood.
The $4 million project is among the first AIDS housing programs financed by low-income tax credits rather than solely through government capital grants. The one-bedroom apartments will be rented, at $200 per month, to people with HIV disease whose annual income is $19,450 or less for an individual or $22,250 or less for a couple.
Residents will not be required to qualify for public housing vouchers such as Section 8 or AIDS housing vouchers.
Each apartment includes a fully-equipped kitchen and bathroom, carpeted bedrooms, and individually controlled air conditioning.
"This is a great project because we've created quality living alternatives for people who need them and need them badly," Rendell said. Noting that the old Victorian houses had been abandoned for many years, he said, "These were wonderful buildings when they were built. They're becoming wonderful buildings again."
The project, developed by We The People in partnership with Pennrose Properties, a leading local low-income housing developer, was supported by the Parkside Historic Development Corporation, which has been working on improving the once-ritzy Parkside area for several years. Marlton Residences is the latest in a series of publicly-funded projects which has revitalized the area in recent years under the leadership of Jim Brown, the corporation's director.
Noting that We The People operates the only PWA-run AIDS housing programs in the region, Charles Starnes, the organization's board president, said, "Over the last ten years, while a lot of people were busy worrying about how to build organizations, we spent our time listening to each other to find out what we really needed to keep each other alive and healthy. And one of the most important things we found we needed was a stable place to live. So we went about trying to solve that problem."
Starnes noted that We The People also operates the 15-room Lombard Street Community, next to its Life Center in south central Philadelphia, and led the advocacy that created a system of AIDS rental assistance and emergency grants in Philadelphia.
Both Marlton Residences and the Lombard Street Community were originally proposed by David Fair, former executive director of We The People, and Scott Wilds, an assistant director of the city's Office of Housing and Community Development, which provided the bulk of the funding for both projects. Unlike Marlton Residences, which is available to all low-income people with HIV in the nine-county Philadelphia region, Lombard Street Community is limited to more disabled PWAs who qualify for rental assistance under the ShelterPlus Care program.
Both Rendell and Starnes said that the development of projects like this and other services for disabled people are threatened in the current political environment.
Rendell noted that the huge federal tax cut being advocated by congressional Republicans in Washington is based on major cutbacks in funding for low-income and AIDS-related housing. He exhorted the group to join with him in pressuring congressional representatives to resist the cuts.
Starnes noted that while healthier people with AIDS continue to be supported with projects like those at We The People, those that are more ill are facing a reduction in the services available to them.
"Members of We The People fought for years to create safe, supportive places for people with AIDS too sick to live on their own, places like the Philadelphia Nursing Home AIDS Unit and Betak ... and for the creation of the Girard Medical Center nursing home for people with AIDS," Starnes said. Noting that financial losses threaten to close the Girard Home, he said that the fight to provide adequate housing and care for people with AIDS is far from over.
"The road is this long," he said, spreading his arms open. "And we're only right here," pinching his fingers together. "In the coming months we will win the fight to keep Girard alive, whatever it takes, and to make sure that every person with AIDS has a stable place to live."
In response to a planned demonstration by the members of We The People and the consumers from ActionAIDS, HMA Healthcare, one of the four Medicaid HMOs operating in southeastern Pennsylvania under the state's HealthChoices program, has agreed to immediately streamline its process for obtaining nutritional supplements.
HMA had been the only company to ignore concerns first raised by the Working Group on HealthChoices and HIV, a coalition of PWAs and AIDS service organizations, over three years ago. Advocates charged that the complicated application process for obtaining nutritional supplements was hindering people living with AIDS from obtaining the supplements. The issue was first brought to the attention of the Working Group by consumers who were registering complaints over a variety of pharmacy-related issues to the group.
Stanley Lynch, MD, the new HMA medical director, said this week that the HMO will no longer require its complicated application process as long as prescribing physicians include basic information, such as the name and HMA identification number, and a confirmation of the patient's HIV infection on the prescription form.
Anna Forbes, staff of the Working Group, told fastfax, "We have been working with all the HMOs on a variety of pharmacy issues and HMA was the last holdout on fixing the problem around nutritional supplements. While all the other HMO's agreed to provide the supplements by prescription, HMA was forcing consumers and their Physicians to complete a complicated form before approval."
Joan Curran, deputy director of ActionAIDS, said, "We all felt like we hit a stone wall. No matter how many meetings we had with them they didn't seem willing to budge. We even had Health Commissioner Richman involved and were getting nowhere. Then the group suggested that it was time to stop negotiating."
Rob Capone, WTP's Executive Director, said that he agreed with the call for direct action to end the stalemate. "We were all frustrated and tired of watching people waste away while HMA reviewed paperwork." Capone told fastfax. "I suggested that we could gather a large number of our membership and join forces with the clients from ActionAIDS to send them a 'stronger message' about how important these supplements are."
Capone also said he thought it only fair to give HMA "one last opportunity" to fix the problem. A letter to the Chris Paterson, CEO of HMA, noting that "it has been consistently shown that one of the leading causes of death for people with AIDS is wasting and that this can often be avoided by providing nutritional supplementation. It is my understanding that all of the participating HealthChoices HMOs have worked with the Working Group to reduce the barriers hindering our access to these life sustaining supplements with the sole exception being your company, HMA."
"As the director of the largest coalition of people living with HIV disease in this region," Capone said, "I am compelled to inform you that I have determined that the time for polite conversation and negotiation is over. I must insist that you, as CEO, take immediate action to correct this life threatening situation."
In his letter, Capone asked HMO to eliminate the two page form that HMA was requiring for approval of nutritional supplements immediately, and suggested that the plan approve the supplements on the basis of a doctor's prescription.
"The decision to supply food supplements is a medical decision, and must be treated as any other prescription. Allow the physicians that you have trusted enough to contract with to make the determination of the necessity of this treatment or we will be forced to pursue a much more vocal and public course of action. I implore you to remove this obstacle that is jeopardizing the health and well being of people living with AIDS in our community, before we are forced to take action."
Capone said that We The People informed HMA that it would pursue an aggressive strategy of protect and civil disobedience if the policy was unchanged by August 6th. On August 5th, the company advised We The People that it would begin allowing those covered by HMA to obtain the supplements solely on the basis of a doctor's prescription.
"It's sad we still have to go to the barricades to get simple, obvious things people with AIDS need to stay alive," Capone said. "But people with AIDS have never been afraid to fight for themselves when necessary. And we'll do it again and again if we have to."
Capone said that the success of the HMA effort is evidence of the value of the Working Group in articulating the concerns of people with HIV/AIDS to the Medicaid companies, and the participation of PWAs in its activities. He encouraged PWAs who have problems with their HMOs to let the Working Group know of their experiences. For more information, call 215-545-6868.
Merck & Co. Inc. scientists are making plans to begin the first human tests of two promising experimental vaccines for use against AIDS developed as part of an intense top-secret research effort, the Wall Street Journal has reported.
The report said the company's top vaccine-research executive confirmed the vaccines' existence and the company's plans to begin administering them in a small number of healthy, uninfected volunteers by year's end.
The executive, Emilio Emini, said that the human tests will be undertaken to help Merck scientists determine if the vaccines can produce in people the kind of immune-system reaction generated in animal studies. Emini, director of Merck's infectious-disease research group, said he didn't want to raise undue expectations, and noted that the upcoming trials will be undertaken simply to help Merck scientists determine if the vaccines can prompt an immune-system response. "We are at the point ... where we need to know if [the vaccines] will trigger the response in people we've seen in animals," he said.
Merck declined to provide much detail about the AIDS vaccines, the Journal reported.
Several other companies are testing prototype vaccines in large and small trials in the U.S. and abroad. But one of the Merck vaccines will be among the first of a class of so-called "naked DNA" vaccines for HIV to go into humans.
Merck licenses the technology of the "naked DNA: from Vical Inc., a San Diego-based company which owns the patent to the technology.
"Naked DNA" is potentially revolutionary because it stimulates both arms of the immune system, antibodies and T-cells, which are immune cells made by the thymus gland.
Traditional vaccines only stimulate antibodies.
One of the vaccines is the first of a family of "naked DNA" vaccines, composed of a gene or genes extracted from the virus. Tests of this vaccine "will be watched closely by AIDS-vaccine researchers because it will provide a critical test of whether DNA vaccines are useful."
A second vaccine in the works, designed to complement the DNA vaccine, involves injecting the AIDS virus into a "defused animal or human virus," the Journal reports. "The current sense is that a vaccine against AIDS will require a combination of a DNA vaccine to prime the immune system followed by a booster of a vaccine involving another virus," said Dr. Margaret Johnston of the National Institute of Allergies and Infectious Diseases. Johnston said, "What's exciting and important is that Merck believes it's far enough along to test something." (Reuters/Wall Street Journal/Kaiser Daily HIV/AIDS Report)
For many women, HIV infection remains undiagnosed and treatment is delayed because of false cultural stereotypes, according to researchers at the University of California, Los Angeles (UCLA).
"Health providers who specialize in women's care may be neglecting to offer HIV tests to European American women," they report in a special issue of Cultural Diversity and Ethnic Minority Psychology. Dr. Gail Wyatt and co-investigators also found that "European American women... had the longest period of HIV infection compared with the other ethnic groups prior to baseline interview."
The researchers evaluated data from a 5-year study of 290 HIV-infected women including African Americans, Latinas, European Americans, Asian/Pacific Islanders, and Native Americans.
"We found that medical professionals were significantly less likely to offer white or Asian women an HIV test or to ask them about their sexual history," Wyatt said in a UCLA press release. "Yet white women are the most likely to be infected for the longest period of time -- an average of 63 months."
Wyatt's group also observed differences in patterns of sexual behavior among the ethnic groups. "Although African-American women were at most risk of HIV infection, they were less likely than European Americans to engage in frequent intercourse, anal sex, or group sex." And compared with European Americans and Asian Americans, they found that African-American women were also less likely to report having a sexual partner who used intravenous drugs.
"Of particular concern were Latinas," they point out. These women were less likely to use condoms and more likely to be younger, less educated, and to have AIDS.
The sexual behavior patterns among these HIV-infected women are consistent with those previously reported in HIV-negative women, the researchers add. "To fully address complex health issues for women living with HIV, health professionals need to develop more comprehensive approaches to offering information about the risks of disease transmission, HIV testing, and referrals for women-centered care on an ongoing basis." (Reuters/Cultural Diversity and Ethnic Minority Psychology)
Pregnant women with the lowest levels of HIV in their blood are the least likely to give birth to a child with the disease, according to two studies in the New England Journal of Medicine.
The findings are part of an ongoing effort by researchers to block the spread of HIV from mother to child.
The first study, led by Dr. Lynne Mofenson of the National Institute of Child Health and Human Development, followed 480 women at 53 treatment centers in the United States and Puerto Rico who were receiving the anti-AIDS drug AZT, sold as Retrovir. The babies were also given the drug after they were born in hopes of preventing HIV infection.
Among the infected women with virus levels too low for routine tests to detect, none had infected babies. The lower the level, the less likely the child would fall ill with AIDS, the researchers found.
The virus level at delivery "was the strongest predictor of the risk of transmission" the Mofenson team concluded.
But the results do not mean that there is a "safe" virus level threshold below which mothers do not risking passing HIV on to their child. So AZT should be given "to all infected pregnant women regardless" of their HIV levels, they said.
The second study followed the cases of 552 pregnant women and concluded that the amount of HIV in the blood "predicts the risk" of passing the disease onto their child.
That study of babies born from 1990 to 1995, led by Dr. Patricia M. Garcia of Northwestern University in Chicago, involved eight medical centers in four states and Puerto Rico. It found that 63 percent of women with the highest levels of HIV who were not receiving treatment spread the infection to their infants, while no women with the lowest virus levels infected their babies.
Previous research has suggested that there is an upper threshold for the amount of virus in the blood "above which transmission is unavoidable, and a lower threshold, below which transmission is rare," Garcia and her colleagues said. "We found no threshold level above which the rate of transmission was 100 percent."
None of the women in this study passed the disease to their babies if they had low levels of the virus, "but there are at least three reports of transmission occurring at low levels" from other studies, they cautioned.
Treatment with AZT reduces the risk of passing HIV to a newborn, they said, but "the same may not be true" for the new AIDS cocktail, which can wipe out -- at least temporarily -- traces of the AIDS virus in the blood.
In an editorial in the journal, Drs. Martha Rogers and Nathan Shaffer of the Centers for Disease Control and Prevention in Atlanta said "Taken together, these studies imply that therapy that maximally reduces the maternal viral level may be one of the most effective intervention strategies."
An important unanswered question is whether doctors can further cut the risk by delivering a baby through caesarean section. A New England Journal study released last January concluded that performing a C-section before the onset of labor can take the 7.3 percent risk of delivering an HIV-infected child and lower it to just 2.0 percent.
Only a small percentage of new HIV infections among homosexual men are linked to 'high-risk' unprotected anal sex, researchers report. This suggests that 'lower-risk' practices, such as unprotected oral sex, may now be driving the epidemic.
"It is important to communicate clearly that these practices are not without risk," according to investigators led by Dr. Eric Vittinghoff of the University of California, San Francisco, and the San Francisco Department of Public Health. Their findings are published in the August 1st issue of the American Journal of Epidemiology.
More than 10,000 new HIV infections continue to be recorded among US gay and bisexual men every year. Previous studies have identified unprotected receptive anal intercourse as posing the highest risk for HIV transmission among gay and bisexual men. Other practices, such as protected receptive anal sex and unprotected receptive oral sex, are assumed to be of lower -- but not zero -- risk.
Vittinghoff's team examined the sexual histories of 1,583 sexually active homosexual and bisexual men living in San Francisco, Denver, or Chicago in 1992-1994. All of these men regularly provided the investigators with detailed reports on the nature and frequency of their sexual contacts.
Forty-nine of the men seroconverted (became infected with HIV) over the course of the study period.
According to the researchers, "unprotected receptive anal intercourse accounted for only 15% of all reported sexual activity" among newly infected men. "Providing that subject reporting was accurate, this implies that a majority of new infections took place via other types of contact."
Unprotected receptive anal sex remained the riskiest of sexual contacts among homosexual men, with a per-contact risk for HIV infection of 0.82% when performed with partners infected with HIV.
The investigators point out that this risk is double that of being stuck with a needle used previously by a person infected with HIV. Furthermore, cumulative risks of infection linked to unprotected anal sex can increase to very high levels as the number of contacts rise. "Prevention messages must continue to emphasize the importance of avoiding this type of contact," the authors conclude.
Other sexual acts carry a lower -- but still significant -- risk, according to the researchers. Risks for condom failure mean that the use of a condom during receptive anal sex reduces per-contact infection risks to 0.18%, not zero. Unprotected receptive oral sex, as well as protected and unprotected insertive anal sex, were each associated with a 0.06% per-contact risk of HIV infection, according to the authors.
Vittinghoff and colleagues speculate that "as (these) lower-risk practices become more common, they may play a larger role in propagating the epidemic." (Reuters/American Journal of Epidemiology)
AIDS Library moves to new home
Philadelphia's AIDS Library, which is part of the AIDS Information Network, has completed its move to its new location as part of Philadelphia FIGHT, at 1233 Locust Street, on the second floor.
AIN merged with FIGHT earlier this year. Other AIN projects which became part of the FIGHT network include the SafeGuards, the Youth Health Empowerment Project, and Critical Path AIDS Project.
The Library lends books, videos and other materials to anyone who signs up for a library card, and offers a computer center which provides access to the Internet and word processing software.
The Library is open over the summer from 10 am to 5 pm Tuesday through Friday.
For more information, call 215-985-4448, ext. 140, or email library@aidslibrary.org.
Margie Seides, a "licensed therapist, comedian and cabaret singer," will offer a "hysterical romp through the world of Psychotherapy" as a benefit for AIDS Services in Asian Communities (ASIAC) this coming Sunday night.
Joining Sedes will be Paul Trueblood, Julie Halston, and Mark Waldrop-(When Pigs Fly).
The $12 cover charge benefits ASIAC.
The event will be held at 8:00 PM on Sunday August 8, 1999, Upstairs at Frangelica, 200 S. 12th St., in Philadelphia. Reservations can be made at (215) 731-9930.
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