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Issue #245: September 3, 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 deaths: gap widens between blacks and whites
CDC pushes partner notification in new strategy
Prisoners much more likely to have HIV
Hinson resigns from crisis committee
Local groups win technology grants
FIGHT offers weekly Tai Chi class
In 1998, deaths from AIDS among African Americans were almost 10 times higher than among white Americans, according to officials at the Centers for Disease Control and Prevention.
Dr. Helene Gayle, Director of the National Center for HIV, STD, and TB Prevention at the CDC, presented these figures to participants of the National HIV Prevention Conference in Atlanta in late August.
In a session that focused on the AIDS crisis in African Americans, Dr. Gayle pointed out some "disturbing" additional data showing strong racial disparities in the rates of HIV infection and AIDS.
A 1998 study, conducted by Dr. Mary Ann Chiasson of the New York City Department of Health and co-investigators, found that African American women represent 53% of the AIDS cases in women in New York City.
African American women were also three times more likely to die of AIDS than were white or Hispanic women, Dr. Gayle told conference participants. And this disparity was not explained by differences in risk behaviors of the subjects.
Dr. Chiasson's group also found that gay and bisexual African American men were two times more likely to die of AIDS than were their white or Hispanic counterparts.
"The research presented here today clearly demonstrates the terrible impact of AIDS on our community and the need for continued aggressive HIV prevention efforts," Cornelius Baker, executive director of National Association of People with AIDS, said in a conference press release.
Part of this effort will include a "fight against a conspiracy of ignorance," he told conference attendees. Specifically, there is a "heavy stigma against homosexuals and bisexuals among African Americans," Baker said.
Change will take time and will not happen until certain issues are better addressed in the African American community, Dr. Gayle continued. These issue include drug use, homosexuality and bisexuality, gender inequality and equal access to healthcare services.
New CDC data show that AIDS killed 17,047 people in the United States last year a 20 percent decline from 1997.
A total of 8,316 blacks died from AIDS last year. That means 49 percent of total AIDS deaths came from a group that makes up only 13 percent of the U.S. population.
Health officials say they fear the ramifications if AIDS once misunderstood as a gay disease now becomes viewed as an illness that affects mostly blacks.
''That's real disturbing,'' said Dr. Helene Gayle, director of HIV prevention at the CDC. ''We know that often times, if a disease becomes higher in populations that are more marginalized in our society, we forget about those problems. We can't afford to forget about HIV.''
"In many ways, the story of how well we do in HIV and AIDS will be told by how well we do with the African-American population," Gayle said.
Thirty-two percent of AIDS deaths in 1998 were among whites, for a total of 5,436. Among Hispanics there were 3,114 deaths, or 18 percent.
Health officials have long blamed poverty and a lack of access to health care for higher rates of disease among blacks. But many blacks also have failed to realize that they are at risk as much as other groups, Gayle said.
''The fact that this was portrayed as a white, gay disease lulled the African-American community into a false state of security,'' she said.
Gayle also mentioned that racism plays a role in who lives and dies with AIDS. "It is sad that we would allow something like skin color to decide whether a person gets necessary treatment," she said.
After peaking at 49,351 in 1995, AIDS deaths dropped 65 percent through 1998. Deaths among Hispanics dropped at the same rate. But for whites the decline was much greater 75 percent. For blacks it was much less, at 55 percent.
The numbers released in August also showed that, although total AIDS deaths continue to drop, the rate of decline has been cut by more than half.
This raises concerns that powerful new drugs may have reached their limit in controlling the disease.
Last year, researchers were stunned by reports that AIDS deaths nationwide dropped 42 percent from 1996 to 1997, results that were credited to powerful drug cocktails that dramatically increase the life expectancy of AIDS patients.
But the decline in deaths slowed to 20 percent from 1997 to 1998.
CDC officials said it's too early to tell if the current treatments have pushed AIDS deaths as low as they can go. One worrisome sign is that the decline in deaths last year occurred mostly in the first three months of 1998. After that, deaths leveled off for the rest of the year.
''We might continue to see that decline,'' Gayle said. ''But it is at least a concern that most ... declines were in the first quarter of 1998 and not in the last quarter...For the time being it appears that much of the benefit of these new therapies has been realized."
Some advocates pointed to the CDC's numbers as proof that the drugs aren't as effective as once hoped.
''Our worst fears have become a tragic reality,'' said Steven Fisher of the advocacy group AIDS Action. ''AIDS drugs don't work for everyone and aren't a cure for anyone.''
The CDC blamed the slowdown on three factors:
Some people still aren't getting tested and treated for AIDS.
Some are finding it difficult to stick to the complicated regimen of pills, which must be taken at certain times of the day, sometimes with food, sometimes without.
Drug-resistant strains of the virus are emerging as patients fail to keep on schedule with their medicine.
The CDC estimates there as many as 900,000 people infected with HIV in the United States, with new infections holding steady at roughly 40,000 a year for the last decade. (Associated Press, Reuters)
Amid evidence of a resurgence of dangerous sexual practices in gay communities in several American cities, the U.S. Centers for Disease Control and Prevention plans to urge the institution of new national HIV testing procedures designed to pinpoint when - and possibly by whom - people are getting infected.
The new procedures involve a more sensitive HIV test as well as a stronger emphasis on getting infected persons to reveal the names of their sexual and drug use partners.
As several cities report disturbing outbreaks of syphilis and gonorrhea among gay men, the CDC convened in Atlanta its first ever National HIV Prevention Conference, which drew public health officials from across the nation.
There, CDC officials unveiled a new "STARHS Strategy" for combating HIV that combines use of a new testing technique that allows technicians to distinguish old infections from those acquired within the previous 120 days with an effort to trace people's intravenous-drug and sexual contacts.
Because people can live symptom-free with HIV for a decade, there was no way previously to tell when they might have become infected. But the new technology changes that: While it's hard for many sexually active people to recall the names and addresses of all their partners, spanning years of activity, it is typically a simple matter to conjure a list for the past four months.
Despite evidence that those getting tested for HIV are resistant to telling officials the names of people with whom they've had sex or shared drugs, CDC wants public health authorities to track down individuals who might have gotten infected and interrupt the chain of transmission on a large-scale basis.
The idea behind STARHS - which is a somewhat tortured acronym for "Serologic Testing Algorithm for determining Recent HIV Seroconversion" - is to do for HIV what has long been done for syphilis and gonorrhea. While the CDC hasn't the legal power to impose any such policy on local public health agencies, it can set suggested guidelines, and some fear that it will die its financial support for AIDS and STD programs - which rely in most cities and states almost totally on CDC funds - to local agreement to enforce the new procedures.
Typically, if the CDC puts on enough pressure, an idea is adopted by most states. That's what happened, for example, six years ago when the CDC suggested that the nation adopt the "Directly Observed Therapy," or DOTs, approach for stopping the spread of drug-resistant tuberculosis that had been successful in New York City.
"With this testing strategy," the CDC will suggest, "we can begin to know which populations are becoming HIV-infected today...and stop the further spread of HIV before it's too late."
But sociologists and many AIDS activists say the policy will face controversy because many recently infected individuals may well be unwilling to give up the names of their sexual and IV drug-use partners. In Philadelphia, although partner notification has been a requirement at AIDS testing sites for years, few of those tested volunteer the names of those in their lives who may be infected.
Some of condemned the CDC's emphasis on partner notification, noting that it is likely to only be emphasized in publicly-funded testing sites visited by low-income and disenfranchised people, who may feel intimidated into providing names. Private physicians conducting the testing rarely seek the names of partners, even though they are supposed to.
Others note that reporting the names of sexual partners of sex workers and the drug partners of needle addicts to government-funded counselors could risk criminal charges against those identified. (Adapted from Newsday)
Prisoners much more likely to have HIV
Prison inmates are five to 10 times more likely than non-inmates to have AIDS or HIV, and recently released prisoners account for one-sixth of the nation's AIDS cases, researchers have announced.
The first comprehensive effort to estimate the prevalence of AIDS and HIV among the nation's nearly two million inmates found that there were approximately 8,900 inmates with AIDS in 1997. That rate is five times higher than the nation at large.
Research presented at the National HIV Prevention Conference organized by the Centers for the Disease Control and Prevention (CDC) also found high levels of sexually transmitted disease among inmates.
"AIDS prevalence was 5 times higher than the total population. HIV prevalence was between 8 and 10 times higher," said Theodore Hammett of Abt Associates, which conducted the study for the private National Commission on Correctional Health Care.
The study estimated that 39,000 people, or approximately 17 percent of the 229,000 people with AIDS in 1996, had been released from a correctional facility that year. The percentages were even higher for HIV infection, hepatitis C and tuberculosis.
"Virtually all inmates return to the community and many of them return with HIV, AIDS and other infectious diseases," Hammett said.
"This means that correctional facilities are critical settings for prevention and treatment interventions for infectious disease," he said.
A separate study conducted by the CDC also found high rates of syphilis, gonorrhea and chlamydia among inmates, particularly women, entering corrections facilities at 14 cities and counties across the country.
The percentage of women entering jails who tested positive for syphilis ranged from 3 to 22 percent. Among men, the figure ranged from 1 to 9 percent, said Kristen Mertz, a medical epidemiologist in the CDC's sexually transmitted disease division.
In juvenile detention facilities, 9 to 17 percent of girls and 3 to 10 percent of boys tested positive for chlamydia, she said.
Researchers said prisons offer a unique opportunity to prevent AIDS and other sexually transmitted diseases.
"Because many inmates are released back into the community within a few days, testing and treating persons entering jails and juvenile detention facilities may reduce transmission in the community," Mertz said.
A survey conducted for the CDC in 1996 and 1997 found that only 10 percent of state and federal prison systems and only 5 percent of city and county jail systems offered comprehensive HIV prevention programs for inmates.
About two-thirds of correctional facilities offered some form of AIDS education, but few offered peer-led programs, instructor education, multi-session counseling and pre- and post-test counseling, Hammett said. (Reuters)
In North America, Western Europe and Australia, protease inhibitors are credited with reducing the number of deaths due to AIDS. However, these drugs are associated with many side effects, including changes in body shape. Now, doctors in France have reported cases of hair loss in patients taking the protease inhibitor indinavir (Crixivan).
The doctors documented hair loss in ten men aged 30 to 51 years who had an average CD4+ cell count of 243. Seven patients had a viral load below 200 copies; the three remaining patients had viral loads ranging between 320 and 47,000 copies. All patients were receiving triple anti-HIV drug therapy that included indinavir.
The patients noticed their hair loss during the first six months of therapy. According to the report, "almost complete hair loss" was experienced in various parts of the body in the following proportions: lower legs (10 patients), thighs (eight), pubic area (five), chest (three) and head (two).
Interestingly, hair loss from the scalp was not as severe as in other parts of the body. In addition to hair loss, eight patients out of 10 experienced dry skin. The patients' hair regrew within four months after patients exchanged indinavir for other protease inhibitors, including nelfinavir and ritonavir/saquinavir. In other cases, indinavir was replaced by the non-nucleoside analogues nevirapine or efavirenz.
The French researchers speculate that indinavir may interfere with vitamin A-like molecules in the body and that this interference may be linked to the hair loss experienced by some people. This link, however, remains theoretical. (CATIE/New England Journal of Medicine)
Hinson resigns from crisis committee
Michael Hinson, co-chair of the Philadelphia HIV Commission, has resigned as the co-chair of a new "Crisis Response Community Advisory Committee," saying that he can't work with Patricia Bass, co-director of the city's AIDS Activities Coordinating Office.
Bass is the governmental co-chair of the committee, which was established to work with a group of federal officials who are evaluating Philadelphia's response to the AIDS epidemic.
The federal group is visiting several cities and conducting what it calls a "Rapid Assessment, Response and Evaluation" under guidelines established by the U.S. Dept. of Health and Human Services (HHS). It was established out of concerns on the federal level that AIDS initiatives in some communities around the nation have not responded to the changing realities of the AIDS epidemic adequately, including improvements in drug treatments and the growing concentration of the epidemic among the poor and communities of color.
HHS recently announced that its overall mission for AIDS services it supports is that AIDS care systems assure "100% access, 0% disparity" in programs supported by Ryan White CARE Act funds. Claude Fox, administrator of the Health Resources and Services Administration (HRSA), said in a June letter to regions and states receiving CARE Act funds that HRSA was "redoubling our focus on achieving access to high quality health care for all persons living with HIV/AIDS and eliminating race, gender and geographic disparities in health outcomes."
In Philadelphia as in most other cities, people of color are disproportionately impacted by the HIV epidemic and generally suffer poorer outcomes, including higher death rates, less access to experienced HIV physicians, and more obstacles to obtaining AIDS drug treatments.
While not providing details, Hinson said that he believes that Bass is manipulating the evaluation process being conducted under federal auspices. "Earlier on in this process, I raised questions with you about our responsibilities and your response was that you wanted me to be the lead." Hinson, who also directs Colours, a black gay AIDS service organization, said in a letter to the Bass. "However, what was in the beginning, and continues to happen, is the non-sharing of information, manipulation as to whom the participants on the committee and teams will be, and blatant disrespect of the key stake holders in our system. This both concerns and alarms me."
Hinson and others have in the past criticized Bass for what they have claimed is insensitivity to the community dynamics of AIDS services in Philadelphia. "I am concerned that under your leadership more community alienation will happen as opposed to community bridging" in the Rapid Response effort, Hinson said.
Noting that the HIV Commission, which is responsible for setting priorities for over $16 million in CARE Act funds in the Philadelphia region, is considering a major overhaul of how it operates, Hinson concluded his resignation letter asking that Bass "take a serious look at your past actions and begin to rectify some of the alienation you have administered."
"Our city is about to enter into a very critical time period of 'restructuring' and we all need to participate equally for the good of this cities public health needs.
Meanwhile, the HIV Commission has asked the city for permission to negotiate a contract with James Harvey, a Chicago AIDS administrator, to replace former Commission manager Bernard Warren, who resigned under fire last week after months of complaints from Commission members to AACO about his performance. The Commission's major leadership group, the Body of Co-Chairs, decided that it wanted to appoint Harvey as an "interim administrator" of the Commission while the group re-organizes.
In a last-minute compromise, California Governor Gray Davis has announced he will sign a bill that would permit needle exchange programs in California -- but only if local permission has been granted and with emergency orders.
The announcement came after press reports that Davis appeared ready to veto the legislation. despite a new poll showing strong public support for giving clean needles to intravenous drug addicts.
The state legislature must amend and approve the bill, with Davis' proposed changes, before the Sept. 10 deadline for this session.
Previous signals from the governor's office indicated that he was leaning toward a veto, which his Republican predecessor, Pete Wilson, had done three times.
Davis' spokesman Michael Bustamante said earlier this week that the governor has "already communicated serious concerns" about the measure.
"The thing we wanted to impress upon the author is that the governor believes there are other ways to address AIDS transmission and drug use without sending a mixed message to California youth with state-sanctioned needle exchanges," Bustamante said.
The bill allows cities and counties to start their own locally funded needle exchange programs, but does not require them. For San Francisco, Berkeley, Los Angeles, Santa Cruz and Marin County, the measure allows health officials to continue current programs without having to go through legal hoops by declaring a state of emergency over the AIDS epidemic every two weeks.
The signals from the governor's office brought an angry response from San Francisco Board of Supervisors President Tom Ammiano.
"As a teacher, as a parent and as a (former) AIDS educator, I think it is the governor who is putting out the double message," Ammiano said. "I am appalled by the lack of conviction and the ignorance in the (possible) veto. Needle exchange has proven to work as a deterrent in the transmission of AIDS."
Although it was never asked by Davis for advice on the bill, the San Francisco AIDS Foundation is lobbying the governor by rolling out something he pays attention to: a poll.
Commissioned by the AIDS foundation and conducted by the Field Institute, the survey of 1,010 adult Californians found 79 percent of Democrats, 75 percent of independents and 54 percent of Republicans support needle exchange programs.
Needle exchange programs got the highest support in the Bay Area, with 83 percent, and the lowest support from the Central Valley, with 65 percent saying they approve of using exchange programs to stop the spread of HIV and blood-borne hepatitis.
The poll, which had a margin of error of plus or minus 3.2 percentage points, also found that 75 percent of people who described themselves as politically "middle of the road" also supported needle exchange programs.
That question was clearly targeted toward Davis, a self-described moderate who feels most comfortable when polling shows the majority of Californians on his side of an issue. The foundation believes Davis can sign the bill without facing a political backlash.
"There is enough political cover in this poll for any elected official to do the right thing by signing it," said Regina Aragon, public policy director for the S.F. AIDS Foundation.
When asked about the poll, Davis spokeswoman Hilary McLean said: "The governor is going to base his decision on the correct public policy."
Former Gov. Wilson vetoed three similar needle exchange measures, saying he believed they lead to increased drug addiction. One Democratic lawmaker who opposed the measure in the Legislature said the state would be sanctioning "the implements of death" in approving such programs.
But AIDS groups and the bill's author, Assemblywoman Kerry Mazzoni, D-San Rafael, point to six federally funded studies showing that needle exchange programs reduce HIV transmission without increasing drug use.
"This is really a no-brainer," Aragon said. "The governor has all the evidence he needs to sign this life-saving legislation."
San Francisco distributes about 2 million clean needles every year, working with a local budget of about $580,000. That money also buys educational materials and referrals to drug-abuse treatment programs for anyone willing to listen at the exchange sites.
AIDS rates among drug users in San Francisco have remained relatively steady while cities without needle programs have seen their rates rise dramatically, city health officials have said.
San Francisco Mayor Willie Brown weighed in on the bill Thursday, saying "in a time when the AIDS epidemic ravages communities of color throughout California, needle exchange programs provide the most potent strategy to prevent new HIV infections. I trust Governor Davis will act in the best interest of the men, women and children of California." (San Francisco Examiner)
The DuPont Pharmaceuticals Company has awarded a grant of $15,000 to We The People to support general operating costs of the coalition.
"We are deeply grateful for this support," said Rob Capone, WTP executive director. "We The People serves a desperately poor constituency of people living with HIV/AIDS, and the government funding on which we rely often is inadequate to the real costs of running our programs. DuPont has come through for us at a critical time as we expand our activities to new centers in other underserved sections of the city."
Capone credit Heshie Zinman, a DuPont representative, for helping to get the new funds.
Philadelphia area groups serving people of color living with HIV disease are among 105 organizations which received an Equal Access Initiative Computer Grant Award from the National Minority AIDS Council and the Office of AIDS Research in August.
Local organizations receiving the computers include AIDS Services in Asian Communities, The RIGHT Foundation, and WISDOM in Philadelphia, The New Castle County HIV/AIDS Resource Library in Delaware, and The Center in Asbury Park, NJ.
Philadelphia FIGHT offers a free Tai Chi class every Monday from 2-3 pm at its offices at 1233 Locust Street on the 5th floor. The program is aimed at helping people living with HIV/AIDS to reduce their stress and build their energy levels, and is part of FIGHT's complementary therapies program.
Tai Chi is a series of gentle stretches designed to increase the flow of energy in the body. Many people feel that they have more energy at the end of the class than in the beginning, making it a good option for those who feel that they're already "too tired to work out."
Participants are not required to register in advance, nor do they have to make a commitment to keep coming every week. For more information, call Shawn Knight at 215-985-4448 ext. 166
Meanwhile, FIGHT has issued a press release highlighting its expansion related to the addition of the programs of the AIDS Information Network (AIN) to its operations. "This union has resulted in a stronger, more diverse agency capable of providing better services to the HIV/AIDS community and to the disenfranchised," the statement said.
FIGHT provides treatment and care at the Jonathan Lax Immune Disorders Treatment Center, a primary care site for individuals living with HIV/AIDS. Physicians at FIGHT are also involved in a number of research studies and are currently enrolling the AIDSVAX trial, an experimental vaccine that may prevent AIDS.
In addition to treatment and research, FIGHT is home to a strong array of prevention, education, and information services including the Critical Path AIDS Project; Project TEACH; The AIDS Library; and the Youth Health Empowerment Project.
"This consolidation is a way for us to provide 'one-stop shopping' services efficiently to a community facing the many challenges of HIV and AIDS into the next millennium," the FIGHT statement said.
FIGHT IS located at 1233 Locust Street in Philadelphia. Information on its programs is available by calling 215-985-4448, or by visiting the group's web site at http://www.fight.org.