-----====[[[[ A I D S w i r e D I G E S T 01.11.93 ]]]]====----- D.C. Targets Homeless in TB Battle * Washington Post (01.11.93), P. A1 Goldstein, Amy Thousands of homeless people in Washington, D.C., will eventually be tested for tuberculosis in an effort to thwart its rampant spread in the District. District health-care workers and 150 volunteers will start testing residents of the city's homeless shelters tonight for TB. Through the mass testing, D.C. health officials hope eventually to reach as many as 5,000 homeless men and women in all 43 shelters. This move marks the first time that any large American city will attempt to systematically examine people in shelters for the homeless to detect and treat TB, according to the Centers for Disease Control. Physicians and health-care advocates across the city said they hope the campaign will draw public and political attention to a serious disease that has been less publicized than AIDS but is inclined to affect many more residents. The rate of TB infection in the District is about three times the national average, according to federal statistics. The disease's prevalence has increased in the last few years, particularly in inner cities, as a result of poverty, recent immigration, and AIDS. A normal person infected with TB bacteria has a 10 percent chance of developing the disease itself. However, the chances escalate among AIDS patients, drug addicts, or those who live in crowded, unsanitary conditions with poor ventilation. Washington, D.C., is a prime target for TB, because HIV is spreading faster there than any other city in the U.S. Also, the city has a large population of homeless people--approximately 10,000-15,000--many of whom stay in shelters at night. Medicine: Second Baboon-Human Transplant Tried * Washington Post (01.11.93), P. A2 Surgeons from the University of Pittsburgh performed their second baboon-to-human liver transplant yesterday, after the moderate success of the first such transplant in June. The new patient was a 62-year-old man who was dying of hepatitis B. Doctors said that if he had been given another human liver, hepatitis B would have destroyed it. Baboon livers, however, are believed to be immune to the disease. The first human recipient of a baboon liver was a 35-year-old HIV- positive man who died 70 days after the transplant. Doctors said in a study released last week that an overdose of an anti-rejection drug hastened an infection that killed him. The first recipient had hepatitis B and was near death when he received the liver during an 11-hour operation on June 28. He also was infected with HIV, but had not yet developed AIDS. Pitt spokesman Mark Kanny said the second recipient is not infected with HIV. Physicians said they were pleased that the first patient's cells coexisted with baboon cells and that he experienced only a mild rejection of the organ. Doctor Fights Back: 'I Don't Have AIDS,' He Tells Town * Los Angeles Times (01.10.93), P. A7 Newberry, Paul A false rumor that a local doctor had AIDS incited fear in many residents of a small Alabama town. Dr. James W. Smith, prominent pediatrician in his home town of Athens, Ala., for more than 18 years, decided on a public defense against a "vicious lie" that spread like gossip. He made the headline on the front page of the local newspaper that read, "Athens Doctor: 'I Don't Have AIDS.'" Dr. Smith said, "People heard that I had tested positive for AIDS. I was supposedly leaving my practice and leaving town." Smith said he first learned of the rumor when his office began receiving calls from nervous parents after Thanksgiving. Subsequently, he found out that Athens-Limestone Hospital local paper the News Courier were receiving calls as well. In addition, other pediatricians were being contacted by parents who didn't want their children to be treated by Dr. Smith any longer because he had AIDS. Smith said he believed his physique contributed to the rumor's spread through the north Alabama town of 17,000. He said, "I am slender. People who have AIDS are usually slender. But I'm slender by design, and I make sure I stay that way" with regular exercise. After all of the hysteria, Smith was approached for comment and his denial ran at the top of the front page of the News Courier on Dec. 6. In the article, the physician confirmed that the rumors were false and that he was "healthy and free of any infectious disease," and offered a $2,000 reward for any information on who started the rumor. The Public's Eye Richmond Times-Dispatch (01.08.93), P. C1 Slack, Charles Although celebrities with AIDS receive much more recognition in their plight with the disease, they are beginning to collectively represent every population affected by AIDS, writes columnist Charles Slack. The recent death of ballet master Rudolf Nureyev was significant not because "we were shocked that a man of his stature died of the disease, but [because of] the fact that we were not shocked," says Slack. Nureyev denied up until his death on Wednesday, Jan. 6, that he had AIDS. Following his wishes, Nureyev's doctor would only say that the dancer died of complications resulting from a "cruel illness." But it was painfully clear to most people that eliminating some medical improbability, the world had lost another public figure to AIDS. AIDS advocates make a strong point when they contend that concentrating on celebrities obscures the many thousands of AIDS patients whose tragic deaths go unnoticed. However, Slack argues that it is only natural to take a special interest in celebrities lives, just as is done in their glories. Within the past two years two highly celebrated athletes--Magic Johnson and Arthur Ashe--disclosed their AIDS-related conditions, demonstrating that even the most healthy individuals can become infected. As a whole, this growing list of famous people stricken by the disease closely resembles the count of AIDS patients everywhere, concludes Slack. FEA--Journal-AIDS Associated Press (01.08.93) Alan Guttmacher Institute, a research institute on human sexuality, reports that the number of teenagers having sex has jumped 63 percent in the past 20 years, according to Ladies Home Journal magazine. The largest increase was among white middle-class girls. However, the age at which they have their first intercourse is declining. In 1988, the latest year for which statistics are available, 27 percent of 15- year-old girls and 32 percent of 15-year-old boys had already had sex. Dr. Laurence Steinberg, professor of psychology at Temple University and co-author (with Ann Levine) of "You and Your Adolescent: Why Can't We Get Through to Them?", said, "What we're finding is that despite all the discussions of safe sex, despite the distribution of condoms, teens aren't using them." Steinberg added, "Parents have to face facts. Teenagers today are wrestling with sexual decisions that many of their parents never had to face--at least, not until they were older." If parents demand that their child wait until he or she is older before having sex, a teen will hear the words but may subsequently not want to talk to Mom and Dad about sex. Dr. Sally Ourieff, assistant attending psychiatrist at McLean Hospital in Belmont, Mass., and instructor of psychiatry at Harvard Medical School, said, "Let's get rid of the myth that talking to kids about sex encourages them to have it." The article in Ladies Home Journal encourages parents not to keep a tight rein over a child's sexuality because it may backfire. Instead, parents should address responsibilities that accompany sexual activity, such as condom usage. San Francisco Mourns Its 10,000th AIDS Death * Reuters (01.07.93) San Francisco--Flags were expected to be flown at half-mast on Friday, Jan. 8, over San Francisco City Hall in observance of the 10,000 people who have died of AIDS in the city, announced officials Thursday. On Thursday morning, the city's 10,000th death was reported since the AIDS epidemic emerged in 1981, said the San Francisco Department of Public Health. Mayor Frank Jordan said, "Today is a very sad day in San Francisco, now that we've reached a milestone of 10,000 deaths from AIDS.... We must continue the fight for prevention, treatment, education, and compassion." Jordan indicated that he ordered flags over City Hall to be lowered to half-mast on Friday and also requested five minutes of silence throughout the city to begin at 9 a.m. on Friday. The San Francisco AIDS Foundation said that the city, with its large homosexual population, ranks behind New York, which has reported 30,772 AIDS deaths, and Los Angeles, with 12,213 deaths from AIDS. AIDS 10th Leading Killer of Americans in 1990 * Reuters (01.07.93) (Atlanta, GA) Among the top 10 causes of death among Americans in 1990, AIDS was ranked 10th, replacing murder as a leading killer, according to the Centers for Disease Control. In the same year, AIDS ranked third as a leading cause of death among young Americans behind only cancer and accidents. A report by a unit of the CDC said that preliminary data for 1991 suggest AIDS may have moved up to the ninth leading killer for all Americans. CDC spokeswoman Sandra Smith said, "Homicides increased between 1990 and 1991 [but] they didn't increase as much as AIDS." The report said AIDS killed 25,188 Americans in 1990, or 14 percent more than the prior year. Although the future of the epidemic appears bleak, AIDS awareness has significantly increased, according to a separate study by the CDC. A 1991 survey of attitudes and knowledge about AIDS demonstrated 29 percent of Americans said they knew "a lot" about AIDS, whereas a year earlier the statistic was only 19 percent. Among all Americans who participated in the survey, more than 95 percent said they knew that anyone infected with HIV could infect someone else by sexual intercourse or sharing drug needles, whether that person has full- blown AIDS or not. Still, more than 60 percent in the survey said it was possible that a person under the care of an HIV-positive nurse, doctor, or dentist would be infected by his or her health-care worker. German Minister Suggests AIDS Test for Refugees * Reuters (01.08.93) (Bonn, Germany) A German government minister incited protests from the opposition and a human rights organization after proposing that foreign asylum-seekers undergo mandatory HIV testing upon entering the country. Foreign Aid Minister Carl-Dieter Spranger said refugees from countries with high rates of HIV infection should be forced to be tested for HIV before being admitted to Germany. Spranger said, "The explosive spread of AIDS in certain countries in Africa and Asia is becoming a growing problem also for Germany through the influx of asylum-seekers." Human rights group Pro Asyl considers the proposal "racist" and added, "The AIDS threat does not come from refugees but has for a long time been a social problem in every society." A spokeswoman for the opposition Social Democrats said the proposal by the conservative minister works only to strengthen prejudices against asylum-seekers, who are frequent targets of neo-Nazi arsonists. Last year, approximately 440,000 Third World and eastern European refugees filed for political asylum in Germany. FEA--NYU-Blood Recycling * Associated Press (01.08.93) Lamparello, Patrick J. As a means to prevent tainted blood transfusions, surgeons are currently recycling blood. They use machines that collect blood from an open incision, cleanse it, and return the red blood cells to the patient. Although the chance of contracting HIV through a blood transfusion is foremost in many patients' minds, the American Red Cross predicts that only one of every 225,000 transfused units is contaminated with HIV. Many companies manufacture blood recycling devices--the most widely used being the Cell Saver. The way blood recycling is performed is simple: a technician uses a suction device to gather blood during surgery. It is spun in a centrifuge to concentrate the red blood cells, which are cleansed in a saline solution to remove contaminants such as bacteria and damaged cells. Approximately 50 percent of the red cells are recovered and are subsequently transfused back to the patient. Blood recycling is used in about 10 percent of all surgery in the United States. This process is not intended for operations in which little or no blood will be transfused. Also, it isn't used in surgery for cancer that has already spread or when there is a serious infection to prevent the spreading of cancer cells or an infectious agent throughout the body. However, blood recycling is used frequently in open-heart surgery, hip replacement operations, back surgery, and some neurosurgical procedures. Moreover, blood recycling can be used in addition to autologous transfusions. The equipment and the technician needed for blood recycling can cost about $500, which is often less than the costs of providing donor blood. Spread of AIDS is Spurred by Racism, U.S. Panel Says * New York Times (01.12.93), P. A14 Leary, Warren E. The National Commission on AIDS said yesterday that the AIDS epidemic should be considered a racial issue because its spread is spurred by discrimination and the disease disproportionately affects minorities. In a report to the White House, the advisory panel said that black and Hispanic Americans now comprise 46 percent of the nation's AIDS cases and that efforts to curb the epidemic have been thwarted by discrimination, poverty, and the lack of health services. The commission, which has one black and one Hispanic member among the 12 commissioners, said the fight against AIDS could be lost if prevention and treatment programs targeted at ethnic groups are not strengthened. Many commissioners said that in order to deal with the epidemic, the ethnic nature of the disease in the United States needed to be stressed, despite the chance that white people might start seeing AIDS as a minority disease that affects "other" people and not themselves. Harlon L. Dalton, a professor at Yale Law school and a commissioner who is black, said, "I am terribly worried that once it is learned that the face of AIDS is darkening, broad public support may fade." The commission's report said, "Injection drug use has played a significant role in the disproportionate impact of AIDS on African Americans and Hispanics-Latinos. In these communities the proportion of AIDS cases attributable directly to injection drug use is four times that for whites." The commission also recommended that more members of racial minorities be included in clinical trials for AIDS treatments. Related Story: Washington Post (01.12) P. A3; Baltimore Sun (01.12) P. 3A Pharmacist With H.I.V. Awarded Job * New York Times (01.12.93), P. B5 Henneberger, Melinda A pharmacist who was denied a job because of his HIV-positive status was rehired without any restrictions in his work by the Westchester County Medical Center in New York, according to a lawsuit settlement that is considered a landmark legal victory for health-care workers infected with HIV. Following a six-year legal battle, a lawyer for the pharmacist said the settlement "sends a very clear message, based on overwhelming expert evidence, that health-care workers pose almost no risk to patients and that discriminating against them is irrational, contrary to the public health and illegal." The county's governing body, the Board of Legislators, unanimously approved the agreement that will allow the hospital to keep its $107 million in annual federal funding, which had been threatened under civil rights laws. The agreement also grants the pharmacist as much as $330,000 in back pay, legal fees, and compensation for "emotional damage." The case emerged in 1986 when the hospital agreed to hire the pharmacist under certain limitations that would have prohibited him from preparing intravenous solutions. Then, hospital officials contended that he could inadvertently prick his finger through his glove and pass a drop of his blood into an IV-bag, where HIV can be transmitted to a patient. The U.S. Department of Health and Human Services ruled in 1990 that the hospital violated the Rehabilitation Act of 1973 by refusing to give the pharmacist a job free of restrictions. The ruling was appealed by the hospital to the department's Civil Rights Reviewing Authority, which upheld the previous decision. Firms Buying Life Insurance of the Dying * St. Louis Post-Dispatch (01.11.93), P. 1 Novak, Tim Viatical settlement companies, which buy life insurance policies of terminally ill patients, particularly AIDS patients, are currently not regulated, but may be soon. These companies, which advertise mainly in publications that target homosexual readers, are unregulated in 47 states and are not insurance companies. But the National Association of Insurance Commissioners (NAIC) has developed a committee to study viatical settlement companies to determine if they should be regulated in each state. Richard Rogers, deputy director of the Illinois Department of Insurance, said, "The NAIC has a model that's being floated. It would require them to be registered, and there would be guidelines requiring what the level of payment might be. That may be the way all states are going." According to Rogers, his agency hasn't received any complaints involving viatical settlement companies, but he said that "the potential is there to take advantage of people." Living Benefits, one of the largest viatical settlement companies, has purchased about 600 life insurance policies since 1989. Critics argue that viatical settlement companies take advantage of dying people. Sister Jean deBlois, associate director of the Center for Health Care Ethics at St. Louis University Medical Center, said, "If the person is in the last stages of AIDS, and somebody's approaching them offering money, they may not have the capacity to make those kinds of decisions. I can't say these people are providing a service, particularly when you look at the profit margin." Vietnam to Test Foreigners for AIDS Reuters (01.11.93) (Hanoi) Many people in Vietnam will be tested for HIV, including foreigners who want to live there, local prostitutes, drug addicts, prisoners, and homosexuals, a news report in Hanoi said on Monday. The Jan. 8 issue of the Saigon Newsreader said that the government released a decision on Dec. 18 stating that these groups would be tested for HIV. The report indicated that local people who tested HIV-positive would not be allowed to get married. It said that foreigners seeking permission to spend more than three months in Vietnam would have to undergo HIV testing. A total of 79 HIV-positive people have been reported in Vietnam, with no cases of AIDS. Last month, Vietnam's national AIDS committee cautioned that growing prostitution activity, drug abuse, smuggling, and tourism would result in an influx of HIV cases. The committee said there were about 300,000 prostitutes in Ho Chi Minh City, formerly Saigon, and some 100,000 drug addicts in Vietnam. However, the state-operated Vietnam News Agency said on Sunday that actual statistics were higher, with approximately 600,000 prostitutes in Vietnam and about 800,000 drug addicts. Chiron Unit Tests Treatment for Cause of AIDS Blindness * Wall Street Journal (01.12.93), P. A6 Chiron Corp. announced it began testing a device that could reduce the cost and toxicity of treating AIDS-related blindness. Chiron IntraOptics Inc., a division of Chiron Corp., obtained exclusive rights for ophthalmic applications of the drug delivery technology from Control Delivery Systems Inc. The company will sponsor the clinical testing that uses the technology to inject anti-viral drugs into the patient's eye to treat infections of the retina caused by cytomegalovirus. Current treatments for the AIDS-related disease, known as CMV retinitis, include injections of the drug ganciclovir, at a cost of about $100,000 a year. An implantable device that delivers the drug may reduce the cost to one-tenth the original sum, according to William Link, chairman and chief executive officer of Chiron IntraOptics. The company also hopes to reduce side effects from the toxins. In pre-clinical trials, the delivery system stopped progression of the disease in 28 out of 30 patients. A second study, to be conducted over an eight-month period, will test 80 patients. In March, the company will begin an experiment with 200 people. Inaugural Notebook: 200 Marchers to Carry AIDS Quilt * Washington Post (01.12.93), P. D3 Pressley, Sue Anne The Presidential Inauguration will involve, for the first time, panels of the Names Project AIDS Memorial Quilt, carried by marchers in the parade. In addition, volunteers will distribute tens of thousands of red ribbons to other participants in the Jan. 20 parade and to viewers along the parade route. Among the leaders in the group of 200 marchers, who will carry 100 panels from the quilt, are the reigning Miss America, Leanza Cornett, who has made AIDS awareness one of her projects; Elizabeth Glaser, founder of the Pediatric AIDS Foundation and a keynote speaker at the Democratic National Convention; and Jeanne White Gender, the mother of Ryan White, the Indiana teenager who died of AIDS in 1989. They will all march behind a banner that reads, "Renewed Hope." Gregg Stull, chairman of the National Capital Area chapter of the quilt project, said that although the AIDS Memorial quilt has been displayed at the former president's back door in the past five years, "neither President Reagan nor President Bush visited the display. This time we have been asked by a president to bring the quilt to him in the first few hours of his administration. Let us hope that this is a signal that the Clinton administration will do all it can to effect an end to the AIDS epidemic." The quilt, in its entirety, contains more than 25,000 panels, commemorating more than 30,000 AIDS patients who have died, and representing 2 percent of AIDS deaths worldwide. TB: The Scourge Strikes Again * Washington Post (Health) (01.12.93), P. 12 Colburn, Don Public health officials made it their goal in 1989 to completely eradicate tuberculosis within 20 years, but three years later they say they have little or no hope of meeting the 2010 deadline. In 1989, the plan was realistic because of three factors: the retreat of TB into isolated pockets of the nation; biotechnology's potential for better means of diagnosing, treating, and preventing TB; and advances in computer and telecommunications technology. But a resurgence of TB, particularly in large cities, has overwhelmed any chance of eliminating the disease. The fight against TB is being driven by factors like the spread of HIV, the influx of immigrants from countries where TB is rampant, and increasing numbers of homeless and chronically ill people in crowded conditions without access to adequate health care. The resurgence of TB is not on a massive scale- -yearly reported cases have increased only a few thousand in the past few years. But the sudden reversal of a steady 30-year decline is alarming. The slow disappearance of the disease had caused doctors and laypeople to think that TB was no longer a significant public health threat. It was in 1985 that TB bottomed out in terms of case numbers. Yet over the past six years, the number of cases reported nationally has climbed from 22,000 to 26,000--a jump of 18 percent. What is most frightening to health officials is the growth of strains of TB that are resistant to drugs like isoniazid, rifampin, and pyranzinamide. F.D.A. Drug Reviews in '92 Fall Short of a Record Pace * New York Times (01.11.93), P. D2 Freudenheim, Milt The Food and Drug Administration last year failed to match the record high of 30 drug approvals in 1985 and 1991 by authorizing only 26 new drugs. But after pressure from the pharmaceutical industry and Congress, the agency expects to drastically cut last year's average review period of more than 22 months for potential new treatments. The FDA has already proved its ability to hasten the review process for chemical compounds that were perceived as priorities. The agency said that in 1992 it had approved four high-profile products in less than eight months: Hoffman-La Roche's DDC for treating AIDS; Burroughs Wellcome's Mepron for AIDS-related pneumocystis carinii pneumonia; Bristol-Myers Squibb's Taxol for ovarian cancer, and SmithKline Beecham's Halfan, an anti-malaria drug. The FDA hopes to cut its review time for high-priority drugs to six months with the help of additional staff members financed by the recently authorized user fees to be paid by the manufacturers of new drugs awaiting approval. The agency took an average of 22.6 months to approve the new drugs last year. In addition to the chemical-compound drugs, the FDA approved 13 biological substances, including Baxter Healthcare's genetically engineered treatment for Factor VIII blood deficiency, in which the patients' blood lacks the protein that causes clotting. Healthy, Gay, Guilt-Stricken: AIDS' Toll on the Virus-Free * New York Times (01.11.93), P. A1 Navarro, Mireya Even though many homosexual men have been spared by the AIDS epidemic, they still have had their lives transformed by the disease because they have seen their friends die from AIDS. An HIV-negative gay man in New York City said, "For a gay man, friends are everything; it's not like we have kids and families." Some of the uninfected men have channeled their hurt and anger into advocacy and social work for the sick and dying. However, mental health experts say many other HIV-negative gay men experience clinical depression, hypochondria, sexual dysfunction, and other serious psychological problems as a result of the 12 years of unrelenting personal loss. Some experts call it a mental health crisis that could have a serious impact on efforts to control the disease. They caution that some gay men are relapsing into unprotected sex, drug use, and other self- destructive behavior because they do not want to survive or do not believe they will. Such reactions have been most prevalent in cities with large homosexual communities like New York and San Francisco. In addition, there has been little mention of the problems of this population, even by the men themselves. Some of the men claim they are too embarrassed to address their problems, and too afraid of diverting attention or resources to themselves, when so many others have greater needs. Moreover, many of these men say they tactfully refrain from discussing their HIV status with friends who are infected. Some have even lied to friends claiming that they, too, are HIV-positive. Thomas Moon, a gay psychotherapist in San Francisco, said that these men will have to live as best they can and experience a great deal of suffering. Stars Flock to Be in HBO Film About the Early Years of AIDS * New York Times (01.11.93), P. C11 Weinraub, Bernard An HBO movie about the first years of the AIDS epidemic will involve several high-profile celebrities. The movie "And the Band Played On" is based on the 1987 best-selling book by Randy Shilts. It gave an account of the early years of the disease, when a small group of health officials and other people fought apathy and hostility from parts of the government, the medical establishment, and even gay groups and individuals. "And the Band Played On" is the first full- scale drama to deal with the politics and early years of the AIDS epidemic in the late 1970s and early 1980s. When the film was first announced, many actors did not want to become involved with it because it dealt with AIDS and gay men. Only when Richard Gere joined up for a small part as a choreographer with AIDS, did others decide it might be worthwhile. Soon, Anjelica Houston and Steve Martin {signed on, and others followed, including Lily Tomlin, Alan Alda, Glenne Headly, Sir Ian McKellen, Howie Mandel, Richard Masur, B.D. Wong, Charles Martin Smith, Phil Collins, and Swoozie Kurtz. Matthew Modine will take the lead role as Don Francis, a researcher who was among the first to recognize the implications of the AIDS epidemic. Lily Tomlin will portray a public health official named Selma Dritz, who played an early role in trying to curb the spread of HIV. The movie, which is longer than two hours, is to be shown on HBO in August or September. News in Brief: Ohio * Advocate (12/29/92) No. 619, P. 25 An HIV-positive man from Elyria, Ohio, filed a complaint with the state civil rights commission on Nov. 18 arguing that he was illegally denied membership at a health club because of his illness. The man, Kevin Fisher, said the club's denial infringed state and federal laws against disability-based discrimination in public accommodations. He said an employee at a Bally's health club in Elyria told him that he would be prohibited from Bally's clubs across the state because he is infected with HIV. However, officials at Bally's headquarters in Los Angeles said the chain does not ban HIV- positive individuals from its clubs. News in Brief: The Nation Advocate (12/29/92) No. 619, P. 28 A federal investigation was requested by hemophiliacs on Nov. 20 to examine allegations that top officials of medical firms knowingly permitted HIV-tainted blood products to enter the nation's blood supply in the early 1980s. Michael Rosenberg, president of the Hemophilia/HIV Peer Association, a national support group, said, "We were contaminated by a specific medical product marketed by conglomerates that knew it was a dangerous product." Rosenberg spoke at the annual meeting of the National Hemophilia Foundation in Atlanta. Despite the Centers for Disease Control's 1982 suggestion that blood products may be contaminated, the products were not routinely screened for HIV until 1985. Doctor Files Lawsuit Against Syringe Firm Over HIV Infection * Wall Street Journal (01.13.93), P. A6 A physician who was allegedly infected with HIV in 1986 when she pricked her finger with a needle sued Becton Dickinson + Co., the syringe's manufacturer, for $1.1 billion in damages. The doctor, who claims the syringe was a hazard, said she contracted HIV when she drew a blood sample from a patient in July 1986 during her first month of an internship and residency training program at a New York hospital. According to the lawsuit filed in U.S. District Court in Manhattan, the syringe required the user to recap it so the blood- filled sample could be taken to a hospital laboratory. The woman claimed that the needles "were grossly defective" because their design required them to be recapped. The lawsuit states that the company and lawyers for the doctor attempted to negotiate a settlement over the past 30 months, but were unsuccessful. Leslie Gordon Fagen, an attorney for Becton Dickinson of Franklin Lakes, N.J., said, "We have reviewed the plaintiff's filing and the company does not believe that it bears any responsibility for the tragedy alleged in the complaint." Schaefer's Advisory Council on AIDS Holds Its Last Meeting * Baltimore Sun (01.13.93), P. 4B Bor, Jonathan The Maryland advisory council on AIDS met for the last time last night. Many members were confused by Gov. William Donald Shaefer's decision last week to disband the group, and said they had done exactly what he asked of them. The 22-member group released a report demonstrating that the state is not fully prepared to deal with the growing number of AIDS patients. The report, prepared by Dr. John Bartlett of Johns Hopkins Hospital, found that newly infected patients still encounter long waits for their first appointments. The council also said that "relatively few physicians" outside major hospitals care for significant numbers of AIDS patients. A total of one-third of AIDS patients on Medicaid use emergency rooms for primary health care because they lack private doctors, said the council. Moreover, Medicaid benefits have been canceled among many AIDS patients. Dr. Richard Johnson, chairman of the council, said before the meeting that he had heard nothing from the governor's office since last week's media reports that said Shaefer would break up the group because he believed it had concentrated too much on patient rights and too little on education and treatment. But a spokesman for the governor said that Shaefer did plan to abolish the commission and assign its duties to his Commission on Alcohol and Drug Abuse, headed by Dr. Neil Solomon. The spokesman also said the commission members have not been informed of his decision because an executive order disbanding the group had not yet been drafted. Tuberculosis Laws Called Lax on Patients' Rights * Washington Post (01.13.93), P. A3 Laws aimed at regulating the spread of tuberculosis are often outdated and inadequate, and neglect to protect the rights of a growing number of patients, according to a report in the Journal of the American Medical Association. Harvard health-law professor Lawrence O. Gostin wrote in the journal that treating TB is essential for controlling the airborne bacterial illness, but only 24 states and the District of Columbia specifically grant health officials the power to impose such treatment. Most laws don't allow health-care officials to observe and confirm that patients take their medication, a technique now deemed to be "state of the art" in curbing TB's spread, said Gostin. "The great majority of states have laws that date back to the early and mid-part of the century, and they're badly antiquated," he added. Gostin discovered after reviewing patients' rights that many states lack provisions to guarantee that people who are forcibly confined or treated have access to an attorney and a court hearing--essential elements of legal due process. In addition, only half the states and the District of Columbia specifically protect the confidentiality of patients with communicable diseases like TB, said Gostin. He demands giving health departments firmer and broader powers, including the resources for providing incentives like cash and clothing to get patients to take medications, and easy-to- understand procedures to guarantee that their rights are protected. He wrote that the battle against TB should concentrate on incentives, social support, education, counseling, drug treatment, housing, employment programs, and improved communication. National Editorial Sampler: What Newspapers Are Saying-- Fort Worth Star-Telegram * United Press International (01.13.93) In order to curb the AIDS epidemic, government at every level must provide funding, programs, research, and distribution of information, and in the process, prevent the infections of those who are unaware of the disease's implications, write the editors of the Fort Worth Star-Telegram. By the year 2000, a total of 81,972 healthy American children will be orphaned by AIDS. Thus, experts believe that the disease will have a catastrophic effect upon society. The number of children left motherless by AIDS has increased in the past decade. In 1983, only 255 were orphaned by AIDS. Next year, there will be an estimated 31,147. Researchers in the Journal of the American Medical Association made the predictions, and say that the numbers are probably low. According to their report, most of the orphans will be poor and black or Hispanic, living in communities least equipped to care for them. The Journal said enhanced efforts are necessary to prevent HIV infection in mothers in addition to support for AIDS orphans. If no appropriate steps are taken, it is alarming to think of what the numbers will be like after the year 2000, and what the societal burden will be on the children themselves. The federal government must lead the way and take aggressive steps to thwart this deadly epidemic, the editors conclude. France--AIDS * Associated Press (01.09.93) Burns, Christopher (Paris) About 40 percent of all deaths among Parisian men aged 25-44 result from AIDS, according to new statistics released by French government researchers. The city's large homosexual population, and resistance to AIDS education by the government and the public, are cited as reasons why France has had the most AIDS cases and death in Europe. Also, Eric Jougla of the National Institute of Health and Medical Research said at least 300 people have died from contaminated blood, contributing to the 535 AIDS deaths of Parisian men aged 25-44 in 1991, up from 358 in 1989. Between the early 1980s and 1991, AIDS killed 11,662 people in France, and the country led Europe with 21,487 AIDS cases. In the United States, however, the total of AIDS deaths was 160,372 through Sept. 30. Dr. Jean-Francois Chambon, medical director of the Association of Research, Communication, and Action for the Treatment of AIDS, accused the government of being reluctant for delaying the development of a health education agency until 1988. It was not until then when condom ads were featured on billboards and in theaters. Health officials have had problems getting French men to accept condoms, either because of personal distaste or Roman Catholic traditions. The Health Ministry did not install a condom vending machine in a Paris high school until December, despite opinion polls demonstrating large support for such a move. Francoise Varet, director of the state-funded French Agency for the Fight Against AIDS, said that the government expects to increase 1993 funding for education and prevention from $9 million to $36 million. The French government has spent $440 million on AIDS since 1984, while distributing AZT free of charge. In-Vitro Activity of Zidovudine Against Mycoplasma Lancet (12/19-26/92) Vol. 340, No. 8834/8835, P. 1543 Papierok, Gerard AZT can no longer be considered as the cause of difficulties encountered during isolation of mycoplasmas from blood, write Gerard Papierok et al. of the International Mycoplasma Laboratory in Signes, France. The researchers reported earlier this year that growth of mycoplasma is inhibited by AZT in vitro. Taylor-Robinson and Furr were not able to verify this, so Papierok et al. contacted them and discovered that the exact same strains were used but that the growth media differed. Papierok et al. have tested the activity of AZT against two collection strains of mycoplasma (Mycoplasma fermentans strain PG18 and M pyrum strain ATCC 25960) in various broth and agar media. The modified SP4 medium used in the previous experiments was the control. This medium revealed an inhibitory effect by AZT. Replacement of the foal serum with fetal calf serum and removal of the ampicillin and co-trimoxazole did not alter the inhibitory activity of AZT against mycoplamsas. But by altering the concentration of CMRL, a nutritive compound containing aminoacids, vitamins, and nucleic acids, radically different results were obtained. Using a low concentration of CMRL, the researchers obtained an inhibitory activity of AZT; with higher concentrations, mycoplasma growth was promoted. These findings help explain the discordance between Papierok et al. and Taylor-Robinson and Furr's data. It is clearly unreliable to study the activity of AZT against mycoplasmas in vitro, and such observations cannot be extrapolated to the natural biochemical setting. The ideal is a culture medium as closely related to blood as possible, the researchers conclude. Latent AIDS Virus Common in Lymphocytes * Chemical and Engineering News (01.04.93) Vol. 71, No. 1, P. 28 A latent form of HIV may be much more prevalent in the lymphocytes of individuals infected with the virus than had previously been believed, according to Ashley T. Haase and colleagues from the University of Minnesota Medical School. The researchers used a newly developed in-situ polymerase chain reaction process to amplify HIV DNA sequences in individual cells in a tumor biopsy from an HIV- positive patient. In-situ hybridization to the amplified sequences demonstrated that 15 to 20 percent of the lymphocytes in the sample contained HIV DNA. The researchers discovered HIV RNA in only one in 1,000 of these cells, however, indicating that the virus was in a latent state in the vast majority of the lymphocytes. These latently infected cells may evade the immune response to the virus and contribute to the spread of the infection within or between individuals. Those researchers who question that HIV is the cause of AIDS argue that very few lymphocytes could be shown to be actively infected with the virus. Therefore, they contend that HIV could not be directly responsible for the depletion of the immune system seen in AIDS. However, Haase et al.'s research indicates that HIV infection itself could cause the gradual eradication of the immune system. Drug-Resistant Strains of HIV are Common * Chemical and Engineering News (01.04.93) Vol. 71, No. 1, P. 28 Strains of HIV that are resistant to AZT have been identified for the first time in lymphocytes from HIV-positive patients who have ever received AZT, according to researchers from the Aaron Diamond AIDS Research Center of the New York University School of Medicine. David D. Ho and colleagues at the research center determined the AZT resistance of HIV isolated directly from lymphocytes rather than the resistance of virus replicated in transformed cell lines, as had been the case in earlier studies of AZT resistance. Viruses isolated from four of 11 patients who had never received AZT were highly resistant to the drug. Three of the four individuals were infected with HIV prior to the widespread use of AZT as an AIDS prophylaxis. Therefore, the researchers concluded that AZT resistance seems to arise spontaneously in an HIV population. They also characterized HIV from 24 individuals infected with the virus and being treated with AZT. The research suggests that the presence of AZT-resistant HIV strains in plasma and in lymphocytes yield worsening AIDS symptoms. Biotech Drug For Hemophiliacs * Science (01.01.93) Vol. 259, No. 5091, P. 32 Holden, Constance AIDS has caused fear in hemophiliacs probably more than any other group, despite efforts since 1987 that make the blood supply safer. Within a year, a severe hemophiliac may be exposed to plasma from more than 100,000 people, according to Alan Brownstein, director of the National Hemophilia Foundation in New York City. He said, "If you have blood products from thousands of human beings, that's tantamount to having sex with them." The sophisticated testing methods have done much to ensure hemophiliacs safe blood, but until now there still was a theoretical chance of contracting HIV, hepatitis, and other virus- caused diseases through blood transfusion. Last month, the Food and Drug Administration approved a recombinant version of factor VIII, the blood protein used to treat the most common form of hemophilia. The new product, made by Genetics Institute of Cambridge, Mass., recombinant antihemophilic factor (Recombinate), has several advantages over plasma-derived preparations, and safety is only one. Since it takes large quantities of plasma to lead to a dose of natural factor VIII, it has been used to treat hemophiliacs only during a bleeding episode. But Brownstein says the new drug can be used preventively, thus improving the quality of life for hemophiliacs. Also, another version of recombinant factor VIII made by Miles Inc. is awaiting FDA approval. Around the Region: Suit Dismissed in Suicide Over AIDS Test * Washington Post (01.14.93), P. B7 A judge in Marion, Va., has dismissed a lawsuit in which a couple filed against a hospital for failing to inform their son of his HIV- negative test result. The son committed suicide because he thought he was infected. Christopher S. Yarber, 21, of Glade Spring, killed himself on Sept. 7, 1990. He had left a suicide note stating "that he had AIDS, and that was the reason he took his life." Yarber's parents sued Smyth County Community Hospital and two doctors for $3 million, alleging that they neglected to inform Yarber of his July 22, 1990, test results. Smyth County Circuit Judge C.B. Flannagan said Tuesday that the suit should not go to a jury based on an allegation that the hospital and the two doctors, Gary Fairchild and James Patterson, had neglected to carry out their required duties in not notifying Yarber. Testimony on Tuesday revealed that Yarber was never told of the test result because the courier for a drug company misplaced it. The Yarbers' attorney, John Lamie, said he would have to discuss the issue with the parents before determining whether to file an amended suit. The judge allowed them 14 days to decide. Grief Over AIDS Spurs Gifts to Neediest * New York Times (01.14.93), P. B3 Levy, Clifford J. The devastating AIDS epidemic has prompted many New Yorkers to donate money through The New York Times Neediest Cases Fund, to be used for AIDS patient care and prevention. The fund gives money to seven charities that have established programs for thousands of adults and children with the disease. Such services include special housing, home-care workers, and meals for seriously ill paitents; grants for medication and other treatment; and counseling for people whose relatives or friends have died from AIDS. A few of the charities are also implementing education programs. However, as the disease continues to spread and the recession worsens, the charities are experiencing tightened budgets that might force some AIDS programs to be discontinued. What is more alarming is that donations to Neediest Cases have decreased so far in this year's campaign, which ends on Feb. 28. The New York Times covers the fund's expenses, so all contributions are directly transferred to the seven charities. One contributor from Manhattan gave $100 to the fund to be used "in making the lives of AIDS victims, especially children, more comfortable in whatever time they have." AIDS Virus Discoverer Links With Applied Immune * United Press International (01.13.93) (Santa Clara, CA) Applied Immune Sciences Inc. announced Wednesday that the French researcher who discovered HIV has agreed to serve as a consultant to the biotechnology company. Luc Montagnier, head of the viral oncology unit at the Pasteur Institute in Paris, will also join Applied Immune's medical and scientific advisory board, said the start-up company. Applied Immune Sciences concentrates on producing cell therapy mechanisms used to harvest cells from blood, bone marrow, and other tissues. The cells are subsequently processed to boost their immune response capability, then reintroduced into AIDS patients. Montagnier said, "I am pleased to be part of the effort to bring this new AIDS therapy to France. It offers one of the few bright spots on the AIDS therapy horizon." Liz Taylor, Audrey Hepburn to Get Humanitarian Awards * United Press International (01.13.93) (Beverly Hills, CA) Oscar-winning actresses Audrey Hepburn and Elizabeth Taylor have been selected by the motion picture academy to receive its prestigious humanitarian award. The Jean Hersholt Humanitarian Awards will be given to Hepburn and Taylor March 29 at the 65th annual Academy Awards ceremonies in Los Angeles. Hepburn is being recognized for her work as UNICEF's ambassador to the world's children. Taylor is to be commended for her work as a leading AIDS activist through the American Foundation for AIDS Research and the Elizabeth Taylor AIDS Foundation. The academy made the unprecedented decision to honor both women in the same year because the "both so clearly deserved this honor," said Academy President Robert Rehme. Business Bulletin: Here's the Drill ... * Wall Street Journal (01.14.93), P. A1 Valeriano, Lourdes Lee Patients' fears and stricter guidelines have forced dentists to spend more money on infection-control procedures. A Dallas, Texas, dentist, who now scrubs down the entire room and changes covers on the chair and other equipment after each patient's visit, has seen disease- prevention costs increase 40 percent in the past two years. A dentist in Michigan who spent $10,000 upgrading his office now charges patients a $3 to $12 "infection-control" fee for each visit. The U.S. market for dental drills has increased to $175 million from $115 million in 1991 because dentists are now required to heat-sterilize drills after each use, which wears the equipment out more quickly than simple disinfecting does. AIDS, By Definition, Will Soon Get Worse * U.S. News + World Report (01.08.93) Vol. 114, No. 1, P. 9 The Centers for Disease Control have finally recognized that many people have AIDS who might have not been correctly diagnosed, which is indicated by the new AIDS case surveillance definition enacted on Jan. 1. The new number of AIDS cases is expected to almost double in 1993 to at least 90,000. The previous definition did not include some symptoms experienced by women and IV-drug users who tested HIV- positive. Also, the new definition includes an important indicator: a drop in a patient's CD4 cells to about one-fifth the normal level. Karen Ringen of the AIDS Action Council said, "The people who will now be counted are already very sick, though they may have been misdiagnosed." The expected rise in AIDS cases will also increase the burden on testing and treatment facilities. "Services already at the wall will have people pounding for more," said Cornelius Baker of the National Association of People with AIDS. The new definition will cause longer lines at clinics, as well as referrals to health-care professionals who have not traditionally served AIDS patients, like women's clinics. Some hope that the lack of money for AIDS services will prompt President-elect Clinton to increase funding for AIDS, which is currently about $2 billion. An Age of Caution * MacLean's (01.04.93) Vol. 105, No. 1, P. 38 Dwyer, Victor As a result of the AIDS epidemic in Canada, condom sales are growing and monogamy is back in style. Instead of turning away from sex completely in the age of AIDS, many people are re-evaluating their attitudes to it and rethinking its place in their lives. People are finally starting to question whether it is worth it to be promiscuous, and whether intercourse is really the best part of making love. A total of 51 percent of Canadians surveyed by Maclean's/CTV agreed that because of widespread fear of AIDS, Canadians are now having less sex outside of steady, long-term relationships. Among those, slightly more than half said that they thought people are "thinking a lot more about sex." Frank Sommers, a Toronto psychiatrist and sex therapist, said, "A lot of people who only a few years ago might have constantly been on the lookout for new partners are now thinking twice about the big, bad sexual world." The poll also suggested that Canadians are purchasing and using many more condoms since Maclean's last asked about condom use in a 1989 year-end survey. The latest poll shows that 22 percent of those who responded to the question said that they used condoms "often" or "always" compared with 14 percent in the poll three years prior. The poll also found that there is a strong correlation between household income and frequency of sexual activity. Those who reported having sex six or more times a month accounted for 47 percent of those earning between $10,000 and $39,999, 58 percent among those between $40,000 and $69,999 and 62 percent among those earning more than $70,000. FDA Gets on the Fast Track * Advocate (01.12.93) No. 620, P. 21 Coward, Cheryl Although AIDS activists and researchers were mostly pleased by the Dec. 8 announcement by the Food and Drug Administration that the Bush administration gave the go-ahead to hasten the drug approval process for life-threatening diseases, they cautioned that the proposed change may not be completely effective. The fast-track approval process requires the FDA to forgo the clinical efficacy trial, taking safe and beneficial drugs to treat life-threatening diseases, like AIDS, directly to the market. Pharmaceutical companies will be required to study the efficacy of new drugs in the market, and if a drug is shown to be ineffective, the FDA will pull its market approval. Thomas L. Copmann, assistant vice president of biotechnology and biologics for the Pharmaceutical Manufacturers Association, a trade group of more than 100 drug makers, said that his group supports the notion of fast-track drug approval but has "serious reservations" regarding the requirement that drug companies conduct efficacy studies. Spencer Cox, a staffer for Community Research Initiative on AIDS, a grass-roots research group in New York City, said he has "enormous concerns about the amount of efficacy data that is being required without knowing whether the drugs are doing anything beneficial. I don't think that may be in the best interest of people with AIDS." However, Dr. Robert Darga, director of programs for the National Association for People with AIDS, a lobbying group, said he favors the fast-track process. People with potentially fatal diseases, he said, "may not have a whole lot to lose." News in Brief: Illinois * Advocate (01.12.93) No. 620, P. 25 Nearly 200 AIDS activists engaged in protest Dec. 1 against a cutback of an Illinois program that subsidizes purchases of AIDS medication. The demonstration occurred at the State of Illinois Center in Chicago; no arrests were made. The rules that were enacted Dec. 1 allow only people whose annual incomes are less than $13,000 to qualify. The program was previously open to people whose annual incomes were less than $64,000, and activists said that the new rules would cause about half of the 1,300 people who used the program to be dropped from it. The protesters demanded to meet with Gov. Jim Edgar, but he refused the request. News in Brief: Virginia * Advocate (01.12.93) No. 620, P. 26 Blacks must battle AIDS with the same passion as they did the Jim Crow laws, said South Christian Leadership Conference president Joseph E. Lowery in a speech in Richmond Dec. 5. Lowery said that health care issues "demand a kind of movement among us that can be no less intense than our movement to get the vote." He spoke at the second annual AIDS awareness banquet sponsored by Help Educate African-Americans About AIDS for Life, a statewide group. Spread of AIDS Expected to Slow; 330,000 Deaths Are Seen by '95 * New York Times (01.15.93), P. A12 AIDS will lead to the deaths of at least 330,000 Americans by 1995, but the disease's spread will slow slightly, according to projections made by the Centers for Disease Control yesterday. Dr. John Ward, chief of AIDS surveillance for the CDC, said, "The AIDS epidemic hasn't plateaued, but it will not grow as fast as in its earlier years." He said that fewer new infections and earlier treatment for infected individuals are possible reasons why the epidemic is unlikely to spread as fast. But the CDC said that by 1995 AIDS would have been diagnosed in more than half a million Americans since the start of the epidemic in 1981. The number of deaths is projected to reach 330,000 to 385,000 by 1995, more than twice the current total. The new federal definition of AIDS is used in the CDC's predictions about the epidemic's future. Under the previous definition, 415,000 to 535,000 Americans would be diagnosed with AIDS by 1995. However, the new definition will add at least another 100,000 patients to that number. The CDC said that AIDS cases will continue to increase faster among women and heterosexual couples, as homosexual and bisexual cases slow down. By 1995, 55,000 to 75,000 women will have AIDS, versus 25,900 now. The number of men with AIDS will fall between 365,000 to 465,000 by 1995--up from 212,148 currently. The CDC did not give exact estimates for the number of children with AIDS. Related Story: Philadelphia Inquirer (01.15) P. A2 Native Study Finds Unsafe Views on AIDS * Toronto Globe and Mail (01.13.93), P. A1 (Mickleburgh, Rod) The first extensive survey on AIDS-related issues of native Canadians has found an alarming level of unsafe sexual practices and ignorance about the disease. The results, contained in a detailed report released Tuesday by the Chiefs of Ontario, have incited concern over the potential for the disease to spread rampantly through Canada's aboriginal communities. The study was conducted over two years, and involved interviews with 658 residents of 11 reserves throughout Ontario. It revealed that 71 percent of the participants felt assured that they were not at risk of contracting HIV infection, while 17 percent had never even heard of the disease, including 45 percent of those living in Northern Ontario. However, more than 40 percent of the men said they had had two or more sexual partners during the previous year, and frequently did not use a condom. Ted Myers, a University of Toronto epidemiologist who lead the study, said isolated, enclosed native communities are particularly at risk because the number of sexual partners is limited. "That could lead to transmission of the virus right through the community," he added. Also, health officials have warned of the danger of prevalent HIV infection among natives due to the extreme poverty in several reserves and their high incidence of sexually transmitted diseases. Ontario native health director Cathryn George said the findings suggest the need for aboriginal communities to develop AIDS education programs for themselves. Drug Firm's Ad Campaign Targets Patients * Toronto Globe and Mail (01.14.93), P. A10 Burroughs Wellcome has selected Atlanta, Ga., as the test site for an advertising campaign promoting its soon-to-be released AIDS booklet. The company started running ads on radio and in newspapers and placing outdoor posters this month to promote the distribution of the booklet "Living with HIV." The publication contains information about Burroughs Wellcome's AZT and two AIDS drugs made by other companies. The campaign is the first by a pharmaceutical company to directly address consumers of AIDS drugs, and it is part of a growing trend among such companies to market their products to patients, rather than physicians. The effort by Burroughs Wellcome comes as new drugs that emulate AZT are starting to reach the market. The ad campaign and booklets are backed by the American Medical Association and 13 other medical health and AIDS service groups, but are funded solely by Burroughs Wellcome. The company said it chose Atlanta to test the campaign because of the city's size and high rate of HIV infection. The newspaper ads show photographs and testimonials from men and women who are infected with HIV. The spots also include a toll-free telephone number--1-800-HIV-INFO--to call and order a free copy of the booklet. Educators Reject Casey's Proposal: Vote to Keep Diversity and AIDS in State Plan * Philadelphia Inquirer (01.15.93), P. B1 Motley, Wanda Pennsylvania education officials yesterday rejected a request by Gov. William Casey to abolish controversial portions of new academic standards for Pennsylvania's public schools, and adopted nearly all of the final regulations. Officials kept provisions--called "learning outcomes"--dealing with education on cultural and ethnic diversity, public health concerns such as AIDS, and skills such as child care and family budgeting. On Wednesday, during an eleventh-hour appeal, Casey encouraged the officials to eliminate those sections from the regulations to stifle any controversy over whether the standards address students' values and attitudes too much. Critics contend that the standards override parental authority. Officials followed the governor's request to get rid of two sections--one dealing with students' knowledge of community health resources and the other a progressive view of what constitutes a family. Casey said, "It virtually guarantees that the counterproductive, distracting, divisive debate on so-called values will only escalate, to the detriment of our focusing on the basic purpose of these reforms." The move yesterday evoked debate about the standards, which officials have called "outcomes-based education." The House and Senate education committees have 20 days to endorse or reject the standards before the state regulatory panel takes final action. The full legislature would have to pass a joint resolution and the governor would have to sign such a measure in order to hinder the implementation of the plan. Back at School, Doctors Study AIDS * Philadelphia Inquirer (01.14.93), P. B2 Collins, Huntly Because thousands of physicians were not in school to learn about AIDS when the epidemic emerged, several are enrolling in mini- residency programs across the country to stay updated on new drugs and procedures. The mini-residency, which pairs community practitioners with AIDS experts, is taking place at 17 centers nationwide, to increase the number of health-care professionals trained to care for HIV-positive people. The Pennsylvania AIDS Education and Training Center, which sponsors a mini residency, is funded with $376,000 from the federal government. It is based at Hanemann University in Philadelphia and the University of Pittsburgh. Since its inception in 1988, the program has trained more than 5,000 health-care professionals, including about 500 physicians. In addition to mini-residencies, the program offers workshops, conferences, and various other training efforts. According to AIDS experts, the training program is especially important because HIV is constantly changing and so are the treatments to keep it in check. Esther Chernak, clinical director of HIV services, aims to get all medical staff trained in AIDS care at Philadelphia's eight public health centers. She said, "I've made it part of my job to get everyone comfortable and competent in dealing with HIV infection," Approximately 40 of the health department's 109 physicians have been trained at the AIDS Education and Training Center. Metropolitan Area News in Brief: Walk for Life Hands Out $450,000 to AIDS Groups * Philadelphia Inquirer (01.14.93), P. B2 The Philadelphia AIDS group that organized the October 25th AIDS Walk for Life has given $450,000 in proceeds to agencies that work with AIDS patients or offer AIDS education. Eric Wichner, executive director of From All Walks of Life, distributed checks to representatives from 32 agencies in a ceremony at Graduate Hospital on Tuesday night. The recipients include Action AIDS, Blacks Educating Blacks About Sexual Health Issues, Congreso de Latinos Unidos, Prevention Point Philadelphia, and West Philadelphia Coalition of Neighborhoods and Businesses. Univax Biologics to Begin Donor Stimulation... * Business Wire (01.14.93) (Rockville, MD) The Food and Drug Administration has granted permission to Univax Biologics Inc. to conduct a plasma donor stimulation program using Genentech's recombinant gp120 HIV vaccine. The objective of the stimulation program is to produce a polyclonal antibody product to be tested in clinical trials for the prevention and treatment of HIV-1 infections. Potential donors are currently being screened and recruited. Univax hopes to start immunizing these individuals by the end of this month. By inoculating donors with the gp120 vaccine, the companies expect to spur high antibody levels directed specifically at neutralizing HIV-1. The polyclonal antibodies will be taken from the plasma of healthy, uninfected volunteer donors for evaluation in AIDS patients in Phase I/II human clinical trials. If the results are encouraging, Univax and Genentech will jointly conduct Phase III trials. The polyclonal antibodies could slow AIDS progression. In addition, they could be tested for their ability to reduce transmission of HIV-1 infection to infants born to infected mothers and health-care workers who may be inadvertently exposed to the virus. Advanced Biotherapy Concepts Raises Funds to Begin... * PR Newswire (01.11.93) (Rockville, MD) Advanced Biotherapy Concepts, Inc. is currently preparing to start clinical testing of its patented treatment for AIDS and other autoimmune diseases. The treatment removes certain substances from the patient's blood by using an immunosorbent column in an extracorporeal device. The Food and Drug Administration approved the test for the treatment of AIDS patients. Testing the safety of the device will be emphasized in the initial clinical trials. Instead of eradicating the virus through the use of drugs, this technique seeks to boost the patient's immune system by maintaining the blood free of certain substances linked with enhanced viral replication and immune dysregulation. The primary substances to be removed are correlated with disease activity and disease progression in both AIDS and such autoimmune diseases as rheumatoid arthritis and systemic lupus erythematosus. A number of institutions have shown interest in participating in the testing, and the company will soon announce which of them will be involved. Noticeboard: Unlinked Anonymous HIV Testing * Lancet (01.09.93) Vol. 341, No. 8837, P. 109 Anonymous HIV testing has been found to be effective in monitoring prevalence of infection in England and Wales. The latest findings show that London has the highest rate of HIV infection. The groups surveyed were women attending antenatal clinics, genitourinary clinics attenders, IV-drug users, neonatal babies, and district hospital patients aged 16-49. Of the antenatal clinic attenders, the rate of HIV infection was 20 times higher in London than elsewhere. Also, the rate of infection was 40 times higher in neonatal babies in London than elsewhere. London genitourinary clinic attenders had a prevalence of 21 percent for homosexual/bisexual men, 1 percent for heterosexual men, and 0.6 percent for heterosexual women. Those figures for attenders outside of London were 5 percent, 0.3 percent, and 0.2 percent, respectively. In London, 6 percent of male and 6.5 percent of female IV-drug users were infected, whereas the rate of HIV infection was 0.8 percent and 0.4 percent, respectively, elsewhere. Higher-than-expected rates of 0.6 percent for men and 0.2 percent for women were found for district general hospital patients from specialties not usually related to HIV infection. The percentages of infections estimated to be not diagnosed by voluntary named testing were 74 percent for pregnant women, 29 percent for homosexual/bisexual men, 60 percent for heterosexual men, and 53 percent for heterosexual women attending genitourinary clinics and 14 percent for IV-drug users. The results indicate that 1,900 women aged 20-34 years in London may be HIV-positive, and among these, 1,500 will have been infected sexually, some within the United Kingdom. Combination Chemoprophylaxis After Needlestick Injury * Lancet (01.09.93) Vol. 341, No. 8837, P. 113 Malcolm, John A. The institution of antiretroviral treatments after a definite percutaneous exposure to blood from a known or probable HIV-positive source should be based on personal informed choice, write John A. Malcolm et al. of the John Hunter Hospital in Newcastle, NSW, Australia. Although AZT is usually administered right after a health- care worker is exposed to HIV-positive blood, it has failed to prevent subsequent HIV seroconversion. HIV strains resistant to AZT occur in about 89 percent of patients with late-stage HIV disease who have taken AZT for 12 months. While the link between in-vitro resistance and clinical evidence of disease progression has yet to be fully established, exposure to an already resistant strain is a possible reason for some failures of prophylaxis with AZT. Combination antiretroviral therapy may be more effective than a single agent in established HIV infection. Health-care workers with definite high-risk exposures should now be given the option of taking two prophylactic antiretroviral drugs, especially if the exposure seems to carry higher than average risk, such as with a large inoculum of blood, or a source patient likely to be viraemic very early or late in HIV infection or who has taken AZT for six months or more. Now that various antiretroviral agents are available, it is practical to tailor drug prophylaxis to the likely sensitivities of the viral strains to which exposure has occurred. Combination antiretroviral therapy may now be seen as a rational form of prophylaxis after occupational exposure to HIV infection, the researchers conclude. NOTE: Compilation by Michael Tidmus : AIDSwire. All rights reserved. Permission is granted to republish on electronic media for which no fee is charged, provided the complete text of this notice is attached to any republished portion or portions. * From the AIDS Daily Summary. The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse has made this information available as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold. Copyright 1992, Information, Inc., Bethesda, MD. -----====[[[[ A I D S w i r e D I G E S T 01.11.93 ]]]]====----- .