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:
Region gets $2m Title I increase
Supreme Court allows HIV prisoner segregation
Hepatitis C infection common in urban PWAs
Experts call for more care access for blacks
Official decries restrictions on blood donations
Most PWAs don't benefit from more calories
Court denies suit on false positive test
African man castrates himself in fear of AIDS
Report criticizes teen abstinence programs
AmFAR treatment directory now online
TEACH offers Bucks County class
First national HPV hotline launched
According to the Philadelphia AIDS Activities Coordinating Office, which administers the funds for nine counties in southeastern Pennsylvania and southern New Jersey, the increase brings the total amount of Title I funding available for direct services to area people living with HIV disease to $18,134,000. The funding is to be spent between March of this year and February of 2001.
A little more than half of the new funds - $1,155,774 - comes from funding awarded under the Congressional Black Caucus Initiative, meaning that it must be targeted to services specifically serving the region's minority populations.
Most of the new funding will support increased primary medical care and case management services, along with a variety of support services aimed at helping PWAs remain in primary care.
The announcement of the new funding came only days before President Clinton pledged to boost federal AIDS funding by $175 million in the fiscal year 2001 federal budget, with most of the money to provide medical care, medication and support services to people with HIV and AIDS.
Clinton will propose increasing funding for the Ryan White Program, which funds primary medical care, drugs, treatment information and support services for some of the estimated 900,000 people with HIV/AIDS, by $125 million. He will also ask Congress for an extra $50 million for programs that seek to discourage people from engaging in behaviors that can lead to the transmission of AIDS and to educate people about the importance of learning whether they have HIV or AIDS.
This money would be spent in part to reach out to those populations at greatest risk of infection, with a special emphasis on racial and ethnic minorities, women, injection drug users as well as young gay and bisexual men.
The proposals will form part of the fiscal 2001 federal budget that Clinton will send Congress on Feb. 7. The White House released details of the proposals to try to drum up public support for them before the budget's formal release.
Clinton's prevention funding increase immediately drew criticism from AIDS Action, the national AIDS lobbying group in Washington.
Calling it "a small but insufficient increase," AIDS Action expressed disappointment with the additional $50 million for HIV prevention. AIDS Action had pressed the administration to end flat funding of prevention programs and called for a $100 million increase to reinvigorate prevention efforts.
Claudia French, AIDS Action acting executive director, said, "While the $50 million increase is a positive sign, it won't support the kind of investments needed to slow the 40,000 new infections each year."
However, AIDS Action did commend the president's request for a $125 million increase in Ryan White CARE Act funding and a $1 billion increase for biomedical research. French said, "While our investment in care and treatment has resulted in lower death rates, our divestment from HIV prevention has allowed HIV to continue spreading unchecked." Jeanne White, mother of Ryan White and AIDS Action's national spokesperson, said, "Ryan's legacy is for increased prevention efforts so that every young person knows how to protect themselves from HIV. The new AIDS budget fails to make the kind of investments needed to fulfill Ryan's vision of an HIV-free generation of young people." AIDS Action pledged to fight for additional prevention funds when Congress considers the budget.
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The high court rejected without any comment or dissent an appeal in a discrimination case brought on behalf of HIV-positive inmates in the Alabama prison system. They have been barred from more than 70 recreational, religious and educational programs available to other inmates.
The justices let stand a U.S. appeals court ruling that dismissed the lawsuit on the grounds that the segregation and exclusion of the HIV-infected inmates does not violate a federal anti-discrimination law, the Rehabilitation Act of 1973.
The U.S. Justice Department urged the Supreme Court to deny the appeal, saying judges may defer to legitimate security concerns by prison authorities in deciding such claims by inmates.
Prison managers must not be deprived of their ability to control inmates in various programs and prevent violence and other types of behavior that pose a substantial risk of transmission of the human immunodeficiency virus (HIV), Justice said.
Alabama, Mississippi and South Carolina are the only states that segregate all prisoners who test positive for HIV, which causes AIDS. In contrast, the U.S. Bureau of Prisons does not generally provide special housing for HIV-positive inmates or restrict their participation in federal prison programs.
In Alabama, state law requires that all new inmates be tested for HIV. Male inmates testing positive are sent to one facility while women testing positive are sent to another.
The prisons segregate the HIV-positive inmates from the general inmate population and house them in separate units. The few programs available to HIV-infected inmates are segregated and in many cases not comparable to those offered to other inmates.
The litigation began more than a decade ago. After a second trial in the case, a federal judge ruled that the risk of transmission of AIDS, acquired immune deficiency syndrome, was significant in all the programs at issue.
The judge in a 476-page decision said the general inmate population would not readily accept the HIV-positive inmates and their integration "would likely degenerate into active violence."
The appeals court, in an 8-3 vote, agreed last year. It said violence, drug use and sex occur in prisons, and that the resulting blood-to-blood contact would pose a significant risk of HIV transmission.
Attorneys for the inmates appealed to the Supreme Court, saying prison officials may not categorically exclude prisoners with HIV from programs because they fear prejudiced-based violence by other prisoners.
Dr. David M. Weinstock, of the New York Presbyterian Hospital/Cornell University Medical Center, and associates determined the HCV seropositivity rate for 1,623 HIV-infected patients seen at the Center for Special Studies at the New York Presbyterian Hospital.
They found that 41.3% of the patients were also seropositive for HCV. In addition, 88.8% of the HCV-seropositive subjects tested positive for hepatitis B virus (HBV).
"Hemophiliacs, intravenous drug users, and patients positive for HBV were significantly more likely to be HCV positive," the investigators report in the December 24th issue of AIDS. "HCV seroprevalence did not differ significantly with respect to sex or race."
The results of multivariate analysis revealed an independent association between HCV infection and older age and HBV seropositivity. HIV risk factors that were independently associated with HCV seropositivity included "hemophilia, intravenous drug use, and unprotected heterosexual contact."
While unprotected heterosexual contact was an independent risk factor for HCV, homosexual contact was not. Dr. Weinstock's group suggests that this difference may be "caused by the under-reporting of risk factors by patients included in the unprotected heterosexual group."
Overall, they conclude that the urban HIV-infected population studied has high rates of HCV and HBV coinfection.
Earlier detection of HIV, combined with the availability of highly active antiretroviral therapy for HIV infection, has resulted in fewer opportunistic infections and more comorbid illnesses such as hepatitis, the researchers point out. Therefore, "new and more efficacious prevention and treatment" of hepatitis is needed. (Reuters/AIDS)
African Americans and Latinos have disproportionately more new HIV infections compared with whites, according to the Centers for Disease Control and Prevention, and in Philadelphia have comprised the majority of AIDS cases since the beginning of the epidemic.
While the overall HIV incidence in the US has been relatively steady at about 44,000 in the last several years, it is been on the rise in African Americans, said Victor Barnes, deputy director of the CDC's division of HIV/AIDS Prevention.
At least half the new infections in 1999 were in African Americans; as a group, they represent only about 13% of the US population.
Barnes said that lack of access to care and less rigorous adherence to treatment regimens are two reasons why the epidemic is surging in African Americans. There is not only a higher incidence of HIV infection among African Americans, there are also higher rates of disease progression and death.
Another problem: In the past, there has not been enough recognition in communities that the disease was making inroads. "If you don't talk about it, and don't recognize it in your own community, then ultimately, it catches you by surprise," Barnes said.
He called on churches, political leaders and other community activists to step up their efforts to smash cultural barriers.
There are other barriers, as well. Because of economics, many do not have a regular personal physician. That is reflected in African Americans' higher use of emergency room and hospital services. William Cunningham and Kevin Heslin of the UCLA Departments of Medicine and Science presented data showing that during a 6-month period, 30% of African Americans used the ER more than once, compared with only 18% of whites.
The two researchers also said that significantly fewer African Americans with HIV-related disease had access to prophylaxis for common opportunistic infections.
Also, African Americans usually do not seek HIV testing until they are symptomatic, Barnes said, adding that this was partly because of the stigma of being homosexual or an intravenous drug user. But, if there were better access to treatment, and places to get HIV testing and care in one place, there might be more who seek help early, he added.
He told the audience that to help curb the epidemic, the CDC plans to lobby for more funds for community programs. The agency also aims to boost its surveillance, so it can better define the epidemic and better target resources. (Reuters)
A U.S. Food and Drug Administration (FDA) rule bars blood centers from accepting donations from men who have had sex with other men since 1977. In early January, Supervisor Mark Leno led a group of HIV-negative gay men to a Blood Centers of the Pacific office in order to protest the refusal of the group's blood donations.
The president of the center, Nora Hirschler, said she agreed with Leno, but she added that the facility would be closed if they did not comply with the federal mandate. Hirschler also voiced concerns that the protest could draw attention away from the severe blood shortage in the region. (San Jose Mercy News)
To date, only one study has examined the efficacy of nutritional supplementation among weight-stable AIDS patients, Dr. Cynthia L. Gibert, of the Veteran Affairs Medical Center in Washington, DC, and multicenter colleagues explain. Some research has suggested that caloric supplements that contain medium-chain triglycerides and hydrolyzed protein may be more easily absorbed than other supplement formulations.
Dr. Gibert's group therefore compared the efficacy of three caloric supplementation regimens randomly administered to 536 HIV-infected patients. The subjects, who had CD4 counts of less than 200 cells per microliter, had experienced an average weight loss of 2.1%, but had stable weights at study entry.
The three arms of this controlled trial were "500 kcal daily of caloric supplement with peptides and medium-chain triglycerides [MCT] plus a multivitamin and mineral supplement, 500 kcal of a caloric supplement with whole protein and long-chain triglycerides [LCT] plus a multivitamin and mineral supplement, and a multivitamin and mineral supplement only."
Over a 4-month period, Dr. Gibert's group observed "no significant differences among the three regimens in the percent change in weight...and body cell mass." Baseline caloric intakes were very high and patient compliance was very good, they point out.
"The study clearly demonstrates that, in the presence of a background multivitamin and mineral supplement, neither a product containing peptides and MCTs nor one containing whole protein and LCTs is better than no supplement in promoting weight gain or in preventing weight loss." (Reuters)
Reprinted from the Phila. Daily News
Not having AIDS turned out to be almost as traumatic as actually having it for
the man known as John Doe.
When Doe found out that he had been misdiagnosed as being HIV positive, he went
to pieces, he claims.
He said he suffered "night sweats, nausea, loss of sleep, skin lesions, rashes, recurring headaches, hair loss, scalp irritation, recurring crying fits, and loss of concentration."
He also complained of "extreme anxiety, depression, belief that he was going to die of AIDS within a few years, post-traumatic stress disorder, permanent lack of trust in medical providers, despondency, humiliation, and social isolation."
All that was fodder for a lawsuit, which the man filed against the Philadelphia Community Health Alternatives - AIDS Task Force, which diagnosed his non-condition, and a doctor who prescribed AZT, administered flu vaccines, and recommended that he participate in a clinical study of AIDS patients with tuberculosis.
When the Philadelphia man, described only as "John Doe," was screened for that program in May 1994, "it was discovered he was not HIV positive," said the state Superior Court.
The court studied the man's complaint, then upheld a lower court ruling dismissing the suit.
"Fear of AIDS claims are not cognizable in the Commonwealth of Pennsylvania," said the appeals court.
After having what he described as an "unsafe sexual experience" in 1992, Doe asked PCHA to test him for AIDS the following year.
The first two tests were not conclusive. However, after a third test, Doe was told that "he tested positive for HIV." He was then referred to a treating physician.
The court said Doe "has not set forth a sufficient claim for negligent infliction of emotional distress."
Silas, 19, from Kamanyi in the central Rwandan district of Gitarama, is recovering at the Butare University Teaching Hospital, following the incident which happened in December, the Imvaho newspaper has reported.
Originally admitted at the hospital for malaria, Silas is said to have sneaked out from his ward after a week when he saw no improvement in his perceived weight loss, the paper said.
On the day he left the hospital, passers-by spotted blood leading from a public toilet. They traced the blood and found Silas desperate for help. They took him back to the hospital, the paper added.
It was later discovered that Silas had cut off his penis with a razor blade, and thrown the severed organ into a pit.
According to Silas's relatives, the young man has a history of mental disorders. As for AIDs, the relatives said, Silas has never tested to find out his status. (Pan African News Agency)
But today, Dr. Thomas "Terry" Jefferson, 53, is broke, divorced, shunned by family and friends and unable to work as a pediatrician. He is HIV-positive.
Jefferson, who was fired in July 1998 from the children's clinic he co-founded here more than two decades ago, claims that HIV, the virus that causes AIDS, is the reason his life has unraveled. He has sued in federal court alleging that he was fired after the clinic discovered he was infected with the virus, although he does not have AIDS.
The suit charges Little Rock Children's Clinic with violating the Americans with Disabilities Act, which since June 1998 has recognized HIV-positive people as legally disabled. Jefferson also alleges that the clinic deliberately allowed his long-term disability insurance to lapse. He has since been denied new insurance coverage because of his HIV status.
The clinic has not specified why Jefferson was fired; under the terms of Jefferson's employment contract, the clinic has no legal obligation to do so.
"We're not going to have any comment on the matter," said Russell Gunter, the attorney representing the clinic.
Dr. Sue Keathley, the clinic's president, who co-founded the practice with Jefferson in 1975 after they graduated from the University of Arkansas for Medical Sciences, declined to be interviewed. The case is expected to go to trial in May.
Jefferson's experience illustrates why many HIV-positive doctors and nurses consider their medical condition intensely private information: No one wants to end up like Jefferson, who followed safety protocol for HIV-positive health workers by reporting his condition to the Arkansas State Medical Board but was fired anyway.
Fearing a ruined career and potential lawsuits, most HIV-infected physicians go to great lengths to hide their medical condition, according to a 1996 report. HIV-positive doctors are "going out of state for medical care and paying for HIV-related blood tests, doctors visits and prescriptions out of pocket" to avoid detection by their employers or state medical board, according to psychotherapist and researcher Michael Shernoff, whose findings were published in the Journal of International Association of Physicians in AIDS Care.
Parents have mixed feelings about taking their children to a doctor who is HIV-positive. Several mothers who did not want to be identified said they would not take their child to a doctor who had the virus, regardless of the situation.
A 42-year-old former nurse who brought her 14-month-old boy to the Little Rock clinic said: "I'd think twice if the doctor had HIV and was performing an invasive procedure. I think a lot of people would be nervous, but it's just fear of the unknown."
Bobbi Ellis of North Little Rock, whose 5-year-old daughter Olivia was at the clinic because of a cold, said she wouldn't mind going to an HIV-positive doctor as long as precautions were taken. "As long as he's a good doctor, doing his job and using protection, I don't see why he shouldn't work."
Employers in health-care settings "tend to have phobic reactions," said Catherine Hanssens, director of the Lambda Legal Defense & Education Fund's AIDS project in New York. "But there is nothing out there in state guidelines or Centers for Disease Control guidelines that suggests a health-care worker is automatically unsafe purely because they have HIV."
Health-care workers make up about 5.1 percent of the 427,795 AIDS cases in which the occupation of the patient is known, according to the federal Centers for Disease Control. The risk of transmission of the virus from doctor to patient is infinitesimal, according to the CDC.
The only documented case of such a transmission in the U.S. involved David Acer, a Florida dentist who died of AIDS in 1990. After one of his patients, Kimberly Bergalis, was diagnosed with AIDS, debates raged from operating rooms to Congress over what precautions health-care workers should take.
Since Acer's case, the CDC have investigated more than 23,000 patients of 63 HIV-infected physicians, surgeons and dentists in the U.S. and no other instance of transmission has been found.
Health-care workers have not been subject to mandatory testing, but medical and dental associations have adopted voluntary guidelines. The CDC recommends voluntary testing but does not require that HIV-infected health-care workers be barred from performing invasive procedures on patients.
Nonetheless, "people remain somewhat hysterical in some cases," said Donald Abrams, president of the Gay and Lesbian Medical Association. "Hepatitis is infinitely more transmissible than HIV. One needs to trust the epidemiology and realize there aren't too many situations where health-care workers can infect patients."
Despite efforts to educate the public, ignorance about HIV and AIDS transmission has actually increased in some aspects, according to a national poll conducted by Gregory Herek, a psychologist at the University of California-Davis.
Herek, who first polled people in 1991, found that when he asked the same questions in 1997, more people believed it was possible to contract AIDS from using the same drinking glass as an infected person--55 percent in 1997, compared with 48 percent in 1991. A higher percentage of people also thought AIDS could be contracted from a public toilet.
"Health-care workers are justifiably scared they'll lose their jobs," said Jennifer Middleton, a staff attorney with the American Civil Liberties Union's HIV and AIDS project. "Courts have upheld dismissals based on unsupported fears (about AIDS). The law has not always been favorable to health-care workers."
The ACLU estimates that less than two dozen discrimination suits have been filed under the disabilities law by HIV-infected health-care workers, and many of those cases were decided against the plaintiff. As a result, AIDS advocates and some legal experts believe the problem of HIV-related discrimination against health-care workers is far more widespread than the number of suits would suggest. (Chicago Tribune)
Advocates for Youth asserted at a briefing in Washington that "the limited funds that the federal government provides for teen pregnancy are not always invested in scientifically evaluated strategies or programs that successfully reduce adolescent sexual risk behaviors and teenage pregnancy."
"The [federal] policy is towards programs that don't work," James Wagoner, president of Advocates for Youth, told Reuters Health. "The AMA and others have withdrawn support for abstinence-only [sexual education] programs," he added. Meanwhile, "federal programs that provide information on contraception have been highly successful," Wagoner said.
"Eighty percent of the decline in teen births is due to an increased use of contraception, while 20% is due to an increase in abstinence," Wagoner said of recent research.
Advocates for Youth say in their report released yesterday that "[r]esearch indicates that balanced, realistic sexuality education - which includes information on both abstinence and contraception - can delay teens' onset of sexual activity, increase the use of contraception by sexually active teens, and reduce the number of their sexual partners."
"The pragmatic approach adopted by European countries is far more effective," Wagoner told Reuters Health. As an example, he pointed out that the US has three times the abortion rate of France.
"We issue a call to Congress to adopt research-driven policies to prevent teen pregnancy," Wagoner said. "This means that Congress should turn away from abstinence-only programs. Pursuing [the current] policies is not only naive and misguided, but dangerous in the era of HIV and AIDS." (Reuters)
Under the group's resolution, the number of needles in use must not be increased and drug treatment must be linked to exchange programs. About 900 ethics professors at universities and seminaries comprise the society, which is based at DePaul University in Chicago. (Washington Times)
The new online edition includes a searchable database of clinical studies of experimental HIV/AIDS therapies; descriptions of all drugs for HIV treatment and associated infections, including information on toxicity and side effects, viral resistance, and drug interactions; contact information for Federal state, and pharmaceutical company drug assistance programs; and detailed information about expanded use and compassionate use programs.
Project TEACH in Bucks County begins in Langhorne on Tuesday, February 8. This is a six session seminar. Classes held on Tuesdays & Thursdays from 10am - 1pm for three weeks. Meals and transportation assistance will be provided. To apply, call Rita Bratton of Family Service Association: 215-757-6916
For more information on the course or Project TEACH, call Julie Davids at Philadelphia FIGHT: 215-985-4448 x 165.
HPV is very common in sexually active men and women. It has been linked to the development of cervical cancer and genital warts.
The toll-free hotline can be reached at (877) HPV-5868 and is open to provide information, counseling and referrals by trained counselors from 2:00 to 7:00 p.m. EST Monday through Friday.
"There is no question that HPV is a major problem clinically in this country both because of the amount of money spent on HPV and the level of concern among the population," Dr. J. Thomas Cox, medical director of the American Social Health Association's (ASHA) National HPV & Cervical Cancer Prevention Resource Center, said in an interview.
About 5.5 million new cases of HPV, the most common sexually transmitted disease in America, occur annually, ASHA reports.
According to Cox, an increasing number of articles written about HPV in women's magazines over the past 3 years have helped to raise awareness that HPV is the most common cause of cervical cancer.
This heightened awareness has fueled demand for information about HPV but also created anxiety about the virus. A goal of the hotline, said Cox, is to provide education and information about HPV.
"Education always reduces anxiety," Cox said.
For example, cervical cancer is widely preventable through screening with the Pap test, a screening procedure that allows doctors to diagnose pre-invasive and early invasive cancer.
According to the American Cancer Society, cervical cancer was once one of the most common causes of cancer death for American women. But rates declined 74% between 1955 and 1992, due mostly to Pap test screening.
Counselors who work on the HPV hotline undergo a certification process where they are trained to address both the physical and psychological aspects of the disease. They work in front of a computer in which they can type in key words and call up information.
The North Carolina-based ASHA (www.ashastd.org) and (www.iwannaknow.org) also provides a general STD hotline, a herpes hotline, and an HIV hotline.
About 12,800 new cases of invasive cervical cancer are expected to be diagnosed and about 4,600 women will die from the disease this year, the American Cancer Society estimates. (Reuters)