In this issue:
Senate committee passes CARE Act
Illinois moves to making needles available without prescriptions
Syringe exchanges don't create new transmission networks
Most serodiscordant, heterosexual HIV couples have unprotected sex
Insurance company lifts AIDS coverage cap
New cases of hepatitis B fall in US
Planning Council, CPG applications available
The Senate bill (S.2311) that provides for reauthorization of the Ryan White CARE Act for FY 2001 - 2005 has been passed on an unanimous vote from the Senate Health, Education, Labor, and Pensions Committee. Only minor technical amendments were added to the bill that passed, leaving important program and policy language intact.
S.2311 retains the basic structure and elements of the existing CARE Act, but would change some areas of current law in ways that AIDS advocates believe would be more responsive to the needs of people who are receiving or are eligible for CARE Act services. Among these changes, the bill seeks to ensure the highest quality of HIV care; calls for the implementation of strategies to reduce or eliminate barriers to HIV care; provides safe-guards to prevent consumers from suddenly losing access to or experiencing cut-backs in services funded under Title I of the CARE Act; and, provides supplemental funding to under-served rural communities. круги отрезные
The measure now moves to the Senate floor for a full vote.
Human Rights Campaign Political Director Winnie Stachelberg said, "This vote was a demonstration of the strength of bipartisan action and how working together to combat HIV and AIDS can save lives. We urge the full Senate to follow the lead of the committee and swiftly vote to reauthorize this pivotal, life-saving program"
Sen. Bill Frist (R-Tenn.), who co-sponsored the measure, added, "Given the fact that federal dollars are what community services and care depend on, this is very important money." Previously, cities were required to log at least 2,000 new AIDS cases during the past five years in order to be eligible
for Ryan White funding; however, a provision included by Frist would lower the funding threshold to 1,000 AIDS cases, "in recognition of the fact that the AIDS epidemic has spread from major cities into more rural areas." He said, "For too long, funding support for some communities ... has been inadequate. I believe this bill will provide critical funding for communities trying to manage this epidemic.
Meanwhile, Rep. Nancy Pelosi (D-San Francisco) has promised to preserve San Francisco's $35 million in annual Ryan White AIDS funds even though some people want to redistribute some of the money to other regions. According to Pelosi, the city could lose $8 million from the program.
When the measure was last updated, a provision was included to maintain San Francisco's funding levels despite the use of a new formula based on the overall number of people living with AIDS instead of the cumulative number of AIDS cases over the years. While other areas with high numbers of HIV and AIDS patients are challenging this exception, Pelosi wants the final measure to include terms
that would freeze the city's share of the money at within 2 percent of its current $35.3 million.
On another front, Rep. Tom Coburn (R-Okla.) will introduce legislation that would amend the Ryan White CARE Act to distribute federal money based on the number of HIV cases, not AIDS cases,
the San Francisco Examiner reports. Since 1991, $6.4 billion has been distributed to state and local governments through the CARE Act, based on a formula using the number of AIDS cases. But public health officials have argued that "it doesn't make sense to continue distributing federal money ... based on tallies of AIDS cases" when medical advances have prolonged HIV in many people.
Patricia Flemming, chief of the CDC's HIV/AIDS surveillance branch, said, "The system that we built that provided the answers 10 years ago isn't providing the answers we need now. The epidemic has changed and the surveillance system needs to change, too." With the present funding formula, Coburn
maintains that areas "with relatively new outbreaks, especially rural areas, are not getting the aid they need." By contrast, cities that have a higher percentage of AIDS cases, such as San Francisco, get a "disproportionate amount of money," Coburn said.
His legislation would mandate that HIV cases act as the basis for CARE Act funding by 2004. Coburn said, "The whole idea is to emphasize prevention and make sure the dollars go where the
disease is."
The CDC recommended in December that state officials report HIV cases, as they now do for AIDS cases. Flemming predicted that "every state will have adopted an HIV reporting system by
the end of 2003." Thirty-two states and the Virgin Islands now have names-based HIV reporting systems, and New York will begin a similar system in June. Four other states and Puerto Rico report HIV cases using a unique-identifier code, while California, Pennsylvania and Oregon have not yet developed tracking systems.
Matthew McClain, chair of the Care Coalition, which represents cities and clinics seeking increased federal funding for HIV patient care, said that HIV data would provide a more accurate
measure of infection, but such data would not be available "until states have developed HIV counting methods that would guarantee privacy." Joseph Kelly, deputy director of the National Alliance
of States and Territorial AIDS directors, said that if accurate HIV reporting is in place in every state, "many of us believe we should move to use HIV and AIDS as a basis for distributing these
Ryan White CARE funds." (Reuters, Kaiser Daily HIV/AIDS Report (www.kff.org)
The Illinois House has voted 65-49 in favor of a bill that would let pharmacists sell syringes to people without a prescription, hoping it will "help heroin addicts avoid the AIDS virus by making it easier for them to buy clean needles."
The bill, sponsored by state Rep. Sarah Feigenholtz (D), would let anyone 18 or older buy 10 new needles at a time. Pharmacists would also be required to offer educational materials on safer
injections, syringe disposal, drug treatment and HIV prevention to those who buy needles.
Critics fear that the bill, which now heads to the state Senate, might increase heroin usage by
providing easier access to needles. They also point out that drug users might not dispose of the needles safely.
"Unfortunately, some people ... will treat these needles just as irresponsibly as they treat their own bodies," state Rep. Bill Black (R) said. Other lawmakers argued that the bill would be more productive if it set up a needle exchange, which "would let people trade used syringes for new ones."
Of AIDS patients living in Illinois, 50% of women and 22% of men contracted the virus through intravenous drug use, according to the state's Department of Public Health statistics. State Rep. Wanda Sharp (D) said, "This is one step -- just one step -- that may help save the lives of our children, our family members." Moreover, the bill's supporters argue that it would also help those who require medical injections but do not carry their prescriptions with them.
"This is not just for HIV and AIDS," state Rep. Elizabeth Coulson (R) said, adding, "It's for diabetics. It's for people that have infertility treatments." (Kaiser Daily HIV/AIDS Report, www.kff.org)
The majority of participants in a syringe exchange program in Baltimore do not form new social networks, according to a report in the March 10th issue of AIDS.
Benjamin Junge and colleagues from The Johns Hopkins University School of Hygiene and Public Health in Baltimore, Maryland, studied 413 participants in the Baltimore Syringe Exchange Program who returned for an interview 6 months after enrollment. Of the participants, 29.8% were HIV-positive and 85.0% were active injectors.
The researchers found that only 7.7% of the individuals reported meeting at least one person at the program since enrollment, with a mean of 3.3 contacts. Compared with individuals who had not met someone, these people were "more likely to have traded sex for drugs or money during the previous 2 weeks."
In addition, active injectors who had met someone at the program were less likely to have injected at least once a day, but more likely to have borrowed used syringes from others. Overall, the researchers found that the use of others' syringes and commercial sex were independently associated with forming social contacts at the program.
"Taken together, our findings argue against major formations of new social networks, and therefore new disease transmission networks, in the context of syringe exchange participation," the authors conclude. (Associated Press)
Mutual of Omaha is eliminating its medical coverage cap for policyholders infected with HIV or AIDS.
Such clients will receive the same medical coverage as those with other ailments, effective May 1, company spokesman Jim Nolan said. The insurance giant, which has policyholders in nearly every state, is eliminating the cap after learning more about medical coverage of AIDS-related problems, Nolan said.
AIDS insurance caps were instituted in the late-1980s when little was known about the ailment or the insurance risks, Nolan said.
"Increased medical knowledge regarding HIV/AIDS allows insurers today to better understand and manage the financial risk associated with AIDS-related claims," he said. He declined to elaborate.
Two Chicago-area men, who are HIV-positive, sued Mutual of Omaha, saying the limits violated the federal Americans With Disabilities Act. Earlier this year, the U.S. Supreme Court declined to hear the case, thus upholding a lower court decision allowing the cap.
One man's policy covered $25,000 for AIDS-related conditions, compared with $1 million for other ailments.
Heather Sawyer, an attorney for the two men represented by Lambda Legal Defense and Education Fund in Chicago, called the cap discriminatory and welcomed the end to the court battle.
"This type of unjustified practice should be and will be eradicated," Sawyer said.
More than two thirds of HIV-serodiscordant heterosexual couples surveyed in California report that they engage in unprotected sex. However, patients using antiretroviral therapy were less likely than the others to report having unprotected sex.
Dr Ariane van der Straten of the University of California in San Francisco and colleagues surveyed 104 couples enrolled in the California Partners Study II. Thirty-seven percent of the seropositive subjects were taking protease inhibitor therapy and 92% had undergone viral load testing. Forty percent said that as of their last test, virus levels were undetectable.
The findings showed that more than two thirds of the subjects had had unprotected vaginal and/or anal sex during the 6 months preceding the survey. According to Dr van der Straten and colleagues, "most respondents, regardless of serostatus, said that viral load testing and awareness of postexposure prevention had no effect on their condom use."
The authors report that "up to 33% of seropositive and 40% of seronegative respondents acknowledged decreased transmission concerns in the light of new HIV treatments." Seronegative subjects reported more risk-taking and less concern about HIV transmission than seropositive subjects. However, subjects receiving protease inhibitor therapy were 2.4 times less likely to have unprotected sex than those not receiving such therapy.
In their report in the March 10th issue of AIDS, the researchers urge physicians to discuss the risks of HIV transmission with their patients and their patients' seronegative partners to help decrease risk-taking in these couples. (Associated Press)
New cases of acute hepatitis B virus infection have been decreasing over the past decade, according to a report by the Centers for Disease Control and Prevention given at the 10th Symposium on Viral Hepatitis and Liver Disease. The incidence rate fell 71.7 percent to 3.9 cases per 100,000 in 1997. The researchers studied the demographic information from 3,842 patients with confirmed hepatitis B and attempted to determine risk factors, such as injection drug use or high-risk sexual activity. The number of cases fell 91.7 percent for injection drug users, 85.7 percent among men who have sex with men, and
44.1 percent among people having high-risk heterosexual sex, possibly due to more vaccination and as a response to the AIDS epidemic, the researchers suggested.
Philadelphia director of social services Estelle B. Richman has announced the availability of applications for appointment to the new Title I Ryan White Planning Council for the Philadelphia region and for the Philadelphia HIV Prevention Community Planning Group.
The new panels, which will continue the work of the current Care Committee and CPG of the former Philadelphia EMA HIV Commission, are expected to be appointed by Mayor Street sometime in June, acting on recommendations from a nominating committee comprised of current members of the committees.
Applicants to the Title I planning group will be drawn from the nine-county Philadelphia eligible metropolitan area (EMA), which includes Bucks, Chester, Delaware, Montgomery and Philadelphia counties in Pennsylvania and Burlington, Camden, Gloucester, and Salem counties in southern New Jersey.
Applications are available by calling 215-546-2013 or by emailing a request to David Fair at drfair@critpath.org.