Clinton asks 5% jump in AIDS funding
Glaxo warns of Ziagen complications
Dangerous interaction between St. John's Wort, Crixivan found
LIHEAP program deadline extended
New bill would cover extended home care
Adherence poor among pregnant Medicaid recipients
News article spurs local needle exchange controversy
Law Project gets new prison grant
CCASS seeks case management assistant
WTP membership meeting set for Feb. 24th
Fulfilling pledges made late last year, Clinton proposed that $100 million of the budget be spent on AIDS prevention, care, public health infrastructure and education in the African and Asian countries hit hardest by the disease. In addition, Clinton's budget seeks $50 million for the Global Alliance for Vaccines and Immunizations, an unspecified increase for vaccine research and a new tax credit to encourage vaccine development. Clinton is also asking Congress to add an additional $40 million for HIV prevention and community interventions, as well as a $35 million proposal for family planning clinics nationwide that also includes HIV prevention efforts.
Under Clinton's plan, which is likely to face strong opposition from Republicans in this presidential election year, the National Institutes of Health would receive a $105 million increase for HIV/AIDS research, the state AIDS drug assistance programs (including Pennsylvania's Special Pharmaceutical Benefits Program) would receive an added $26 million, and the Housing Opportunities for People with AIDS (HOPWA) program would receive a $260 million increase.
The budget proposal immediately drew the ire of Republican members of Congress, although none specifically targeted AIDS programs. House Budget Committee Chair John Kasich said, "What you have in this budget is an opportunity for politicians to just go out and tell every single group who has any kind of an interest at all, 'Oh, we're taking care of you.' That's not leadership. It's all things for all people."
But Winnie Stachelberg, political director for the Human Rights Campaign, praised the budget, saying, "We are pleased with the overall funding which will help initiate new research and improve the quality of life for people living with HIV and AIDS." She added, "We are looking forward to working with the administration and Congress on adequate funding levels for the Ryan White CARE Act, as well as ensuring reauthorization without negative amendments."
Another looming obstacle facing the Administration's AIDS program this year is an effort to change the way federal AIDS funding is distributed from Washington. Under the present version of the Ryan White CARE Act, funding is distributed to cities and regions with a high incidence of AIDS cases directly, as well as to states. Under a new GOP proposal, supported by many state governments, all federal AIDS funding would be distributed in "block grants" to states, which would then get to decide how much was made available to communities within that state. Most Philadelphia advocates believe that a block grant method would lead to a reduction in funding for the Philadelphia area and political interference from state officials in how the funding is allocated.
Meanwhile, the leading AIDS lobbying group, AIDS Action, criticized Clinton's plan for failing to dramatically increase funding for AIDS prevention activities. The group said that the increase of less than $40 million in federal prevention funding is "half of what is necessary for slowing the spread of HIV infection." AIDS Action also criticized the plan because it "ignored the devastation in communities of color by flat funding the Minority AIDS Initiative." Clinton's proposal would increase funds for the CDC's Prevention Program from $695.3 million in FY 2000 to $734.3 million in FY 2001.
Acting AIDS Action Executive Director Claudia French said, "While the nearly $40 million increase is a slight improvement, it won't support the kind of investments needed to slow the 40,000 new infections each year. ... While our investment in care and research has resulted in lower death rates, our divestment from HIV prevention has allowed HIV to continue spreading unchecked. ... Now we look to Congress to turn President Clinton's ounce into a pound of prevention."
Rep. Nancy Pelosi (D-Calif.) called the Clinton proposal "a reasonable start," but urged other Democrats to "fight for funding above the president's request, especially in ADAP, which pays for life-saving drugs for people with HIV who cannot afford to pay for the drugs on their own." (Reuters/NY Times/AIDS Action/Kaiser Daily HIV/AIDS Report)
Approximately 3% of people who have started abacavir develop a potentially life-threatening hypersensitivity reaction in clinical trials of the drug. Doctors and patients have been warned to look out for at least two out of the following groups of symptoms: fever; shortness of breath, sore throat or cough; skin rash (redness or itching); nausea or vomiting or diarrhea or abdominal pain; or severe tiredness or achiness or general "ill" feeling.
Other rare reported symptoms include joint pain, conjunctivitis, mouth ulcers and low blood pressure.
Glaxo-Wellcome now says that approximately one-fifth of people who develop the hypersensitivity reaction have symptoms such as cough, severe sore throat and shortness of breath. 80% of patients who died as a result of the hypersensitivity reaction experienced these symptoms.
If the hypersensitivity reaction develops, abacavir treatment should be stopped immediately and should not be re-started.(aidsmap.com)
The findings are detailed in the Feb. 12 issue of The Lancet. "When St. John's wort and the protease inhibitor indinavir are taken together, the levels of indinavir in the blood drop dramatically," explained the study's principal investigator, clinical pharmacokineticist Dr. Stephen Piscitelli of the NIH Clinical Center's Pharmacy Department. "When the body eliminates the antiviral drug too quickly, there can be a loss of therapeutic benefit."
AIDS research clinician Dr. Judith Falloon of the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), collaborated on the study. "St. John's wort's effects on indinavir concentrations are large enough to be clinically significant," she said. "Patients and health-care professionals need to be aware of this interaction. Most people taking medications to treat HIV infection should avoid using St. John's wort."
The NIH Clinical Center study, conducted among eight healthy volunteers, first measured the amount in the body of the drug indinavir when taken alone. Next, study participants were given only St. John's wort for two weeks. Finally, indinavir and St. John's wort were given together.
"The results were dramatically conclusive," Piscitelli noted. "All the participants showed a marked drop in blood levels of indinavir after taking St. John's wort. The drop ranged from 49 percent to 99 percent."
"It's vital that we understand how drugs and herbal products interact," said Dr. John I. Gallin, Clinical Center director. "This research is important because it demonstrates that a common agent such as St. John's wort may have unsuspected adverse effects on the function of a drug essential to the health of a very vulnerable population."
Substances in both St. John's wort and in indinavir are thought to share a metabolic pathway, which suggested the probability of the drugs' interaction, Piscitelli said. The active ingredient in St. John's wort is suspected to induce drug metabolism, which revs up the rate the liver eliminates indinavir from the body.
Consequently, there's not enough indinavir in the blood to do the job it's designed to do. "The low blood levels also can lead to drug resistance," said Piscitelli, who heads the Clinical Pharmacokinetics Research Laboratory at the NIH hospital. "Resistance to indinavir can decrease the response to other protease inhibitors." They include nelfinavir, amprenavir, ritonavir and saquinavir.
"Many people think that herbal products like St. John's wort are safe, but there can be dangerous interactions when taken with other medications prescribed to treat medical conditions," added Piscitelli. "This study demonstrates how dangerous that interaction can be and how important it is for patients to keep their physician and pharmacist informed about any use of herbal products."
Applications for the emergency assistance are available from County Assistance Offices throughout the city. To be considered, the applications much be either brought into the CAO by February 29th or be postmarked by midnight on 2/29/00.
For more information, contact Harry Geller at the Pennsylvania Utility Law Project, or through e-mail to hgeller@mindspring.com.
House Bill 3000 would use state and federal money - now limited almost entirely to nursing-home care - to pay for home-care services, adult day care, and assisted living.
The Assisted Living Reform Act, if passed, would dramatically expand eligibility for publicly funded long-term care in Pennsylvania, and where people can receive it. Generally, elderly and disabled Pennsylvanians now must be sick enough to need a nursing home before they can get publicly funded help. And by and large that help must be given in a nursing home.
In the new bill, one need not be indigent to qualify. Pennsylvanians with incomes up to $1,500 a month would be eligible for publicly funded services.
Advocates say the proposed law would allow people to receive care where they want it most - in their own homes - and also save taxpayers up to $1.3 billion a year.
"It's a win-win for everybody," said Ann S. Torregrossa, director of the Pennsylvania Health Law Project, a nonprofit advocacy group. "It allows people to stay in their own homes as long as they can and it contains long-term care costs. It's what Pennsylvanians want."
Across the country states have been trying to change how they provide and pay for long-term care, moving away from a system that favors costly nursing homes to one that allows people more choice and flexibility, and serves more people at less cost to taxpayers.
Oregon, Washington and Wisconsin are among the leaders in this reform effort, while Pennsylvania - with the second-highest percentage of elderly in the nation, after Florida - has been considered near the rear. This legislation, if passed, would put Pennsylvania in the forefront.
According to Torregrossa, caring for a person in a nursing home costs Pennsylvania taxpayers $36,267 per year. Providing home- and community-based services for a person with nursing home-level needs costs an average of $12,780 per year, she said.
Another key element of the legislation would establish standards and consumer protections for all people in assisted-living facilities or who receive assisted-living services at home. It would empower the state Health Department to set and enforce those standards.
The authors of the bill are Dennis O'Brien (R., Phila.), chair of the House Health and Human Services Committee, and Mike Veon (D., Beaver), the minority whip.
"This bill provides two important things: access and choice," O'Brien said. "You're denying reality if you don't provide options. Our population is growing increasingly older. . . . To say you have to stay at home until you're sick enough for a nursing home is ridiculous in this day and age."
Said Veon, "We wanted to tell Pennsylvanians: Whether you're in a nursing home, assisted-living center, or personal-care home, there are rules and regulations to protect you."
The bill stems from last summer's recommendations of a work group of government agencies, consumers, advocates and providers of long-term care. The group spent three years trying to figure out how long-term care should be provided in Pennsylvania. Torregrossa served as chair and advised O'Brien and Veon in drafting the bill.
"The bill is really important, especially for Alzheimer's families, because it will offer the opportunity for choice for services," said Helen-Ann Comstock, executive director of the Alzheimer's Association of Southeastern Pennsylvania and one of the members of the work group.
"Since most families' first choice is to be able to have services in the home, this bill will help. But secondly, if there is going to be institutionalization, most families' preference is for something like assisted living, rather than a nursing home," Comstock said.
"Assisted-living facilities are springing up all over, and unfortunately now, they are all private pay. They are just what families would like, but out of the price range for most people."
Comstock also strongly favored setting and enforcing strict standards. "There is a need to protect the possibility of less expensive assisted-living facilities springing up that don't have trained staff, that don't provide the care that families need," she said.
Not all members of the work group agreed with all its recommendations last summer. And not all agree with some key provisions of House Bill 3000.
The Pennsylvania Association of Non-Profit Homes for the Aging does not support the bill, according to Ron Barth, its executive director. He supports much of what it tries to do but is concerned that the standards for assisted living may be too strict, making it difficult if not impossible for many of the state's 1,800 licensed personal-care homes to qualify as assisted-living providers. As a result, he says, consumers would be denied the flexibility they want in choosing an appropriate setting.
Barth also says the legislation calls for specifics that the work group never agreed on last summer. For instance, the legislation now says an assisted-living unit must provide a private bath and kitchenette.
Another concern is that the shift to home care might not cut costs. Feather O. Houstoun, secretary of the Department of Public Welfare, expressed concern that nursing homes would remain full and costly, while new home- and community-based services may only increase the burden on state taxpayers.
Houstoun could not be reached for comment last week, but Torregrossa and other supporters insist that costs will drop as more consumers choose the much less expensive home care. Torregrossa also said the legislation was designed to increase the number of Medicaid "waivers" - which allow people to use federal money for home care rather than nursing homes - from a few thousand today to 36,000 by 2010.
O'Brien and Veon say bipartisan support will greatly improve chances of the bill's passing. O'Brien says he realizes the bill is sweeping and there will be disagreements.
"We float the whole boat, maybe we won't get it all," he said. "The good issues will rise to the top." (Michael Vitez, Philadelphia Inquirer)
Although more HIV-infected women in the US are being prescribed antiretroviral therapy, "prescriptions do not ensure adherence," Dr. Christine Laine of Thomas Jefferson University in Philadelphia, and her colleagues point out.
To further investigate the level of and factors associated with adherence to treatment, Dr. Laine's group conducted a retrospective study in which they reviewed the Medicaid pharmacy claims for 549 HIV-infected women prescribed antiretroviral drugs 2 months before delivery.
If the antiretroviral drug covered less than 80% of the days from the time of prescription throug the last two trimesters, they considered adherence to be inadequate. "Only 34.2% of 549 subjects had at least 80% adherence based on pharmacy data, a rate that remained stable over time," the researchers report in the February issue of Obstetrics and Gynecology.
Compared with older women, women under the age of 20 years had lower rates of adherence. Ethnicity was also significantly associated with adherence, they continue. Compared with white women, black and Hispanic women were about 20% less adherent to treatment.
Other significant factors associated with poor adherence were chronic diseases, drug use or methadone treatment, and residency in New York City.
Conversely, Dr. Laine's group found that women who were on antiretroviral therapy before becoming pregnant and those who received HIV services or specialty care had higher levels of adherence.
"Our results are worrisome in that relatively few HIV-infected pregnant women had adequate antiretroviral adherence," the investigators conclude. As a group, the adherence levels in these women were generally lower compared with the adherence rates reported for nonpregnant HIV-infected subjects.
"Identifying factors likely to put women at risk for poor adherence to antiretroviral therapy could help target adherence interventions." However, relatively few factors distinguished those with low adherence rates, suggesting that more research to identify predictors of adherence will be needed.
The pamphlet was part of a series produced under the leadership of former Prevention Point director Julie Parr which the group claimed was aimed at helping drug users, sex workers and others whose behavior puts them at high risk of HIV infection to be as safe as possible while continuing to engage in the behavior. A similar controversy last summer, about a leaflet which seems to instruct crack cocaine users on how to safely use a crack pipe, convinced the group to pull back on all of the leaflets, according to Rob O'Brien, the group's new executive director.
Despite the controversy, however, the Daily News reported that the leaflets had been approved for distribution by the Health Dept.'s Coordinating Office for Drug and Alcohol Abuse Programs (CODAAP), even though Prevention Point had chosen on its own not to use them. Several city councilpeople pledged to call public hearings on why CODAAP approved the publications in the first place.
While CODAAP officials have been largely silent during the controversy and have said that they will continue to support the needle exchange program, sources said that Health Dept. staff continued to believe that the approval of the leaflets was appropriate.
"Harm reduction makes sense for some people," one staff member, who asked not to be identified, told fastfax. "After all, these leaflets weren't being distributed to school kids, but to people nobody else is able to reach."
According to the Daily News, City Councilman Richard Mariano from Kensington is demanding the CODAAP publicly explain why it approved the leaflet, called "Tricks of the Trade: Health & Safety Tips for Street Sex Workers." Mariano has also asked City Councilwoman Marion Tasco from Northwest Philadelphia, who chairs the Council's Health and Welfare Committee, to hold hearings on how the leaflet came to be approved.
Street's spokesperson, Barbara Grant, said that the Mayor "doesn't want the city to have anything to do with" the pamphlet. But she said he continues to support the needle exchange program. "Prevention Point is a model program for preventing HIV infection," Grant told the Daily News. "They want to hand out useful information. But this is going too far."
Prevention Point has run a needle-exchange program since 1991 and gets about 60 percent of its funding from the city.
According to the Daily News, the pamphlet offers tips to prostitutes on what to wear, how to negotiate with a "john" and how to avoid sexually transmitted disease. It also advises sex workers that "clothing and accessories should be attractive to customers, but still safe. Do not wear anything that will slow you down if you have to run." It further advises "sex workers" to "negotiate services and prices outside the car and circle it completely before entering to see the number of riders and the location of door handles. Have a price list and time limits and stick to them. GET YOUR MONEY UP FRONT!"
O'Brien defended the pamphlet, saying that prostitution is a fact of life. Teaching safety to street- walkers and protecting them from AIDS and other sexually transmitted diseases requires realistic language, he said. (Philadelphia Daily News)
The grants will fund programs that are designed to educate inmates about the value of knowing their HIV status, seeking proper treatment and adhering to drug treatment regimens. Specifically, the grants will support positions such as HIV treatment educators and advocates, and jail project coordinators. In addition, the funds will support programs implemented by AIDS service organizations within the prison setting.
"HIV and AIDS continue to be far more prevalent among incarcerated individuals than in the total U.S. population," said Carl Pelzel, vice president, oncology/HIV sales and marketing at Glaxo Wellcome. "There is a real need to provide HIV treatment information to inmates because we know that only a small percentage of jail systems offer comprehensive HIV/AIDS education programs. If we are to effectively address the HIV epidemic in the U.S. for current and future generations we must ensure that HIV patients in our prisons are educated about the value of knowing their status, preventing further infection, and treatment. Glaxo Wellcome is committed to helping fund programs that specifically address the issues of prisoners living with HIV and AIDS."
The project will receive $12,500 for its activities on behalf of Pennsylvania prisoners with HIV disease for the coming year.
The Case Management Assistant works cooperatively with Case Manager in providing direct services to people living with HIV/AIDS throughout Chester County, with primary focus in predominantly Spanish-speaking communities; provides transportation, companionship and emotional support to people living with HIV/AIDS throughout Chester County; is actively involved in the CCASS speakers' bureau; educates the public about the HIV/AIDS epidemic; and maintains monthly reports.
The position requires a high school diploma or GED, and fluency in Spanish and computer literacy are required, as well as a valid driver's license and clean driving record.
Interested parties should mail or fax their resume and a cover letter as soon as possible to Executive Director, CCASS, 31 South 10th Avenue, Suite 2, Coatesville, PA 19320-3561. No phone calls, please.