-----====[[[ A I D S w i r e D I G E S T 02.01.93 ]]]====---- AIDS Tracking Request Raises Privacy Issues * Washington Post (01.31.93), P. A19 The Pennsylvania Department of Health announced that it wants medical laboratories to report the names of patients with white blood-cell counts low enough to indicate potential AIDS cases. But critics argue that such reporting violates individuals' rights to privacy and may deter people from undergoing testing and treatment for AIDS. The health department's request, released on Jan. 4, was drafted to better gauge the spread of HIV infection under the new federal definition of the disease. Laboratories were asked to report the patient's name, address, age, sex, and race. State officials mentioned that the labs were being encouraged to provide the information, but compliance was not mandatory. Francis J. Stoffa Jr., executive director of the AIDS Task Force, said, "It's abhorrent. This is statistics at the expense of privacy and the confidence that people require to come forward to get early intervention and treatment." In addition, critics said the new reporting could result in mistaken identification of AIDS among people who experience other disorders affecting white blood cells. However, Bobby Jones, state director of AIDS epidemiology, said all names would be kept confidential. He added that the program could help determine the number of AIDS cases across the state by pushing physicians to report them more effectively. Advertising: Turning a New Page, Playboy Takes Up the Fight Against AIDS * New York Times (02.01.93), P. D6 Elliott, Stuart Playboy magazine is taking an unprecedented move this month to support the Design Industries Foundation for AIDS, known as Diffa, which has raised more than $10 million for AIDS-related causes since 1984. Although the amount to be given by fund- raising and in-kind contributions like employees' time and services is uncertain, it could eventually reach seven figures. George W. Slowik Jr., Diffa's chairman in New York and publisher of the trade magazine Publishers Weekly, said, "Playboy can have tremendous impact in terms of broadening the types of individuals and organizations that will pay attention to the issue." In the past, publications have avoided AIDS issues, because they fear being labeled as gay and losing readers and advertisers, according to AIDS groups. Michael S. Perlis, Playboy's president and publisher in New York said, "We're a magazine about men and all the pursuits that men enjoy, so we've always believed in communication about all things sexual. That means AIDS is something for us to talk about. We want to alert people that safety and responsibility are an important part of sexuality in the 90's." This month's issue of Playboy has a full-page advertisement, produced by the magazine and running space donated by the magazine, promoting a T-shirt design competition. The T-shirts with the winning design will be sold through Playboy's pages, and all proceeds will be donated to Diffa. Also, on Feb. 10, a "Valentine Day's for Couples Only" party in New York, sponsored by Playboy, will benefit Diffa. In future issues, the magazine will feature candid safe-sex ads in donated space. D.C.'s New Death Row * Washington Post (01.31.93), P. C1 Mencimer, Stephanie The Washington, D.C., Department of Corrections should provide a compassionate release program for inmates with AIDS, while educating prisoners on how to prevent HIV infection, writes columnist Stephanie Mencimer. To incarcerate a person in the District costs about $23,300 a year. But an AIDS patient who needs acute medical care can cost the system more than $60,000 a year. What is worse is the projected 3,000 HIV-prisoners who have not yet developed AIDS and who will need medical care within the next decade. Even though it is six years into the war on drugs, which came with tough mandatory minimum sentences, D.C. prisons are now overwhelmed with high-risk people. A Department of Corrections study that will be issued this month says that more than 20 percent of all D.C. inmates are HIV-positive. That is compared to one-tenth of 1 percent of the public at large, according to Keesler King, director of Whitman-Walker Clinic's AIDS education program. Dr. William Hall, assistant director of health services for the D.C. Department of Corrections, predicts that as many inmates will die of AIDS this year as in all the previous years combined. Prisoners with AIDS do not obtain adequate medical care in the prisons. If a ward is already full of inmates requiring specialized care, AIDS patients must be shackled to a bed in a regular hospital room with a 24-hour armed guard at the door-- even prisoners who are so near death they couldn't possibly escape. Not only could the city find considerable savings in releasing inmates with AIDS, but it would also relieve the strain that they put on the criminal justice system, concludes Mencimer. U.S. Tuberculosis Cases Increasing Alarmingly * United Press International (02.01.93) Wasowicz, Lidia (San Francisco) Tuberculosis is reappearing in the United States and the list of those infected is growing by more than 20,000 each year, according to an expert who spoke at the four- day Second International Workshop on the Oral Manifestations of HIV Infection. Dr. John Molinari, chairman of the Department of Biomedical Sciences at the University of Detroit Mercy School of Dentistry, said, "The annual increase of 20,000 new cases-- plus an additional 1,000 per year--was not counted on by the U.S. Public Health Service, which had set the year 2010 for the total eradication of the disease." He said there is "potential for a major explosion" in the number of infections from TB. "Mycobacterium Tuberculosis poses significantly different risks from those of the blood-borne microbes that cause hepatitis and AIDS. The current trends are very disconcerting," noted Molinari. He said the resurgence of TB is partly due to the influx of immigrants from Third World countries where the disease runs rampant and also due to the spread of HIV infection and poverty. Molinari told dentists to take protective measures even though they face a much smaller risk than hospital or nursing home workers who come in prolonged contact with undiagnosed patients. A total of 200 health-care workers have tested positive in TB skin tests at one facility alone, although none have shown symptoms. Because only five percent of infected people show any signs of the disease during the first 12 months, many of the remaining 95 percent may not even know they are contagious. He said another 10 percent will develop symptoms over the next two years, but the rates among HIV-positive patients are much higher. Brain Biopsy for Intracranial Mass Lesions in AIDS * Lancet (01.23.93) Vol. 341, No. 8839, P. 242 Martinez, Esteban While brain biopsy should not be used on random AIDS patients with intracranial mass lesions, the more defined the indications are for brain biopsy, the more effective this diagnostic procedure will be, write Esteban Martinez et al. of the Hospital Clinic i Provincial in Barcelona, Spain. A Nov. 7 Lancet editorial on brain biopsy for intracranial mass lesions in AIDS says that primary prophylaxis for toxoplasma encephalitis might be effective. But there are no conclusive data on how effective it would be. Also, primary prophylaxis for toxoplasma encephalitis is not widely accepted. Whether an AIDS patient with intracranial mass lesions should be treated empirically with antiotoxoplasma drugs will depend on several individuals and geographical characteristics. The number of CD4 cells per uL, the presence of previous positive serological rests for Toxoplasma gondii, and the number of lesions on compared tomography or magnetic resonance imaging should all be considered. The patient's clinical status will decide whether biopsy would establish a definite diagnosis if non-invasive procedures had failed to do so. Moreover, routine necropsy in AIDS patients would establish the aetiology of intracranial mass lesions in an individual and the prevalence of various causes in a specific AIDS population as well as its relation to immunity status or other epidemiological factors, the researchers conclude. Violation of Disabilities Act? * American Medical News (01.25.93) Vol. 36, No. 4, P. 1 McCormick, Brian A Philadelphia-area physician has filed a lawsuit under the Americans with Disabilities Act (ADA) and is believed to be the first such professional to do so. The orthopedic surgeon, known only as John Doe, accuses Philadelphia's Mercy Health Corp. of infringing upon the law's anti-discrimination provisions, which consider HIV infection to be a disability. Dr. Doe's HIV- infected status was first learned by officials at Mercy Catholic Medical Center after one of his colleagues disclosed it in 1991. The hospital subsequently obtained permission under a Pennsylvania law to inform Dr. Doe's patients of a possible exposure risk and offer them HIV testing. After conducting a "look back" study, Mercy Catholic suspended Dr. Doe's privileges. Hospital medical staff officials later decided to reinstate those privileges without restrictions, if Dr. Doe posed no substantial risk to patients. However, last July the hospital board overruled the physicians. They told Dr. Doe he could perform "invasive procedures" only if his patients signed consent forms indicating they had been informed of his condition. Dr. Doe filed suit in late November after months of attempting to negotiate a settlement that did not include such notification. But hospital officials claim they were justified and within the law. Dr. Doe sued under Section I of the ADA, which prohibits discrimination in employment, and under Section III, which prevents public accommodations from discriminating against the disabled. In addition, he filed a complaint with the Equal Employment Opportunity Commission under the ADA. Availability of Sulfadiazine--United States * Journal of the American Medical Association (01.27.93) Vol. 269, No. 4, P. 461 Requests for the drug sulfadiazine/trisulfapyrimidine (triple sulfa) were given to the Centers for Disease Control by pharmacies nationwide between Dec. 6-12, 1992. Sulfadiazine and triple sulfa are sulfa drugs frequently used in combination with pyrimethamine for the treatment of central nervous system toxoplasmosis in patients with AIDS and newborns with congenital infections. A telephone survey was conducted by the CDC and the Food and Drug Administration because of the requests. It was conducted among all pharmaceutical manufacturers approved to make these drugs and several major distributors that in the past were suppliers of the two sulfa drugs. It was found that were no large inventories of either drug available from major distributors. Until a commercial source of sulfadiazine is fully restored, doctors should consider using clindamycin in combination with pyrimethamine for the treatment of acute toxoplasmosis in AIDS patients. This combination has been reported to be similar in efficacy to pyrimethamine and sulfadiazine in the treatment of acute toxoplasmic encephalitis in such patients. For secondary treatment there is no consensus on an acceptable alternative, but a combination approach may be better than single-agent regimens. The CDC has acquired a small supply of sulfadiazine/triple sulfa that will be provided for persons with acute disease who cannot tolerate clindamycin and for congenitally infected infants. Those doctors who wish to obtain a three-week supply of triple sulfa or sulfadiazine from the CDC for such patients must give the CDC an abbreviated medical history, a Toxoplasma antibody titer, and reasons why clindamycin could not be administered. News in Brief: Ohio * Advocate (01.26.93) No. 621, P. 25 The U.S. Department of Health and Human Services announced on Dec. 17 that Memorial Hospital in Fremont, Ohio, could be disqualified from receiving reimbursements under the Medicare program because it allegedly refused treating a man with AIDS. Federal officials said the hospital's action violated the Americans With Disabilities Act, which forbids discrimination based on disability. However, hospital officials do not feel they violated the law. News in Brief: International * Advocate (01.26.93) No. 621, P. 31 HIV infection may be spreading uncontrollably throughout many parts of the world, according to medical experts. William Haseltine, human retrovirology division chief at Harvard University's Dana-Farber Cancer Institute, said that nearly 5 million Americans could have AIDS or be infected with HIV by the year 2000. HIV could infect more than 1 billion people--one fifth of the world's population--in the decades following the year 2000, said Haseltine. Statistics by the World Health Organization indicate that HIV infection has been reported in almost all nations, and full-blown AIDS in 164. Dr. Michael Merson, AIDS program chief at WHO, said, "The next two to three years are critical. We are running out of time when we can make an impact, especially in Asia." Physicians at WHO estimate that 1.2 million Asians contracted HIV by mid-1992, compared with 675,000 six months earlier. They also say the epidemic seems as if it's ready to spread rampantly throughout Asia--much as it did in Africa 10 years ago. WHO projected in December that most of the 10 million children that AIDS will have orphaned by the year 2000 will be from sub-Saharan Africa. However, the Global AIDS Policy Coalition, an advocacy group, said in its annual report, issued in late 1992, that several countries seem to be apathetic about trying to control AIDS in the Third World. Developed countries spending to fight AIDS in developing nations has been static since 1986. About eight times more was spent in 1991 on AIDS prevention in North America than in the entire developing world, and six times more was spent in Europe, despite statistics showing the growing AIDS problem in the Third World. Dentists at Greater Risk for Hepatitis Than AIDS Infection * United Press International (02.02.93) Wasowicz, Lidia San Francisco--The risk of dentists becoming infected with hepatitis is more than 50 times higher than that for HIV, according to a researcher attending the Second International Workshop on the Oral Manifestations of HIV Infection. Eli Capilouto, associate professor at the Lister Hill Center for Health Policy at the University of Alabama, said he examined the chance of infection with either hepatitis B virus (HBV) or HIV, through a needle stick or a prick with a sharp instrument. "I calculated the cumulative annual risk for HIV infection for dentists is 3 per 100,000," said Capilouto. He added, "But hepatitis B--because of its much higher prevalence--carries a greater chance of transmission, 16 per 10,000. That means a typical dentist in a typical population is over 50 times more likely to be infected from HBV than HIV." This comparison applies only to dentists who have not been vaccinated against hepatitis. Capilouto chose midrange statistics for his calculations resulting from various data. While estimates differ greatly, the middle-of-the-road figures show that 700,000 of the 249 million Americans are infected with HIV, or 0.28 percent. But for hepatitis, the number of Americans infected with HBV is about 1 million, or 0.4 percent. While death from AIDS is almost inevitable, a dentist is 1.5 times more likely to die from HBV than an HIV infection, said Capilouto. He made his conclusions after using national surveys that show an average dentist has a total of 2,800 annual visits from patients. Capilouto discovered that out of 10,000 visits, 12 patients carry the risk of infection with either virus. Health-Care Safety Rules * Wall Street Journal (02.02.93), P. B6 A federal appeals court in Chicago ruled that new workplace- safety guidelines intended to protect health-care workers from hepatitis B and HIV infection are valid. The appeals court rejected a challenge by the American Dental Association (ADA), which contended that it was unfair to apply the rules to all health-care workers when some are more likely to be exposed to infection than others. The court admitted that the rules, instituted by the Occupational Safety and Health Administration last year, might be expensive to follow and unneeded in some situations, but it maintained that they are valid. The guidelines involve standards for protective clothing and workplace cleanliness, and they mandate that employers provide free, confidential HIV tests to workers exposed to infection. The new rules will cost the health-care industry $813 million, according to OSHA. However, industry representatives and the appeals court indicated the cost could be even higher. The Seventh U.S. Circuit Court of Appeals said the ADA and others arguing the rule had not shown that the benefits were outweighed by the costs. Dissenting Judge John L. Coffey questioned whether OSHA rather than government health agencies should be regulating health care. He said, "I am forced to assume that because of the excessive media coverage regarding the AIDS virus, fueled by one single episode involving Kimberly Bergalis in Florida contracting AIDS from her dentist, OSHA decided to promulgate this over-expansive rule." The ADA is considering a rehearing or a Supreme Court review and is asking Congress to revise the rules. Pa. Expands Coverage of HIV Drugs * Philadelphia Inquirer (02.02.93), P. B3 Motley, Wanda Pennsylvania welfare officials yesterday extended the number and types of AIDS drugs available to sick people who depend on state assistance to receive medication. Officials said that 10 additional drugs, including antibiotics and anti-HIV drugs, will be provided under Pennsylvania's Special Pharmaceutical Benefits Program. The program is funded with $2.5 million from federal and state sources, and covers only four drugs used in the treatment of AIDS. AIDS activists applauded the decision by the Department of Public Welfare, but said the expansion was long overdue and in some ways imprudent. They said that most of the newly covered medications have been widely prescribed for the last several years. In addition, AIDS advocates chastised the state for its handling of the program, which approves only specific name drugs rather than families of drugs. "With the technology developing so rapidly, it's limiting the potential benefit for persons living with AIDS by restricting them to specific brand names," said Bruce Flannery, a spokesman for ActionAIDS in Philadelphia. However, Welfare Department spokeswoman Mary Ellen Bolish said the state could not afford the program if it involved families of drugs. The program serves Pennsylvanians who earn too much to be eligible for Medicaid, but less thanJ$30,000 annually for families and $25,000 for individuals. The new drugs available include Videx, Hivid, Zovirax, Foscavir, Cipro, Bactrim/Septra, Dapsone, Mycelex, Nizoral, and Diflucan. The program already provides AZT, Pentamidine, Alpha-Interferon, and Ganciclovir. Pa. Reviews AIDS Policy for Labs * Philadelphia Inquirer (02.02.93), P. A1 Collins, Huntly Pennsylvania health authorities announced yesterday that they would reexamine the controversial new AIDS policy that asks laboratories to report by name people with low white blood cell counts. Due to pressure from AIDS activists, Philadelphia's health commissioner, Dr. Robert K. Ross, said the city would immediately suspend its implementation of the state policy, which began on Jan. 4. "The city has not adequately explored the alternatives [to name-based reporting]," said Dr. Ross. The controversy involves the state's request that medical laboratories voluntarily report to state health officials the name, address, age, sex, and race of anyone who has fewer than 200 T-cells per cubic milliliter of blood. Because of the new federal definition of AIDS, which states that T-cell levels under 200 could indicate that a person has the disease, Pennsylvania made its move accordingly. State officials have said they would use the names to contact patient's physicians, reminding them of their legal obligation to report anyone with AIDS. In order for the state to receive its share of federal funding of AIDS, an accurate count of all AIDS patients needs to be obtained. However, critics argue that revealing the names is illegal under a state law that protects the privacy rights of HIV-positive individuals. The law, known as Act 148, requires that no one can reveal confidential information, such as test results, related to a person's infection with HIV. Critics also argue that naming people with low T-cell counts will discourage them from being tested and treated for AIDS. Philippines Warned of AIDS Crisis * Reuters (02.01.93) (Manila) The AIDS case rate in the Philippines is starting to resemble that of Thailand, said Philippine Health Secretary Juan Flavier on Monday. The chief government supporter on the use of condoms told a forum on family planning, "If we don't do anything today, five years from now we will be where Thailand is today--1,500 HIV infections per day or about half a million infections a year." Flavier said there had already been 368 reported cases of HIV infection in the country. He added that unreported cases could total as much as 36,000. Among the 368 HIV-positive individuals, 89 developed full-blown AIDS, and 62 of the AIDS patients have died. Flavier has aggressively pushed the use of condoms to thwart the spread of HIV in the largely Roman Catholic nation. He was condemned by church leaders who oppose artificial contraception and was criticized for condoning sexual promiscuity by urging the use of condoms. "The fact is promiscuity came ahead of condoms," said Flavier in response. "Be good. If you can't be good, be careful. If you can't be careful, use condoms," he said. WHO Calls on Companies to Fund AIDS Prevention * Reuters (01.31.93) Davos, Switzerland--The World Health Organization (WHO) official responsible for the agency's Global Program on AIDS encouraged business leaders on Sunday to invest in programs to prevent the spread of HIV infection. WHO's Michael Merson told a news conference at the annual World Economic Forum, "Money spent now on changing behavior to slow the spread of infection will return billions of dollars of lost income and health care expenditure in the economy." He added that direct costs of AIDS to health and welfare services worldwide were already using up about $5 billion a year. In addition, the direct costs of the epidemic through lost productivity, lost markets, and the cost of training new workers to replace those lost to the disease could be up to 10 times greater. Merson said companies could help combat the disease by educating staff about AIDS at the workplace and by supporting research into prevention and care of those infected with HIV. He said companies could also support government and community AIDS "prevention and care" efforts, both by donating money and seconding staff to provide practical assistance. He said, "In the United States, average treatment costs for an AIDS patient are around $100,000, so by preventing 10 people from becoming infected a company health scheme will save $1 million." A study had demonstrated that Thailand had health-care costs to as much as between $615 and $1,000 a year. However, indirect costs to the economy through premature death of adults in the prime of their working years was nearly $22,000 per death. Stretched Thin: Jump in AIDS Caseload Puts the Squeeze on State and Local Agencies * Advocate (02.09.93) No. 622, P. 18 Akin, Scott R. The federal government's new definition of AIDS, put into effect on Jan. 1, is expected to double the caseload and will severely strain AIDS services, according to AIDS activists. Cornelius Baker, director of public policy and education for the National Association of People With AIDS, a Washington, D.C.-based lobbying group, said, "The federal government hasn't responded by creating policies that recognize the greater expanse of the disease." AIDS experts argue that a lack of planning and preparation by federal, state, and local governments continued throughout the approximately two years that the Centers for Disease Control spent disputing the expansion. Dr. James Ward, acting chief of the surveillance branch of the CDC's HIV-AIDS division, said the impact on local health care resources should be limited because people who are considered as having AIDS are not significantly more ill than they were before the definition took effect. However, Jim Singleton, an epidemiologist in the California State AIDS office, said that once people learn that they have what is considered AIDS in the new definition, "they may be more likely to seek treatment" than when they were just HIV-positive. Public hospitals providing AIDS treatment may be inundated with even more patients, but that does not make much of a difference since they were already overwhelmed, said Dennis Andrulis, president of the National Public Health and Hospital Institute. Catherine Lynch, a policy associate at the New York City AIDS Service group Gay Men's Health Crisis, said the CDC, "can define AIDS any way it wants, but if people can't get to a doctor, it doesn't mean anything." Ensuring Proper AIDS Treatment * Business Insurance (02.01.93) Vol. 27, No. 5, P. 17 Woolsey, Christine "Waiting for the first case of AIDS before starting an education program is like waiting to create a fire evacuation program when you smell smoke," says Paul A. Ross, corporate manager of the HIV/AIDS program at Digital Equipment Corp. Ross, who is the entire staff of the five-year-old AIDS Program Office, currently oversees educational programs and consults with management and personnel to assess the incidence and emerging issues of the disease at the company. But by March, Digital should have finalized standards of care for HIV and AIDS patients. The guidelines were developed by Ross and the 85 Health maintenance organizations that serve Digital's employees after Ross conducted a survey which showed mixed reactions concerning healthcare from HIV/AIDS patients who had switched from the company's managed indemnity plan to the HMOs. The program has already saved Digital money. Ross says, "The average cost of our HIV cases ranged from $90,000 to $120,000 from diagnosis to death. Our costs now are about $80,000 or less per case, while the average cost for companies our size is still about $120,000." Because of this cost efficiency, the program has not been cut, while many other company functions have been eliminated. Children With Pulmonary TB Respond Well to Drug Therapy * AIDS Alert (01.93) Vol. 8, No. 1, P. 5 HIV-positive children with pulmonary tuberculosis, including those with drug-resistant strains, can be effectively treated. Drug therapy was successful in 10 HIV-infected children with pulmonary TB who were studied at the Children's Hospital of New Jersey in Newark--one of whom had multidrug-resistant TB. There were no TB recurrences or TB-related deaths after 14.2 months. Children with non-resistant strains of TB responded well to treatment with isoniazid (INH), rifampin, and/or pyrazinamide (PZA). The child with the drug-resistant form of TB was treated with a combination of five medications: INH; rifampin; PZA; streptomycin; and ethambutol. Dr. George McSherry, assistant professor of clinical pediatrics at the University of Medicine and Dentistry--New Jersey Medical School in Newark, said due to the increased prevalence of drug-resistant TB in Newark and surrounding regions, the facility's protocol now requires HIV- positive children to receive a combination of three drugs as initial therapy. He added that they usually start children with pulmonary or extrapulmonary TB on INH, rifampin, and PZA until the sensitivity reports are returned. Since HIV destroys the body's ability to react to purified protein derivative (PPD), not all children with HIV have positive PPD skin tests. Therefore, in children who are suspected of having TB or of being exposed to TB, additional testing such as a chest X-ray or lung biopsy may be needed. McSherry said that children who are suspected of having TB but who have a negative PPD are treated, regardless. "Most HIV-positive children with TB in this series had typical pulmonary TB, most had some degree of PPD reactivity, and all were successfully treated," said McSherry. Haitians With HIV Stage a Hunger Strike at Base * Philadelphia Inquirer (02.03.93), P. G1 Cole, Richard The HIV-positive Haitian refugees who are being held at the U.S. Navy's Guantanamo base were participating in a hunger strike yesterday. Lt. Cmdr. Gordon Hume of Atlantic fleet headquarters in Norfolk, Va., said that about 270 refugees, including all the children except infants, have not taken food since Friday. The refugees' attorney, Michael Ratner, said his clients intended to end their legal limbo, which has lasted more than a year in some cases. Ratner said, "Two people fainted yesterday. But the hunger strike is continuing until we get some commitment from the administration that we are going to get these people out." Hume said physicians and nurses were examining the refugees' health but were not taking any action to interfere with the strike. U.S. Immigration and Naturalization spokesman Duke Austin said the refugees' demonstration would not change their status. "Dissident behavior will not be rewarded," he added. But an INS official speaking on condition of anonymity said the status of the Haitians on Guantanamo was being reviewed. The Guantanamo refugees are unlike most of the 40,000 Haitians repatriated from the United States after a bloody coup in September 1991, because they have been found to have a preliminary claim to political asylum. Several refugees were linked to the government of President Jean-Bertrand Aristide, ousted in the military coup. Typically that would allow them to make a formal asylum claim in the U.S., but because they tested HIV-positive, they are barred under U.S. immigration policy. Ratner said they were not requesting immediate release, but would settle for knowing a date when they could be let out. Related Story: Los Angeles Times--Washington Edition (02.03) P. A5 AIDS Leaflet Cleared--With Caution * Toronto Globe and Mail (02.02.93), P. A16 MacLeod, Robert An explicit brochure on AIDS prevention and sadomasochistic activity should be provided for the community with sensitivity, decided the Toronto City Council yesterday. The front cover of the controversial brochure, entitled "Safe S/M: Advice on AIDS Prevention," depicts a pair of handcuffs. The AIDS Committee of Toronto, which obtains about $300,000 a year from the city for its anti-AIDS campaign, distributes the brochure. Councilor Chris Korwin-Kuczynski was fired last month from his position the chairman of the city's board of health after stating an opinion that the pamphlet, with its references to "whipping, fisting" and "electric torture," is not the sort of activity the city should be seen as encouraging. Yesterday, Korwin- Kuczynski failed to convince the city council to stop the AIDS committee from printing and distributing the pamphlet. But the council did agree to a suggestion from Mayor June Rowlands that it ask the AIDS committee to take special precautions to guarantee that the S+M material is given only to the community for which it is intended. Councilor Peter Tabuns, who was Korwin-Kuczynski's predecessor as chairman of the board of health, said the pamphlet has been available since 1984. "We are engaged in a very profound struggle with a very deadly disease. And one of the tools we have, since we don't have a cure and we don't have a vaccination, is information put forward to people in a way that they understand and in a way that they're willing to accept." He argued that Korwin- Kuczynski is attempting to create a "moral panic." National Briefs: Patient Wins Case of Bias Over AIDS * Boston Globe (02.02.93), P. 15 A dentist was found by the New York State human-rights commissioner to have discriminated against a patient with AIDS when he discontinued her root-canal treatments. Commissioner Margarita Rosa ordered on Jan. 26 that Smithtown dentist Stanley Brottman pay Renee Allen of Freeport, N.Y., $25,000 for the mental anguish and humiliation he caused her. In addition, Rosa ordered Brottman to display posters that outline patients' rights. Brottman refused to comment, but his attorney, Kevin J. Murtaugh, said, "I was surprised at that high figure." Murtaugh added that Brottman probably would not appeal the ruling. Metropolitan Area News in Brief: Restaurants to Donate Proceeds to Fight AIDS * Philadelphia Inquirer (02.03.93), P. B2 Some Philadelphia-area restaurants will participate in the third annual "Dining Out for Life" benefit for AIDS tomorrow night by donating one-third of their food sales. The four AIDS organizations sponsoring the benefit are ActionAIDS, the AIDS Coalition of Southern New Jersey, the Delaware County AIDS Network, and the Fund for Living of Montgomery County. Jesse Milan, board president of ActionAIDS, said the goal was to raise $100,000, an increase from the $70,000 raised last year. He said that more than 100 restaurants are expected to participate. White AIDS Babies Have Earlier Symptoms Than Black Infants * United Press International (02.02.93) Wasowicz, Lidia (San Francisco) White infants with AIDS experience more and earlier oral manifestations of the disease than black infants with AIDS, according to a researcher who spoke at the four-day Second International Workshop on the Oral Manifestations of HIV infection. Francisco Ramos-Gomez, assistant professor in the Department of Growth and Development at the University of California--San Francisco, conducted a study that showed the first mouth lesions were diagnosed at a median age of 3.2 months in the nine white children involved, compared to 8.1 months in the eight black children infected with HIV. Also, about 90 percent of the white infants experienced pseudomembranous candidiasis--a painful fungus on the tongue or back of the throat--by their first birthday, compared to slightly more than 60 percent for the black children. Ramos- Gomez said, "Since African-Americans tend to have worse results than whites in most studies, these were surprising findings." He believes the difference may be related to how the mother contracted HIV. Medical care was not a factor because the number and frequency of visits to the doctor were the same for the two groups. The sex of the child also did not make any significant difference. Ramos-Gomez observed 41 HIV-positive newborn to 13-year-olds at Children's Hospital in Oakland from 1991 to late 1992. A total of six of the children, ages 9 and older, were infected through tainted blood or blood products; the remaining 35 through their mothers before or at birth. Because oral lesions are among the first AIDS symptoms exhibited in adults, Ramos-Gomez said he thinks this will also hold true for children. Error Prompts Retesting for AIDS * United Press International (02.02.93) (Fort Lauderdale, FL) Health-care workers started testing about 600 people again for HIV after learning that a Fort Lauderdale woman was falsely diagnosed as testing positive for the virus at a public health clinic. The initial 10 patients were retested Monday and the results are expected next week. Broward County health-care workers expect to inform and retest all those who had blood tests for AIDS at three public clinics in Hollywood, Fort Lauderdale, and Pompano Beach between July 1 and Jan. 20. The retesting follows a case where Susan Gibson, of Fort Lauderdale, said county health-care workers incorrectly told her she was infected with HIV. She went to the Fort Lauderdale clinic for a blood test July 24, thinking she had an iron deficiency. She agreed to have an HIV test, although she had been celibate for more than six years and she thought it was nearly impossible for her to be infected. She was told she tested positive for HIV a week later. After friends and relatives convinced her to be tested again, she tested negative at two independent labs. Because of Gibson's case, health-care workers are focusing first on retesting patients who had HIV tests at the same clinic the day Gibson was tested, and the day before and after. Dr. Clarence Smith, medical director for the county's Human Services Department, said, "She was the only one in those three days who tested positive. My concern is that there is a person out there who was given her test result, which is negative, and they are actually positive." Fashion Industry Celebrates Itself at an Awards Ceremony * New York Times (02.03.93), P. C3 Morris, Bernadine) The Council of Fashion Designers of America held an awards ceremony Monday night honoring outstanding members of the industry. But the ceremony was not without AIDS awareness. Nearly everyone was wearing the red ribbon handed out at the door. Patrick J. O'Connell, who created the symbol for the Ribbon Project of Visual AIDS, an artists' group, received a special award for his efforts. Before the curtain lifted on members of the council arranged on bleachers, all wearing their red ribbons, O'Connell made a request for more AIDS support. The ribbons united the group, which was unusual. Why AIDS Policy Must Be a Special Policy * Business Week (02.01.93) No. 3303, P. 53 Stodghill, Ron et al. Although several American corporations have instituted AIDS policies aimed at preventing discrimination and accommodating infected employees, fear and mythology surrounding the disease can still be prevalent. Workers often fear contracting HIV from an employee through casual contact. In addition, the disease's association with homosexuals and IV-drug users can prompt scorn and prejudice that other diseases don't. What is most important in establishing an anti-AIDS program is that companies should not anticipate trouble before they take a stance on the issue. That means an extensive program should be endorsed from top executives on down the corporate ladder. Ignorance and secrecy are the most disruptive elements concerning AIDS in the workplace. AIDS experts say a policy of strict confidentiality is necessary to protect the privacy of an HIV-positive employee. This is particularly important since the virus can stay latent for years before affecting the employee's health or productivity. The main goal of an anti-AIDS program should be to foster an environment that makes HIV-positive employees feel comfortable to disclose their condition. Videos, seminars, and literature are effective forms of education. The concept is to dispel myths, present the company's policy, and address ways to prevent the spread of HIV. Also, companies should ensure that all points of view are represented in the AIDS education programs. The Centers for Disease Control and the American Red Cross both provide information and inexpensive counseling to help create successful anti-AIDS programs for businesses. Study Finds PCP, MAC, Are Common in Children With HIV * AIDS Treatment News (01.93) Vol. 8, No. 1, P. 5 Pneumocystis carinii pneumonia (PCP) and Mycobacterium avium complex (MAC) appear to be the most prevalent AIDS-related conditions among children with HIV infection in Los Angeles County, according to a study led by Laurene Mascola, MD, MPH, chief of U.S. Public Health Service at the Los Angeles County Department of Health Services. Among 134 infants and children diagnosed between June 1982 and December 1991 who had 245 AIDS- defining illnesses, PCP was the most common condition, followed by MAC. Between 1982 and 1987 and between 1988 and 1989, 25 percent of the children had PCP, but from 1990 to 1991, 30 percent of them had PCP. A total of 8 percent of the children had MAC from 1982 to 1987, compared to 10 percent from 1988 to 1989 and 19 percent from 1990 to 1991. The study showed that the incidence of MAC, which was previously believed to be a problem in children, is rising, said Mascola. Several of the children studied in Los Angeles are transfusion recipients, who usually live longer than children who contract HIV perinatally, she said. "Therefore, the longer you live, the lower your CD4 counts go, and the more at risk you are for infection with MAC," said Mascola. She believes the increased incidence of PCP is a result of increasing numbers of children who acquire HIV perinatally in Los Angeles. She said, "The only way PCP prophylaxis is going to work is if we detect [HIV] at birth.... Basically, PCP is increasing because children still aren't being diagnosed at birth." Managing AIDS: How One Boss Struggled to Cope * Business Week (02.01.93) No. 3303, P. 48 Stodghill, Ron Although AIDS has been present for more than a decade, many companies still do not know how to address the issue. The Centers for Disease Control say that one in every 250 Americans is HIV-positive, while most are aged 25-44--the core group of the American work force. Frank Daloisio, an AIDS-infected sales person with Digital Equipment Corporation (DEC), had trouble telling his boss, Jean Lagone Smith, about his condition. DEC is renowned for its exceptional AIDS policy, but it is no panacea. Frank was diagnosed with HIV infection in 1983 and continued to work at DEC in Washington, D.C., because "I needed my benefits," he said. But because of frequent absences from the office for doctors visits and a research experiment in which he was a subject, his co-workers began to ask questions. By 1987, he decided to leave for DEC's office in Dallas because, he said, "I've seen people lose jobs, life insurance, health insurance, you name it." However, after six months in Dallas he became severely ill and moved back to the Washington office to be closer to family who lived in Pennsylvania. A year later, Jean hired him to work for her in Blue Bell, Pa. The first 18 months of his job in Blue Bell worked out well. But again his health began to deteriorate. He had to leave the office numerous times to treat his condition. Although Jean was annoyed by his absences, she soon found compassion for Frank once he revealed his condition. Also, the company created a new position for him that allowed for more flexibility. Jean said that while DEC's AIDS policy was helpful, it did not run the business for her. She added that she had to make the decisions that would affect everyone in the sales force. Effective Test is Developed to Find AIDS in Newborns * New York Times (02.04.93), P. B8 Hilts, Philip J. A new technique developed by researchers at the University of California--Los Angeles (UCLA) can determine whether infants are infected with HIV. The method is faster than current tests and can detect more than 80 percent of the infants who are not infected. The new test uses the conventional approach for finding HIV, but precedes it with another overnight test that separates the mother's and infant's antibodies. The study is featured in today's issue of The New England Journal of Medicine, and was led by Dr. Yvonne Bryson. The researchers reported on 29 babies born to HIV-positive mothers, and the new method was found to be accurate in detecting infection in all of the babies. The report mentioned that about half of the infected infants contracted the virus in the womb and half during birth. Dr. Bryson said that is significant because it may be possible to take special precautions in delivery to prevent fetuses from swallowing blood or secretions from the mother and to prevent cuts or abrasions that may provide an opening for infection. She added that infants who might be infected get tested at birth, when it would be possible to detect infections that took place in the womb, and then retested four to six weeks later to detect infections that occurred at birth. But the test is still awaiting Food and Drug Administration approval, which is expected to be relatively quick. The new technique is relatively simple and costs only about $80, in contrast to the hundreds of dollars and difficult laboratory work needed for previous tests. This enables infants to be tested earlier, and allows more infants to be tested in developing countries that lack the resources for more complex tests. Related Story: Philadelphia Inquirer (02.04) P. A16 Effective Test is Developed to Find AIDS in Newborns: Work on Vaccines * New York Times (02.04.93), P. B8 Hilts, Philip J. The Swedish government is expected to announce today that it will launch a trial in which 1,000 patients will be used to determine whether vaccines may be used to treat AIDS instead of merely prevent infection with HIV. The experiment is the first large-scale, rigorous scientific test of whether vaccines can boost the immune system even after a person contracts HIV infection. If it proves successful, it is hoped that injections will postpone by months or years the onset of opportunistic infections. Vacsyn, the drug made by MicroGeneSys Inc. of Meriden, Conn., will be used in the trial in an experiment on HIV-positive people who are asymptomatic. The trial will be double-blind, which means neither the patients nor the doctors will know who is given the vaccine and who is getting the placebo. Dr. Britta Wahren of the Karolinska Institute in Sweden, one of the researchers in the trial, said the findings from the experiments are not expected until 1995. The trial is significant because tests of Vacsyn have been debated at the National Institutes of Health and are now being scheduled in the United States. Those tests will use other vaccines, in addition to Vacsyn. Early experiments at the Walter Reed Army Institute of Research in Washington, D.C., and in small trials in Canada and Sweden showed that patients who received Vacsyn did not show signs of depletion of their immune systems. Although the results were positive, they were not dramatic in the small pool of patients. Setting Goals for AIDS Policy * Washington Post (02.04.93), P. D.C. 3 Washington, D.C.-area AIDS activists, service providers, and HIV-positive individuals will convene at the District Building on Saturday in a daylong session designed to formulate input for a federal agenda on the needs of HIV-positive people. The Clinton administration requested the recommendations from affected communities across the country. The meeting is one of 25 nationwide and is open to anyone who is interested. Later this month, representatives from the 25 meetings will gather in Washington to develop a document to give to the Clinton administration. Alina Patton of the D.C. CARE Consortium of local AIDS advocacy organizations said, "This is the first time in the 11-year history of AIDS that a president has actually turned to us and asked for our input." The issues expected to be addressed are federal leadership in prevention, research, care, and anti-discrimination efforts. The session was organized by several AIDS education and service organizations, including the Inner City AIDS Network, Northern Virginia AIDS Ministry, Whitman Walker Clinic, Carl Vogel Foundation, and the D.C. CARE Consortium. Midwest Report: Michigan Guards Want HIV Inmates Isolated * Chicago Tribune (02.03.93), P. 1-3 On Tuesday, after a bloody fight at a maximum-security prison in Jackson, Mich., a group representing prison guards requested the isolation of HIV-infected inmates. Two guards were cut in the arm and hand as they attempted to break up a fight between two inmates, one of whom had a knife. One prisoner was HIV- positive, said Corrections spokesman Warren Williams. "There's at least the possibility that the inmate's blood may have been on that knife, and that knife did cut the officer," said Williams. Fred Parks, president of the Michigan Corrections Organization, which represents the state's 7,300 prison guards, demanded the seclusions of HIV inmates. He projected that about 10 percent of the state's 35,000 inmates are HIV-positive. An Activist Is Appointed to Head City AIDS Office * Philadelphia Inquirer (02.04.93), P. B2 Collins, Huntly Richard Scott, a Philadelphia AIDS activist and union agent for white collar workers, has been appointed the new director of the city's AIDS Activities Coordinating Office. Dr. Robert K. Ross, the city's health commissioner, is expected to announce the appointment of Scott today. Ross said that Scott's past experience working in the city health department would be "enormously useful" in improving the city's anti-AIDS efforts. Within the last year, some AIDS organizations have criticized the city's AIDS office for its lack of direction and leadership. The agency has a staff of about 40 people and a budget of about $18 million in federal, state, and local funds. Scott, who worked as a union agent for District Council 47 of AFSCME for the past eight years, will take over as the director in the AIDS office on Feb. 16. He mentioned yesterday that he would concentrate on boosting AIDS funding at all levels of government, improving clinical care of HIV-positive people being treated at city health clinics, and also improve the city's attempts to track the course of the AIDS epidemic. He said the city's AIDS efforts should not neglect certain groups such as HIV-positive women, the minority poor, and gay and bisexual men who may not be using condoms. He is currently chairman of the AIDS Advocacy Coalition, which represents local AIDS service groups, and serves on the board of the Philadelphia AIDS Consortium. Scott was one of 14 people nationwide last year to win a congressional award for his work on promoting AIDS education with union workers. Safety Group Draws Up Its '93 Wish List * Los Angeles Times--Washington Edition (02.04.93), P. A5 Loew, Karen The Coalition for Consumer Health and Safety is expected to present proposals to the Clinton administration, including two on AIDS-related issues, that it hopes will receive serious consideration. The coalition, which represents 35 consumer, health, and insurance organizations, has prepared the legislative proposals and regulatory changes to give to the president. Among the proposals is a recommendation that the White House establish a "federal interagency mechanism" to coordinate the federal response to AIDS, as the National Commission on AIDS has advised, along with a hastened implementation of the commission's other recommendations. It also requests that legislation be formed to establish penalties for violence against "vulnerable" adults, including HIV- positive people. AIDS Children Get Better Dental Care in Foster Than Birth Homes * United Press International (02.04.93) Wasowicz, Lidia (San Francisco) Children with AIDS who live in foster homes receive much better dental care than those who live with their birth parents, according to a researcher who spoke at the four- day International Workshop on the Oral Manifestations of HIV Infection. Fred Ferguson, associate professor at the School of Dental Medicine, State University of New York--Stony Brook, said, "My findings suggest there is a great difference in the risk for plaque, gingivitis, and caries in infected children depending upon their place of residence." Ferguson said all of these conditions are easily prevented and recommended early dental counseling. He said that health-care workers should be trained to teach the basics of good dental health to the parents of HIV-positive children. These involve avoiding unrestricted bottle nursing, cleaning the child's mouth and teeth, minimizing use of pacifiers coated with honey or other sugary substances, and limiting foods high in sucrose. Ferguson studied 32 boys and 26 girls between six months and 15 years old infected with HIV. Among the 58 children, 23 were living with their birth families and 35 with foster parents. All of the children living with their natural families were allowed continuous use of a juice or milk bottle, and 100 percent suffered from plaque and caries. But none of the adopted youngsters showed any symptom of these problems. Truth and Consequences: Teen Sex * American Enterprise (01-02.93) Vol. 4, No. 1, P. 52 Besharov, Douglas J. and Gardiner, Karen N. The sexual revolution that began thirty years ago progressed well into the late 1980s. A total of ten million teenagers will partake in about 126 million acts of sexual intercourse this year. Also, about three million teenagers will contract a sexually transmitted disease such as chlamydia, syphilis, gonorrhea, pelvic inflammatory disease, and even HIV infection. More than half of all unmarried teenage girls report that they have had sex at least once. In addition, sexual activity is starting at even younger ages. The National Study of Family Growth found in 1988 that the percentage of 18-year-olds who reported being sexually active increased about 75 percent between 1970 and 1988, from about 40 percent to about 70 percent. In 1990, 32 percent of ninth-grade girls (aged 14 and 15) reported ever having had sex, compared to 49 percent of the males in the same grade. The National Study of Adolescent Males conducted in 1988 and 1991 found that the average number of partners reported by males in the 12 months preceding the survey grew from 2.0 in 1988 to 2.6 in 1991. Nearly 7 percent of ninth-grade females told the Youth Risk Behavior Survey in 1990 that they had had intercourse with four or more different partners, while 19 percent of males the same age had reported doing so. Although the AIDS epidemic has not reached the adolescent population in huge proportions, the Centers for Disease Control reports that most of the current AIDS cases among people in their 20s were probably contracted in the teenage years. In order for this trend not to continue, public policy must try to lower the rate of sexual activity and raise the level of condom use. More AIDS Drugs Needed, AZT Study Concludes * Advocate (02.09.93) No. 622, P. 22 Coward, Cheryl The recent study which found that AZT-resistant strains of HIV can be transmitted from person to person left few public health experts surprised, but they warned the study emphasizes the need for more new AIDS drugs. Dr. Wendell T.W. Ching, assistant clinical professor of medicine at the University of California- -Los Angeles (UCLA), conducted the study at the Aaron Diamond AIDS Research Center in New York City with three researchers form the medical school at New York University (NYU). The study's findings were reported in the Jan. 1 issue of the Proceedings of the National Academy of Sciences. Ching said, "People are usually infected with various strains of HIV. Once people start taking AZT, the resistant strains are the ones that survive." He said it is these strains that are transmitted through high-risk behavior. "We were able to find AZT resistance in patients who never had any exposure to AZT," he said. Earlier research found AZT resistance developing in people who had taken the drug over a long period, but studies had not shown the existence of AZT-resistant strains of HIV in people who had never taken AZT. Although the Food and Drug Administration accelerated its approval process for experimental anti-AIDS drugs and other treatments for life- threatening conditions, it is not expected to drastically increase the number of AIDS drugs under development, according to insiders. Ching said the study showed "it is probably quite easy for the virus to have a resistant strain propagate itself. This implies that future medications will have to be tested for resistance after the virus is exposed to the medication." News in Brief: Michigan * Advocate (02.09.93) No. 622, P. 25 Nearly 18 percent of the Michigan residents who responded to a survey conducted by the state health department said that a five-year-old state-funded anti-AIDS advertising effort helped convince them to stop practicing high-risk sexual behavior, said state public health director Vernice Davis Anthony. Approximately 60 percent of the participants said the campaign informed them of the state AIDS hotline, said Anthony. She added that the number of calls answered by the hotline has grown by 64 percent since the campaign began in 1988. In addition to the anti-AIDS program, the state also funds anti- smoking, anti-violence, and cancer prevention ad campaigns. A total of $1.7 million has been used to fund all of the campaigns. Research Group Says AIDS Epidemic Will Have Little Effect on U.S. * New York Times (02.05.93), P. A12 The National Research Council has found that although thousands of people have died from AIDS and there is currently a sense of emergency about the disease, the AIDS epidemic will have little impact on the lives of most Americans. The National Research Council's study, released yesterday, said that AIDS was concentrated among homosexuals, drug users, and the poor and undereducated--so-called "socially marginalized groups" with "little economic, political, and social power." Consequently, the council said that AIDS "will disappear," not because, like small pox, it will have been eliminated, but because those who continue to be affected by it are "socially invisible, beyond sight and attention of the majority population." The council is part of the National Academy of Sciences, a private organization funded by Congress to provide scientific advice to the federal government. The study concluded that public health officials will return to more conventional practices, including HIV testing, after initially abandoning them. The report said that AIDS has evoked an awareness that involves a wider acceptance of measures that help promote "safe sex," including the use of condoms. The study said that while AIDS has strained health-care resources in some communities, most areas have been able to take in the new patients. The effect of AIDS on clinical research has led to fewer restrictions on the testing of drugs for lethal diseases, the council found. However, the study said that as the epidemic becomes more centralized in poor communities, the resources for voluntary efforts may decrease. Related Stories: Baltimore Sun (02.05) P. 1A; Los Angeles Times--Washington Edition (02.05) P. A1; Philadelphia Inquirer (02.05) P. A3 Clinton Will Drop Travel Ban on HIV Patients * Los Angeles Times--Washington Edition (02.05.93), P. A6 Lauter, David and Cimons, Marlene President Clinton wants to eliminate the controversial prohibition against HIV-positive foreigners entering the country, the White House said Thursday, but administration officials conceded that quick action is not likely. George Stephanopoulos, the President's communications director, said that he could not provide a date for abolishing the rule because the government has not yet reviewed its Haiti policy. Approximately 270 Haitians, most of whom are infected with HIV, are being detained at the U.S. naval base at Guantanamo Bay in Cuba, even though they have been approved for political asylum. Clinton advisers indicated that the president is not eager to start a controversy over another gay-related issue, as he did recently over the military ban on gays. Therefore, the administration will not take action on the policy toward Haiti until later this year. The ban on HIV-positive foreigners was instituted in 1987 by the Reagan administration. Health experts have repeatedly contended that AIDS--unlike highly infectious tuberculosis--should not disqualify a foreign immigrant because the disease cannot be contracted through the air or through casual contact. Dr. James O. Mason, the former assistant secretary of Health and Human Services who opposed the ban on HIV-positive foreigners, quietly signed off on removing the ban after the presidential election and sent a directive for final approval to the White House budget office, according to government sources. However, Stephanopoulos said the issue would be referred to the Justice Department for review before a final decision is made. Japanese Electronics Firm Reports Biological Discovery * Washington Post (02.05.93), P. F3 Blustein, Paul A Japanese electronics company has developed an antibacterial material that is believed to possess antiviral properties that could be effective against viruses such as HIV. Matsushita Electric Industrial Co., the maker of Panasonic, Technics, and other electronic products, has found a new substance that can deactivate HIV in a test tube. The company said it will "make the substance available for research." Last spring, Matsushita researchers developed the Amenitop agent, an antibacterial powder with special properties that allow it to be mixed into plastics. The company was attempting to develop a process for making its appliances, such as electric dish dryers, free of bacteria. The researchers thought that if Amenitop were mixed into the plastic, the appliance wouldn't spread bacteria to dishes the way other brands can. Later in the year, Matsushita introduced an Amenitop-laced cordless phone and personal fax machine. Subsequently, the company conducted joint research with an Osaka University professor, Shigeharu Ueda, to determine if Amenitop was effective against bacteria and viruses. They found that Amenitop is indeed "effective in inactivating" certain viruses, including HIV and herpes, in the test tube. Matsushita spokeswoman Jane Sweeney said regarding the finding, "Well, we're into speculation here. But HIV, you know, can only be transmitted through bodily fluids.... So, it's very, very speculative..." Many Doctors in Mass. Help HIV Patients Track Partners * Boston Globe (02.04.93), P. 1 Tye, Larry Due to the lack of the state's resources for tracking needle- sharing and sexual partners of HIV-positive patients, several Massachusetts doctors do the tracking themselves in cooperation with their patients. The Massachusetts Medical Society is currently pressing the Department of Public Health to improve its partners notification program. Although the health commissioner opposes such an idea, some of his staff claim that lives could be saved if they were provided with more information on people with HIV and more freedom to trace their sex and needle-sharing partners. Dr. Nicholas J. Fiumara, who until 1984 ran the Health Department's communicable and venereal disease program and now runs the sexually transmitted disease clinic at the New England Medical Center, is one of the physicians who conducts his own sex/drug partner tracing. "I interview all my patients and ask that they bring in their sexual contacts. I do it routinely and have been since 1985." He added, "Among medical groups there is a consensus that these people should be interviewed for contacts, the sexual contact should be examined, and if they're infected, they should be treated." While many doctors do their own contact-tracing, they are not trained in the techniques and "if they divulge information to someone they know is at risk, they can be sued by the patient; they face criminal charges," said Dr. William Callahan, president of the Massachusetts Medical Society. In addition, he said that in order to be effective, contact- tracing should be done through public health workers, who "are trained, they're qualified, and they're confidential." Newspaper Says 72 Have Died of AIDS in Russia * Reuters (02.03.93) (Moscow) A total of 72 people have died of AIDS in Russia in the seven years since the first case was identified, according to the evening newspaper Izvestia. The paper said 611 people are infected with HIV, and 92 people have full-blown AIDS. Epidemiologist G. Pankova said that 18 adults and 43 children had died from AIDS in the Commonwealth of Independent States (CIS), which includes most of the states of the now defunct Soviet Union. In the late 1980s, Russia experienced scandals involving hospitals that re-used needles and ignored basic health guidelines. More than 100 children were among those who contracted HIV in 1989 after they were infected with tainted blood. Former Russian Health Minister Andrei Vorobyov said in March that thorough testing for HIV had helped control the number of Russians infected with the disease. He announced that the government had implemented a three-year anti-AIDS program and said the estimates of a drastic rise in HIV infections had not been fulfilled. Japan--AIDS Drug * Associated Press (02.04.93) (Tokyo) A Japanese company has announced that it has found a less expensive way to develop AZT. Kanematsu Corp. expects to begin selling thymidine, a primary ingredient in AZT, made by the new technique by the end of this year. The compound will be sold to drug companies that will subsequently use it to make AZT. Kanematsu spokesman Yoshikazu Tsugawa said the agent will be made by Kobayashi Koryo, a pharmaceutical company, using a process that is up to 50 percent less expensive than the conventional method. Tsugawa said thymidine is currently made through fermentation, while the new process developed by Kobayashi Koryo uses heat evaporation. He said, "There are many people around the world, particularly in poorer countries, who can't afford the medicine. Bringing the price down should make it available to many more people." He added that Kanematsu expects to concentrate on markets in India and Brazil. Sexual Risk Behaviors of STD Clinic Patients Before and After Earvin "Magic" Johnson's HIV-Infection Announcement--Maryland, 1991-1992 * Morbidity and Mortality Weekly Report (01.29.93) Vol. 42, No. 3, P. 45 Former basketball star Magic Johnson's announcement that he tested HIV-positive prompted behavioral change throughout society. A study by the Centers for Disease Control found that people were inclined to be more selective when choosing a sexual partner and tended to have fewer partners after Johnson's announcement. The study involved 283 people attending a sexually transmitted diseases (STDs) clinic in a Maryland suburb of Washington, D.C., during the 14 weeks before and the 14 weeks after Johnson revealed his HIV-positive status. Among the participants, 186 (66 percent) were interviewed during the 14-week preannouncement (July 29- Nov. 1, 1991) and 97 (34 percent) during the 14 week postannouncement period (Nov. 11, 1991-Feb. 14, 1992). Overall, 87 (31 percent) had had one or more STDs during the previous 12 months; 220 (78 percent), two or more sex partners during the previous 12 months; and 157 (55 percent), 10 or more sex partners during the previous 10 years. The CDC found no significant differences in patients' reports of condom use in vaginal sex during the previous 3 months. But substantially fewer patients in the post-announcement period than the preannouncement period reported having had either "one-night stands" (20 percent versus 31 percent) or three or more sex partners of the opposite sex (21 percent versus 32 percent) during the previous 3 months. Differences Between Anonymous and Confidential Registrants for HIV Testing--Seattle, 1986-1992 * Morbidity and Mortality Weekly Report (01.29.93) Vol. 42, No. 3, P. 53 While people seeking anonymous or confidential HIV testing reported similar risk factors, confidential registrants were more likely than anonymous registrants to test positive for HIV, according to a study conducted by the AIDS Prevention Project (APP), which is part of the Seattle-King County Department of Public Health. APP clients have been offered a choice in how they register since 1986--either confidentially (using names) or anonymously (using an identified code). Between June 1986 through March 1992, the APP collected demographic, behavioral, and clinical data on 9,993 persons seeking HIV testing. Among the 9,310 persons who were tested and for whom follow-up information was available, the percentage who returned for results (93.7 percent) did not differ by sex. Of the 6,841 men who were tested and for whom follow-up information was available, there were no differences in the proportions of anonymous or confidential registrants who did not return for results. But of the women who were tested and for whom follow-up information was available, 73 (7.8 percent) of 930 confidential registrants and 86 (5.6 percent) of 1,530 anonymous registrants did not return for results. It was found that both men and women who registered anonymously were older, better educated, and more apt to report middle-or upper-income levels and were less likely to test HIV-positive. Men who tested anonymously were somewhat more inclined to report having had sex with other men. Women tested anonymously were more likely to report heterosexual contact as the primary risk factor. Mycoplasma Fermentans in Individuals Seropositive and Seronegative for HIV-1 * Lancet (01.30.93) Vol. 341, No. 8840, P. 271 Katseni, Vassiliki et al. There is no link between infection by the mycoplasma and the stage of AIDS, CD4 count, or HIV-1 load, according to Vassiliki L. Katseni et al. of the St. Mary's Hospital Medical School in London, U.K. Mycoplasmas have been believed to serve as a co- factor to explain various unknown features of infection by HIV. The researchers sought Mycoplasma fermentans by means of a semi-nested polymerase chain reaction (PCR) in samples of peripheral-blood mononuclear cells (PBMC), throat swabs, and urine samples from 117 HIV-positive patients (of whom 114 were homosexual men). M. fermentans was found in 12 (10 percent) PBMC samples, 15 (23 percent) of 65 throat samples, and 4 (8 percent) of 55Jurine samples form the HIV-positive subjects. The organism was found in similar proportions among 73 HIV- negative patients recruited from a sexually transmitted diseases clinic (9 percent, 20 percent, and 6 percent, respectively); again, most of the men (40 of 50) in this group were homosexual. This suggests that M. fermentans is part of the normal flora of the throat and genitourinary tract, isolated rarely because of the insensitivity of culture techniques. The researcher's culture procedure is a hundred to a thousand times less sensitive than the PCR. The high sensitivity of the PCR increases the chance of false-positive results, but the researchers negative controls in each assay remained negative--the proportion of samples positive was similar for each batch tested, and repeated tests produced the same results. These findings do not eliminate the potential that the mycoplasmal infection could influence the speed of disease progression, the researchers conclude. Total Lymphocyte Count as a Prediction of Absolute CD4 Count and CD4 Percentage in HIV-Infected Persons * Journal of the American Medical Association (02.03.93) Vol. 269, No. 5, P. 622 Blatt, Stephen P. et al. When a doctor must evaluate an HIV-positive individual without a recent CD4 count, the combination of clinical data and the total lymphocyte count (TLC) may allow a reasonable estimation of the vulnerability of that individual to opportunistic infection, write Stephen P. Blatt et al. of the Military Medical Consortium for Applied Retroviral Research in San Antonio, Texas. The researchers conducted a study of 828 patients with no prior history of AZT use, from January 1985 through July 1991. The sensitivity, specificity, and likelihood ratio (LR) of the TLC, in the range of 1,000 to 2,000 CD4 T- cells, in predicting an absolute T-cell count less than 200 or a CD4 percentage less than 20 percent were calculated. It was found that the TLC between 1,000-2,000, appears to be a useful predictor of significant immunosuppression as measured by a T- cell count less than 200 in HIV-positive persons. The LR for a given TLC value and the pretest probability of immunosuppression can be used to determine the posttest probability of significant immunosuppression in individual patients. For instance, a patient with a TLC less than 1,500 and a pretest probability of 16 percent, the posttest probability of a low T-cell count increases to 53 percent. But a TLC greater than 2,000 in an individual with a pretest probability of 30 percent will decrease the posttest probability of a low T-cell count to less than 4 percent. Physicians should find these data effective in helping estimate the risk of opportunistic infection among HIV-positive persons who present with syndromes that are potentially compatible with opportunistic infection but who have not had a prior T-cell analysis. 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 02.01.93 ]]]====---- .