Foglietta leads call for more minority AIDS funding
City sets public hearings on funding cutbacks
HHV-6 linked to disease progression
No decline seen in HIV among IDUs
Many young gay men are not practicing safe sex
Fish oil not seen as useful for weight loss
Williamsport surgeon sued for denying care
Case management project seeks input from clients, staff
Colours sponsors workshop on HIV services to sexual minorities
Foglietta was the keynote speaker at a conference on AIDS in the African American community sponsored by the Minority AIDS Coalition of Philadelphia and Vicinity, the Minority AIDS Project of Philadelphia, and One Day At A Time. Numerous black elected officials and community leaders also spoke at the conference.
The audience of over 400 seemed to be most moved by angry comments by adolescents working to combat HIV infection among other teenagers.
"We go into the trenches," Derwood Bell, a youth outreach worker with YO! ACAP, a teen HIV prevention project operated by the Minority AIDS Project. "We call them the trenches because nobody else will go there. How are you going to give money to people who see young boys standing on the corner hustling and are afraid they will rob them?"
"When you do the most, you get the least," added Jeff Johnson, another YO! ACAP volunteer, noting that a white-run youth AIDS project in center city was awarded a new van for outreach while YO-ACAP volunteers have gone unpaid. "We gotta switch that!"
In his remarks, Foglietta also called for an "increase [in] the support for groups which provide counseling, treatment and other services to African-Americans with HIV in order to prevent their becoming symptomatic and increased efforts to "involve persons with HIV/AIDS in the planning, resource allocation and administration process."
"Five years ago, the impact of HIV/AIDS on the African-American community was an issue that almost no one wanted to talk about," Foglietta said. "Blinding ourselves to HIV/AIDS in the 1980's has led directly to the crisis we face today."
The congressman's remarks came only days after federal officials from the Health Resources and Services Administration informed the Philadelphia region that it would suffer an immediate $1.8 million cutback in federal AIDS funding for direct care services, a reduction of almost 20% for currently operating projects. Philadelphia AIDS Activities Coordinating Office director Jesse Milan said that the city would find additional funds to keep some programs operating for a few weeks while decisions on what projects are eliminated are discussed with the regional HIV/AIDS Commission.
Angry complaints about funding discrimination
Almost 400 people, mostly North Philadelphia residents, attended the Temple conference on Saturday, March 30th. Several federal officials, including HRSA AIDS policy director Dr. Eric Goosby, HRSA associate administrator Dr. Robert O'Neill, Samuel Taveras of the U.S. Centers for Disease Control and Prevention HIV/STD/TB Prevention Program, and the region's HRSA project officer were also in attendance. Lynn Yeakel, regional director of the U.S. Dept. Of Health and Human Services, was also in attendance representing President Clinton.
Jesse Milan, director of the city's AIDS Activities Coordinating Office, and Sonya Hunt-Gray, manager of the HIV/AIDS Commission, also attended.
About thirty community residents and AIDS activists from the African American community spoke at microphones to challenge federal officials on how federal funds are allocated in the Philadelphia region, and the relative lack of funding for minority-operated organizations.
"AIDS is spreading among African Americans more rapidly than ever before," said James Roberts, executive director of the Minority AIDS Project. "Many of the neighborhood based African American AIDS service agencies in Southwest Philadelphia, in South Philadelphia, in West Philadelphia, in North Philadelphia and in Germantown rely" on the federal funding which has now been cut," he said. "Ironically, these small organizations, many of which have grants as small as $20,000, have no other reliable source of funding. The people who run them are so busy trying to provide services that they don't have the time or the funds to develop a fundraising staff. They have had to depend on the federal government for funding."
Roberts criticized the planned Philadelphia to Washington AIDS Ride for refusing to allow minority-run organizations to participate in the fundraising event, and for concentrating the proceeds in organizations which are already financially well-established.
"I see a different picture in many of our minority-run organizations," Roberts said. "I see people with AIDS themselves working full time hours with part time pay to save lives in their communities. I see offices where there are no fine furnishings, no state-of-the-art computer hookups, maybe just enough heat in the winter and certainly no central air in the summertime."
Federal AIDS funders and "the AIDS Bike racers who will pedal for dollars this June will not guarantee one dime to any of these brave, front-line workers," Roberts said.
Gerald Wright, president of the Minority AIDS Coalition, told the crowd that "much of the $20 million dollars [in public AIDS funds allocated to Philadelphia] is spent on efforts and projects with little relevance to the HIV/AIDS epidemic as it impacts on the African American poor today."
"More of the federal dollars must reach the communities where major impact of the HIV/AIDS epidemic in Philadelphia is which is the African American community. The allocations process should not divert money to favored agencies without regard to where the epidemic is.
"While four of five people diagnosed with AIDS in Philadelphia are people of color -- and of those, 70% are African American -- about 20% of the AIDS care dollars spent in this region go to organizations based in, sensitive to, and run by people of color. And while money for prevention services is more evenly distributed, the process of allocating those dollars is regularly subverted," Wright said.
"Built primarily on city, state and federal dollars, one downtown AIDS organization -- which has perhaps three people of color among its 40 professional staff, and none in leadership positions in the agency -- has a larger budget than all of the minority-led AIDS care organizations combined," Wright noted. "This is because our AIDS service system has been based on the premise that only white people with political connections can run the effort to fight AIDS among people who are not white.
"When we advocated for a more open and fair planning and allocation process for the distribution of Ryan White and CDC dollars in Philadelphia, the city government finally eliminated the corrupt and racist process implemented by The Philadelphia AIDS Consortium -- but proceeded to replace that planning process with one in which no one on the front lines of minority agencies fighting AIDS was allowed to participate. While we were excluded from this supposed "community" planning process, those who run downtown organizations and their allies were placed in meaningful and determinative roles. Please listen. While groups such as the HIV Commission, our local Ryan White Planning Council, and the HIV Prevention Community Planning Group, are legislated for the purpose of assuring community input and involvement in the allocation of scarce HIV/AIDS resources, not only have people of color been dis-empowered and marginalized, but those planning groups often make critical decisions without adequate time, training, or information."
Wright described the activities of organizations funded through the Minority AIDS Project despite the small amounts of funding made available to them by the city and others funders.
"But now, it's all being undermined and smothered," he said. "Since our first few months of operation, we have needed to fight defensive actions against extraordinary attacks on our ability to function against the lack of understanding of people in authority.
"Since day one, city officials have simply refused to understand or support the concept of collaboration and coordination that the Minority AIDS Project has fostered," Wright continued. "They've placed in positions of authority individuals with long records of insensitivity and lack of understanding of the realities of low-income people and people of color. Where we have sought to build networks of mutually supportive efforts, they've used your funds to nurture competition and dysfunction, and treated our system as one would the proverbial disliked relative you hope goes home right after dinner."
Wright continued, "The examples of the second class treatment of minority AIDS services are legion. We'd need several of these conferences just to scratch the surface. But there are some glaring and memorable examples. There's the time that the former director of the city's AIDS Activities Coordinating Office -- the one being sued by ten African American city employees for consistent racial bias and employment discrimination -- cut off all prevention funding for minority community HIV/AIDS organizations in his first six months in office. (Only the last-minute intervention of Mayor Rendell prevented Philadelphia from being the only major city in the nation with no minority-run HIV/AIDS education programs.)
"There's the untiring efforts of some people in authority positions to interfere in our efforts to provide technical assistance and capacity building services to our member groups, by refusing to let us do our jobs and instead attempting to reduce our role to being only an extension of a cumbersome bureaucracy. The same bureaucratic structure that could not understand the impact of HIV/AIDS on African Americans until forced to do so five years ago.
"When we attempted to enforce legitimate fiscal operating standards for some of our member groups, the city's response was to seize the money away from us and directly fund organizations which have been unable to tell us how they spent their money in previous years -- in one case for four years.
"When we have tried to build a collaborative process with non-minority run HIV/AIDS service organizations, we've been discouraged from those partnerships and seen what little funding we have threatened on a constant basis. The message, knowingly or unknowingly communicated is, it is not fiscally safe to associate with African American AIDS groups.
"And now, we find that the city's application to HRSA -- the one which led to a reduction in federal HIV/AIDS funding to our region of almost $2 million -- so fundamentally misconstrues and misrepresents vital elements of what we do that they have encouraged you to cut our funding."
Wright said that "we've been told that among the reasons for this deadly cut was a decision by some of the federal officials here today to reject funding for what the city called 'risk reduction/outreach' services provided by organizations supported by the Minority AIDS Project. They said that HRSA would not fund these projects because they were 'education' rather than 'direct care' activities. In fact, allegedly some city staffers have even said that since HRSA objected to using Ryan White funding for the risk reduction activity, the projects should simply be terminated.
"Elimination of the projects would effect crisis intervention case managers and intervention specialists at about 23 organizations, most of them at the Minority AIDS Project.
"The problem is, this whole fiasco is based on a total misunderstanding and misrepresentation about what we at MAPP actually do...That's not fair, it's not what the comprehensive regional plan says, but it is consistent with years of subversion of the legitimate efforts of our most disenfranchised communities to rid themselves of AIDS."
Wright, Roberts and several other speakers called on federal officials to implement direct funding for minority-run services in Philadelphia to sidestep what they called the discriminatory funding practices of the city health department and the Philadelphia AIDS Consortium, which allocates state and federal AIDS funds as well.
AACO director Jesse Milan told the crowd that he recognized that the history between government funders and minority organizations had been troubled in the past, but that he was dedicated to making a change.
"I have inherited some awful institutional relationships in this community," Milan said, referring to minority complaints about funding allocations made through AACO and the Philadelphia AIDS Consortium in the past. He said that he and health commissioner Estelle Richman were committed to assuring that "the mistakes of the past will not be replicated."
Milan called for a meeting in his office with leaders of minority AIDS organizations in early April to discuss ways to guarantee that the funding process becomes more sensitive to the needs of minority communities fighting AIDS.
City
sets public hearings on funding cutbacks he region's HIV Commission, which by federal law determines the allocation of federal Ryan White CARE Act Title I funding for AIDS services in southeastern Pennsylvania and southern New Jersey, will hold a series of public meetings to discuss options in light of the $1.8 million cut in Ryan White funding for the region for the coming year. The hearings will be held:
Monday, April 8th, 4pm-8pm
Chester County AIDS Support Services, 1822 Strasburg Road, Glenview Bldg., Coatesville, PA [610-692-2301]
Tuesday, April 9th, 5pm-7pm
Intercultural Famliy Services, 4225 Chestnut Street, Philadelphia, PA [215-546-0300, x3250]
Thursday, April 11, 12:30pm-7pm
Kennedy Hospital, Gerontology Bldg., 30 E. Laurel Road, Stratford, NJ [609-962-4430]
Thursday, April 11, 7pm-8pm
St. John's Church, Main & Richardson Sts., Lansdale, PA [610-272-1520]
Friday, April 12, 4pm-6pm
Catholic Social Services, 130 E. 7th St., Chester, PA [610-874-6424]
Case management project seeks input from clients, staff
The case management coordination project of the city's AIDS Activities Coordinating Office is seeking people living with HIV/AIDS who participate in the case management system, and case managers, to complete a confidential survey about HIV/AIDS case management services.
Clients and case managers in the five southeastern Pennsylvania and four southern New Jersey counties are being asked to participate. Surveys are available in English and Spanish, and assistance is available to those unable to read the survey.
To obtain a survey, call 215-685-6808 or 215-685-6426.
Results of the survey will be utilized to develop training programs and standards for the area's case management system.
No decline seen in HIV among IDUs
The seroprevalence of HIV among the dynamic population of injection drug users remained unchanged from 1988 through 1993, according to a report in the current issue of the American Journal of Epidemiology.
Dr. D. Rebecca Prevots and colleagues at the Centers for Disease Control say that this "...stable seroprevalence...suggests continued transmission among these individuals in both high-and low-prevalence areas of the United States."
Dr. Prevots used national unlinked sentinel surveillance data to detect trends in HIV seroprevalence among injection drug users who entered drug treatment programs over a six-year study period. Data were obtained from 60 different locations and HIV test results were obtained from more than 70,800 specimens. Seroprevalence trends by age, race/ethnicity and by high- or low-prevalence location were also recorded.
HIV "...seroprevalence remained stable among most age and race/ethnicity subgroups," Dr. Prevots reports. "Seroprevalence generally remained low in low-prevalence groups and high in high-prevalence groups. However, we observed a moderate decline in HIV seroprevalence among older, white injection drug users in high-prevalence areas. Decreasing prevalence was also observed among young, white injection drug users in both high- and low-prevalence areas," she adds.
The trend toward an increase in heroin use "...may signal a potential second wave of HIV transmission [and]...emphasizes the need for both primary and secondary prevention strategies," Dr. Prevots concludes.
Colours sponsors workshop on HIV services to sexual minorities
The Colours Organization will sponsor a one-day workshop focusing on HIV/AIDS service delivery to sexual minority people on Tuesday, April 30th, from 10 a.m. to 3 p.m. at the Church of St. Luke's and the Epiphany, 330 South 13th Street, in center city Philadelphia.
The event is advertised as an "interactive, information sharing workshop with a focus on helping area providers design effective HIV/AIDS services for sexual minority people infected with and affected by HIV/AIDS."
Facilitators include George Bellinger, of New York's Gay Men of African Descent; Gregory Hutchings, prevention coordinator for the Washington D.C. Dept of Public Health; Ivan Torres, a public health advisor of th D.C. health department; and the Rev. Rainey Cheeks, pastor of the Inner Light Fellowship. Various Philadelphia area HIV/AIDS service providers will also be presenting.
To register, please contact Jerome Cale at The Colours Organization, 1108 Locust Street, 1st Floor, Philadelphia, PA 19107, or call 215-629-1852.
Fish oil not seen as useful for weight loss
Taking dietary supplements of fish oil for management of advanced AIDS-related weight loss does not seem to have any beneficial clinical effects, new research suggests. Previous studies in normal patients indicated that the supplements reduced the production of interleukin-1 and tumor necrosis factor by peripheral blood mononuclear cells. Research also showed that the supplements prevented interleukin-1 and tumor necrosis anorexia in animals. Marc K. Hellerstein and colleagues at the University of California at San Francisco followed 20 patients with weight loss associated with advanced HIV infection. The patients' body weight, percent fat, and fat-free mass stayed the same. Hellerstein concluded that fish oil cannot overcome AIDS-related wasting, but may have an effect in stable AIDS patients.
Williamsport surgeon sued for denying care
A federal judge in Pennsylvania refused to dismiss a lawsuit filed against a surgeon in which the surgeon was charged with denying treatment to an HIV-positive hospital patient.
In Sharrow v. Bailey, the plaintiff, Jeffrey Sharrow, charged that Dr. John H. Bailey, Jr., "...violated the Americans with Disabilities Act and Section 504 of the federal Rehabilitation Act by denying him a public accommodation purely because of his disability," according to the March 22 issue of AIDS Policy and Law. Mr. Sharrow, whose legs were amputated following an automobile accident, entered Williamsport Hospital and Medical Center with a fever, chills and pain in his right stump. The rod that held Mr. Sparrow's prosthesis to his right leg was loose and infected. The lawsuit states that Dr. Bailey would not operate until special protective suits were obtained to protect the surgical team against HIV infection.
The hospital refused to order the protective suits because the suits were "..above and beyond the standards of the hospital and the guidelines of the federal Centers for Disease Control and Prevention for orthopedic surgery involving patients with HIV." Dr. Bailey continued to refuse to perform the surgery, which was ultimately performed by another surgeon.
Dr. Bailey argued that the hospital was liable. The Court rejected Dr. Bailey's argument, and stated: "The fact that the denial did not take place on the defendant's premises does not mean that no violation occurred and no cause of action exists." However, the court did refuse the plaintiff's claims for intentional infliction of emotional distress.
More hope from gene study
A new study suggests that gene therapy may be able to keep critical immune cells active in HIV-infected individuals. In the study, which is reported in the Proceedings of the National Academy of Sciences, T cells usually attacked by HIV were removed from three HIV-positive patients, genetically modified with an antiviral gene, and returned to the patients. The procedure kept the T cells alive four to five times longer than the unmodified cells. The therapy may be able to prolong the time before an HIV-infected person develops AIDS, said author Gary Nabel of the Howard Hughes Medical Institute at the University of Michigan.
HHV-6 linked to disease progression
Human herpesvirus 6 (HHV-6) plays an important role in the progression of HIV infection, a new study says. Konstance Kehl Knox and colleagues at the Medical College of Wisconsin at Milwaukee report that HIV appears to use HHV-6 as a tool for destruction. The researchers took lymph node samples from 10 HIV-positive patients and HIV-negative controls. The samples from those with HIV contained a large number of cells that were actively infected with HHV-6, while none of the samples from the HIV-negative patients were infected with HHV-6. Knox theorized that HIV infection may be dependent on activation by HHV-6, and that drugs to block HHV-6 and HIV simultaneously in the early stages of HIV infection could slow or stop the progression to AIDS.
Meanwhile, in another study it was found that opportunistic infections and AIDS-related cancers are developing at a more advanced stage of immunosuppression than previously reported, according to new analysis by Johns Hopkins researchers. Compared with late 1980s estimates, the incidence of Pneumocystis carinii pneumonia (PCP) and Kaposi's sarcoma have decreased. Richard D. Moore and colleagues analyzed data from more than 1,200 HIV patients who were treated at an urban university clinic between July 1989 and April 1995. The most common opportunistic disease was Candida esophagitis, followed by PCP, Mycobacterium avium complex bacteremia, cytomegalovirus and AIDS dementia complex. The least common complications were non-Hodgkin's lymphoma, tuberculosis, progressive multifocal leukoencephalopathy, and cryptosporidiosis.
Many young gay men are not practicing safe sex
by Laura Simonsen
Medical Tribune News Service
Young gay men are twice as likely as older men to engage in unsafe sex, a New York study shows.
Thirty percent of men born in the 1970s reported high-risk intercourse, double the rate i\Ir( Qher age group, according to Laura Dean and Ilan Meyer of Columbia University in New York, who are involved in an ongoing study of gay men that began in 1985.
"With even slight increases in unsafe sex, AIDS could become endemic in the gay community for another 30 years," Dean said.
The new study group of 174 young men in New York confirmed previous findings that gay men engage in unsafe sex based on qualities of their partner and characteristics of the encounter.
For example, young gay men who practice high-risk sex do so with partners whose HIV status they think they know or with whom they have a regular relationship, according to the study.
Having friends and acquaintances with AIDS did not deter them from taking risks, the researchers noted, and those who reported very high-risk sexual behavior rarely sought help or advice from AIDS prevention programs.