published by We The People Living with AIDS/HIV of the Delaware Valley, Inc.
COMHAR denies disability to PWA clinician
Immigration bill denies AIDS care to aliens
Protease combo trials yield different results
HMOs under fire on patient care
Uncircumcised men at greater AIDS risk
Confidential AIDS list made public
LA Times awards WTP publications
Kirk said that COMHAR had agreed to provide him the coverage at the time of his employment as part of the regular employee benefit package. "They were fully aware I had AIDS and assured me that the disability plan would cover me if I became too ill to continue to work," he said.
Kirk was informed of COMHAR's decision by Matthew Elavumkal, COMHAR executive director, at a meeting last week.
Elavumkal denied that COMHAR was at fault for the denial. CNA [COMHAR's insurance company], turned down Kirk's disability application because his AIDS diagnosis was a "pre-existing condition," he told fastfax. He said that CNA's plan contained a provision excluding long-term disability coverage for any condition of an employee that existed for one year prior to employment. He also denied that the policy exclusion was directed specifically to people with AIDS.
Elavumkal said that "COMHAR was and still is concerned about Dr. Kirk's situation" and had, through its attorneys, fought aggressively to change CNA's position but to no avail.
Kirk is a member of We The People's board of directors, and is co-chairperson of the Philadelphia HIV Commission, the Title I Ryan White Planning Council for southeastern Pennsylvania.
Kirk had originally applied for his long-term disability benefit after consistent bouts of illness forced him to retire from his practice in the spring of 1995.
Kirk was hired as a clinician for PACTS --the only HIV-specific mental health service in the Philadelphia area, which also operates the Community Living Room -- in July, 1993, and was promoted to the position of Director of Education in September, 1994.
A credentialed expert in the field of counseling those with terminal illnesses, Kirk was hired not only because of his professional background but because his own AIDS diagnosis was seen as an enhancement to his responsibility of counseling PACTS' HIV+ clientele.
"Ted Kirk was hired because he was a person with AIDS with unique experience and expertise for working with people with AIDS," said Joe Cronauer, executive director of We The People Living with AIDS/HIV. "It is extremely ironic that one of the main reasons he was hired is now being used as a reason to deny him the basic financial security he needs to live."
"I think it is ironic that I worked in a program providing mental health treatment to persons with HIV and AIDS and when I needed COMHAR support, I am told there is none coming," Kirk told fastfax. "It seems to me that COMHAR is hoping I will die, thus giving them a final solution to this matter."
"I feel like I've played by the rules and followed the system," Kirk said, noting that his doctors and attorneys had worked closely with CNA and COMHAR since last summer, on the promise that a resolution would be found. "Now, it seems, COMHAR is only concerned with itself and not people with AIDS, including me."
Kirk said that in a September 18th meeting requested by Yolanda Lollis, an attorney from the AIDS Law Project, with Elavumkal, COMHAR personnel director Ginny Bernier, and COMHAR attorney Steven Williams, he was offered a lump sump payment of only $3,000 -- on the condition that he return to work part-time at COMHAR. Kirk said that beyond the fact that his disability makes it impossible to work, accepting a part-time position at COMHAR would also require him to give up his health benefits and might threaten his SSI disability coverage, which currently amounts to about $497 per month.
Elavumkal said that COMHAR's offer of new employment was not a condition of accepting the $3,000 payment, but was based on their understanding that Kirk was feeling better and might be able to return to work.
Elavumkal said that his agency could not afford to cover the disability benefit -- which he said might ultimately cost over $100,000, depending on how long Kirk lives -- because all of its resources are restricted to providing services to people with mental illness and mental retardation in the city's Kensington and Lower Northeast neighborhoods. "We have minimal discretionary funds," he said.
Under the CNA long-term disability plan he was promised when he joined COMHAR, Kirk would receive $1,549 per month in disability payments -- 60% of his monthly income at the time of his disability -- for the rest of his life.
Kirk had offered to accept a partial payment on his disability claim totaling $13,949 (back payments to November, 1995, when his claim would originally have gone into effect), as well as monthly payments of $1,549 for the next five years.
"If all employers followed COMHAR's policy, no person with AIDS would ever be able to obtain long-term disability coverage since it's almost impossible to pinpoint when a person becomes infected," Cronauer said. "CNA and COMHAR have made it clear that they are willing to sacrifice the life and work of an individual who gave them his all, simply to try to save a little money."
"For an organization that tries to tell PWAs that they are committed to their mental health, this is a stupid, cruel, heartless decision. Obviously they hope that through their delaying tactics they will put Ted off until he dies -- which will happen sooner rather than later, thanks to COMHAR."
Cronauer said that We The People will be organizing a series of "public actions" to dramatize Kirk's plight and attempt to secure a change of heart on the part of COMHAR.
"We The People members were willing to starve themselves to death several years ago to keep Betak open," Cronauer said, referring to the 17-day hunger strike held by WTP members in 1994 which successfully pressured the state to keep the city's only AIDS nursing home open. "Our members risked arrest to jump-start the city's AIDS housing system. We've shown our willingness to go as far as we need to, to keep our members alive. We are the first, last -- and sometimes only -- line of defense for people with HIV and AIDS abused by the system supposedly set up to help us live."
"Ted Kirk is one of us, and we won't let him down. COMHAR cannot be allowed to do this to one of us. We won't let them. If they don't change their minds, they won't know what hit them." In a statement faxed to We The People on Wednesday, Elavumkal said that he hoped any advocacy efforts on Kirk's behalf would not jeopardize COMHAR's effort to continue to provide services to people living with HIV/AIDS.
Kirk told fastfax that he has retained a private attorney to pursue an action against COMHAR and CNA to win back his disability benefits.
"I'm hoping that it won't come to a long legal battle," he said, noting that he has been hospitalized several times in the past few months. "I don't think I have the time."
Immigration bill denies AIDS care to aliens
The House of Representatives passed legislation this week which contains provisions that would eliminate all publicly funded HIV treatment services for legal immigrants and undocumented individuals, according to the AIDS Action Council.
These provisions were not included in the original House and Senate immigration measures passed earlier this year. They were added during conference negotiations, and conferees were denied an opportunity to offer an amendment to strike these provisions.
No other disease is singled out for denial of treatment except HIV and AIDS.
The recently signed welfare reform bill already dramatically restricts the health care access available for all immigrants and undocumented persons, according to the Council. The conference report on the Immigration Reform Bill goes even further by explicitly denying medical care for legal immigrants and undocumented persons who test positive for HIV. If they test positive for any other communicable disease they will have access to treatment for those diseases; if they test positive for HIV, on the other hand, they will be barred from accessing necessary medical care for HIV/AIDS.
"There is no logical public health or public policy argument for distinguishing HIV and AIDS from all other communicable diseases," the Council said in a statement. "It makes no sense to allow testing and treatment for tuberculosis or influenza while refusing it for HIV and AIDS."
"The only explanation for these provisions is mean-spiritedness and blatant discrimination," the group charged. "These provisions will effectively undermine the nation's ability to control the spread of the AIDS epidemic and to respond to the needs of HIV-infected individuals for life-saving medical and care services. "
The Senate will consider the conference report on the immigration bill within the week.
AIDS Action urged advocates to contact their Senators at 202-224-3121 and President Clinton at 202-456-1111 to oppose the legislation.
Protease combo trials yield different results
by Mark Mascolini, AIDS Treatment News No. 254
Two trials testing the combination of the protease inhibitors ritonavir and saquinavir recently came to different conclusions, possibly explained by differences in trial size, drug dosage, and disease stage of the participants.
Studies have suggested that ritonavir greatly increases blood levels of saquinavir, making a combination of the two especially attractive. One trial of 63 individuals, led by Dr. William Cameron of the University of Ottawa, found that two different doses of the drugs decreased viral load up to 99 percent and increased CD4 counts by 80 to 100 points.
However, a smaller, nine-person study led by Dr. Bernard Hirschel of the University Hospital of Geneva, showed that viral load was reduced by at least 90 percent, though it quickly rebounded in some patients. The trials suggest that resistance to the drugs does not develop immediately, although it could emerge later. Researchers are now attempting to find the proper dosing strategy--one that is strong enough to suppress viral replication and prevent resistance while being mild enough to be tolerated.
HMOs under fire on patient care
The Washington Post this week features a front-page story on the managed care backlash at both the state and national level.
Lawmakers are responding to concerns that managed care "has gone too far" by crafting legislation "to limit how far these health plans, particularly HMOs, can go," the Post said. Among the recent moves to rein in managed care are the maternity-stay legislation passed this week by Congress, as well as the consumer protection ballot initiative pending in Washington state and a pending initiative in Oregon that would bar capitation.
The concern being expressed by managed care opponents, the Post reports, "is whether, in the rush to cut costs by shifting millions of people into managed care, the health of patients is being jeopardized." Backers of anti-managed care legislation argue that the "dynamics" of the HMO marketplace make cutting costs a primary goal. As a result, there is a fear that HMOs will delay access to or refuse to pay for specialists, tests or some treatments. As a result, 33 states passed anti-managed care bills in the first half of 1996, according to Families USA.
However, Gail Wilensky, chair of the Physician Payment Review Commission and former head of the Health Care Financing Administration, said that "a lot of the current furor about denial of services has been generated by doctors and hospitals feeling the effects of managed care on their wallets."
Wilensky says, "Physicians and hospitals are getting squeezed by competition with HMOs on payment and don't like it." She also argues that the managed care backlash is being fueled by patients who are unaccustomed to having limits placed on medical treatment. The Post reports that Wilensky and others who question the need for government involvement say that many of the problems found under managed care also happen in traditional fee-for-service medicine. "In the public arena, problems are often attributed to managed care plans that are the results of mistakes and misjudgments that doctors can make in any type of health plan," said American Association of Health Plans (AAHP) President Karen Ignagni. According to the AAHP, managed care plans have a better system for assuring quality care because they systematically review the medical literature and the records of their own patients to develop guidelines on the best methods of care. In addition, says AAHP Vice President Rick Smith, HMOs stress preventive care.
In an op-ed in the Washington Post, Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, and Lauren Dame, staff attorney for the group, write about the latest "managed care cost-cutting measure -- outpatient mastectomies." Two Connecticut HMOs have begun to encourage outpatient mastectomies for some patients, saying it is "safe and medically appropriate." Wolfe and Dame write that "HMOs defend their policy by claiming that decisions on when to discharge a patient are made on a case-by-case basis, using HMO guidelines. But guidelines have a way of becoming the norm, establishing a standard against which any patient who needs to be treated differently must fight." They say "the issue is not whether outpatient mastectomies ever are appropriate" but "whether HMOs should set standards based on the small number of the most 'successful' (atypical) patients, and then place the burden on doctors to prove the additional treatment is needed for the rest." They also write that "[b]ecause of the way some HMOs pay their doctors, a conflict of interest exists" between doctors, who may be penalized for requesting an overnight hospital stay, and the best interests of patients. Wolfe and Dame call for comprehensive legislation to "deal with the interconnected problems of HMOs ... in a system where profits are increasingly the goal."
Uncircumcised men at greater AIDS risk
A study of immigrants to Israel may help explain earlier findings that link uncircumcised men to a higher risk of AIDS, researchers said this month.
The new study found that uncircumcised men harbor more bacteria in the intact foreskin, including more microbes for sexually transmitted diseases, compared to circumcised men, said Dr. Michael Dan, head of the infectious diseases unit at E. Wolfson Hospital, near Tel Aviv.
Sexually transmitted diseases are known to boost the chances of catching the AIDS virus, so the high levels of microbes in the foreskin may explain previous studies that linked uncircumcised men to a higher risk for AIDS, Dan said.
As new immigrants to Israel underwent ritual circumcision, Dan and his colleagues examined the bacterial flora on the foreskins. Researchers studied 125 men, aged 2 to 54 years of age, and compared the bacteria to samples taken from the penises of 46 circumcised men.
"The higher prevalence of bladder infection-causing bacteria of uncircumcised males as compared to that of the circumcised probably explains the increased rate of urinary tract infections in boys and adults with preserved foreskins," Dan reported to the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy, sponsored by the American Society of Microbiology.
Bladder infection-causing bacteria appeared more often in uncircumcised, than in circumcised, males of all ages, Dan said. For example, he found E. coli, which can infect bladders, in 17 percent of men with foreskins and 4 percent of circumcised men.
"Sexually transmitted bacteria, such as streptococci and mycoplasma, were isolated almost exclusively in uncircumcised males 15 years of age and older," he said.
Dan said that most boys in the United States are circumcised at birth, but in the 1970s, doctors began questioning the advantages of routine circumcision.
However, Dan said, recent studies support the idea that circumcision reduces urinary tract infections and other diseases such as inflammations of the penis and foreskin and penile cancer.
"Penile cancer is the only malignant disease that can be prevented categorically by a prophylactic procedure: circumcision," Dan said. "Our study supports views recommending routine performance of circumcision as a measure to prevent a number of severe diseases."
Confidential AIDS list made public
Florida health officials have confirmed that a confidential list of nearly 4,000 St. Petersburg area residents who have HIV was illegally acquired from the Pinellas County Health Department and mailed to the Tampa Tribune.
Along with the list, Tribune officials said they also received an anonymous letter claiming a health department employee had been trying to distribute the names to customers of a bar that caters to Tampa Bay's gay community.
The letter-writer claimed to have made a copy of the list after the employee dropped it while drunk.
The Florida Department of Law Enforcement launched an investigation to determine how and why the list had been made public, and health officials said the probe should not be lengthy.
"The investigation is focused on personnel who had access to the list, which is a small and restricted group," said Dr. Richard Hunter, deputy state health officer.
"Individuals who don't need to work with that data have no ability to access it. That narrows it down considerably," Hunter added.
The Tribune delivered a copy of the list to the state Department of Health, but officials refused to verify its authenticity.
"We're just not going to speak to the list," said Hunter, "because that would be a further breach of confidentiality.
But the Tribune reported that the names of several people who have publicly acknowledged they have AIDS appear on the list.
Breaching the confidentiality of the list is a second-degree misdemeanor, authorities said.
The Pinellas County Health Department, like others in Florida, keeps names of AIDS patients to track trends of the disease.
Health officials and AIDS advocates were concerned the incident would frighten people into desperate actions, since many AIDS patients don't tell their bosses, friends and even relatives because they fear discrimination.
"I could see tons of tragedies if people thought their names would get out," said Marcia Levy of the Tampa AIDS Network. "Who knows how many people have copies?"
Officials were concerned the breach in confidentiality would prevent people from getting tested for AIDS, since by Florida law doctors must report the names of those who test positive.
"I'm always concerned about that. We of course have a duty to have a system that is completely confidential," said Hunter. "There are ramifications for our whole ability to perform what we think are essential public health tasks."
Worker denies leak
Meanwhile, a state health worker has denied that he's responsible for the leak.
"Somebody knows what I do and used my name, I would suggest as a personal vendetta," said William B. Calvert III, who is on paid leave pending an by the state Department of Health and Rehabilitative Services.
Calvert, one of three workers with access to the list, which is kept in a secured office, denied showing the list to anyone. He said he took it out of the office for field work and it was stolen.
HRS has barred workers from removing confidential AIDS information from state offices, and ordered a review of confidentiality procedures.
Health workers often would take their laptop computers to doctor's offices to collect details on new AIDS patients, Fulton-Jones said. They then make sure the person hasn't already been entered into the database.
The AIDS data, collected by local health departments, are sent to the Centers for Disease Control in Atlanta. Reports come into the local health unit from doctors, hospitals and other health care providers.
When the information is forwarded to the CDC, the names are removed and each case is assigned a code. Officials say the names are kept at the local level to avoid duplication.
We The People's web page can be reached at http://www.critpath.org/wtp. The Times PickLA Times awards WTP publications
The World Wide Web versions of We The People's monthly newsletter, Alive & Kicking!, and fastfax, were selected by the Los Angeles Times as their Web Pick on July 24th.
"We believe that your site is of real value to the people who use our site, and we believe many of them will want to see what you have to offer," the Times said.