-----===[[[ A I D S w i r e D I G E S T 01.25.93 ]]]===----- In Deception and Denial, an Epidemic Looms * New York Times (01.25.93), P. A1 Brooke, James The rate of HIV infection in Latin America is expected to exceed that of the United States, as a result of sexual promiscuity, dishonesty, and the lack of adequate prevention efforts. A large amount of the growth in HIV cases transpires among women, a fact that physicians attribute to a propensity for homosexual and heterosexual affairs by men and a traditional reluctance to discuss these with their wives. In Latin America, fewer than 8,000 AIDS cases had been reported six years ago. Today the number is reaching nearly 60,000 and estimates of cases are even higher. In Brazil, an increasing proportion of HIV infection is among women, which has pushed the number of infected people to about one million in a population of 150 million, according to some AIDS researchers. But in the United States, with its population of 225 million, the same number of infections are present. Government officials and private researchers say that Mexico, which is the third most populous nation in the Americas with 85 million people, has an estimated 225,000 people infected with HIV and could have as many as 500,000. Last month, the Health Ministry announced that about 200,000 HIV-positive people live in Columbia out of a population of 33 million. Current figures show that 5,000 people have developed AIDS so far. However, private groups caution that by the end of this decade one million Colombians could be infected. Dr. Marcelo del Castillo of the Hospital de Clinicas in Buenos Aires said that in Argentina, which has about 100,000 HIV-positive residents, "30 to 50 percent of the patients who have developed the disease are not reported." Related Story: Baltimore Sun (01.25) P. 4A California Inmates Win Better Prison AIDS Care * New York Times (01.25.93), P. A12 Gross, Jane Due to worsening conditions and rising numbers of HIV cases, the California Medical Facility, the prison at Vacaville, has launched a $5.8-million plan to improve the care of AIDS patients. The improvements will include a renovated housing unit, a hospice, an enlarged staff, an ombudsman to hear complaints, warmer clothes and nutritional supplements, and sensitivity training for guards. The new program is targeted at improving medical care for inmates with AIDS and at correcting an attitude of apathy or even hostility that correction officials have lately realized is a problem at the facility. The improvements follow months of turmoil at the medical prison, which is home to more than 3,000 ill inmates, 300 of whom are known to be infected with HIV. As a whole, there are 109,141 state prisoners in California, 893 of whom are known to be infected with HIV, and as many as 5,000 more who are thought to be infected. Last spring two leading AIDS experts at the prison resigned, as a result of frustration over limited resources and what they considered institutionalized indifference toward AIDS among prisoners. After their departure, the quality of care deteriorated, prompting the deaths of some inmates whose calls for help went unanswered. Some HIV-positive inmates stopped eating as a form of protest. Although the new program is encouraging, some inmates and advocates fear that correction officials are more interested in damage control than in lasting reform. Skaters Dance Around AIDS Issue * Washington Post (01.25.93), P. C1 Brennan, Christine Because of growing concern about the spread of HIV infection among the worldwide figure skating community, Craig McQueen, an orthopedic surgeon who is chairman of the U.S. Figure Skating Association (USFSA), came to the national championships to discuss the issue with skaters. Three world-class Canadian men's figure skaters have died of the disease in the last 14 months, including Rob McCall, the 1988 Olympic bronze medalist in ice dancing. John Curry, the 1976 men's Olympic gold medalist, has returned home to England, as is dying of the disease. Several publications said that Czechoslovakia's Ondrej Nepela, the 1972 Olympic gold medalist, died of AIDS. Although some prominent American skaters say their sport is unfairly singled out, McQueen is very concerned. "If the same thing that is happening in Canada in this sport happens in the United States, we could lose a whole generation of skaters, performers, coaches, and choreographers," he said. McQueen, who lost his brother to AIDS three years ago, went to Phoenix, Ariz., last Saturday to give a seminar on the disease. However, only 20 people came to hear him speak. Officials said that there were about 300 skaters at the national championships, and they all had been informed of the seminar. Among the 20 people who attended the discussion, not one was a skater, according to a spokesperson. McQueen said, "A lot of kids think they are infallible. All of the USFSA's leaders are concerned. I don't known how concerned the skaters are. That's what worries me." AIDS and Race * Washington Post (01.25.93), P. A16 The new groups at high risk of HIV infection need to be addressed by the government with compassion and support, and more realistic prevention programs should also be implemented, write the editors of the Washington Post. The new report by the National Commission on AIDS, "The Challenge of HIV/AIDS in Communities of Color," emphasizes that the disease is no longer an affliction found primarily in gay white men. African Americans and Hispanics, which comprise 21 percent of the American population, accounted for 46 percent of all AIDS cases as of last September. Of those who are HIV-positive but asymptomatic, the percentage of these groups is projected to be much higher. The report stresses that HIV is transmitted by individual behavior, but suggests that "social and economic factors have a powerful influence on how individuals behave." Information alone will not prevent the spread of HIV among IV- drug users and prostitutes. School-based AIDS education programs will be much less effective in communities where drop- out rates are high. Also, early treatment with new AIDS drugs will be delayed or even unavailable where patients are indigent and lack adequate medical care. Programs with immediate goals such as prevention must be designed for different racial groups at high risk. However, long-term efforts to cope with the social ills are also part of the solution. AIDS patients in the first decade of the epidemic were primarily well-educated, employed, insured, and highly motivated. A more aggressive government effort is needed to target the new high-risk groups, conclude the editors. Malone, Magic Clear Air * New York Times (01.25.93), P. C2 Basketball stars Karl Malone and Magic Johnson blame a lack of communication and the intrusion by the news media for reports in November that Malone prompted Johnson to retire. On Saturday, the two spoke for the first time since the incident. Johnson, who is infected with HIV, said that Malone's statements in an article in The New York Times on Nov. 1 about playing against an HIV-positive opponent did not compel him to retire. Johnson said, "I knew that Saturday, Oct. 31, I was going to retire. I called home and told my wife. Then that article came out Sunday. You get a player of Karl Malone's magnitude to say what he said and it's a big, big story." He added, "A small thing turned into a major thing. Probably more for Karl than for me because he had to keep going into all these cities and answer all the questions. That was too bad." FDA Approves Seragen's Application to Test IL-2... * Business Wire (01.21.93) (Hopkinton, MA) Seragen Inc., maker of receptor-targeted therapeutic products called Fusion Toxins, received FDA approval to begin clinical testing of DAB389IL-2, the new version of its Interleukin-2 (IL-2) receptor-targeted fusion toxin, in HIV-patients. Phase I/Phase II trials will be conducted at Beth Israel and Boston City hospitals. They will also experiment on the drug in Johns Hopkins University Hospital to determine the safety of DAB386IL-2 in HIV-infected individuals. Previous studies showed DAB386IL-2 to stop HIV-1 replication in infected human lymphocytes, the holding place of the virus. Viral replication was halted in laboratory strains of HIV-1. Unlike other drugs, DAB386IL-2 targets receptors, present on replicating cells, instead of the virus itself. Seragen's products may also be effective against other diseases. Currently, the company tests IL-2 on patients with rheumatoid arthritis, Type-1 diabetes and chemotherapy- resistant lymphomas. By 2000, Tokyo to Have 10,000 AIDS Carriers * Reuters (01.22.93) (Tokyo) Approximately 10,000 Tokyo residents--30 times the current official total--will become infected with HIV unless young adults become less promiscuous, according to a study released on Friday. The National Institute of Public Health conducted the study, which suggested that the Japanese government target promiscuity at home rather than attempt to stop citizens from contracting the virus abroad. The study said that if Tokyo residents in their twenties and thirties became less promiscuous, the number of AIDS carriers would increase only to about 2,000 by the year 2000. The Japanese anti-AIDS campaign, in the past, emphasized the dangers of infection overseas rather than at home. The study projected that about 1,500 people in Tokyo are currently infected with HIV. Official statistics by the health ministry report a total of 344 HIV- positive people in the capital. The simulation study concentrated on how heterosexual contact in the 20-30 age group could spread HIV in large cities, and they chose Tokyo as their model. The most recent government figures show that nationwide there were 508 AIDS patients with the full-blown disease and 2,456 HIV-positive people. Senior bureaucrats concede that these statistics account for only a fraction of the actual number because many cases remained unnoticed or go unreported. In the early 1980s, most of Japan's AIDS cases were among hemophiliacs who contracted the disease through tainted blood transfusions. But now, most infected people have contracted the disease through heterosexual contact. States Crack Down on HIV Transmission * Advocate (01.26.93) No. 621, P. 22 Akin, Scott R. Due to long sentences recently imposed on two HIV-positive men who knowingly placed their sexual partners at risk for transmission, legal experts are expecting an increase in similar prosecutions and are warning that people may be discouraged from being tested for the virus. Salvadore Gamberella, of Houma, La., was sentenced to ten years at hard labor Dec. 14 after he became the first person convicted under his state's five-year-old law against HIV transmission. The sentence came two weeks after Portland, Ore., resident Alberto Gonzalez was sentenced to 5.5 years in prison for attempted murder. Benjamin Schatz, executive director of the American Association of Physicians for Human Rights, a professional association, said the prosecutions "provide a disincentive for you to know your HIV status. If you don't known your status, you can do whatever the hell you want." However, Stephen Callahan, assistant district attorney, who in November obtained the conviction in Louisiana, said the prosecutions are justified because "there's a need to protect noninfected people." Lawrence Gostin, a professor of health law at Harvard University and the executive director of the American Society of Law, Medicine, and Ethics, said that nationwide, more than 300 HIV-positive people have been prosecuted under laws against HIV exposure. Some states, like Oregon, do not have specific laws against HIV transmission, but instead prosecute cases of HIV transmission under homicide and assault laws. Schatz said, "As long as society continues to focus on the person with HIV as opposed to encouraging others to protect themselves, the rapid spread of the epidemic will continue." Noticeboard: Immunotherapy for HIV Infection * Lancet (01.16.93) Vol. 341, No. 8838, P. 171 The National Institute of Allergy and Infectious Diseases will be conducting a pilot trial under the DATRI program that will treat HIV-positive patients with cultures of their own HIV- specific cytotoxic cells. The DATRI (Division of AIDS Treatment Research Initiative) was started in October 1991 as a means for rapidly conducting clinical trials of new therapies for HIV infection and HIV-related conditions. Those treatments found to be promising may then be considered for larger-scale trials by the Institute's other AIDS networks--the AIDS Clinical Trial Group (ACTG) and the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). About 15 to 24 patients with CD4 counts of 100-400 will be involved in the trial (DATRI 006), which is scheduled to be conducted at the New England Medical Center in Boston, Mass. Participants will receive 1 billion, 5 billion, or 25 billion cytotoxic T cells and be followed up for two weeks. Only one patient can be enrolled per month, so it could take up to two years for the trial to be completed. Condom Use and Sexual Identity Among Men Who Have Sex with Men--Dallas, 1991 * Morbidity and Mortality Weekly Report (01.15.93) Vol. 42, No. 1, P. 7 Men who have anal sex with men but do not consider themselves homosexual or bisexual are not practicing safe-sex behaviors to reduce their risk for HIV infection with the same rate as men who self-identify as homosexual or bisexual, according to a study by the Dallas County (Texas) Health Department (DCHD). The group conducted a study among men who have sex with men to determine the relation between the adoption of safer sex practices and sexual self-identity, as well as HIV information- seeking, exposure to the homosexual or bisexual community culture, and comfort in disclosing sexual identity. The subjects were only men who reported having had sex with men who visited DCHD clinics for anonymous HIV counseling and testing from January through June 1991. The survey found that the average score for the frequency of reported condom use for men who had anal sex with men and self-identified as homosexual or bisexual was significantly higher than for men who had anal sex with men and self-identified as straight. Those who reported never using condoms accounted for 64 percent for those self- identified as straight, but 16 percent for those self- identified as homosexual or bisexual. The average score for reported frequency of condom use for men who suggested that they often sought AIDS information in newspapers, brochures, or leaflets was drastically higher than for men who did not seek such information. Those men who reported comfort in revealing one's sexual status to family members also had a higher rate of condom use. Men indicating that they read materials dealing with homosexual issues used condoms more frequently than those who reported not reading such materials. Sex Adds to Fears of Parents of Retarded * New York Times (01.26.93), P. A1 Belkin, Lisa While topics of relationships and sexuality are difficult to address for any parent, they are even more so for the parents of the mentally and emotionally disabled. Doctors, therapists, and families did not even discuss sexuality and the mentally retarded for decades. But in recent years sexual expression has been viewed as a right. Many parents and programs began educating those who are capable of understanding about sex. Yet now in the age of AIDS, the ground is shifting again, as guardians are concerned about the newest risks of sex. Before parents can decide what to discuss with their child, they have to determine how much their child can understand. Betty Pendler, who leads sexuality workshops for parents of the mentally retarded, decided that her own daughter, who can travel on her own and manage the basics of daily life, could understand almost everything. She says her daughter, Lisa, knows all about AIDS prevention and birth control. But another mother said that her son, who has Down syndrome, barely comprehends the basics. The primary concern of most parents is that their children understand enough so they are not easy targets for abuse. According to Pendler, parents sometimes face the issue of homosexuality among retarded adults. She said it took many years for experts to determine that some mentally disabled people are capable of consenting to sex. It is still unclear what level of understanding is required to choose homosexual sex. Although there is no reason to believe that the level of homosexuality is high among the mentally retarded population, Pendler added, there is no reason to believe it is low either. AIDS Scams Con the Unwary * Washington Post (Health) (01.26.93), P. 9 Henry, Sarah Underground drugs taken to treat AIDS can often result in unwanted side effects, even though many AIDS patients feel desperate enough to try anything that might cure them of the disease. One case of drug fraud involved Jim Looney, an HIV- positive man from Los Angeles, who took Viroxan to treat his condition. He heard about the underground treatment and decided to start injecting the drug--a plant extract that his lawyer describes as having the consistency of refrigerated honey. His physician had subsequently convinced him to have a catheter surgically inserted into a vein in his chest so that the Viroxan could flow directly into his blood stream. Looney is one of as many as 100 HIV-positive patients who were convinced that Viroxan concocted in a doctor's home could keep them alive, even cure them of AIDS. He spent about $20,000 on the treatment, which he took for about nine months. Consequently, he developed lumps of dead tissue on his buttocks and hips from the painful Viroxan injections and potentially serious blood clots from the catheter. The drug also accumulated under his skin, causing his arms and fingers to swell. Looney, as well as eight other patients, has filed a civil lawsuit alleging medical negligence and malpractice, fraud, conspiracy, and emotional distress against the physicians, radiologist, pharmacist, and Los Angeles hospital where he had his surgery. The case emphasizes the difficult issue for the entire AIDS community. Many HIV-positive individuals are willing to try federally unapproved treatments, some of which seem effective for maintaining health, but find out too late that the treatments actually are useless. Mom With AIDS Seeks Precedent * Chicago Tribune (01.25.93), P. 1-7 Fegelman, Andrew A Chicago woman with AIDS wants a guardian appointed to care for her two young children only after she can no longer care for them. In addition, she wants to remain their only parent until that day arrives. The unnamed woman's attorney, Linda Rio, expects to test the limits of the Illinois probate law on Monday when she asks a Cook County judge to establish a new category of guardian. Rio said she will ask Judge George Cole to name the woman's sister as the children's guardian, but the girl's aunt would only take the role when their mother is not well enough to care for them. The request contradicts Illinois law, which often views guardianship as something immediate. Rio said that nothing happens with terminally ill parents, at least until the parent dies. In those cases, it can be more than a month before a guardian is named. Attorneys are calling the new concept stand-by guardianship, a policy they say is becoming necessary as more parents die of AIDS, leaving a growing number of children orphaned. According to advocates, a change in the law is not only needed because of AIDS cases, but for any terminal illness. The AIDS Legal Council of Chicago and Families' and Childrens' AIDS Network have filed legal papers supporting Rio's position. They also expect to request that state legislation similar to what has been approved in Florida, Michigan, and New York provide for the appointment of stand-by guardians. Susan Curry, legal director for the AIDS Legal Council, said, "This is a disease where the law has to bend, where the judges and the legislature have to institute more flexible procedures for those parents." Ramos Backs Condoms for Anti-AIDS Fight * Reuters (01.25.93) (Manila) Philippine President Fidel Ramos on Monday endorsed efforts to curb the spread of HIV infection by backing the use of condoms. He said that condom use was government policy as a means to "stop, deter, or minimize AIDS as a universal threat that could even affect very adversely the survival of mankind." His position could broaden the rift with the powerful Roman Catholic Church, which objects to the government's population policy and any form of artificial birth control. In the Philippines, more than 350 people are reported to be infected with HIV, but government officials say the actual number could be 10 times as high. AIDS Discoverer Plans New Group to Combat Disease * Reuters (01.24.93) (Paris) French AIDS researcher Luc Montagnier announced Sunday that he was helping establish a new organization to fight AIDS. Montagnier, who co-discovered HIV in 1983 along with U.S. researcher Robert Gallo, said he and UNESCO (the United Nations' science and education body) director-general Federico Mayor expect the group to research AIDS and run prevention programs. Montagnier said that the group would be formally announced next week. He added, "The project came up as a result of a meeting with the head of UNESCO." He said one objective of the group will be to examine areas of research that were neglected because they were "risky" and might not have produced any results. "There have been advances on the virus but not so much on the illness itself. There are still a lot of areas to be explored," said Montagnier, adding that these areas involved issues like the effects of the body's response to AIDS. In Le Monde newspaper, Montagnier wrote an article that reviewed 10 years of AIDS findings, and said that the outlook for stopping the disease was not very clear. "There are 10 million people infected, of whom the majority will die in the next 10 years, unless progress is made in treatment," he said. Moreover, he said AIDS could also be hiding a time-bomb in the form of infectious diseases such as tuberculosis, which was almost eradicated in the developed world but is in danger of reemerging. French Minister Urges Ex-Patients to Get AIDS Tests * Reuters (01.24.93) (Paris) French Health and Humanitarian Action Minister Bernard Kouchner encouraged all people who were operated on or received a blood transfusion in the last 10 to 15 years to undergo HIV and hepatitis testing. In France, more than 1,200 hemophiliacs were infected with HIV after receiving transfusions from contaminated blood stocks in the mid-1980s. Most of the hemophiliacs were infected with HIV before controls to screen and purify the blood products took effect in 1985. Last year, the government introduced legislation to streamline the country's system of blood donation, storage, and distribution in order to make the system completely safe. Kouchner said, "Other developed countries seem to deal with this plague better than us." He supports controlled distribution of needles--to prevent HIV infection through shared contaminated needles--and also medical use of methadone, a drug used to help IV-drug addicts break their habit. According to official estimates, of the 150,000 to 300,000 heroin addicts in France, 40 percent are HIV-positive. Miss America Presents Panel for National AIDS Quilt * United Press International (01.25.93) (San Francisco) Miss America Leanza Cornett on Monday offered a panel for the national AIDS quilt commemorating Florida women who have died from AIDS. Cornett, 21, of Jacksonville, Fla., presented the panel to Names Project, the organization which handles the famous quilt that honors AIDS patients. The panel featured a quote from Mother Teresa and listed names of several Florida women who died of the disease. Kimberly Bergalis, who asked Congress for more AIDS funding before dying in December 1991, was one of the women listed on the quilt section. Cornett has served as a volunteer for more than a year with the Hope and Help Center of Central Florida, which cares for AIDS patients. Cornett said she considers herself "an AIDS activist first, Miss America second." She hopes to have a career in theater and said that she has lost several actor-friends to the disease. Her outspokenness on the AIDS issue is a departure from Miss Americas of the past. However, she said the pageant is firmly standing behind her. Vaccine Trials to Begin * American Medical News (01.18.93) Vol. 36, No. 3, P. 19 Clinical trials are expected to begin this month to learn whether three genetically engineered HIV vaccines can be safely used by HIV-positive pregnant women to protect their developing babies from infection. The trials will be conducted by researchers from Connecticut and Yale Universities in Hartford, Conn. The first trial will consist of 24 HIV-positive women in their sixth month of pregnancy who will be given the gp160- class vaccine, manufactured by MicroGeneSys Inc. of Meriden. Five other trials across the country will test the safety of the vaccines in newborns and other children by the spring. Approximately 20-30 percent of all babies born to HIV-positive mothers develop HIV infection themselves. AIDS's Economic Toll is Staggering, Too * Business Week (01.25.93) No. 3302 Collingwood, Harris The worldwide economic impact of the AIDS epidemic could be as devastating as its toll on human lives. A recent study by DRI/McGraw-Hill predicts that by the year 2000, AIDS-related medical expenses and lost productivity throughout the world will escalate and cost as much as $500 billion annually. This would be equivalent to the size of Mexico's economy just disappearing. Africa and the Middle East will feel the hardest impact from AIDS, which could depress their gross domestic product (GDP) by more than 4 percent by the next century. In addition, Asia, aside from Japan, could lose as much as 3 percent of national output. While Japan has a low rate of HIV infection, it could be affected by depressed exports to North America and the rest of Asia, where the epidemic is more prevalent. According to DRI, the Japanese economy will lose about 1 percent GDP--about as much as the U.S. Business Briefs: 91 AIDS Drugs Now in Testing * American Medical News (01.11.93) Vol. 36, No. 2, P. 14 The Food and Drug Administration approved three new AIDS drugs during 1992 and another 11 await approval, reports a survey by the Pharmaceutical Manufacturers Association. Among 91 AIDS treatments and vaccines in development, 50 involve women and 13 involve children in clinical trials. A total of 17 AIDS drugs had been approved as of December 1992. Japan Plans Gene Therapy Research for AIDS * Reuters (01.26.93) (Tokyo) Japan will launch a long-term research effort into gene therapy as part of its anti-AIDS campaign, according to a health ministry official. Shigeki Shiiba of the ministry's health science division said the group will allot 150 million yen ($1.2 million) this year to begin basic research on gene therapy. "Gene therapy is a highly promising area ... but it will take a long time, say more than 10 years, before it becomes practical," said Shiiba. The therapy is a controlled experimental treatment which involves the introduction of new genes into the body to correct an inherited or acquired condition. In a separate announcement, the ministry's AIDS Surveillance Committee said Tuesday that Japan reported 10 newly diagnosed AIDS cases and 59 new HIV-positive individuals in the November-December period. The committee said that Japan's reported cases of full-blown AIDS totaled 543, in addition to 2,551 people infected with HIV during the period that ended on Dec. 31, 1992. Japan's cumulative death toll from AIDS is 298. Among the 69 new cases diagnosed in November- December, more than 40 were women from Southeast Asia working in the entertainment industry, said a committee spokesman. Previously, most Japanese viewed AIDS as a disease that primarily affected foreigners, especially homosexuals and IV- drug users. Now, most of the Japanese that contract HIV do so through heterosexual contact. BRF--AIDS-Watches * Associated Press (01.25.93) Washington--AIDS activists gave members of Congress broken wristwatches on Monday to signify that time is running out for aggressive action against the disease. A letter delivered to the 540 members of Congress by ACT-UP said, "For the past 12 years, Congress has collaborated with the Reagan-Bush administrations in their criminal neglect of the AIDS crisis." In addition to the letter, about two dozen ACT-UP members who had driven from New York delivered broken wristwatches to the congressional offices. The organization is requesting that Congress form a "Manhattan Project" for AIDS research and spend another $500 million for prevention and education, said Scott Sawyer, an ACT-UP spokesman. Iran Says 219 Infected With HIV, 45 Died of AIDS * Reuters (01.25.93) (Nicosia) Iran revealed Monday that there have been 219 reported cases of HIV infection, and 45 AIDS patients have already died of the disease. The Iranian news agency (IRNA) cited an official from an anti-AIDS group who told a seminar in Tehran that if the Iranians were not educated about the risks of the disease, the "problem would be much greater in the future." Deputy Health Minister Saeed Namaki said in December that 42 people had already died of AIDS, and 169 others had the disease. The official said, "Restricting sex to its religiously established forms would offer the surest way for harnessing the epidemic in Iran." Previously, Iranian officials said AIDS was not a severe problem in the country, which has a population of 60 million people. Clerical leaders said Islamic ethics helped control the spread of HIV in Iran. In December, Iran said it was introducing mandatory HIV testing for foreigners wishing to stay in the Islamic republic for more than three months. HemaCare Begins Construction of Plasma ... * HealthWire (01.25.93) (Los Angeles, CA) HemaCare Corp. announced Monday that it has taken a significant step in furthering its efforts to develop a series of hyperimmune, gamma globulin, pharmaceutical products to treat AIDS and other conditions. The company has leased a building in Valencia, Calif., which will house a plasma fractionation facility. The first application of the facility will be to transform the human plasma being used in the company's Passive Hyperimmune Therapy (PHT) AIDS therapeutic research project into intravenous gamma globulin or antibody concentrate. Dr. Joshua Levy, HemaCare's medical director and principal investigator of its PHT clinical research, said, "The construction of the fractionation facility is a major step in HemaCare's development of a safe and effective AIDS therapy. The gamma globulin concentrate obtained by fractionation will have greater drug purity and stability and be more widely accepted by the medical community than the current whole plasma product." He added, "We expect that the pilot plasma fractionation facility will be completed in six months and that intravenous gamma globulin may be produced by the end of 1993. By utilizing self-contained, modular, independent, manufacturing units, other plasma products in addition to the initial HIV antibody plasma product may be produced in this facility." Israel-AIDS * Associated Press (01.26.93) (Jerusalem) The Israeli government will require immigrants from Western nations and all foreign workers to be tested for HIV before entering Israel, the Health Ministry announced Tuesday. A ministry statement indicated that HIV-positive immigrants would have their cases reviewed but did not say whether they would be rejected. The new policy, developed by the health and interior ministers, will be instituted Monday. Critics claim that the mandatory tests are unfair because they single out groups from certain countries when Israel is supposed to be a haven for all Jews around the world. However, Yehuda Weinraub, a spokesman for the Jewish agency that deals with immigration, said the country's policy of citizenship to Jews can exclude those who are a threat to public health. The statement by the ministry did not list the countries included in the category "Western nations." It said immigrants from the former Soviet Union and developing countries, in addition to tourists, foreign embassy staff, and journalists, are exempt from the mandatory tests. Those individuals account for most of Israel's immigrants. Since 1989, more than 400,000 Jews have come from the former Soviet Union, and about 50,000 have come from Ethiopia since the mid-1980s. Weinraub said about 1,500 Jews a year immigrate from France and England, but did not have any figures for other Western European nations. Ira Cohen, a spokesman for the Association for Americans and Canadians in Israel, said about 3,000 immigrants come to Israel from North America every year. Ohio Officials Fear TB Increase * United Press International (01.26.93) (Cleveland, OH) Ohio health officials are monitoring a nationwide rise in tuberculosis cases and believe the state might be on the brink of a similar increase. For the third consecutive year, Ohio has reported a constant rate of TB cases. There were 378 identified TB cases in Ohio during 1991, the most recent statistics available. Dr. Frits van der Kuyp, director of the Cuyahoga County tuberculosis control service at MetroHealth Medical Center in Cleveland, said that Ohio doctors may also be increasingly confronted with multi-drug-resistant TB. Eight cases of drug-resistant TB transpired statewide in 1991. However, state public health officials said the number could be higher because only half of the total tuberculosis cases were examined for resistance. As many as 500,000 Ohioans may be infected with TB bacteria, but for most, the disease remains dormant. Dr. George Hurst, assistant chief of the Ohio Department of Health's division of preventive medicine, said, "There is a direct link to declining resources and increases in TB cases. In Ohio, we have the opportunity to avoid the epidemic increase the others are experiencing." Ohio uses a $350,000 federal grant for TB tracking, education, and for four nurse outreach workers who manage all the TB patients and guarantee that those patients take their medications, said Hurst. However, he projects that it will cost as much as $1.5 million to attack Ohio's TB problem. Senate Committee Approves Family Leave, NIH Reauthorization * United Press International (01.27.93) (Washington, DC) The Senate Labor and Human Resources Committee has approved the National Institutes of Health reauthorization bill. The legislation was vetoed by former President Bush because it allowed the use of fetal tissue in medical research. But President Clinton, by executive order, has already approved the use of fetal tissue for such research. The bill supports women's health research, funds cancer and heart research, provides support for fighting AIDS, and guarantees freedom of medical research. Data, Doubts Emerge From D.C. TB Tests * Washington Post (01.26.93), P. D1 Goldstein, Amy One homeless resident out of four in Washington, D.C., is believed to have been exposed to tuberculosis, according to District health officials. However, advocates for the homeless claim that the aggressive testing of more than 1,200 residents at homeless shelters does not accurately portray the dimensions of the public health threat. D.C. Public Health Commissioner Mohammad Akhter said that two weeks after the campaign began, which is the first systematic attempt by any large American city to detect and treat TB among the homeless, only half of the 248 people who have tested positive for exposure to the disease have gotten the chest X-rays necessary to confirm whether they have active cases. Operators of the 15 shelters and other advocates for the homeless said they are unsure how the city expects to track down those exposed people, or how it plans to find more than 200 other homeless people who were given TB skin tests but never returned to a shelter to learn the results. Akhter conceded that the health-care workers, in planning the effort, had not been sensitive enough to clients. They failed to plan ahead for some people who would be afraid-- and refuse--to board vans to get X-rays at hospitals. City health officials plan to reach as many as 5,000 men and women in all 43 shelters. New statistics show that 25 percent of the 983 shelter residents whose test results have been read so far are infected with TB. Among those who tested positive, 129 have gotten X-rays, which show only three men have active cases and thus are contagious. Janelle Goetcheus, medical director of Health Care for the Homeless, a nonprofit group, said that the low infection rate reported may reflect problems in the tests. AIDS Czar Issue: Report to President or Report to HHS? * AIDS Treatment News (01.15.93) No. 167, P. 6 ACT-UP/New York started a letter writing effort after reports revealed that Donna Shalala, the new Secretary of Health and Human Services (HHS) wants the new "AIDS czar" promised by Clinton to report to her, rather than directly to the president. Many believe that such a position should report directly to the president because there are many facets involved in the AIDS epidemic other than just those of the HHS. A quote from the ACT-UP/New York letter read, "The rationale for the position requires the immediate attention and direct access to the president, with special powers to coordinate, across all governmental agencies and branches, the federal government's response to AIDS. It also requires the full commitment of the president to use his office as a 'bully pulpit,' to ensure a timely response to AIDS." United for AIDS Action has also joined the campaign to have an AIDS czar in the Clinton administration. National Institutes of Health: Top AIDS Official to Leave * Science (01.15.93) Vol. 259, No. 5093, P. 303 Cohen, Jon Daniel Hoth, head of the AIDS unit at the National Institutes of Health (NIH), has announced that he will soon resign after serving 5 years with the unit. Hoth told his staff and superiors at the Division of AIDS (DAIDS), a branch of the National Institute of Allergy and Infectious Diseases (NIAID), that he feels he has achieved what he set out to do at NIH. Hoth, an oncologist, came to DAIDS from the National Cancer Institute in 1987. Since his arrival, the DAIDS staff has increased from 24 to 135 and the budget has tripled to $325 million. Moreover, Hoth's unit monitors more than 35 percent of the entire NIH AIDS budget. Many fellow researchers commend Hoth for expanding the AIDS Clinical Trials Group (ACTG), a nationwide network of researchers who test new treatments. Hoth has also held a primary role in the decision to enhance the NIH's AIDS vaccine effort, both in the United States and abroad. However, Hoth has been widely criticized by AIDS activists. They say he allowed the ACTG to concentrate too much attention on AZT while ignoring other encouraging treatments. Activists have also accused DAIDS of footdragging, of not involving women and children in trials, and of ignoring the regions hardest hit by the epidemic. Derek Hodel of the Washington-based AIDS Action Council said, "Hoth presided over a tremendous and very painful growth period in DAIDS. Now we have the chance to solidify and address the problems with the organization we've identified." Dinkins Promises to Maintain AIDS Services Level * New York Times (01.28.93), P. B3 Belkin, Lisa New York City Mayor David N. Dinkins' administration announced yesterday that it would continue to provide its various services for AIDS patients, as a new federal definition of the disease qualifies more people for assistance. City officials said they would earmark $38 million over the next two years to make services available, including rental assistance, nutritional assistance, and child placement for people who are defined as having AIDS. Officials added that if that is not enough, the administration will allocate more funds. The Mayor's proposal, which is expected to be issued tomorrow, will be part of New York City's four-year financial plan. On Jan. 1, the Centers for Disease Control implemented the new definition that doubles the number of people classified as having AIDS. This raised the question of whether the city would maintain the same level of services to a much larger group of people. The Mayor's proposal is expected to be the solution. BarbaraJTurk, deputy director of the city's Office of Management and Budget, said the $38-million figure was based on an estimate by her office that the demand for AIDS services would jump 30 percent, to 17,622 from 13,555, as a result of the new definition. Turk said the proposal would add $8.7 million to the 1993 budget of the Human Resources Administration, which would otherwise have $124.3 million. She added that the proposal would provide an additional $28.8 million to the agency's 1994 budget, which would otherwise be $162.1 million. The rest of the money will be given to the Department of Health. Small Town Offers Disturbing Look at Future of the AIDS War * Los Angeles Times--Washington Edition (01.28.93), P. A5 Clary, Mike A small town in Florida with a predominantly black population has been designated "the AIDS capital of the world" because of the prevalence of HIV infection among heterosexuals. In the last ten years, 381 AIDS deaths have been reported in Belle Glade, Fla.--a rate four to five times the national average. The town is home to migrant workers and is located southeast of Lake Okeechobee. Since AIDS was first identified in the early 1980s, no town has been more researched, no population more examined, questioned and tested than that of Belle Glade, where 52 percent of the 17,000 year-round residents are black and 12 percent are Latino. AIDS is believed to have emerged in Belle Glade early, in the late 1970s, possibly with the migrant stream of farm workers. By the time the disease was detected in the town, it had become an epidemic spread by prostitutes, IV- drug users, and apathetic sexual attitudes. Researchers discovered in 1985 an infection rate of 1.85 per 1,000 people, which is higher than in New York City or San Francisco. But the main population that was infected in Belle Glade was among heterosexuals, not homosexual men or IV-drug users like everywhere else. Tedd V. Ellerbrock, an epidemiologist with the Centers for Disease Control, said there is anecdotal evidence that several towns in Florida and throughout the South may have similar rates of HIV infection. Still, no town has suffered more from the stigma of AIDS than Belle Glade. Some southern Florida high schools even refused to play Belle Glade in football for fear of contracting HIV. Israel Will Not Demand Foreigners Pass AIDS Tests * Reuters (01.27.93) (Jerusalem) A ruling which would have mandated that foreigners who visit Israel for more than three months undergo HIV testing has been reversed by the country, an interior ministry spokeswoman said Wednesday. The ruling, which was to be enacted this month, spurred controversy in Israel when it was announced in November. The rule would have required foreigners who wanted to stay more than three months and who tested positive for HIV to be forced to return home. The spokeswoman said the interior, health, and immigration ministers had decided not to mandate HIV testing of tourists who want to stay longer. She said, "Foreign visitors can stay on freely--the announcements of changes in regulations are now invalid." Previously, Israeli physicians, parliamentarians, and AIDS activists argued against the rule, claiming it was discriminatory and ineffective. In addition to the reversal, the spokeswoman said, the ministers rejected a proposal that would have forced new immigrants to undergo HIV testing. Israeli law prohibits HIV-positive immigrants from entering the country, but none have been expelled despite reports that Ethiopian newcomers were infected with HIV. Between 1985 and October of 1992, the health ministry reported 195 AIDS cases among an Israeli population of 5 million. Among those AIDS patients, 138 died and 14 left the country. An additional 963 Israelis have tested positive for HIV. Philippines--AIDS * Associated Press (01.27.93) (Manila, Philippines) The first Protestant Philippine president is challenging the powerful Roman Catholic Church hierarchy by supporting his health secretary's policy of distributing condoms to thwart the spread of HIV infection. In the May 1992 presidential election, the church hierarchy generally opposed Fidel Ramos, and has opposed the condom policy of Health Secretary Juan Flavier. Approximately 85 percent of the 62 million Filipinos are Catholic. On Monday, Ramos said, "This is government policy and it has already been announced in connection with the universal clamor for the control of AIDS as a universal threat. I don't think there is any question about that." The Catholic Bishops Conference of the Philippines argues in a pastoral letter to be read in churches Feb. 7 that government promotion of "safe sex" is "tantamount to condoning promiscuity and sexual permissiveness and to fostering indifference to the moral demand as long as negative social and pathological consequences can be avoided." Still, prostitution is prevalent in virtually every city in the country. The Department of Health states that 362 Filipinos have been found to either have AIDS or HIV infection. However, AIDS testing is not widespread in the Philippines, and the department estimates that only one out of every 100 AIDS patients or HIV-positive patients have been identified. While condoms are openly sold in pharmacies, critics oppose the government funding their distribution. Several congressmen requested Flavier's resignation last month after he distributed condoms to reporters before Ramos' visit to Thailand. In Delco, a Lesson in Compassion * Philadelphia Inquirer (01.28.93), P. B1 McCullough, Marie and Janco, Mary Anne An interview in McCall's magazine about a boy's fight with AIDS might have provoked ostracism from the Delaware County, Pa., community, but fortunately, residents were supportive. Diane McCullough spoke with the magazine weeks ago and disclosed her son Kyle Cocco's AIDS-related condition. But when the news finally reached the community yesterday, people responded to McCullough's courage with concern and compassion. "I expected more negative feedback from people who don't know me," said McCullough, who is also HIV-positive. On Tuesday, Parkside Elementary School, where Kyle is in third grade, arranged a parent's meeting with McCullough and educators from the Delaware County AIDS Network in Pennsylvania. While Parkside principal Fred Passante learned about Kyle's condition a year ago, he was bound by state law to keep it confidential. At the meeting, questions and concerns were raised, but the reaction was nothing like what has transpired in other schools and other areas. Lisa Cosentino, the AIDS Network educator, said, "There was a lot of warmth for the child we were discussing. Parents were concerned about how to explain AIDS to their own children- -how could they explain the illness and death and loss." Maggie Lyman, president of the Parkside Parent-Teacher League, said Kyle's classmates "want to know what they can do for him." Passante had already educated his staff about AIDS and ensured that they practice universal safety precautions. The school's 228 students will receive additional AIDS education. Also, the district has provided a thick packet of information to help parents discuss the disease with their children. School Chief, Now Dead, Is Accused of Stealing * New York Times (01.28.93), P. B1 Raab, Selwyn Federal prosecutors yesterday alleged that Alfredo Matthew Jr., a deceased superintendent of a Bronx school district, was the leader of an embezzlement and money-laundering scheme that victimized a pair of anti-poverty agencies designed to assist impoverished elderly people, homeless people infected with HIV, and indigent parents in need of day care. The prosecutors claim Matthew and his associates diverted $185,000 in federal and municipal funds from Hispanic Social Services Inc. and the Puerto Rican Home Attendant Services Program and used the money on such personal items as meals at restaurants, airline flights, home furnishings, clothing, toys, and tickets to New York Yankees baseball games. Matthew apparently killed himself in an Albany, N.Y., hotel earlier this month. Authorities have charged three of his coworkers in the embezzlement scam. AIDS Costs--One More Reason for Health Reform * American Medical News (01.11.93) Vol. 36, No. 2, P. 3 Culhane, Charles Although the 1992 estimate of the national cost of treating HIV was $10.3 billion, it will increase to more than $15.2 billion by 1995, which is about a 50 percent jump, according to a federal health official. Dr. Fred Hellinger, an official of the Agency for Health Care Policy and Research, said, "Available information indicates that both the average cost of treating a person with AIDS and the average cost of treating an individual with HIV without AIDS are higher than recent studies calculated." Hellinger testified at a hearing before the Senate Finance Committee's subcommittee on health for families and the uninsured. Sen. Don Riegle (D-Mich.) said that approximately 29 percent of AIDS patients in the United States are uninsured, while about 40 percent of AIDS patients are covered through Medicaid, now the primary payer for medical services related to AIDS. In addition, Medicaid provides health care for about 90 percent of the children with AIDS. Dr. Hellinger projected that the average annual cost of treating an AIDS patient is $38,300, and the cost for a person with HIV is $10,000. The average lifetime cost of care for an AIDS patient is $102,000--about twice that of a breast cancer patient, and five times that for a patient with lung cancer. Hellinger said that his predictions only refer to the cost of medical services such as hospitals, physicians, drugs, nursing homes, and home health care. He did not calculate what the expense would be for the use of nonmedical support services like testing, education, counseling, and the indirect costs of lost productivity. Projections of the Number of Persons Diagnosed With AIDS and the Number of Immunosuppressed HIV-Infected Persons-- United States, 1992-1994 * Morbidity and Mortality Weekly Report (01.15.93) Vol. 42, No. 1, P. 17 The Centers for Disease Control recently issued new predictions of the number of Americans who will initially be diagnosed with an AIDS-related condition under the 1987 AIDS surveillance case definition between 1992-94. The report also gives projections of the number of HIV-positive persons with T-cell counts under 200, in addition to estimates on the effect of adding this measure of immunosuppression to the 1993 expanded AIDS surveillance case definition. About 58,000 persons in the United States had AIDS as diagnosed by the 1987 definition during 1991. Between 1992-94, the number of persons who have illnesses meeting these criteria is expected to increase by a few percent annually, with about 85 percent of those people being reported to the CDC with cases of AIDS. The rate of increase in reported AIDS cases in persons who contracted HIV through heterosexual contact is expected to be greater than that in persons who contracted HIV through IV-drug use or male homosexual/bisexual activity. The CDC predicts that an additional 120,000-190,000 Americans had HIV-related severe immunosuppression as of January 1993. If the AIDS definition was not changed, about 50,000-60,000 reported AIDS cases would have been expected in 1993. The expansion of the AIDS surveillance case definition to include HIV-related severe immunosuppression should increase reported cases by about 75 percent. Also, the number of AIDS cases reported in 1994 is still expected to exceed by 10-20 percent the number that would have been reported if the 1987 definition had remained in effect. Ill--But Willing to Work * U.S. News + World Report (01.25.93) Vol. 114, No. 3, P. 71 Saltzman, Amy Discrimination against ill employees, such as AIDS patients, has decreased as a result of the Americans with Disabilities Act and more corporate AIDS awareness. Nevertheless, ill workers who hope to keep their jobs and even climb the corporate ladder can expect to encounter resistance from employers concerned about productivity. Some well-meaning employers admit that they consider many of the working ill as temporaries. Obtaining the support of co-workers is crucial, since ill employees must be realistic about the workload they can handle but demonstrate that they are effective workers. Fritz Rumpel, director of information services for Mainstream Inc., a training firm in Dallas and Bethesda, Md., that helps employers accommodate sick and disabled workers, recommends that employees who are uncomfortable with addressing their illness directly with co-workers should request that the company bring in a counselor from a local support group or association to discuss the disease. In the United States there are 20,800 people in the workforce with AIDS, and 44,800 with HIV infection. In addition, two thirds of large companies and 1 in 12 small companies have knowingly employed a worker with AIDS or HIV infection. Although it is commendable that many ill employees work harder to prove that they can still do the job, it will likely backfire if the illness progresses and work begins to slide. One way to accommodate an ill employee would be to trade daily responsibilities for special projects with flexible schedules that can prevent conflicts with colleagues. Another option would be to switch to a job where there is less reliance on coworkers. RISE-Resistant Tuberculosis Meningitis in AIDS Patient * Lancet (01.16.93) Vol. 341, No. 8838, P. 177 Horn, David L. et al. The optimum therapy to treat RISE-resistant tuberculosis meningitis in AIDS patients remains to be found, write David L. Horn et al. of the Lincoln Medical and Mental Health Center in the Bronx, N.Y. TB meningitis is rare, although HIV-positive patients from endemic areas for TB are frequently reported to have meningeal involvement with appreciable mortality. Seldom are drug-resistant strains of Mycobacterium tuberculosis detected in cerebrospinal fluid cultures. RISE-resistant TB, a subset with exceptionally broad resistance, is defined as resistance to at least rifampin, isoniazid, ethambutol, and streptomycin. An HIV-positive man with a gunshot wound to the abdomen was presented in July 1992 with high temperature, night sweats, weight loss, weakness, occipital headache, and confusion. His white cell count was 500. Chest radiography showed left apical pleural thickening and a bullet in the abdomen. Intravenous acyclovir, ampicillin, and cefotazime, and oral isoniazid, rifampin, pyrazinamide, ethambutol, and pyridoxine were administered. On the third day, the patient had shallow respirations, anisocoria, absent corneal reflex, spasticity of the left side with hemiplegia, hyperreflexia, clonus, and bilateral Babinski signs. Although there were aggressive supportive measures, the patient died on day 9. Postmortem cerebrospinal fluid culture grew M. TB that was resistant to isoniazid, rifampin, ethambutol, streptomycin, ethionamide, and kanamycin, and susceptible to capreomycin, cycloserine, and ciprofloxacin. Because RISE-resistance was not detected until after death, it hindered effective therapy, conclude the researchers. After Magic Johnson's Disclosure, Risky Sex Dropped, Study Finds * New York Times (01.29.93), P. A16 Once basketball star Magic Johnson revealed his HIV-positive status, fewer people in a Maryland clinic reported having one- time sexual encounters and multiple sexual partners, according to a study by the Centers for Disease Control released yesterday. The study was the first to examine reaction to a celebrity's disclosure about being infected with HIV that did not exude a bias that could affect the findings, said the CDC. The agency surveyed 283 people at a sexually transmitted disease clinic in Montgomery County, Md., from July 29, 1991, through Feb. 14, 1992, about high-risk sexual activity. The CDC asked how often in the last three months each person had a one- time sexual encounter or had three or more sexual partners. In addition, the CDC asked how often the subjects used condoms. Magic Johnson disclosed that he was infected with HIV and would retire as a player with the Los Angeles Lakers on Nov. 7, 1991. By that time, more than half of the participants had been surveyed. Among the 186 individuals surveyed before the disclosure, 31 percent reported having one-time sexual encounters in the previous three months and 32 percent reported three or more sexual partners, said the CDC. Following the revelation, 20 percent of the 97 people surveyed reported one- time sexual encounters and 21 percent reported three or more partners. The remaining 24 people in the study were the only ones who were surveyed a full three months after Johnson's announcement, and they had the largest decline in high-risk sexual behavior. Related Story: Baltimore Sun (01.29) P. 2B Clinton Talk is Urged * New York Times (01.29.93), P. A16 The National Commission on AIDS has requested that President Clinton address the American public about AIDS. In addition, the commission also urged him to boost research spending on the disease and lift the immigration ban on HIV-positive foreigners. The 15-member commission issued a letter yesterday that it had sent the President, encouraging him to follow through with his campaign vow to "discuss the AIDS crisis with the American people" early and frequently and to appoint a White House-level AIDS coordinator. The letter said, "Americans have heard almost no discussion of AIDS by our Presidents during the first 12 years of the AIDS epidemic." It also said that although the consequences of the epidemic are devastating, the country still lacked a comprehensive plan to combat the disease. The commission also advised the president to instruct Secretary of Health and Human Services DonnaJE. Shalala to create "a national strategic plan to confront the epidemic," including candid prevention programs that deal with sex and drugs. The group asked Clinton to provide full funding for the Ryan White CARE Act, which is targeted at cities that have been hit hardest by the epidemic. The current allocation of $348 million is less than half the amount Congress approved. Lifting the restrictions on HIV-positive people was another commission request. It said the government should stop compelling military recruits, Peace Corps applicants, and others to undergo HIV testing. The group also suggested providing immediate treatment for drug addicts who seek aid. Despite its requests, the commission is expected to be discontinued in September. Private AIDS Foundation is Sponsored by UNESCO * Wall Street Journal (01.29.93), P. B2B HIV discoverer Luc Montagnier and United Nations Education, Scientific, and Cultural Organization (UNESCO) chief Federico Mayor have established a private foundation to hasten AIDS research and care for AIDS patients and their families. Montagnier, who discovered the virus in 1984, said, "We can no longer depend on governments and international organizations." The World Health Organization predicts that 13 million people are infected with HIV worldwide. The foundation, co-sponsored by UNESCO, will establish medical facilities in Europe, North America, and Africa to use findings from laboratory research in clinical research. Montagnier said the foundation would have close relations with AIDS research centers in France and the United States, in addition to international organizations like the U.N. Development Program and the WHO. French Health Minister Bernard Kouchner revealed that the first pilot center will open in Paris later this year, but would not say when. He said the foundation would open a facility in Abidjan, Ivory Coast, to treat and research Africans' immunological systems and make scholarships available for African children orphaned by AIDS. The foundation, which has been in the developmental phase for several years, has already acquired $500,000 in grants. Related Story: New York Times (01.29) P. B4 CDC-HIV Count * Associated Press (01.28.93) Neergaard, Lauran (Decatur, GA) Because the Centers for Disease Control is contemplating implementing a means of reporting HIV cases by name, AIDS experts warned that HIV-positive Americans may not trust the government enough to reveal their names. Jeffrey Levi of the AIDS Action Council said to the CDC, "When do they hear the CDC is interested in them? When they want their names. They have to feel they're going to get something back in return." On Wednesday, the CDC convened a meeting of AIDS experts in suburban Atlanta to help it establish guidelines to determine exactly how many Americans are infected with HIV. The agency is considering whether to advise states to report HIV cases by identifying patients, either by name or special code. This type of reporting would guarantee that patients aren't counted twice and would enable physicians to give them appropriate care, said the CDC. State health departments have collected the names of patients with full-blown AIDS and forwarded that number to the CDC since the beginning of the epidemic. Only 24 states count by name the people who test HIV-positive but do not yet have AIDS, so there is no real data on HIV cases. Since many people fear that their confidentiality may be violated, they might avoid identified testing altogether, said Levi. He urged the CDC to push for a federal confidentiality law that would be more forceful than CDC regulations or state laws. Dr. James Curran, the CDC's associate AIDS director, admitted that the CDC's image has been tarnished by the Bush and Reagan administration policy against expanding AIDS services. But he said the CDC could improve its work with better knowledge of the prevalence of HIV infection. AIDS a Minefield, Woman Tells Hearing * Toronto Globe and Mail (01.28.93), P. A6 Downey, Donn A Canadian woman spoke of her plight with AIDS in Toronto Wednesday at a hearing held to determine the penalty on her family's former doctor, who did not tell the woman's husband he might have received an HIV-tainted blood transfusion during his heart surgery in 1984. Consequently, Rochelle Pittman's husband, Kenneth, contracted HIV and infected her as well. Kenneth Pittman died of AIDS in March 1990 at the age of 59, still unaware that he was infected. That following September Rochelle discovered that he infected her with HIV. She said that it is impossible to live a normal life when a person's immune system has to be assessed every three months. She admitted that she is neurotic and depressed. Dr. Stanley Bain, the former president of the College of Physicians and Surgeons, was found guilty of two counts of professional misconduct. In November, he testified that he thought it was best not to tell Pittman of his condition because he thought the man would be devastated by the news. However, Rochelle said, "He was a fighter," adding that suicide would not have been an option. If he knew earlier of his AIDS-related condition, her husband could have lived longer, said Rochelle, and would have been able to spend more time with their four children to prepare them for his death. Rochelle Pittman is suing Dr. Bain, the Canadian Red Cross, and Toronto Hospital for $2 million. The disciplinary committee of the College of Physicians and Surgeons of Ontario could reprimand Dr. Bain, suspend him, or revoke his license to practice medicine. It reserved its decision Wednesday on Bain's penalty. Massachusetts Launches Gay Teen Health Campaign * United Press International (01.28.93) (Boston, MA) A Massachusetts commission on gay youth announced a new state-operated public health effort targeted at homosexual teenagers. The program is the first of its kind in the nation. The Governor's Commission on Gay and Lesbian Youth, formed by Republican Gov. William Weld last February, said homosexual teenagers will be paid about $6 an hour to advise other teenagers on gay health issues. Commission Chairman David LaFontaine said the campaign will concentrate mostly on AIDS, suicide by gay youths, and alcoholism. LaFontaine said, "This is the first time that any governor has used the resources of the state government to reach out to gay and lesbian youth." He added, "Governor Weld deserves a lot of credit, especially as a Republican, for putting forth these kinds of programs." About $200,000 was allotted last year to provide training and education of the gay teens who will lecture on health issues, said LaFontaine. Homosexual teenagers throughout the state attended public hearings in November to learn how they could join the program. The sessions will occur at community-based health centers across the state, with the aid of the state Department of Public Health. LaFontaine mentioned that he has met with officials in Rhode Island and Connecticut, who are pushing for similar programs in their own areas, and he said he hopes other states will follow their examples. Selected Behaviors That Increase Risk for HIV Infection, Other Sexually Transmitted Diseases, and Unintended Pregnancy Among High School Students-- United States, 1991 * Journal of the American Medical Association (01.20.93) Vol. 269, No. 3, P. 329 The rates of sexual activity among adolescents in the United States has increased since 1970 along with the rate of sexually transmitted diseases, including HIV infection. A national survey was conducted by the Centers for Disease Control's Youth Risk Behavior Surveillance System. It obtained a sample of 12,272 students representative of students in grades 9-12 in the 50 states and the District of Columbia. Among the students participating in the state and local surveys, 33-79 percent reported ever having had sexual intercourse (median: 55 percent; national prevalence: 54 percent); 54-78 percent reported being currently sexually active (median: 70 percent; national prevalence: 69 percent); and 8-46 percent (median: 20 percent; the national prevalence: 19 percent) reported having had sexual intercourse with four or more partners during their lifetime. In 27 of 28 sites, male students were more inclined than female students to report ever having had sexual intercourse and having had four or more sex partners during their lifetime. But in 26 of 28 sites, female students were more likely than male students to report being currently sexually active. The percentage of students who reported IV- drug use ranged from 1-4 percent (median: 2 percent; national prevalence: 2 percent). And 5 percent or less of male and female students reported IV-drug use in all sites. Of the students participating in the state and local surveys who reported current sexual activity, 58-87 percent (median 77 percent; national prevalence: 82 percent) reported they or their partner used contraception, including condom use. Sclerotherapy for the Treatment of Nodular Intraoral Kaposi's Sarcoma in Patients with AIDS * New England Journal of Medicine (01.21.93) Vol. 328, No. 3, P. 210 Muzyka, Brian C. and Glick, Michael Intraoral injection with sodium tetradecyl sulfate is a rapidly effective and well-tolerated treatment for nodular intraoral Kaposi's sarcoma (KS) and should be considered an alternative regimen for these lesions, write Brian C. Muzyka and Michael Glick of Temple University School of Dentistry in Philadelphia, Pa. Kaposi's sarcoma frequently presents as a cutaneous lesion, but intraoral lesions are the initial manifestation in 20 percent of AIDS patients. Treatment of intraoral KS is necessary to reduce the size and the number of lesions. Radiation therapy is most common, but it may induce severe mucositis. Due to the vascular nature of these lesions, sclerosing solutions may be either an appropriate primary treatment or an adjunctive treatment to reduce the size of the lesions before radio-therapy. The researchers used intralesional injections of 3 percent sodium tetradecyl sulfate to treat 12 AIDS patients who had 14 clinically or histologically confirmed intraoral lesions of KS; 4 of the patients also had cutaneous lesions. Because of the potential for injection necrosis, no more than two intraoral lesions were treated at one time in any patient. The treated lesions, which ranged in size from 4-15 mm, changed color from purple to black immediately after the injections, but no associated pain or other side effects were reported. The injections were repeated in three days if the lesions had not decreased in size. Overall, their size decreased by an average of 80 percent within 14 to 21 days, and the lesions disappeared in four patients. No additional clinical progression of the lesions was found in the follow-up evaluation of all patients 24 weeks after treatment, the researchers conclude. A Global Agenda for AIDS * Lancet (01.23.93), P. 234 Horton, Richard The main factor contributing to the spread of the worldwide AIDS epidemic is indigence, according to the first full-scale progress report by the World Health Organization's Global Program on AIDS (GPA). Poverty causes men to leave families to find work, encourages drug use, and makes prostitution a means of survival for women and children. The GPA said, "AIDS then completes the vicious circle by making the community even poorer." There were approximately 11.5 million cases of AIDS and HIV infection worldwide as of January 1992, reported WHO. The number of cases could reach 30-40 million, with 90 percent of those affected living in developing countries, by the year 2000. While the annual prevalence of HIV infection in developed countries is thought to have peaked in the mid-1980s, the incidence continues to rise in Africa, Asia, and Latin America. The GPA's budget was deeply affected in early 1991 by the Gulf War. From an expected annual income of $100 million, only $17.9 million had been received from contributing countries during the first six months. The final total was $82 million. Regardless of the threat to the funding, 135 research projects were backed by the GPA, and over 45 percent of them were based in Africa and Asia. The chief research areas have been vaccine development, clinical research and drug development, diagnostics, and epidemiological surveys. 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 01.25.93 ]]]===----- .