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Issue #248: September 24, 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:
US withdraws AIDS drug threat to S. Africa
DC demonstration on AIDS drugs set for October 6th
Drug-resistant HIV on the rise
Low literacy tied to adherence problems of black PWAs
DC vote counted, voters support marijuana as medicine
Connecticut officials question coded HIV reporting
PWA Art Show planned at Way Center
The United States has announced that it has defused a controversy over access to AIDS drugs for millions of poor South Africans, an issue that had strained the countries' relations and hounded Vice President Al Gore's presidential campaign.
The announcement follows a decision of several pharmaceutical companies to "suspend" a lawsuit which had delayed implementation of a South African law which would have allowed the country to import or produce cheaper versions of AIDS drugs developed by U.S. drug companies.
U.S. Trade Representative Charlene Barshefsky said the United States had agreed to support South Africa's efforts to obtain cheaper AIDS medicines in exchange for promises that the measures would not violate drug companies' patent rights.
"The government of South Africa is battling a very serious AIDS pandemic," Barshefsky said in a statement. "The United States government fully supports President (Thabo) Mbeki and his government in their effort to combat this problem and is committed to do whatever it can to help."
Mbeki has accused American drug companies of charging exorbitant prices for anti-AIDS drugs. U.S. pharmaceutical manufacturers countered that the South African government has passed legislation that would violate patent and copyright protections granted them under international trade rules.
Pressed by drug makers, U.S. officials, led by Vice President Al Gore, also objected to the South African law, which could allow local manufacturers to make cheaper, generic copies of AIDS drugs or import medicines from a third party. Gore, as the Chair of the U.S./South Africa Bi-national Commission, and Barshefsky had threatened sanctions against South Africa over the issue.
South Africa is one of the countries hardest-hit by the AIDS crisis across sub-Saharan Africa. An estimated 6 million of South Africa's 44 million people have HIV or AIDS, and about 1,500 are believed to be infected with HIV each day.
The U.S. policy had outraged AIDS, health and consumer activists around the world. Activists from the AIDS group ACT-UP had targeted their anger at Gore, who had raised U.S. concerns in meetings with Mbeki. Protesters embarrassed Gore on the campaign trail with signs and chants. In Philadelphia, 700 demonstrators showed up at a campaign fundraiser and declared Gore's current policy to be one of "Medical Apartheid."
Eric Sawyer, a protest organizer, praised the deal with South Africa as an advancement in providing impoverished AIDS patients with life-extending medicines.
"I think it's a terrific step toward providing affordable medicine to poor people living in countries like South Africa," Sawyer said.
A Gore spokesman said that the vice president "is pleased this issue has been resolved."
"He's eager to continue his work with President Mbeki and others to confront the crisis of AIDS in Africa and around the world," the spokesman said.
The deal also satisfied drug makers, who said they welcomed South Africa's pledge to abide by agreements on patent protection.
"We think that's fine," said Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, a trade association.
Trewhitt added, however, the agreement was general, and drugs makers would scrutinize its implementation.
As part of the deal, the United States will restore preferential trade treatment for a handful of South African products as soon as Congress reauthorizes the program, Barshefsky said.
A U.S. trade official said South Africa would remain on the Clinton administration's "watch list," a signal of U.S. concern but not enough to trigger sanctions. Barshefsky could decide whether to remove South Africa from the list as part of a separate review expected to be completed by mid-October, the official said.
South Africa has never used the disputed portions of its Medicines Act, which drew protests when it was amended in 1997.
"The announcement today that the United States will stop bullying South Africa to abandon efforts to make essential medicines available to its population may save thousands of lives," says Robert Weissman, co-director of Essential Action, a corporate accountability group founded by Ralph Nader.
"Until the terms of the agreement are known, we cannot be sure the United States intends to operate in good faith," cautioned Weissman. "The agreement appears to call only for South Africa to agree to comply with its obligations under the World Trade Organization intellectual property agreement -- which South Africa has repeatedly declared it would do."
"If the U.S. position has in fact changed, it is largely due to the courageous activities of AIDS activists who forced the issue on to the public agenda," Weissman said.
"The announcement today appears to be a crucial victory, not only for people with AIDS but others in South Africa who may soon gain access to essential medicines they would otherwise go without," Weissman said. "But much more needs to be done -- the United States must internationalize the agreement with South Africa, so other nations can employ compulsory licensing and parallel imports without fear of repercussion. And the U.S. should immediately license the patent rights it holds to essential medicines to the World Health Organization, which could then disseminate low-priced versions of the medicines worldwide."
The law at the heart of the issue was passed in 1997 with the hopes of giving South Africa's AIDS patients access to less expensive versions of drugs to treat HIV disease. The law would apply to all medicines, but the focus of the dispute has been on AIDS since AIDS drugs are so expensive that they are out of reach of most South Africans.
The most contentious parts of the law involved two provisions to lower the price of AIDS drugs. The first would allow the import of commercial drugs from third countries where they are available at a lower cost, a practice known as parallel importing. The second, called compulsory licensing, would allow the South African Government to license local companies to make generic versions of the drugs.
The World Trade Organization allows both practices under certain conditions, but the pharmaceutical companies, backed by the Administration, opposed them.
An American trade official said that the law was written too broadly and could allow abuses; the official said the Administration was willing to back down from its position now that South Africa has pledged in a letter to strictly abide by the trade organization's conditions.
The new agreement does not resolve the ultimate status of the law, which has not taken effect pending the pharmaceutical companies' legal challenge. South Africa's Health Minister, Manto Tshabalala-Msimang, has said the country was considering redrafting the law.
Advocates responded positively to the U.S. announcement.
"If this agreement truly puts an end to the U.S. Administration's immoral pressure campaign against South Africa, then it's a victory for millions of South African citizens," said ACT UP New York's Mark Milano. "Now, the Clinton/Gore Administration must extend this policy to all nations in need of affordable medicines for people with AIDS and other serious illnesses," continued Milano.
"The United States must encourage, rather than prevent, access to affordable medicines for all poor nations," said Asia Russell of ACT UP Philadelphia. "The U.S. must send a clear message that it will never again use these bullying tactics to prevent worldwide access to medicines."
Sawyer, a leader of the anti-Gore protests, said that "This is an important first step, but more needs to be done. Under the Bayh-Dole laws, the U.S. Government holds the patents or licensure rights for numerous medications developed at taxpayer expense. Gore must work to implement these already existing laws and turn over medicines to an international body such as the World Health Organization. The WHO could make these drugs available to poor countries at or below manufacturing expense. This must be done quickly, to prevent the millions of deaths that will occur in the next few years from AIDS and other diseases."
"The U.S. Government has failed to implement the Bayh-Dole laws because drug companies don't want us to know that the expensive drugs we buy only cost pennies to produce," stated Susan Whitaker of AIDS Drugs for Africa.
"Drug companies claim that their exorbitant profits are necessary to cover research and development, even though actual drug development costs are heavily subsidized by U.S. taxpayers."
The protestors stated that disruptions and demonstrations will not end until the Administration transforms trade policy to support access to essential medications, rather than the whims of pharmaceutical companies placing profit before human lives.
"Saving lives in Thailand, Brazil and India is just as vital as saving lives in South Africa," explained John Bell of ACT UP Philadelphia. "The United States must cease its harassment of countries taking legal measures to provide essential medications for their populations, and implement our own laws that could pave the way for drug access."
DC demonstration on AIDS drugs set for October 6th
In an effort to dramatize the demand that AIDS drugs be made available to every nation, ACT UP and other groups are sponsoring a major demonstration in Washington, DC, on Wednesday, October 6, beginning at noon at Farragut Square, 17th Street and Connecticut Avenue.
The location is near the office of US Trade Representative Charlene Barshevsky, who has led U.S. efforts to threaten less wealthy countries with economic sanctions if they try to use AIDS drugs manufactured by U.S. companies in ways which the companies believe threatens their profits.
In Philadelphia, buses will leave at 8 am from Broad and Walnut Streets. Lunch will be provided. Transportation is also available from New York and other locations.
"90% of people with HIV worldwide have no access to lifesaving drugs," a statement announcing the demonstration said. "Poor nations seek to manufacture affordable generic versions of expensive drugs, and also shop around the globe for the best price. These legal and common trade practices are used by the United States and many other whiter, wealthier nations without fear of punishment. Rather than supporting these efforts, the US Government threatens developing nations with sanctions and demands changes in the laws of sovereign countries.:
The statement continues, "As the top trade official of the United States, Charlene Barshevsky plays big stick for the drug companies -- the world's most profitable industry and top contributor to politicians. For poor nations populated mostly with people of color, the racist trade policies of the US are a death sentence."
For more information, call ACT UP Philadelphia at 215-731-1844.
Drug resistant-strains of the AIDS virus are becoming more prevalent, researchers reported Tuesday, a development that may warrant pretreatment screening as well as a renewed emphasis on the need to practice safe sex.
A study of 80 men by the Aaron Diamond AIDS Research Center at Rockefeller University in New York found that about one in six carried a strain of HIV that was resistant to at least one of a combination of drugs commonly used against the virus.
"We need to explore how widespread this resistance is," said Daniel Boden, the lead author of the study.
The study, published in the Journal of the American Medical Association, was the first published that measured drug resistance since patients began taking a daily combination of drugs.
"HIV has a much tougher time resisting three drugs than one," Boden said. "Until we know how much resistance there is and what is causing it, we recommend that infected patients who are able to should follow the multi-drug therapy."
The death rate from AIDS dropped 47 percent in the United States between 1996 and 1997 after the multi-drug approach became commonplace.
But the study found that the success of the drugs worried scientists about the increased transmission of drug-resistant strains.
"If it appears that HIV resistance to drugs is becoming more common in the future, we may have to alter current strategies for treatment," said Martin Markowitz, co-author of the study. "But until we know more, we do not want patients to stop taking drugs because in most cases they are quite effective."
The study said the findings supported the use of resistance-testing during treatment and called for additional tests to determine whether resistance profiles should be developed to determine what kind of drug treatment is best.
In another study also published in the journal, the University of California at San Diego found that 25 of 141 individuals infected in the past year had varying degrees of resistance to one or more drugs.
The authors of that report also called for further study "to assess the need for routine drug resistance testing to guide clinical management."
Roger Pomerantz, director of the Center for Human Virology at Jefferson Medical College in Philadelphia, said in an editorial in the same issue that both studies showed "tailor-made, designer therapies" to combat the virus may be on the horizon.
"HIV evolves differently in different areas in the country. Defining resistance for each drug is exactly what we did in the early part of the century for bacterial infections," Pomerantz said.
Drug-resistant HIV, he said, will "most likely will accelerate over the next several years. Importantly, safe sex practices should continue to be stressed to all patients, even those receiving combination antiretroviral therapy." (Reuters)
African Americans, particularly women, are become more and more predominant among people with HIV disease in the U.S. Scientists, for years, have been baffled by life-threatening disease and continue to examine reasons why the disease continues to run rampant in specific communities, even though medical advances have increased life expectancy.
In a study published in the August issue of the Journal of the National Medical Association (JNMA) authors Seth Kalichman, Sheryl Catz and Bineetha Ramachandran explore the association between education literacy to HIV treatment adherence and barriers to care among African Americans living with HIV/AIDS.
The National Medical Association is a medical society representing more than 20,000 African American physicians.
A community-recruited sample of 85 African American men and 53 women living with the disease completed measures of health literacy, health status, treatment adherence, emotional well-being, and barriers to care. The results indicate that participants with lower education-literacy levels were more likely to miss medications because they were confused about dosage amounts than participants with higher literacy levels. Depression was also linked to those with low literacy, along with problems accessing medical care.
Experts determined that the ability to read and comprehend medical instructions plays and important role in health, health care and treatment adherence. According to the researchers, tailored interventions, ie graphic instructions will assist low-literacy individuals to follow their recommended medication regimen. (US Newswire)
Almost a year after the balloting, voters in the nation's capital learned yesterday that nearly 70 percent of them favored medical use of marijuana. Votes on their referendum were finally counted after a judge overruled a congressional ban.
That doesn't mean marijuana is now legal for medical purposes in Washington. Congress will get at least one more chance at the issue. U.S. Rep. Robert Barr (R-GA) immediately announced that he would introduce legislation to block it "if the D.C. Council enacts the measure and if a budget standoff between the White House and Congress stalls a separate city marijuana ban," according to the Washington Post.
"It would be a travesty for Congress to stand by and allow a handful of activists to overturn federal narcotics laws with an argument that is, medically speaking, the worst kind of quackery," Barr said. Barr has tacked an amendment onto pending D.C. Appropriations legislation that would prohibit any city efforts to loosen drug regulations. President Clinton has threatened to veto the appropriations bill for other reasons.
Rep. Ernest Istook (R-OK), chair of the subcommittee overseeing the district's spending bill, lent his support to Barr's amendment, saying that Initiative 59 reflects Democrats' "soft on drugs policy." If the initiative becomes law, Istook said, it will "hijack D.C.'s progress on the road to recovery."
As passed, District of Columbia Initiative 59 would allow doctors to inform their seriously ill patients of the option of using marijuana to ease certain symptoms and side effects of treatment related to AIDS and cancer.
"That will allow a patient to bring a physician in to testify in court, seeking a medical exemption from prosecution under the D.C. Uniform Controlled Substances Act," said Wayne Turner, coordinator of the AIDS Coalition to Unleash Power, a gay rights and patient advocacy group.
The D.C. chapter of ACT UP helped collect the signatures of 32,000 registered voters needed to put the measure on the ballot in November.
After the proposal is submitted on Capitol Hill, Congress would have 30 legislative days to pass a resolution of disapproval. If it didn't, the measure would become law.
"Our democracy has not fallen apart because [some] states have medical marijuana in them," said Mary Jane DeFrank, executive director of the Washington-area American Civil Liberties Union, which filed the lawsuit to force the ballot counting.
Although 11 of 13 D.C. Council members and Mayor Anthony Williams supported the measure, the White House and the Republican majority in Congress have cited a lack of conclusive medical research in their opposition.
"Marijuana continues to be a Schedule I substance and is still illegal under federal law to cultivate, possess or use," said Joseph C. Peters, acting assistant deputy director of the Office of National Drug Control Policy.
"It would send a terrible message to America's young people to allow those laws to be openly flaunted in the same city where they were passed," Barr said.
U.S. District Judge Richard Roberts ruled that preventing city officials from counting and certifying the referendum results was a violation of the constitutional rights of district voters.
Sixty-nine percent of district voters cast their ballots in support of the measure. Thirty-one percent opposed the initiative in an election that brought out 40 percent of the district's 353,503 registered voters.
Five states -- California, Oregon, Washington, Alaska and Arizona -- also have passed medical marijuana initiatives. Three others -- Nevada, Colorado and Maine -- are expected to consider similar measures over the next 14 months. (AP, Washington Post, Atlanta Constitution-Journal)
Connecticut state health officials are questioning the state's use of non-name HIV reporting, saying the current system does not provide enough information on how the virus is spread.
From January to June, 352 HIV cases were reported in Connecticut, including 44 in Hartford and 40 in New Haven, according to state health department's HIV/AIDS Surveillance Semiannual Update.
But officials say there are many inconsistencies in the way labs report results to the state, and it is too soon to tell what the numbers mean.
Municipal and state testing labs began tracking HIV cases through a confidential reporting method in January. The reports initially were supposed to be anonymous and provide information on gender, race, age and residency.
But the results show that 90 percent of those tested could not be identified by race and about 50 percent could not be identified by residence. Without that information, AIDS prevention services might not be able to tell how the disease is spreading or which populations are most affected.
Beth Weinstein, director of the state's AIDS program, said labs need to be told what information to collect. The current system cannot catch all instances of repeat testing, said Dr. Aaron Roome, a program coordinator for the state.
There also are inconsistencies in how long it takes labs to report results to the state, said Debra Katz, director of the Stamford Health Department's AIDS program.
"There are problems," Weinstein said "The laboratories can only report to us what they are provided."
Until 1998, Connecticut was one of 18 states that did not report HIV in adults, tracking only cases among children under age 13.
Through advanced treatments, the progression from HIV infection to AIDS has been decreasing, but the number of those living with HIV has increased.
According to the report, there have been 10,706 AIDS cases in Connecticut since 1980. There are an estimated 5,440 Connecticut residents living with AIDS.
During the first six months of the year, whites comprised 38.8 percent of the cases; blacks made up 29.4 percent; and Hispanics accounted for 30.8 percent. Compared with last year, those percentages represent an increase among whites and Hispanics and a decrease among blacks.
The William Way Community Center will sponsor an art show featuring the works of local gay, lesbian, bisexual or transgendered people with AIDS beginning on November 1st.
The Center is currently soliciting artists to submit their works.
The show will be on display in the entire first floor lobby of the William Way Gay & Lesbian Center, 1315 Spruce Street in Center City. Works will be limited to wall display only. The exhibit is expected to run from November 1st to December 30th 1999. The centerpiece of the show is a memorial to Philadelphia artists Gene Hurley, who died from AIDS on June 15th.
Submit sample photo(s) or slide(s) to Art Show, 2037 Chestnut Street, P.O. Box 2236 , Philadelphia, PA 19103. For more information, email Nov99art@aol.com or call 215-545-0111.