Alive & Kicking!'s fastfax

Citing fiscal problems, the Rev. Robert Betts, executive director of Episcopal Community Services, fired his top AIDS service managers last week without prior notice, along with a secretary in the program.

His action threw ECS' numerous AIDS programs, including its case management, nutrition, transportation, counseling and home care projects into confusion as duties were rapidly temporarily reassigned to other agency staff. All of those fired -- including AIDS program director Gary Bell, were African American.

Only AIDS program personnel were affected in the cutback. People with AIDS are the largest client population at ECS, which also operates programs serving the elderly, children and the homeless

Bell had worked for ECS for sixteen years. His responsibilities also included supervision of a home care program for the elderly, a project serving homeless women in recovery, and other ECS projects.

In a letter to We The People sent the day after the firings, Betts said that the AIDS programs would continue at ECS and identified an interim leadership for the programs.

Officials at the AIDS Activities Coordinating Office of the Philadelphia Health Department told Alive & Kicking! that Betts had assured them that ECS remained committed to continuing its AIDS programs in the future.

The firings occurred less than a week before ECS was set to assume new duties managing admissions and case management functions at the new St. John's Good Shepherd House, an emergency shelter for homeless people with AIDS. AACO officials said that Betts had informed them that ECS intends to keep its commitment to the shelter program despite the terminations.

Rumors of conflict between Betts and Bell have been spreading for several months. Betts, appointed to head the social service agency two years ago by the Episcopal Diocese of Pennsylvania, had sought to remove AIDS programming from the ECS strategic plan last year, but was prevented from doing so after complaints from several members of the ECS board.

Several African Americans associated with ECS who contacted Alive & Kicking! said they believed that Betts was motivated by racial bias in his terminations of the four employees. "It's obvious that Betts is out to get Gary Bell and the black staff loyal to him after all these years," an ECS volunteer, who asked not to be identified, said. "They fired a black secretary with years of seniority at the same time as they just hired a new white secretary," the employee said. "The only reason for that is that the black secretary worked for Gary, and would do anything for people with AIDS no matter what Betts thought was important."

These employees noted that while Betts blamed fiscal constraints for the firings, the agency has recently expanded its administrative staff and purchased at least fifteen new computers.

The black secretary referred to by the volunteer conducted a popular annual toy drive for HIV-infected children at Christmastime. Betts said that the toy drive would continue this year, under the direction of Verna Oliver.

ECS is the largest provider of AIDS-related home care and homemaker services in the city, working under a city contract awarded in 1988. The ECS home care program is the only such service available to people with HIV/AIDS regardless of their insurance status.

Betts has been the center of controversy since his earliest days as ECS director. Several top managers have resigned since his appointment; a black social worker promised a promotion was passed over in favor of a white outside employee, leading to increased racial tension at the agency.

Betts has also been criticized for elminating the organization's Cultural Diversity Committee (called the Racism Committee prior to his appointment), which had been established to deal with racial tensions in the agency.

Shortly after his appointment, the Episcopal Diocese investigated charges from a woman ECS employee that Betts had sexually harrassed her on the job, but the Diocese said after its investigation that it had found no merit to the charges.

State says TPAC violates contract in fund awards

The Pennsylvania Bureau of HIV/AIDS has told Rashidah Hassan, "acting co-president" of the Philadelphia AIDS Consortium, that the agency is in violation of its contractual agreement with the state health department because it has allocated state funds to agencies represented on its own board of directors.

Bonnie Jo Brautigan, Public Health Program Administrator for the state HIV bureau, told Hassan on November 17th that TPAC's contract with the state prohibits the awarding of funds to agencies who are members of TPAC or who have employees who serve on the TPAC board.

Brautigan said that she had previously raised the issue with TPAC but had received no response.

The prohibition affects over $3 million of funds awarded to over 30 organizations with representatives or employees on the TPAC board.

TPAC was named as the official "planning council" to develop priorities for, and allocate, federal and state AIDS funding in 1990, and its board was gradually expanded to include over 80 people representing agencies in southeastern Pennsylvania and southern New Jersey.

Only five organizations are named as specific members of TPAC: ActionAIDS, BEBASHI, Congreso de Latinos Unidos, Philadelphia Community Health Alternatives, and We The People. The five groups, called "founding members," started TPAC in 1989.

At least thirty organizations which receive funding through TPAC are represented on its board of directors, in apparent violation of a state contract provision which prohibits making "any contract for reimbursable services" with "a member of the governing body or Board of Directors" or "a company, corporation, or any organization" in which a member of the Board of Directors has "an adverse interest."

Last summer, Philadelphia health commissioner Estelle Richman removed the planning council responsibilities from TPAC with regard to federal AIDS funds awarded through the city health department. TPAC has retained, at least temporarily, its responsibility for the allocation of state AIDS funding and Ryan White CARE Act Title II funds, which are also distributed through the state.

In her letter, Brautigan indicated that the state has raised this issue several times in the past with TPAC staff and board leadership but has gotten no response. She said that the state had offered TPAC the opportunity to request an exception to the conflict of interest provision but that none has ever been requested. TPAC board members had never been apprised of the existence of the contract provision, despite great controversy for several years over the public perception that the group was steeped in favoritism and conflicts of interest in its allocation procedures.

It was unclear why TPAC board members had never previously been made aware of the contract provision.

The conflict of interest charges leveled by the state are not new to TPAC. Similar charges three years ago from the federal Health Services and Resources Administration, which administers federal Ryan White CARE Act funds, led to the creation of the city's Resource Allocations Advisory Committee (RAAC), to make allocations of most Title I and Title II dollars available in the region.

In a statement to the media issued when he announced the planned protest, Minority AIDS Coalition president Gerald Wright noted that TPAC had failed, in almost all of its funding allocations processes, to prevent conflicts of interest from interfering with the outcomes. In one process, he noted, two applications for funding were lost and funding targeted to services of those agencies was instead diverted to a group which had a representative on the allocations panel, and that several other allocations panels used by TPAC also included individuals who were employed by agencies applying for funding.

Last month, several TPAC board members charged that an "objective" review panel appointed by TPAC in the fall had ignored approved funding priorities in the allocation of $160,000 in state funds for AIDS education programs. Despite the fact that TPAC had said that services to sexual minority men of color and substance abusers were its highest priority, none of the funding was allocated to those areas. Almost 70% of AIDS cases in the Philadelphia region have occurred among black gay men and substance users.

Hassan, at the TPAC Executive Committee meeting in late November, said that she interpreted the board's list of priorities as a range of choices for the review panel to consider, rather than a ranking of target populations in order of priority. Joe Cronauer, a PWA representative on the TPAC board representing We The People, challenged that interpretation, saying that the board discussion clearly indicated that the "priorities were priorities, that is, the higher ones are more important than the lower ones, just like the dictionary says." He asked for a transcript of the board discussion on the issue to be presented at the next meeting of the Board of Directors.

No response to that request had been made at press time.

TPAC cancels board meeting to avoid MAC protest

Meanwhile, a meeting of the TPAC board of directors scheduled for December 13th, which was set to adopt a new strategic plan for the organization that would have dramatically changed its focus and activities, was quickly canceled only hours before it was scheduled to start, after the Minority AIDS Coalition announced that it would conduct a protest outside the meeting.

The meeting was also scheduled to take up a controversial set of new funding allocations which have been widely criticized for being in violation of specific funding guidelines adopted by the Board earlier this year.

The protest, called under the slogan "We've Had Enough," was set to call for TPAC's removal as the decisionmaker on the allocation of state AIDS funds available to the Philadelphia region. MAC charged that the continued conflicts of interest and alleged racial discrimination in TPAC's actions made it no longer a viable mechanism for the fair distribution of increasingly limited government AIDS funding.

TPAC "acting co-president" Audrey Tucker faxed a brief cancellation notice to TPAC board members only hours before the board meeting was scheduled to start, claiming that the meeting had to be canceled because a quorum would not be present. Her action came after TPAC staff telephoned some board members prior to the meeting telling them that the protest had been scheduled and asking them if they "still wanted to come."

Ironically, Tucker's action followed by only two days the cancellation of the annual Christmas Tree lighting in Harrisburg by Governor Ridge, who blamed a planned protest by ACT UP and others against the state's failure to provide funding for nursing care and other AIDS services for his decision not to hold the event.

After hearing that the TPAC meeting had been cancelled, TPAC PWA board member Leonard West charged that TPAC had "deliberately sabotaged" the meeting and had called him to "discourage me from coming."

"They made it sound like I'd be risking my life because people with AIDS and people of color were going to come to the meeting," West said. "TPAC's afraid of people of color and people with AIDS. They want to keep us all away so they can do their disgusting dirty work out of sight."

West has served the longest term as a TPAC board member representing PWAs.

"I think the only thing that can save TPAC at this point is if we protest at every meeting until they realize who they're supposed to be working for," he said.

An informal telephone poll conducted by We The People on December 14th identified 32 board members who said they had intended to attend the meeting -- 12 of whom actually did come to the meeting site, since they hadn't received the cancellation fax in time. 27 board members need to be present for a quorum, according to the TPAC by-laws.

Average attendance at TPAC board meetings over the past two years has been between 30 and 35, according to published minutes of the meetings.

Almost all major business of TPAC is actually conducted at the Executive Committee of the board of directors, a 20-member group with only two black members. The charge that real decisionmaking authority at TPAC has been shifted to the less representative Executive Committee has itself become an issue among minority and consumer members of the TPAC board.

It was unclear at press time whether TPAC would schedule a new meeting for its board, or would wait until the next regularly-scheduled meeting in February.

The group had previously canceled its scheduled board elections in October, pending the outcome of a strategic planning process initiated over the summer to redefine its role in light of the withdrawal by the city of its responsibility for the allocation of city and Title I CARE Act funds. TPAC had pledged to hold public hearings on its strategic plan, but has not distributed the plan widely. The group set one unpublicized strategic planning hearing in November, which was scheduled for the same day and time as the initial meeting of the new HIV Commission, one wich many TPAC members serve. No one attended the hearing.

Minority AIDS Coalition president Gerald Wright said that his group planned to renew its protest "at any meeting" of the TPAC board scheduled for the future, until the group gets action from Governor Ridge and Mayor Rendell to eliminate what he called "the conflicts of interest, racist decisionmaking and violations of its own procedures that have typified TPAC activities in recent months."

About 300 people participated in the MAC protest on December 13th, even though the TPAC board meeting was not held. At the protest, speakers condemned TPAC for refusing to follow approved priorities in allocating its funding and for preferential treatment given to white-led AIDS groups for services delivered to primarily African American and Latino constituencies.

Abbott labs drug is found promising in two AIDS studies

Two new studies published in the New England Journal of Medicine indicate that Abbott Laboratories' experimental drug ritonavir is effective in increasing patients' immune cells and decreasing levels of HIV in their bloodstreams. Ritonavir is currently in Phase III clinical trials, although these newly published studies were based on smaller Phase I/Phase II tests conducted earlier.

Abbott recently announced that it will be making ritonavir available through a lottery to about 2000 people with AIDS throughout the world.

According to Martin Markowitz of the Aaron Diamond AIDS Research Center, an investigator in one of the studies, initial results show ritonavir to be as effective as another experimental drug under development by Merck & Co. Some medical analysts, noting that HIV mutates, are skeptical about protease-inhibitor drugs, but Markowitz expresses optimism while admitting the new drugs may have to be used in combination with other therapies.

Volunteers needed for national study on alternative medicine

Bastyr University's AIDS Research Center is recruiting people who are HIV-positive to participate in the first nationwide study of alternative medicine and HIV/AIDS. Bastyr University is the only regionally accredited multidisciplinary natural medicine university in the country.

The purpose of the study is to direct future clinical research in HIV/AIDS by bringing to light evidence of alternative treatment methods which may lead to slower disease progression, longer survival, or a cure.

Funded in 1994 by a landmark grant from the NIH Office of Alternative Medicine, the Center is studying various types of alternative medicine being used to treat HIV/AIDS. The study addresses how health outcomes differ in people using alternative medicine, conventional medicine, or a combination of the two.

Participation in the study is limited to completing a questionnaire three times over a one-year period in order to track the health status of the patient. Specific treatments will not be prescribed or recommended. To be eligible, people must be HIV-positive, at least eighteen years old, currently using alternative therapies as a part or all of their treatment program, and able to give informed consent. All patient information is held in the strictest confidence.

Practitioners who use alternative medicine are urged to become a part of a national network of clinical sites and help recruit their eligible patients to participate in the study.

For information, or to participate, contact Candi Wines at Bastyr University's AIDS Research Center at (800) 475-0135.

FDA panel okays new CMV treatment

An advisory panel to the U.S. Food and Drug Administration has recommended the approval of Chiron Corp.'s Vitrasert, an implant that would directly administer to the eye drugs for Cytomegalovirus retinitis, a potentially blinding disease in people with AIDS. CMV retinitis affects as many as 40 percent of all people with AIDS, often when they have less than one year to live.

Vitrasert would deliver Cytovene (ganciclovir) via a time-release delivery system implanted in the eye. The panelists recommended that Chiron undertake further studies to determine how the implant might be used with other drugs to treat CMV symptoms throughout the body. They also voiced concerns about a side effect, which caused some patients' retinas to detach from their eyes.

AIDS "clearly discriminates," study shows

A new study published in the journal Science indicates an AIDS epidemic that is both smaller than the government has said and one that clearly discriminates.

The study notes the overwhelming differences between infected groups. In January 1993, for example, just one in 2,000 white women between the ages of 18 and 59 was infected, compared to one in 204 white males. Furthermore, the rate for black females was one in 135, the rate for black males was one in 44, and the rates among Hispanics were one in 294 females and one in 69 males.

Study author Philip Rosenberg of the National Cancer Institute used a technique called back calculation which involves looking at the number of current AIDS cases and then calculating back to when the infections must have occurred. The U.S. Centers for Disease Control and Prevention, meanwhile, has been forced to lower its projections as well as its infection estimate.

New Jersey rejects denial of insurance coverage

New Jersey Insurance Commissioner Elizabeth Randall has rejected a proposal that would have allowed group insurers to test for HIV and deny coverage to individuals who test positive.

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