Researchers optimistic on new HIV drugs
Updated AIDS treatment guidelines released
Evidence supports danger of HIV reinfection
Estrogen offers hope against HIV
Priests have high rate of HIV disease
Women prisoners more likely to be HIV+
Maryland report touts code identifiers for HIV reporting
HIV exposure before birth may affect immune system
PWAs at high risk for physical abuse
Study: danger of oral sex high
Richman announces revised AIDS planning process
State sets TV ads to encourage women to get tested
Drug companies reported on both new classes of drugs -- notably the fusion inhibitors that stop HIV from infecting cells -- and on new versions of older drugs aimed at helping patients whose virus has learned to elude medications.
Fourteen HIV drugs are now in use, but as many as 40 percent of HIV-infected patients in the United States have strains of HIV resistant to them. The virus evolves while inside a patient, and these mutated forms can also be passed on to others.
"Each new drug that comes to market makes the other drugs more useful for everyone," Dr. Robert Schooley of the University of Colorado Health Sciences Center in Denver told a news conference. "New drugs add value to old ones rather than replacing them."
The reason is that adding a new drug to the popular cocktail approach -- known as highly active antiretroviral therapy or HAART -- can boost the effects of the entire mixture, so that patients do not have to discard the whole batch and start over.
And researchers told the conference that it is time to start using tests to see if the virus will resist drugs.
"It is clear that resistance testing has come of age," said Dr. Scott Hammer of Columbia University in New York said.
He said groups are now pressing for government funding so that every patient can find out if he or she has a resistant form of the virus before starting what may be a drug cocktail of only limited use.
Hammer said when a patient becomes resistant to a drug, doctors need to look at the overall cocktail, not just a single drug. Resistance testing usually points to one drug, but that does not mean a one-to-one substitution of that drug is the right thing to do.
"What is means was that drug was put at threat because of the overall regimen potency," he said.
The most interesting drugs were discussed early in the meeting -- the fusion inhibitors, which stop the virus from getting into the cells it infects.
T-20 and T-1249, made by Durham, North Carolina-based Trimeris Inc. (NasdaqNM:TRMS - news) in partnership with F. Hoffmann-La Roche , are the furthest along in development.
Dr. Daniel Kurtizkes, also of the University of Colorado, pointed out that some patients showed resistance to T-20 when it was used for just 4 weeks.
Yet another new class works against the receptors, or chemical doorways, that HIV uses to get into cells. The virus uses two receptors designed for chemokines, the message-carrying hormones of the immune system.
The Schering-Plough Research Institute reported on SCH-C, a drug that could be available as a pill. It blocks the CCR5 chemokine receptor.
AnorMED, a Canadian company, said its compound, AMD3100, interfered with another receptor used by many variants of HIV to get into cells, known as CXCR4.
Merck & Co. had to pull its report on a new protease inhibitor combination, MK-944A. It found the drug affected the kidneys of rats and has, at least temporarily, stopped giving it to people.
Merck had planned to present the first safety data that showed the drug, a combination of L-756423 and indinavir, could be given twice a day and not make patients too ill.
The drug reduced virus to low levels in the blood of 70 percent of patients when given once a day and 93 percent when given twice a day. Adding a little bit of indinavir, which Merck sells under the name Crixivan, makes L-756423 more effective.
Abbott is taking a similar approach with its ABT-378/ritonavir mix. The researchers said even when the patients' virus started to resist ABT-378, the drug cocktail controlled viral load.
But Schooley was skeptical. "I have no doubt but that given enough time and exposure, (the virus) will develop a high level of resistance against this drug like any other," he said.
Another new protease inhibitor, Bristol Myers Squibb's BMS-232632, worked in a once-a-day dose, researchers told the meeting.
A new non-nucleoside reverse transcriptase inhibitor under development by Agouron/Warner-Lambert shows just as much potency on its own as triple therapy, researchers said. However, the first reported data on a dual NNRTI combination proved disappointing, and provided further proof that Triangle Pharmaceuticals NNRTI emivirine is going to be difficult to sell to doctors and people with HIV.
AG-1549, or capravirine, was tested in treatment-naive individuals at five separate doses, and compared with AZT/3TC/nelfinavir. The highest dose, 2100mg twice daily, reduced viral load by 1.69 log after ten days, whilst the triple combination reduced viral load by 1.65 log after ten days. The drug was well tolerated, with no evidence of rash, but some clinicians feel that capravirine will need to be tested for longer to determine whether rash is a problem because this side effect may take longer to emerge (as it can do in other NNRTIs). Mild nausea, vomiting and headache were the most frequently reported side effects.
Emivirine, on the other hand, exhibited less stellar characteristics in a number of studies presented at the conference. As salvage therapy for people who had failed on PI, emivirine was tested in combination with efavirenz and two nucleoside analogues. Eight patients took emivirine and efavirenz for eight days before adding NRTIs, but researchers found that emivirine seems to have a negative effect on efavirenz levels that is not improved when the efavirenz dose is increased from 600mg to 800mg per day. Three of eight individuals also discontinued therapy due to serious rash, and only three of eight patients had a sustaind virological response at week 16.
A separate analysis of three large studies of emivirine in combination with two NRTIs found that the drug performed poorly in individuals with viral load above 50,000 copies. In study MKC 302, only 30% of patients with baseline viral load above 100,000 copies had viral load below 400 copies at week 24, and only 10% had viral load below 50 copies. Even in the MKC 301 study for individuals with viral load below 50,000 copies, only 37% had viral load below 50 copies at week 24.
The one bright prospect for emivirine is the evidence that it is probably possible to use other NNRTIs subsequently in about 50% of people who suffer viral rebound on the drug. Only 45% of people who developed NNRTI mutations displayed a pattern that would indicate cross-resisistance to efavirenz, but the picture for nevirapine resistance was less clear. (Reuters/aidsmap.com)
"The number of treatment options for HIV-infected individuals has increased dramatically, making decisions regarding therapy more and more complex," panel co-chair Dr. Anthony S. Fauci, of the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland, commented in a statement.
"The new guidelines, based on the latest available research findings, provide recommendations on how to optimally use the many antiretroviral medications and sophisticated laboratory tests now available to people living with HIV," he added.
The Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents were initially published in 1998 and are updated frequently. Recognizing that individuals with HIV will probably not be cured with currently available treatments, the updated guidelines contain a new section called "The Goals of Therapy." The guidelines also contain a new hypertext link to information on the use of antiretroviral drugs in pregnant women.
The guidelines include recommendations on the use of new tests to look at resistance to antiretroviral drugs, which "...can help to explain the reasons for treatment failure and guide the rational selection of a new drug regimen," according to a statement from panel co-chair Dr. John G. Bartlett of Johns Hopkins University Medical Center, Baltimore, Maryland.
The recommendations on the use of drugs in the early stages of HIV infection have been reorganized. Drugs are now categorized as "preferred" on the basis of pill burden, dosing frequency, toxicity and other considerations, not simply their ability to suppress viral load.
The guidelines can be obtained from The HIV/AIDS Treatment Information Service (ATIS) at www.hivatis.org, by calling 1-800-448-0440 or 1-301-519-0459, or by sending an e-mail request to atis@hivatis.org. (Reuters)
Dr Jonathan Angel of Ottawa Hospital described the case of a man who a experienced a sudden and dramatic fall in his CD4 count after eight years of relative non-progression and very low viral load. In the space of six months during 1998 his CD4 count fell by more than 400 cells/mm3 and his viral load surged from around 20,000 copies/mL to above 100,000 copies/mL. The patient failed to respond to protease inhibitor therapy and doctors began to investigate why.
The patient, a 40 year old gay man, suggested that he could have become re-infected during a relationship with a highly treatment-experienced man during the latter half of 1997. When virus samples from the two men were compared, along with a stored sample from 1989, it was discovered that regions of the reverse transcriptase and protease genes that don"t normally mutate bore a strong resemblance to each other. 12 samples from other patients at the clinic which served as controls did not show the same resemblance. The man had also developed mutations associated with 3TC resistance and protease inhibitor resistance, and insisted that he had taken no antiretroviral therapy apart from participating in a short trial of Ribavirin in 1989.
Dr Angel told the meeting that these findings provide the strongest evidence yet for HIV-1 re-infection, with significant public health implications. Although re-infection after seroconversion has been demonstrated in chimpanzees, many people with HIV and clinicians have remained sceptical about the possibility of re-infection and its effects.
The Ottawa case joins a still unpublished Swedish case first presented in October 1998, describing a woman who acquired a protease-resistant virus from a sexual partner. (aidsmap.com)
The experiment found that estrogen injected into a small group of female monkeys caused a thicker layer of vaginal cells, offering protection against HIV. Marx noted that more research is needed to prove that topical estrogen cream would help humans against HIV, but scientists are viewing the findings with optimism.
Dr. Fred Valentine, an AIDS expert at New York University, believes that "estrogen use might become a very important method by which women could reduce their chances of becoming infected with HIV through sexual intercourse." In Marx's study, all six monkeys that received no hormone replacement became infected after SIV was squirted into their vaginas, while five of the six monkeys that received progesterone and none of the monkeys in the estrogen group contracted SIV. (CDC Daily News)
The Kansas City (Missouri) Star reported that at least 300 Roman Catholic priests across the United States have died of AIDS-related illnesses, and hundreds more are living with HIV.
The estimates of AIDS and HIV-related casualties were culled from interviews with clergy, medical experts, and by analyzing health statistics.
In Missouri and Kansas alone, at least 16 priests and two religious-order brothers have died of AIDS since early 1987, the daily reported. The Star noted that because of the sensitivity of the matter, many infected priests kept their HIV status hidden and some death certificates included false information
The problem has become serious enough that church officials in many dioceses and religious orders now require applicants for the priesthood to take an HIV-antibody test, according to the Star.
In a survey conducted by the newspaper, many priests praised the church's compassion in dealing with priests ill with AIDS, covering their medical costs and giving them care and lodging until they die.
But other priests faulted the church for not providing sufficient sexual education that might have prevented infection in the first place.
"Sexuality still needs to be talked about and dealt with," said Reverend Dennis Rausch, a priest with AIDS who runs an AIDS ministry program for Catholic Charities in the Archdiocese of Miami, Florida.
Catholic Church officials said the report is not a surprise, since the disease is found throughout society. Kansas City Archbishop James Keleher called AIDS the "black plague of our times."
Spokeswoman Rebecca Summers of the Catholic Diocese in Kansas City noted that the church is aware not all priests are celibate - despite their vows - as they reflect society today. (Agence France-Press)
The report said that the nation's female inmate population in state and federal prisons in the 1990s doubled, growing far faster than the male population.
The study, commissioned by Del. Eleanor Holmes Norton (D-D.C.), also found that the majority of women in prison are incarcerated for nonviolent crimes, are mothers and are incarcerated at great distances from their children, and that women in prison are more likely to suffer from HIV infection and mental illness than men are.
The study - the second commissioned by Norton on women-in-prison issues - prompted her to prepare three bills to help improve conditions for incarcerated women. "In placing women in carbon copies of male institutions, the U.S. and the states are not meeting some important gender-specific health and other services," Norton said. "As a result, prison systems have failed to respond effectively to rates of HIV infection and mental illness among female inmates that are greater than among males and have actually reduced drug treatment--even though nonviolent drug crimes are the major cause for female incarceration."
A separate study on the transfer of female inmates from D.C. prisons to Bureau of Prisons facilities found that two-thirds of the 218 female inmates relocated were sent to a federal prison in Danbury, Conn.--a facility 300 miles from the District. That's too far and one more reason to seek a community-based program in the District, Norton said. "It's so far that there is very little contact between the children and their mothers," Norton said. "That creates a situation in which it will be very difficult to integrate these mothers back into the care and supervision of their children once they're home."
The GAO looked specifically at the federal Bureau of Prisons, the California Department of Corrections and the Texas Department of Criminal Justice - the nation's three largest prison systems.
Norton said she will introduce a bill that requires, as a condition for receiving federal funding for construction of prisons for female inmates, states to submit a plan on how they intend to provide gender-specific health and other services. She said she also will submit a bill requiring the Bureau of Prisons to use existing prison construction funds to establish two pilot community-based facilities in the District for nonviolent, short-term or pregnant offenders. A third bill would allow sentencing alternatives in the federal system, such as allowing first-time nonviolent offenders to serve their sentences at a community-based facility.
Norton, speaking at a news conference in Washington, said that she was also troubled by the study's finding that female inmates have a higher rate of HIV infection and mental illness than men. Black females are also more than twice as likely as Hispanic females and eight times as likely as white females to be incarcerated. In part, that's because of the unequal racial impact of the mandatory minimum and repeat offender provisions, Norton said. In June, Norton released the results of her first GAO-commissioned study on women in prison. The study found that prison systems in the United States, including the District's, continue to see sexual misconduct by correctional staff members against female prisoners. (Washington Post)
They say this shows that HIV surveillance can be accomplished "without the creation of state-wide name-based registries."
Whether to use a name- or non-name-based HIV registry has been under debate, Dr. Liza Solomon and colleagues write in the November 1999 issue of the Journal of Acquired Immune Deficiency Syndromes. Those advocating a name-based system point out that databases can be easily linked, and worry about the inaccuracy of a non-name-based system, according to the authors. Those advocating a non-name-based system argue that names of HIV-infected individuals could be inadvertently disclosed and result in discrimination, which could discourage them from seeking testing and early treatment.
After the Maryland legislature repeatedly defeated attempts to establish a name-based HIV registry, a non-name-based system was established in 1994. It uses a unique identifier (UI), a 12-digit code consisting of the last 4 digits of the US Social Security Number, the 6 digit date of birth, a 1 digit code for gender, and a 1 digit code for race or ethnicity.
To evaluate the uniqueness of the code, Dr. Solomon's group analysed complete identifier numbers in the registry as of April 1998 and found that the full 12-digit UI provided a "virtually unduplicated count" that was 99.8% unique. The researchers also looked at the completeness of the UI, which is created by healthcare workers when ordering an HIV or CD4 test, and found that date of birth was completed 98.3% of the time and gender was present 98.8% of the time. Race and social security numbers were completed less often, with race completed 84.1% of the time, and social security numbers present in 72.4% of cases. Using two different methods, the researchers found that reporting of HIV results to the registry was complete in 87.8% and 84.8% of cases.
"The desire for the creation of HIV surveillance systems offers an opportunity to develop creative systems to allow data collection without using name-based registries," the authors note.
"Responses such as the criticism surrounding national medical registries and legislation prohibiting research without patient consent will continue unless the medical and public health community engage in discussions with communities about how and under what circumstances data may be collected and names may be stored," they warn. (Reuters)
Like HIV-infected children, these children show signs of abnormalities in the maturation of T cell lymphocytes, white blood cells that play an important role in resisting infection, principal investigator Dr. A. Vigano of the University of Milan, Italy, told conference participants. Vigano's team studied the immune cells from 61 children who were born to HIV-infected women, but who did not become infected.
The findings from these children were compared with those of 26 HIV-negative unexposed subjects matched for age and with those of 25 older HIV-infected children. The investigators note that 19 of the children born to HIV-positive mothers had been exposed to the drug zidovudine, used during pregnancy to reduce the risk of the baby becoming infected. The researchers found that the immune cell profiles of the children exposed to HIV before birth were "significantly different" from those of the unexposed children. Specifically, they observed changes in the numbers of certain cells that suggest immune activation in these children.
Vigano and colleagues concluded that even in the absence of HIV infection, HIV exposure may affect the immune system of infants born to HIV-infected mothers. She also speculated that these data may provide evidence that HIV infection was fought off by the immune systems of these children before birth. However, the researcher noted that this has yet to be established, and that the long-term clinical implications of these lymphocyte abnormalities are still unknown.
In fact, nearly half of HIV-positive adults reporting physical abuse said that revealing their HIV status was a "trigger for violent episodes," according to Dr. Sally Zierler of Brown University in Providence, Rhode Island, and colleagues. They published their findings in the February issue of the American Journal of Public Health.
The study authors examined data from face-to-face and telephone interviews with nearly 2,900 HIV-infected adults from across the US. "Physical harm was done overall to nearly 13% of people since their diagnosis of HIV infection," Zierler told Reuters Health. Rates for abuse in HIV-infected women were double those of infected men, and triple the national average for women -- overall, about 1 in 5 HIV-infected women reported physical abuse.
Among men, gay infected males were at higher risk than heterosexual males, with 11.5% and 7.5%, respectively, reporting episodes of physical abuse subsequent to their diagnosis. Zierler noted that most of those subjects reporting abuse said it was perpetrated by "someone important to them." When asked whether they thought they had suffered assault because they were HIV+, "nearly half of the participants who were harmed reported 'yes,'" Zierler said.
Some episodes of abuse may have been related to a disclosure of HIV status (i.e., informing a partner that one is infected), while other episodes may have been prompted by what the authors describe as "ongoing stressors related not only to HIV infection but to poverty, social isolation, and antigay hostility."
Should these findings cause HIV-infected persons to keep their status a secret? "Not at all," said Zierler, since "we cannot say from this study if the fact of having HIV infection caused more interpersonal violence to occur than would have otherwise happened." The authors were not able to find a direct cause-and-effect relationship between abuse and infection with HIV. In fact, the study findings suggest that shared factors -- homelessness, illicit drug use, poverty -- may raise the likelihood for both physical abuse and contracting HIV. Zierler does believe that those caring for persons with HIV must remain alert to the potential for physical abuse in their patients.
"Health workers should be screening routinely their HIV patients by asking them if they have experienced physical harm or threats of harm in their relationships," she explained. "What we are saying is that violence victimization should be addressed within the context of HIV care." (Reuters)
A study released Feb. 1st found that oral sex was probably the cause of 8 percent of recent HIV infections among a group of homosexual men examined in San Francisco.
In the past, there have been occasional reports of people apparently catching HIV orally. But health investigators have had difficulty being certain, since gay men who have oral sex also may engage in other, riskier sex practices, such as anal intercourse.
Now diagnostic tests allow doctors to narrow down the timing of HIV infections. They were used in the latest study, described as the most definitive on the subject to date.
The work was conducted by the Centers for Disease Control and Prevention and the University of California at San Francisco.
"While oral sex may still be safer than anal intercourse or vaginal intercourse, it is not without risk and perhaps has higher risk than we would have expected otherwise," said Dr. Helene Gayle, the CDC's AIDS chief.
The researchers sought to learn the means of infection in 102 gay and bisexual men who had recently caught HIV. When all other possible means of infection were ruled out, oral sex turned out to be the only risk behavior in eight of these men. Most of them said they thought oral sex had little or no risk.
Because of the strict criteria used, the real number of cases resulting from oral sex may actually have been higher. For instance, two men said they had oral sex but not anal sex. But they also said they had blacked out once and could not be sure what had happened, so they were excluded from the total.
All of the men apparently caught the virus by giving oral sex, rather than receiving it, and none used condoms.
"We know that the only safe sex is total abstinence or sex with a mutually monogamous, non-HIV-infected partner," Gayle said.
"Everything else has some degree of risk. The sense that oral sex is safe sex may have been an unfortunate message."
Gayle said she assumes that the risk of oral sex when properly using a condom is close to zero.
She also said that if oral sex alone has played a large role in the spread of AIDS, that would already have become obvious during the 20 years of the epidemic.
Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, noted that some gay men turned to frequent unprotected oral sex after giving up anal intercourse.
"A lot of us in the public health field have been saying all along to be careful of unprotected fellatio," he said. "People think the risk is low, but what's low?"
Dr. Frederick M. Hecht of San Francisco General Hospital, a co-author of the study, said anal intercourse may be 100 times riskier than oral sex. "The message is not that everyone will get infected through oral sex," he said.
Because of declines in unprotected anal intercourse, there has been a big reduction in high-risk exposure, Hecht said, but there is still plenty of low-risk exposure through oral sex without condoms, "and that low risk adds up."
The new estimate, calculated by a team that includes Northwestern University researchers, already is spurring a fresh historical inquiry into the mystery of how a form of HIV jumped the species barrier from chimpanzees to kill more than 16 million people worldwide.
In an attempt to explain the early routes of human contact with virus-infected chimps, some researchers are looking at events long seen as unconnected to the spread of HIV, such as African railway construction in the first decades of the 20th Century.
The findings were aired publicly Friday in the journal Science, within an HIV research review article by Dr. Beatrice Hahn of the University of Alabama at Birmingham. Hahn's paper included a description of a still-unpublished study on the date estimate, performed by researchers at Northwestern, Alabama and the Los Alamos National Laboratory in New Mexico.
Pushing back the time when HIV first appeared in people would be especially significant because the earliest known HIV infection was discovered in a stored blood plasma sample dating to 1959.
Many experts concluded that the virus had gained a foothold just a few years before then.
Although researchers caution that the new 1930 estimate has a 20-year margin of error, it is based on increasingly sophisticated computer models of how HIV evolves.
In addition to helping vaccinemakers forecast the evolution of the virus, understanding the enigma of HIV's origins would let experts assess whether more epidemics might spring from African primates. Findings in the last year suggest as many as 27 different primate species in Africa are naturally infected with simian viruses related to HIV, carrying the risk of more transmissions to people.
It may well be impossible to pinpoint the precise place or time when the AIDS virus first infected people, said Dr. Steven Wolinsky, a researcher at Northwestern University Medical School who specializes in the evolution of HIV. But, he said, narrowing the window of cross-species infection could bring insights into how the virus quietly evolved before it became an explosive epidemic in the 1980s.
"Chances are that this was in the population for a long time, and then something made it really take hold," said Wolinsky, who co-wrote a 1998 paper that used a less sophisticated method to calculate that HIV emerged sometime in the first half of the 20th century.
The estimate of 1930 offers a new focus for African scholars studying the roots of HIV, said Jim Moore, an anthropologist at the University of California at San Diego.
"This directs us to what I think is the right time," Moore said.
Theories about the source of AIDS have abounded in the nearly 20 years since the disease was first recognized through its effects on American homosexual men. Reports in the mid-1980s that HIV had entered humans through African green monkeys soon proved false when genetic tests showed that the species' simian virus was not closely related to HIV.
More recently, the contention that HIV was accidentally passed to people in Africa during tests of an oral polio vaccine in the late 1950s gained weight with the publication last year of the book "The River" by British science writer Edward Hooper. The book documented that many early centers of the AIDS epidemic in central Africa had been polio vaccination sites years before, and that the vaccines might have been contaminated with viruses from primate tissue.
Debate over the issue shifted again at an HIV conference in Chicago last year. A team led by Hahn announced findings that the virus' most common form, Group M of the strain HIV-1, bore the closest genetic resemblance to a virus found naturally in the chimp subspecies Pan troglodytes troglodytes.
The report concluded the virus probably was transmitted to humans somewhere within that chimp subspecies' natural rain-forest habitat: a region that includes the west African nations of Gabon, Cameroon, and the Republic of Congo.
Yet until the recent date estimates, researchers have been at a loss to give a historical account of what might have brought people into increased contact with chimps in that part of Africa.
Efforts to time the epidemic's origin have relied on a huge computer database of HIV-1 samples maintained at the Los Alamos National Laboratory in New Mexico. Researchers use genetic sequences from the samples to calculate an evolutionary tree, which shows roughly when the ancestral virus of Group M would have existed.
Chimp-human infections may have posed a growing hazard in the first few decades of the 20th Century, some historians say.
The French colonial government that ruled west equatorial Africa then enacted a brutal policy of using forced labor for large construction projects, said Bruce Fetter, a social historian of colonial Africa at the University of Wisconsin at Milwaukee. By far the most infamous example was the Congo-Ocean railway, built between 1921 and 1934 in an area then called the French Congo.
More than 20,000 workers are thought to have died during the railway's construction, most from malnutrition. The nightmarish project became bogged down for years as it cut through sparsely inhabited rain forest near the west equatorial coast--prime habitat for Pan troglodytes troglodytes.
Lack of food may have driven the workers to desperate measures, Fetter said.
"If they were underfed, they might have gone off and trapped animals in the forest because they were hungry," Fetter said. "It was something they might not otherwise do."
Even more intriguing is the railroad's location near the earliest known case of HIV. The Congo-Ocean's eastern terminus in Brazzaville sits just across the river Congo from the city of Kinshasa, where the 1959 HIV-positive plasma sample was taken.
The early 20th Century also saw an increase in the capture of chimps from that part of Africa for use in zoos and circuses overseas, according to some researchers.
"Zoos really took off in (the U.S.) around the turn of the century," said Moore, the anthropologist. "It probably would have been the first time people were trying to capture chimps alive.
And you're a lot more likely to get bitten by a live one."
Unsanitary vaccination campaigns by the French in central Africa in the early 1900s might have allowed HIV to take root. Moore points to evidence that one clinic used just six needles to immunize more than 89,000 people against sleeping sickness in 1916.
Other researchers see potential problems with the 1930 estimate for HIV's origins.
Preston Marx, a virologist at the Tulane University primate center in New Orleans, said he dates the virus' spread closer to 1950, when African nations began a sharp increase in vaccination programs using shared needles.
Different objections come from Edward Hooper, who has clashed with Hahn and other scientists over his theory that HIV spread through contaminated oral polio vaccines. In an interview, Hooper said it's unlikely HIV would have left no traces between an emergence around 1930 and the first known case in 1959.
For that to happen, Hooper said, the virus would have had to be "hidden in a village somewhere, cooking slowly and silently."
Hahn argued that the 1930 estimate "tends to weaken" Hooper's own theory, since the polio vaccinations in central Africa started only in 1957.
One point on which all of the researchers agree is the urgent need for more testing of African primates for viruses related to HIV. Such tests, Hahn said, could help settle the scientific debate while warning of possible new threats to humans.
"If anything, human contact with these species and potentially infected blood has increased rather than decreased in recent years," Hahn said. (Chicago Tribune)
The region recently received a $2 million increase in funding it receives under Title I of the Ryan White CARE Act, bringing the amount available for the nine-county metropolitan area to over $18 million. The AIDS planning process also sets priorities for about $6 million in AIDS prevention funds awarded to Philadelphia county for AIDS prevention activities.
Approximately $6 million additional dollars are allocated through the local Philadelphia city budget for a variety of AIDS services, as well as the operations of the city's AIDS Activities Coordinating Office.
Last November, Richman announced that because of continued controversies and complaints about the cumbersome and political nature of the Philadelphia HIV Commission, she was suspending the formal operations of the Commission, a large body that adopted, usually without change, the recommendations of subcommittees which set priorities for direct care and AIDS prevention services. At that time, she charged a small group, comprised mostly of people living with HIV disease, to look at other models for AIDS planning that might alleviate some of the problems which had disrupted the Commission's efforts. While this group developed its recommendations, the two subcommittees continued their work on priorities for AIDS funding for next year.
Ironically, the Commission had been formed by Richman in 1995 to alleviate similar problems that had led to enormous controversy at the Philadelphia AIDS Consortium (TPAC), which at the time set priorities for the Title I funds. TPAC today continues to set priorities for state and Title II funding, but has no role in the much larger funding pool represented by Title I and CDC awards.
Richman announced that the Commission would not be reconvened, and that instead the existing planning committees, called the Care Committee and the Community HIV Prevention Community Planning Group, would make the final recommendations on how federal AIDS funds should be allocated. Numerous advocates have said that the extra step of seeking the endorsement of the often politically-stalemated HIV Commission, as well as disputes over hiring and supervision of Commission staff, were largely responsible for the controversies which surrounded the Commission over the past several years.
Under the restructured planning process, each of the planning committees will report to a planning director working for Richman in her new position.
An HIV Coordination Committee, formed from the co-chairs of the planning committees as well as the Deputy Managing Director for Policy and Planning, the director of the AIDS Activities Coordinating Office, and the Health Commissioner, will oversee efforts to assure consistency in the planning process and to share information among the groups. Three other committees, responsible for overseeing financial operations of the planning process, nominating members of the committees, and developing policies and procedures, would also have representation on the Coordination Committee under the new design.
The new planning process will also have a Consumer Committee, described as responsible for "consumer-related needs assessments....trainings of consumers and community members, and coordinating with affected communities." Members would include people living with HIV disease and representatives of communities targeted for AIDS prevention activities.
Still other committees are also envisioned in the new plan. These include three regional subcommittees for Philadelphia, Pennsylvania suburbs, and the New Jersey counties in the metropolitan area, which would make region-specific recommendations to the Care Committee for the use of Title I funds in their communities.
Richman said that the planning process would be staffed by an overall Director of HIV Coordination, who would report to her office, a training coordinator, and planners. The details on the staff structure have not yet been developed.
Richman said that the Housing Committee, which for the past six years has worked to assure coordination between Title I funding and funding awarded to the region under the Housing Opportunities for People with AIDS program and other federal housing programs, will continue, but the specific functions of the committee and its relationship to the AIDS planning process was still to be worked out with the Office of Housing and Community Development, which originally established the group.
Richman also said the new system will be phased in gradually over the next several months.
"There isn't a date when all of this is going to magically happen," she said.
Richman said that a renewed search for qualified individuals to participate in the various committees will probably be undertaken once the new process begins to take shape. "We're trying to make it as inclusive as possible, so [that] as many people as possible have a voice," she told the Philadelphia Gay News. But participants must undergo adequate training to ensure their competency and their commitment to serve, she told PGN.
PGN also reported that AIDS activists who attended the meeting praised the new system.
"The new system is giving the community more power, and control, than ever before," said activist Andre Ford. "It [new system] is more streamlined, less hierarchical. The community will be on an equal footing with AACO."
Stacy Bryant, another AIDS activist, also praised the new system, saying that "Everything [in this new system] is the way it should have been from the beginning," according to PGN.
Michael Hinson, a co-chair of the disbanded commission who called for similar changes during his tenure in that role, told PGN that he also was optimistic about the new system.
"I think it sounds good," he said. "From what I understand, there will be an attempt to coordinate HIV services with other city services utilized by people with HIV/AIDS." It is important for the new system to connect blacks, Latinos and poor people with needed medical services, Hinson said. "It [new system] is at least attempting to go in that direction, which is a very positive step," Hinson said.
But Hinson also said much of the success of the new system depends on the quality of people who serve on it. (Health Department, Philadelphia Gay News)