-----===[[[ A I D S w i r e D I G E S T 04.26.93 ]]]===----- Gay Americans Throng Capital in Appeal for Rights: A Festive Mood Amid Demand for Equality * New York Times (04/26/93), P. A1 (Schmalz, Jeffrey) Hundreds of thousands of gay and lesbian Americans and their supporters gathered in Washington, D.C., yesterday to celebrate homosexuality and demand their rights which include more funding for AIDS research. President Clinton, who decided not to attend the protest, going instead to Boston to speak before newspaper publishers, sent a five-paragraph letter that was read to demonstrators by Representative Nancy Pelosi, a Democrat from San Francisco. In the letter, Clinton reaffirmed his commitment to increasing spending for AIDS research. But some AIDS activists at the gay rights march were skeptical of Clinton's promise. Larry Kramer, AIDS activist and playwright, said that the president had not kept his AIDS-related promises, including one to appoint a federal coordinator of AIDS issues. During the march at 2:00 P.M., hundreds of people under the banner the Gay Men's Health Crisis of New York conducted a "die-in", in which they lied down in front of the White House to represent the number of people who have died from AIDS. Other demonstrators passed by shouting "Where's Bill?" British Health Worker Contracts HIV From Patient * United Press International (04/23/93) (London) The case of a British medical worker who contracted HIV from an infected patient is raising questions over whether terminally ill AIDS patients should receive certain emergency treatment. In Saturday's issue of The Lancet, it was reported that a 59-year-old woman who was working to resuscitate a 22-year-old AIDS patient contracted HIV from that patient. It said she incurred a "deep penetrating injury" with a sharp blood transfusion apparatus that had been used on the AIDS patient. The health-care worker subsequently tested HIV-positive. The report said, "This case highlights the increased risk to staff of doing emergency procedures on patients with AIDS who are terminally ill. Our resuscitation policy now clearly states the importance of taking into account the risk of HIV transmission whenever a decision is made on the appropriateness of attempted resuscitation." In addition, the health-care worker contracted the virus even though she underwent treatment with AZT within an hour of the incident. The report stated that the virus which infected the health-care worker was "substantially less sensitive" to AZT than HIV in patients who had not received the drug. The AIDS patient, who died four weeks later, had also been administered AZT for 18 months. "It is therefore possible that this woman's strain of virus was resistant to (AZT)," the report said. Because the patient had full-blown AIDS, it also indicates that her blood had high levels of virus in it. UN Agency Declares Tuberculosis Emergency * United Press International (04/23/93) The World Health Organization on Friday declared a "global emergency" regarding the resurgence of tuberculosis worldwide. WHO said that because the disease will claim more than 30 million lives in the next 10 years unless aggressive action is taken to control its spread, it was taking "the extraordinary step of declaring tuberculosis a global emergency." The United Nations health agency said, "Tuberculosis is the leading cause of death from a single infectious agent, a bacterium that already infects one third of the world's population." WHO said that in many parts of the world TB's spread is "out of control," it added that each year "eight million people are developing the disease." The agency said "The disease, preventable and treatable, has been grossly neglected and no country is immune to it." In addition to global business travel and migration, refugees from wars and famines, "the deadly link" between TB and HIV is another major factor in the rise of TB. According to WHO, there has been "a dramatic rise" in TB cases in North America and Europe in the past five years. For instance, there has been a 12 percent increase in the United States between 1986 and 1990, a 28 percent rise in Italy between 1988 and 1990, and a 33 percent increase in Switzerland from 1986 to 1990, said WHO. "However, the great majority of today's cases, and more than 95 percent of TB deaths, are in the developing world." It said the best way to prevent transmission of TB is to cure infectious cases in their early stages. Clinton Health Chief Heckled by AIDS Activists * Reuters (04/22/93) (Washington) Health and Human Services Secretary Donna Shalala was criticized by a few AIDS activists Thursday evening when she spoke about the Clinton administration's AIDS policy at a dinner sponsored by the National Minority AIDS Council and Broadway Cares/Equity Fights AIDS, an entertainment industry group. One demonstrator was led out of the dinner by security guards after interrupting Shalala's speech with shouts of "liar." Other protesters held up signs and blew whistles as Shalala delivered what had been considered the administration's first major pronouncement of AIDS policy. Some of the signs said, "Donna Do- Nothing" and "Donna You're Killing Us." Shalala said, "We need everybody--those who disagree with us and those who support us." Many members of Congress and congressional and White House staff aides attended the dinner. Before Shalala began her speech, several other speakers referred to a change in Washington brought on by Clinton's election and said it would help fight AIDS. However, activists are angry that President Clinton has not yet appointed an AIDS "czar"--a senior adviser to coordinate AIDS efforts--as he promised during the presidential campaign. In her speech, Shalala promised to "make our choice (of an AIDS policy coordinator) soon--which you can count on." Sweden Jails Man From Zaire for Passing on AIDS * Reuters (04/23/93) (Stockholm, Sweden) Because an HIV-positive man from Zaire knowingly transmitted his infection to two women, a Swedish court decided to jail him for five years, to be followed by life expulsion from Sweden. In addition, the court demanded that Jean-Charles Mboutou pay $110,000 in compensation to each of the women, according to court spokeswoman Barbra Wikstro. She said that Mboutou was residing at a refugee hostel in western Sweden at the time of the offenses. HIV Never Sleeps, Loves a Good, Stiff Drink * Advocate (05/04/93) No. 628, P. 14 HIV replicates quietly in the lymph nodes, according to a study published in the March 24 issue of Nature. The virus can spread in the body for about ten years before AIDS symptoms are exhibited, the report said. In addition to a brief flu-like attack soon after infection, patients could feel fine even as HIV cells replicate in their lymph nodes and related organs. Health officials say the findings could help physicians rethink when to start treating the disease. In a separate study published in the March issue of the Journal of Infectious Diseases, Dr. Omar Bagasra of the Thomas Jefferson University in Philadelphia found that even moderate alcohol consumption may accelerate the growth of HIV. His study revealed that drinking only two beers both suppressed the body's immune system and enabled HIV to replicate more rapidly. Crusade for Condoms * Far Eastern Economic Review (04/22/93) Vol. 156, No. 16, P. 24 McBeth, John Philippine Health Secretary Juan Flavier's approach to controlling the country's population and the rate of AIDS cases is in direct opposition of what the Catholic Church preaches because it promotes the use of condoms. In addition, there is evidence to suggest that Filipinos are simply taking less notice of the Catholic Church on issues such as AIDS and birth control because they feel it is out of touch with the times. Although Flavier and President Fidel Ramos disagree with the Catholic Church's belief that using condoms encourages promiscuity and sexual immorality, they must proceed with caution because roughly 80 percent of the 63 million Filipinos are Catholic. However, Ramos and Flavier will not allow the church to dictate policy. The Catholic Church insists the only way to prevent HIV infection is to abstain from sex. Flavier does emphasize abstinence first, but says that condoms should be used if abstinence is not applied. "We will educate and inform the public and let them decide. It's not up to the Church or me to make the decision," said Flavier. In the Philippines, 373 people have been reported with HIV, 22 people have full-blown AIDS, and 66 people have died of AIDS. While the figure may be relatively low, Flavier cautions that 100 times that number--or 37,000--probably are infected with HIV. Currently, Flavier is planning to establish 30 centers nationwide to test five different groups--sex workers, soldiers, overseas contract workers, students, and truck drivers. The testing will be conducted on a voluntary basis, and is essential if health officials are to elucidate the actual extent of the problem. Immediate Versus Deferred Zidovudine * Lancet (04/17/93) Vol. 341, No. 8851, P. 1023 Peto, Richard and Collins, Rory AIDS patients and their physicians need to know whether the net effects on survival of a policy of early use of AZT are slightly favorable, slightly unfavorable, or negligibly small, write Richard Peto and Rory Collins of the Radcliffe Infirmary in Oxford, U.K. The European "Concorde" study randomized to a policy of immediate AZT in early HIV disease (877 patients) versus a policy of deferred AZT that would generally be started only when, perhaps several years later, symptoms of AIDS-related complex (ARC) or AIDS developed (871 patients). After a mean follow-up of only 3 years (throughout which time the mean CD4 cell count was significantly higher among those allocated AZT) the numbers of deaths were 95 with immediate versus 76 with deferred drug. Such discouraging numbers of deaths, rather than the numbers who developed ARC or AIDS, are the most fundamental findings thus far from Concorde. If AZT is moderately effective but is soon bypassed by viral resistance, then a policy of immediate AZT might be expected slightly to increase the time until symptoms develop, but slightly to decrease the time from symptoms to death. The net effects of early AZT use may, however, take many years to determine reliably, not only because large numbers are needed for statistical stability but also because treatments that have little or no net effect on early mortality might have a moderate net effect (in either direction) on late mortality. Therefore, the only way to estimate the balance of these opposing effects reliably is by strict randomization and indefinite mortality follow up of large numbers of asymptomatic HIV-positive patients, the researchers conclude. Are There Two Types of Response to HIV? * Lancet (04/17/93) Vol. 341, No. 8851, P. 1023 Phillips, Andrew N. et al. The notion that there is a substantial group of individuals who do not show immunological progression in HIV disease is highly unlikely, write Andrew N. Phillips et al. of the James Pringle House in London, U.K. In the March 6 issue of the Lancet, Dr. Rowe reports the apparent existence of a "group of rule-breakers" who are "infected but do not show immunological progression." He states that after an initial decline to 500/uL, CD4 counts in some 15 percent of infected individuals--designated non-progressors--stabilize or rise slightly for many years. That the rate of CD4 cell count decline in HIV infection varies greatly is beyond dispute. But introduction of the notion of immunological non-progressors in HIV infection seems to be appropriate only if the CD4 cell count experience of infected individuals falls into two groups: those who develop very low CD4 counts (progressors) and those who do not (non-progressors). The researchers followed a cohort of 111 HIV-positive men with hemophilia for up to 12 years from seroconversion and have been measuring CD4 lymphocyte counts about every 6 months since 1982. The figure shows the estimated probability of the CD4 count having fallen to various values by 10 years from HIV seroconversion. The estimates indicate that although counts of almost half of the patients decline below 50/uL by 10 years from seroconversion, those in only a few patients remain above 600/uL. Nevertheless, the researchers conclude that their findings do not indicate the existence of a significant group of people who are resistant to immunological progression. Disputed Tests Set on Vaccine for AIDS * New York Times (04/27/93), P. C3 Meier, Barry The controversy surrounding an experimental therapeutic AIDS vaccine was recently resolved when, by mutual agreement, responsibility was shifted from the Department of Defense, which initially planned to conduct the tests among members of the armed forces, to the National Institutes of Health. The new plan requires the vaccine, known as gp160, to be tested and compared against other experimental therapeutic AIDS vaccines. The agreement resolves a long-standing debate over the testing of gp160. Congress earmarked $20 million last fall for testing the drug after an intensive lobbying effort on behalf of the vaccine's manufacturer, MicroGeneSys Inc. of West Haven, Conn. Leading federal researchers, including Dr. Bernadine Healy, the director of the National Institutes of Health, and Dr. David A. Kessler, the Commissioner of Food and Drugs, immediately objected to the allocation, contending that researchers rather than politicians should dictate the nation's agenda for research. However, Defense Department researchers maintained that gp160 should be tested alone, calling it the most promising of the experimental AIDS vaccines. But other AIDS researchers said that gp160 did not appear to be significantly more effective than other experimental vaccines. Therefore, Health and Human Services Secretary Donna Shalala intervened and requested that the Defense Department transfer funds so that multiproduct trials could be executed by the NIH. Consequently, NIH will now conduct large-scale human trials of gp160 and other vaccines made by Genentech, Chiron-Biocine, ImmunoAG, and Immunization Products Ltd. Mapping Progress of AIDS Virus * Toronto Globe and Mail (04/26/93), P. A11 Hess, Henry The case of a London, Ontario, man infected with HIV subtype A who infected three women with the same strain received the attention of a New Mexico AIDS researcher. The HIV-positive man allegedly infected three women with the same strain, marking the first time anyone had found that particular version of HIV in North America. Gerald Myers, custodian of the international HIV/AIDS data bank at Los Alamos National Laboratory, charts the global p-H$IV. He said the new finding added another colored dot to his computerized map of the epidemic. Since the mid-1980s scientists have known that not all AIDS viruses are the same. Last year, researchers at Los Alamos used a method known as genetic sequencing, which is, essentially, the snipping out of tiny bits of HIV and examining the organization of the building blocks that create its genetic code. They ran the results of the genetic sequencing through the computers at the lab and found five distinct HIV-1 subtypes, labeled A through E. The B virus is predominant in North and South America, as well as Australia and much of Europe, while Africa has all the other types and Asia falls somewhere between. Dr. Myers said, "It has been suspected that E might be more transmissible heterosexually." In addition, he said that while the Ontario sample of subtype A was the first reported in North America, "there probably are more subtype A viruses in the U.S. and North America." He added, "But because the B virus had such an overwhelming head start" in this part of the world, it accounts for the overwhelming majority of infections. 5 Texas Girls Say They Had Sex With an HIV-Infected Male to Get Into Gang * Baltimore Sun (04/27/93), P. 7A The reports of five teenage girls from San Antonio, Texas, who allege they were dared to have unprotected sex with an HIV-positive male as a part of a gang initiation are being investigated by police. However, police revealed yesterday that there is little they can do unless one of the girls comes forward to file a criminal complaint alleging sexual assault or claiming someone knowingly exposed them to HIV without their consent. According to Planned Parenthood of San Antonio, five 14- and 15-year-old girls who were tested for HIV told counselors that they had sex with an HIV-positive male gang member to become initiated. "If the test came up negative, then it was like they were brave enough to have unprotected sex and they were tough enough and their body was tough enough to fight disease," said Planned Parenthood spokeswoman Jo Ann King-Sinnett. None of the girls has tested HIV- positive so far, said King-Sinnett. But because the teenagers told counselors their sexual activity occurred late last year and in January, the virus could still show up in their blood over the next several months. Police and Planned Parenthood would not disclose the name of the gang to prevent giving the group publicity. King-Sinnett did indicate it is one of the city's largest, based on the predominantly Hispanic west side. AIDS in Asia: As the HIV Virus Takes Hold, Many Fear a Human--And Economic--Calamity * Boston Globe (04/26/93), P. 39 Nickerson, Colin Because it takes years for HIV to develop into full-blown AIDS and the first cases of the disease did not appear in Asia until recent years, the death toll in the continent remains quite low. While there is no official figure of AIDS deaths, experts say a reasonable prediction is about 14,000. However, nearly 2 million Asians have already contracted HIV. International health organizations say between 10 million and 20 million Asians will be infected with HIV by the year 2000. It was not until two or three years ago that the Japanese finally acknowledged the disease that they previously considered "the fire across the river" referring to infected foreigners. Also, in Thailand the first case of HIV infection had not been detected until 1984. In Asia, prostitutes are the main carriers of HIV infection, which is also increasingly spread among IV-drug users. In addition, male homosexual contacts contribute to HIV transmission--but to a far lesser extent than in the West. India and Thailand are home to catastrophic proportions of HIV infection. Both countries have huge, largely unregulated sex industries where the prevalence of HIV among prostitutes is estimated at 20 percent and rising. But Thailand has launched a $48 million AIDS prevention campaign which includes extensive distributions of free condoms; intensified monitoring of brothels; and widespread blood-screening tests. According to Chinese health officials, only 1,000 cases of HIV infection have transpired out of a population of 1.1 billion. But international researchers deem the figure is much higher and the infection rate is escalating in the southern provinces, where IV-drug use is on the upswing and prostitutes abound. Around the Region: AIDS Rapist Receives 3 Life Terms * Washington Post (04/27/93), P. D5 HIV-positive Alexandria, Va., man, who was aware of his infection and committed two rapes last year, has been sentenced to three life terms plus 75 years in prison. Charles Devlin Thompson broke into two homes and raped female residents at knifepoint last fall. He cut the throat of one of the women when she called for help, Thompson subsequently admitted in court. Assistant Commonwealth's Attorney Glenn C. Alexander told Circuit Judge Donald H. Kent during last Thursday's sentencing proceeding that Thompson should never again walk free since he knew that by raping the women he might expose them to HIV. The women have been tested for the virus, but the results were not publicly disclosed. AIDS From an M.D.? Time (04/26/93) Vol. 141, No. 17, P. 17 Despite the death of Kimberly Bergalis--the young Florida woman who contracted HIV from her dentist--doctors say they are much more at risk for becoming infected with HIV from their patients than vice versa. The Journal of the American Medical Association (JAMA) recently published three studies that back the doctors' claim. Researchers found three HIV-infected physicians--two surgeons and a dentist--who continued to practice almost until their death. The researchers subsequently tested patients--more than 2,500 people--who had undergone invasive procedures while the doctors were infected. Some of the patients were HIV-positive, but none of them contracted the virus from their doctor. An accompanying JAMA editorial said studies were reassuring, but it added that it would be more convincing to start from the other end--to find one patient who contracted HIV from a doctor and then test the doctor's other patients. However, this is not easy because of all the doctors with AIDS, the only one who has been connected to transmitting HIV to his patients is the dentist of Kimberly Bergalis. Exogenous Reinfection With Multidrug-Resistant Mycobacterium Tuberculosis in Patients with Advanced HIV Infection * New England Journal of Medicine (04/22/93) Vol. 328, No. 16, P. 1137 Small, Peter M. AIDS patients can become reinfected with Mycobacterium tuberculosis either during therapy for the original infection or after therapy has been completed, write Peter M. Small et al. of the Howard Hughes Medical Institute at Stanford University in Stanford, Calif. The researchers gathered clinical information on 17 patients seen at a New York City hospital who had repeatedly positive cultures for M. tuberculosis. All patients underwent an analysis of restriction- fragment-length polymorphisms (RFLPs) on serial isolates of M. tuberculosis. A total of six patients had isolates that remained drug- susceptible, and the RFLP patterns of these isolates did not change over time. Out of the 17 patients, 11 had isolates that developed resistance to antimicrobial agents. The RFLP patterns of the isolates from six of these patients remained essentially unchanged (two strains showed one additional band) despite the development of drug resistance. In five other patients, however, the RFLP patterns of the isolates changed dramatically at the time that drug resistance was detected. The change in the RFLP pattern of the isolate from one patient appeared to be the result of contamination during processing in the laboratory. In the remaining four patients, all of whom had advanced HIV disease, the clinical and microbiologic evidence was consistent with the presence of active TB caused by a new strain of M. tuberculosis. Resistance to anti-TB drugs can develop not only in the strain that caused the initial infection, but also as a result of reinfection with a new strain of M. tuberculosis that is drug resistant, the researchers conclude. Brief Report: Primary Infection With Zidovudine-Resistant Human Immunodeficiency Virus Type 1 * New England Journal of Medicine (04/22/93) Vol. 328, No. 16, P. 1163 Erice, Alejo et al. People can become infected with strains of HIV that are already resistant to AZT, write Alejo Erice et al. of the University of Minnesota Medical School. Strains of HIV-1 with reduced sensitivity to AZT have been isolated from patients treated with the drug for six months or more. Resistance to AZT is linked with late-stage disease, low CD4 lymphocyte counts, longer antiretroviral therapy, and specific mutations in the reverse transcriptase gene of HIV-1. The clinical significance of infections with resistant HIV-1 isolates is not well understood. A 20-year-old homosexual man infected with HIV-1 in the early course of disease was examined by the researchers who found that the patient had decreased susceptibility to AZT in vitro. The researchers also found that the HIV-1 strain isolated before the start of AZT therapy contained a mutation in position 215 of the reverse transcriptase gene. The presence of the mutation at position 215 has been linked with resistance to AZT and the mutation has not been found by direct probing or sequencing with the polymerase chain reaction in 98 isolates obtained from HIV-1 infected persons before AZT therapy. The patient reported no previous use of AZT, his blood was negative for the drug, and his mean corpuscular volume was normal at base line. Since one of his sexual partners was receiving AZT (and therefore could have been harboring a high percentage of resistant HIV-1 variants), the researchers conclude that he acquired an AZT-resistant virus. The Administration of Didanosine (ddI) in the Adult: A Nursing Perspective * Journal of the Association of Nurses in AIDS Care (01/93-03/93) Vol. 4, No. 1, P. 23 Vaccariello, Janet; Funesti, Julie C.; Laverty, Maura K; etal. Since Bristol-Myers Squibb received FDA approval for didanosine (ddI) in the treatment of HIV-infected patients, the drug's use has risen. Nurses need a full understanding of the drug, its side effects, and nursing implications. The two methods for administering ddI are tablets and sachet. Tablets must be eaten and swallowed thoroughly, either at once or in quick succession. Alternatively, the tablets can be dissolved in at least 1 ounce of ice water, and drunk immediately. Patients should drink another glass of water to decrease dry mouth that occurs when chewing the tablets. The sachet, or buffered powder, must be emptied into about 4 ounces of water and stirred until totally dissolved. Patients should ingest immediately. The dosage for either the tablets or the sachet is one pill every 12 hours. The tablets will be a lower dose than the sachet because the drug in the tablets is more bioavailable. Nurses should take cautious steps when dealing with pregnant patients, those breast-feeding, those on low-sodium diets, and patients with phenylketonuria. The drug can cause neuropathy, pancreatitis, and diarrhea as side effects. F.D.A. is Moving to Approve Marketing of Female Condom * New York Times (04/28/93), P. A13 The Food and Drug Administration revealed yesterday that it expects to approve the marketing of the first female condom in the United States to help protect women against HIV infection and other sexually transmitted diseases (STDs). Even though there is limited data on the efficacy of the product, the agency said it was prepared to give final approval to the Reality female condom made by Wisconsin Pharmical Company. The condom is a lubricated polyurethane sheath that has flexible polyurethane rings on each end, one of which is inserted into the vagina. The FDA said that the device, which was unanimously endorsed in December by an advisory committee, would be approved if the manufacturer performs additional tests of its efficacy and includes specific information on the label. Wisconsin Pharmical would be required to state on the label that male latex condoms offer "highly effective protection" against HIV and other STDs, the agency said. Also, the FDA said it would require the product's label to indicate that the pregnancy rate for those using the device--about 26 percent--is higher than the rate for other female barrier contraceptives. But a study of 200 women who used the condom for six months said the high rate of pregnancy might have been caused by incorrect use of the device, said the FDA. Dr. David A. Kessler, the commissioner of the FDA, said, "The female condom is not all we would wish for, but it is better than no protection at all." The agency said it hastened the review process for the condom because the device offers women the chance to protect themselves without the cooperation of their sexual partners. Related Stories: Washington Post (04/28) P. A5; Philadelphia Inquirer (04/28) P. A2; Los Angeles Times--Washington Edition (04/28) P. A1; Baltimore Sun (04/28) P. 3A French AIDS Discoverer Exploring New Lead for Vaccine * Reuters (04/27/93) (Brussels, Belgium) The French co-discoverer of HIV is currently researching a vaccine against the disease, the Belgian daily Het Nieuwsblad reported Tuesday. Luc Montagnier told the newspaper that he was investigating so-called co-factors, which he said apparently help HIV develop into full-blown AIDS. He said, "Contrary to what we thought a few years ago, it's not the AIDS virus that kills the cells. We see that a big number of cells in an AIDS patient--more than those affected by the virus--have a tendency to die spontaneously." He said, "It is as if the immune system commits suicide." Montagnier added, "We think that co-factors are involved in that activation process. Compare the virus with a flame and the co-factors with oil thrown on the fire." He said he believes "some phyla of mycoplasma, which are small bacteria which enter the cells," to be co-factors involved in activating the virus. Montagnier said that his research into co- factors is not the only potential scenario, but he said, "We cannot take the risk of not studying this scenario thoroughly." He could not provide an exact date for a vaccine. "Some time ago I talked about five years but science evolves by leaps. Maybe somebody will find something tomorrow. Maybe research for co-factors will be successful," he said. "For the moment the best vaccine is information and the condom," Montagnier indicated, adding that it was becoming increasingly difficult to stop the spread of HIV. Moreover, he said 60 percent of HIV-positive patients develop full-blown AIDS 12 years later. Montagnier projects that, by the end of the decade, the number of people infected with HIV would increase from the current 10 million to possibly 40 million. Health Professionals Announces Major Research Agreement With Hoffman-La Roche * Business Wire (04/27/93) (Fort Lauderdale, FL) Health Professionals Inc. announced Tuesday that its subsidiary, Center for Special Immunology Inc. (CSI), has signed an agreement with Hoffman-La Roche Inc. to participate in Phase III multicenter research to examine combination dosages of two HIV drug therapies. The study has been launched as part of Hoffman-La Roche's commitment to provide further data to the Food and Drug Administration to support its marketing application. The study will research the appropriate dosage of DDC and dosing schedule of AZT for use in combination therapy. William M. Reiter, MD., FACP, CSI's principal investigator in the study, said, "We are very pleased to be involved in this research. We have the opportunity to help in better defining a combination approach which could prove instrumental in the care of those afflicted with HIV infection." Through its subsidiary, CSI, Health Professionals Inc. runs a national network of research and primary care facilities specializing in immune system disorders, particularly HIV and AIDS. The network, in conjunction with biotechnology and pharmaceutical companies, conducts multicenter trials. Man With HIV Sues Pittsburgh Hotel Over Firing * United Press International (04/27/93) (Pittsburgh) An HIV-positive man from Pittsburgh, Pa., has filed a discrimination suit against the Ramada Hotel, where he served as a sales manager, for firing him because of his HIV-related condition. Mitchell Kaplan of Pittsburgh filed the lawsuit on Monday in Allegheny County Common Pleas Court. The suit alleges the hotel discriminated against Kaplan based on a non-job-related handicap, and is seeking reinstatement with backpay and unspecified damages. Donald O'Connor, the hotel's attorney, argued that Kaplan was not fired as a result of a disability. He said a Pennsylvania Human Relations Commission investigation neglected to find evidence of discrimination in the case. Polydex Successfully Completes Second Stage Animal Trials on New AIDS Drug; Initiates Third Stage Trials on Larger Animals Using Human Sized Applications * Business Wire (04/26/93) (Boynton Beach, FL) Polydex Pharmaceuticals Ltd. revealed Monday that it completed animal tests to determine toxicity of a complex of Cytochalasin-D and Dextran or Dextran Sulphate. These completed second stage trials have found in vivo efficacy in small animals with minimal incidence or implications of toxicity. In addition, it was disclosed that third stage trials are now being conducted at the same laboratories of Microbiological Associates Inc., in Rockville, Md. This stage will use dosages of the AIDS drug that would be closer to human strength applicability on large animals. Cytochalasin-D havshown to inhibit syncytium formation while Dextran Sulphate has demonstrated an effect on the enzyme in HIV and prevents its replication. Thomas C. Usher, chairman and CEO of Polydex, said it is becoming increasingly understood throughout the scientific community that a combination of drugs or sequence of them may be the best way to combat HIV once and for all. He said, "As to our own efforts in this war on AIDS, we are to date highly encouraged by the results of the combination of Cytochalasin-D, Dextran and Dextran Sulphate. Our earlier concern was the toxicity of Cytochalasin-D used by itself. However, trials to date in using our special formulated metabolized combination of Cytochalasin-D and Dextran Sulphate, as noted have shown minimal toxic implication to no apparent side effects at all. This success has encouraged use to move to the next clinical stage in applying human sized dosages to larger laboratory animals." United Biomedical Begins Next Step Towards Synthetic AIDS Vaccine * Business Wire (04/26/93) (Hauppage, NY) United Biomedical Inc. (UBI) has broadened its clinical trials of a prototype synthetic AIDS vaccine to include populations at risk for HIV infection. UBI began initial Phase I safety trials in February 1993 with the National Institutes of Health AIDS Vaccine Clinical Trials Network of a synthetic vaccine representing a highly immunogenic region of HIV. Due to its successful demonstration of safety, UBI has currently initiated clinical trials of its prototype vaccine in small numbers of volunteers at risk for HIV infection. The study, now being conducted at the University of California--San Francisco, will assess safety and immune-stimulating capacity of the UBI vaccine in 24 adult participants. Because HIV varies extensively worldwide, most researchers now agree that a safe and effective AIDS vaccine must protect against globally diverse HIV strains. They also believe that vaccines that are based on a single strain of HIV will likely be ineffective in prevention of HIV/AIDS. The UBI synthetic AIDS vaccine strategy is unique among current AIDS vaccine approaches in that it is intended to be a multi-component vaccine to address global variation of the virus. UBI is already clinically testing a prototype combination of multiple peptides from five variants of HIV with the intention of designing a final vaccine candidate of 15-20 international variants capable of developing worldwide protection. US Test of AIDS Vaccines is Broadened Beyond VaxSyn * Nature (04/15/93) Vol. 362, No. 6421, P. 581 Macilwain, Colin The controversial trial of a single AIDS vaccine to be conducted by the U.S. Army has been changed so that the National Institutes of Health will compare the efficacy of three other vaccines instead. The U.S. Departments of Defense and of Health and Human Services recently agreed to spend $23 million to test the efficacy of three potential vaccines on 9,000 people after the Army had reported its intention to proceed with a single trial of VaxSyn, a gp160 therapeutic AIDS vaccine produced by the Connecticut biotechnology company MicroGeneSys. The company successfully lobbied Congress last fall to allot $20 million for that reason, but the NIH has agreed to provide the additional money needed for the expanded trials. Researchers and AIDS activists, who previously argued that it would be premature to conduct a large-scale trail of only VaxSyn, applauded the NIH's decision. The announcement regarding the accord was postponed as the Clinton administration attempted to determine how to reconcile language in last year's defense appropriations bill with its decision that the NIH should spend the money instead of the Army. However, MicroGeneSys President Frank Volvovitz questions whether a multiple trial large enough to provide complete results can be conducted for $23 million. The trial is expected to administer each vaccine to 3,000 people, whereas the Army's initial plan was to give VaxSyn to 10,000 people. Either approach would signify the largest clinical trials thus far researching the ability of therapeutic vaccines to thwart the onset of AIDS in HIV-positive subjects. Attitudes of Dentists to HIV-Positive Patients * Lancet (04/17/93) Vol. 341, No. 8851, P. 1032 Porter, Stephen Because of dentists' reluctance to treat HIV-positive patients, there is a need for reassessment of dentists' responsibilities in health care, write Stephen Porter et al. of the Bristol Dental School and Hospital in Bristol, U.K. Even though there are rumors of a reluctance to provide dental care to HIV-positive persons, there are few, if any, objective data about the willingness of British general dental practitioners to treat such individuals. The researchers conducted telephone surveys of 51 randomly selected general dental practices in London during February of 1993. One of the researchers sought private treatment for a toothache. Once he was accepted or rejected he then claimed to be (but was not) HIV-positive but asymptomatic. There was an initial ready acceptance for treatment in all of the 51 practices. But once the researcher's HIV status was disclosed, only about one- fourth of practices remained willing to provide dental treatment, just under half immediately refused all treatment, and a third advised that he attend a dental hospital or another practitioner. The World Health Organization, the General Dental Council, and others state that dentists have an ethical responsibility to provide dental care of all HIV-positive patients. Some studies have indicated that not all dentists are, however, willing to provide dental care for HIV-infected patients, but these studies only assessed the likely attitudes of dental staff. However, Porter et al.'s study revealed that when these attitudes were actually tested, there was clear reluctance to treat, despite the low risk. AIDS Patients Are First in Line * Nature (04/22/93) Vol. 362, No. 6422, P. 684 Swinbanks, David Initial trials of gene therapy in Japan are likely to involve AIDS patients and will be conducted by a private company. Mitsuru Miyata, editor of the newsletter Nikkei Biotechnology, projects that the blood product manufacturer Midori Juji (Green Cross Corporation) will be first on the basis of the worldwide marketing rights it holds for a gene therapy treatment for AIDS developed by Viagene Inc. of San Diego, Calif. The retrovirus vectors used in gene therapy have a risk of causing cancer, which has prompted concerns by Japan's Health and Welfare Ministry. However, Viagene's vector system using the full- length copy of the HIV envelope protein has already been approved in the United States, which is expected to ease its approval through the Japanese ministry. Funds for developing the gene therapy guidelines were provided from the ministry's anti-AIDS campaign, thus indicating that the first clinical trials will involve AIDS patients. New York Seeks Curbs at Sex Clubs * New York Times (04/29/93), P. B3 Navarro, Mireya The New York City Department of Health announced Wednesday that it would order business establishments that promote sex among customers to take measures to prevent the transmission of HIV, which would compel businesses to monitor sexual activity to prevent any unsafe practices. New inspections will be conducted by about a dozen Health Department employees who were trained to enforce compliance at the establishments known as sex clubs. Health officials said clubs that fail to comply could be warned, fined, or even closed. The new policy was prompted by a recent proliferation of sex clubs, where patrons pay an entrance or membership fee to have sex in open areas and closed rooms. Although the clubs are legal, the state health code prohibits them from allowing sexual acts that carry a high risk of HIV infection. Last February, a New York State AIDS Advisory Council, a panel of doctors, government officials, and community representatives, recommended to the Health Commissioner Margaret A. Hamburg that more aggressive action be taken to control the spread of HIV in the clubs. The new policy requests that clubs take a series of measures, including educating patrons on what is considered high-risk sexual conduct and installing monitors to supervise their behavior. In addition, it suggests that the clubs make structural changes so that the activity of patrons can be easily observed. However, state requirements may change because of new information about the risk of HIV infection. The state sanitary code currently categorizes high risk activity as fellatio and anal sex. But the AIDS Advisory Council recommended that the regulations be amended to ban only anal and vaginal sex without condoms. Fertility Programs Attacked in Study * Toronto Globe and Mail (04/28/93), P. A1 Mickleburgh, Rod Several Canadian fertility programs keep inaccurate records, and some put women at risk for HIV infection, according to a study conducted by the Royal Commission on New Reproductive Technologies. The study revealed that several practitioners and one hospital clinic used fresh sperm in their efforts to impregnate women artificially, leaving some women open to the potential of HIV infection. A total of 41 fertility programs in 27 hospitals and clinics offering in vitro fertilization (IVF) and artificial insemination were surveyed by the researchers. They also examined the conduct of 11 doctors providing artificial insemination as part of their private practice. During 1991, about 6,300 Canadian women underwent either IVF or artificial insemination, the study found. It also revealed that there were wide variations in practice, including many involving violations of the fertility industry's own guidelines. Regarding the risk of HIV infection through contaminated sperm, the study mentioned that guidelines instituted by the Canadian Fertility and Andrology Society mandate that all sperm used in artificial insemination be frozen and stored for at least six months before use. Also, the guidelines said that sperm donors should be tested for HIV six months after their donation to ensure they were not infected at the time of their donation but at a stage that was too early for HIV antibodies to be detected. According to the study's findings, one teaching hospital and three of the 11 doctors surveyed did not test sperm donors at all for their HIV status, and two hospitals did not do follow-up testing of donors. AIDS Study Links Unsafe Sex, Drugs * Toronto Globe and Mail (04/28/93), P. A8 Hess, Henry The greater knowledge someone has about AIDS, the less inclined he or she is to engage in high risk sex--unless drugs are involved-- according to a Canadian study published this week in the U.S. journal Annals of Epidemiology. The study discovered that in the case of gay men in Toronto, the rate of risky sexual activities decreased significantly between 1985 and 1990. However, it also found a relationship between unsafe sex and use of recreational drugs, especially amyl nitrate (known as poppers), marijuana, and alcohol. The report's leading author, Prof. Liviana Calzavara of the University of Toronto's department of preventive medicine and biostatistics, said the risk of combining drugs and sexual activity needs to be more focused. Dr. Calzavara said it is undetermined whether drug use leads to risky sexual behavior by reducing inhibitions, or whether people use drugs because they plan on engaging in risky sex. However, the report does indicate that the use of poppers is the strongest predictor of unprotected sex. The five-year study involved 249 gay or bisexual men and was conducted at the University of Toronto. Dr. Calzavara said that since the presence of high risk activity has declined steadily over time, it shows that community groups have properly educated gay and bisexual men. She added that it's important to get the same information to young people and heterosexuals. Teacher May Have Exposed Teens to HIV * Washington Post (04/29/93), P. C1 Shen, Fern A high school teacher from Anne Arundel County, Md., who was recently charged with having sex with several teenage girls, may have been exposed to HIV, according to his lawyers who urge all of his sexual partners to get tested for the virus. But Ronald W. Price told his attorneys that he doesn't think he is infected, though he has been promiscuous and may have been exposed to the virus, said Timothy F. Ubreit, one of Price's lawyers. Price was suspended last week from Northeast High School and has been under house arrest since April 21. But authorities allowed him to leave his home on April 22 to tape the "Geraldo!" show in New York. However, soon after the show aired yesterday, his lawyers said Price believes he may have been exposed to HIV. "He believes he might be HIV-positive and...it is essential that the young ladies be tested" for HIV, said Jonathan S. Resnick, one of Price's lawyers. Price petitioned the court yesterday for permission to leave the house to get tested for HIV. The lawyer said Price made a mistake when he said on "Geraldo!" that he had practiced safe sex with the girls. Resnick said, "We're asking anybody within the past 10 years [who has had sexual contact with Price] to be tested." Eye Treatment--HFR * Associated Press (04/27/93) (Universal City, CA) Drug pellets implanted in the eye of AIDS patients can feasibly save their sight, according to experts at a seminar sponsored by the fund-raising charity Research to Prevent Blindness. The implanted medicine pellets have already prevented blindness in dozens of AIDS patients and should be widely available in about two years. Dr. Jay S. Duker of Boston's New England Eye Center demonstrated how AIDS patients can prevent blindness by using small, dot-shaped, drug-filled pellets that are surgically implanted in the eyes. The procedure takes about 20 minutes. Last year, Duker reported that repeated bouts of AIDS-related cytomegalovirus retinitis, a blinding condition, were avoided in 90 percent of 30 patients who had the plastic-covered implants, which slowly released the drug ganciclovir for either four or eight months. Duker said the researchers have recently tested the eight-month pellets in another 28 patients and found they were 93 percent effective. The pellets keep the drug in the eye, where it is needed, and out of the blood, where it can cause potentially deadly anemia. The pellets are easier to administer than the intravenous infusions of ganciclovir that take a few hours every day, and will cost patients $10,000 to $15,000 per year compared with $50,000 annually for infusions, said Duker. A Global Crisis: Rising AIDS Cases * Pharmacist (04/93) Vol. 18, No. 4, P. 18 Pal, Somnath The reported number of worldwide AIDS cases has increased from 314,610 in 1990 to 611,589 in 1992, an average annual increase of 38 percent, according to the World Health Organization. Due to under-reporting, the actual total cumulative number of AIDS cases in 1992 may be more than 2.5 million, with 13 million persons infected with HIV. The World Health Organization now receives reports of AIDS cases from more than 190 countries. The agency believes the highest rates of increase in HIV infection were in Southern and Southeastern Asia. Africa reported a 60 percent rise in AIDS cases from 81,019 to 129,066 during 1991. Those countries that have the highest rate of cases include the United Republic of Tanzania, Uganda, Zaire, Malawi, and Kenya. In the Americas, the total of 252,977 AIDS cases reported at the end of 1991 was 40 percent higher than the total reported at the beginning of 1991. The majority of the cases were in the United States, Brazil, Mexico, Canada, and Haiti. In Europe, the greatest number of cases continued to be reported from France, Italy, Spain, Germany, and the U.K. The highest rates per 100,000 population were France, Spain, Switzerland, Italy, and Romania. But in Asia where there is an alarming rise of HIV infections, very few AIDS cases continue to be reported. The highest number of cases are in Australia, Japan, New Zealand, Israel, and Thailand. The World Health Organization says the global AIDS case surveillance data remain highly inaccurate. Not all countries consider AIDS a public health problem. Also, there are wide variations in the detection and reporting of AIDS to WHO. Cases that were diagnosed as far back as 1979-80 ontinued to be reported to WHO in 1989. Tuberculosis: Current Strategies * Pharmacy Times (Supplement) (04/93) Vol. 59, No. 4, P. 44 O'Brien, Lisa W. Since 1986, the number of new cases of tuberculosis has risen to 10.2 cases per 100,000 population. Many of these new strains resist first- line drugs used for therapy, leading to toxic substitutions. Groups at a higher risk for contracting or spreading tuberculosis include close contacts with known cases, HIV-positive patients, those with ailments that decrease a patient's immune system, those with poor socioeconomic status, homeless individuals, intravenous drug users, alcoholics, and healthcare employees. M. tuberculosis pulmonary disorder affects AIDS patients differently than patients with normal cellular immunity. This is usually due to a reactivation of a latent infection. Several objectives should be weighed when approaching treatment for the disease. These goals include changing the sputum cultures to negative as fast as possible, attaining complete cure without a relapse, and preventing the emergence of drug resistance. Normal treatment involves administering a combination of drugs for six months. When M. tuberculosis resists two or more of the first-line drugs, therapy can involve second-line drugs. Drug Therapy For Three Opportunistic Infections Associated With AIDS * Pharmacy Times (Supplement) (04/93) Vol. 59, No. 4, P. 13 Womack, Angela C. Anti-retroviral drugs, such as zidovudine (AZT), didanosine (ddI) and zalcitabine (ddC) increase survival in patients with AIDS. However, the drugs do not stop the development of AIDS and the infections that represent it. Cryptococcus neoformans, a ubiquitous, encapsulated yeast-like fungus from pigeons and other birds, passes to humans via Zfinhalation and causes cryptococcal meningitis. C. neoformans can live unrestricted in AIDS patients because of the weakness of their immune systems resulting from a decrease in T-4 lymphocytes. Drugs that can treat this infection, representing 5 percent to 10 percent of patients with AIDS, include amphotericin B alone or combined with flucytosine and fluconazole. However, scientists have not determined the best drug therapy for cryptococcal meningitis. Cytomegalovirus (CMV), a ubiquitous virus of the herpesvirus family, may be a threat to life in a immunocompromised patient. CMV can show up as pneumonitis, retinitis, arthralgias, febrile, mononucleosis, enterocolitis, encephalitis, or disseminated infection. Ganciclovir and foscarnet are the normal treatments for CMV retinitis. The Red Plague: Do Red Ribbons Really Help in the Fight Against AIDS? * Advocate (05/04/93) No. 628, P. 34 Weir, John Controversy surrounds the question of whether the red AIDS ribbons are functional or purely decorative. According to AIDS activists, the ribbon is an empty gesture offered trendily by pandering celebrities at media events. Even former first lady Barbara Bush removed her ribbon before joining her husband on the podium at the Republican National Convention last summer. Larry Kramer, AIDS activist and writer, is concerned that the ribbon takes the place of more aggressive and effective political action. He said, "If every famous person who wore a red ribbon made a phone call to Bush or Clinton, instead, this plague would be over." However, the red ribbon advocates claim the symbol promotes sensitivity toward AIDS patients. David Michaels and Susan Simons of the West Coast Ribbon Project said celebrities help promote AIDS awareness when they wear the ribbons. "If a certain celebrity does nothing else but spread" AIDS awareness, Michaels and Simons wrote recently in an editorial in the Los Angeles Times, "then he or she will have done something good and important with the power that comes with being famous." But many people feel pressured to wear the ribbons. Actor Rob Lowe said, "I guess it's getting to the point where it's bad if you're not wearing one of these things." Nevertheless, the ribbon does translate into money for people with AIDS. Proceeds from ribbon sales by the American Foundation for AIDS Research (AmFAR) go to medical research; Hollywood Helps distributes the money to various AIDS charities; and the Red Ribbon Foundation, working with Project Angel Food, serves 400 meals in Los Angeles every day to people with HIV and AIDS. Widened Definition of AIDS Leads to More Reports of It * New York Times (04/30/93), P. A18 Altman, Lawrence K. The revised federal definition of AIDS has resulted in an expected influx of reported cases during the first quarter of 1993, health officials said yesterday. More than 35,000 AIDS cases were recorded in the first quarter of this year, which is an increase of 204 percent over the number reported for the same period last year, said the Centers for Disease Control. CDC officials had predicted that the new definition would lead to a 75 percent increase in cases for 1993, but had not made an estimate for the first quarter. John Ward, a CDC official, said the agency believed most of the new cases were due to the reporting effect, either entirely or partially. "We do not think the 204 percent increase will be sustained," said Ward. CDC officials also said that the surge in cases could be the outcome of state and local health officials waiting to report new cases until the definition was revised on Jan. 1, Ward said. The new definition added tuberculosis of the lungs, recurring pneumonia, and invasive cervical cancer to the list of 23 other conditions. It also includes the results of a laboratory test for CD4 cells demonstrating a severe immune deficiency. Any HIV-positive person with fewer than 200 CD4 cells would qualify as an as an AIDS case. Among the 35,779 AIDS cases reported in the first quarter, 21,582, or 60 percent, qualified as AIDS under new conditions added in 1993. The remaining 40 percent would have qualified as having AIDS under the older definition. The CDC projected that there would be between 52,000 to 61,000 cases reported in 1993 under the old definition, and from 91,000 to 106,000 under the new definition. Related Stories: Washington Post (04/30) P. A3; Philadelphia Inquirer (04/30) P. A2; Baltimore Sun (04/30) P. 7A Birthday Bash's Beneficiary is AIDS Fight * Baltimore Sun (04/30/93), P. 1D Hardin, Wayne A birthday party for Alexander Baer, a renowned Baltimore interior designer, will use art to benefit AIDS. For a $100 donation, participants will receive a chance to fill an "empty canvas" for a "good cause" and be able to create their own masterpiece. The auction to be held Sunday is called Art for Life and the reception will be held in a grand ballroom at the Belvedere in Baltimore. All of the proceeds will be given to Lifesongs for AIDS, a nonprofit organization, to fight "the devastation of HIV and AIDS." The canvases will serve as a backdrop for the auction. Joanie and Aaron Young will organize the event, which features about 150 works form locally and nationally known artists. Baer says he believes about 50 people will be involved in the auction, but Joanie Young says the number may be double that. Maryland Governor William Donald Schaefer signed his drawing of a "ship of state" as "a composition by William Donald Schaefer." The creations include paintings, drawings, collages, poetry, notes and signatures. They have expressed humor, sadness, and wit--reflecting the joy of knowing Baer and the seriousness of AIDS. Musicians at the event will perform for free and friends of Baer will serve as waiters and waitresses. Lifesongs will get 20 percent from sales of the artwork, which will range from $100 to "into the thousands" and have minimum bids of "far less than retail value," said Joanie Young. According to Baer, Art for Life's goal is to raise $20,000. Baer said he is excited to raise money for AIDS because "There's almost no one this disease hasn't touched in some way." Haitian Detainee Dies of AIDS * United Press International (04/29/93) (Homestead, FL) An HIV-positive Haitian refugee held at the U.S. Navy Base in Guantanamo Bay, Cuba for 18 months, died of an AIDS-related condition two weeks after he was permitted by a judicial order to enter the United States for medical care. Joel Saintil, who died of liver failure Tuesday night at his father's home in Homestead, was one of 40 Haitian AIDS patients and their families allowed to enter the United States earlier this month. However, his father said the judicial order came too late. "What they sent to me was equal to a dead man or a zombie," said Moise Saintil. After Joel Saintil was intercepted by the U.S. Coast Guard when he tried to sail into the United States without a visa, he was taken to a refugee camp at the naval base. There, immigration officials decided he had grounds to pursue a political asylum claim in the United States, but he was infected with HIV. U.S. policy prohibits HIV-positive foreigners from entering the country. Therefore, Saintil was caught in legal limbo. U.S. District Judge Sterling Johnson Jr. of New York issued an interim order in March mandating that the Justice Department bring the most ill Guantanamo Haitians into the United States because the base cannot properly care for them. Michael Ratner, a New York lawyer representing Guantanamo Haitians, said the U.S. policy against HIV-positive foreigners had shortened Saintil's life. A total of 181 Haitians are still at the Guantanamo camp, including 155 who are HIV-positive, said an immigration spokeswoman. The others are children or spouses of those with HIV. A lawsuit to determine their fate is still pending before Johnson. Adult Vaccinations Could Save Lives * United Press International (04/28/93) (San Francisco) Inoculating adults with vaccines that prevent three diseases could save nearly 70,000 American lives each year, according to an article in Thursday's New England Journal of Medicine. The researchers urge immunization against influenza, hepatitis B, and pneumococcal pneumonia. Some 50,000 to 70,000 adults in the United States die from these infections annually, said Dr. Pierce Gardner, chairman of the American College of Physicians' task force on adult immunizations. He said an aging population, AIDS, and the surge of bacteria resistant to antibiotics suggest deaths attributed to pneumococcal pneumonia--the leading cause of pneumonia-related hospitalizations of adults--will exceed the current annual estimates of 40,000. Only about 14 percent of those older than 64 and 5 percent to 7 percent of 18-to-64 year-olds at risk for bacterial lung infection are vaccinated. The pneumococcal vaccine is 46 percent to 93 percent effective, depending on age and severity of illness, said Dr. William Schaffner of Vanderbilt University School of Medicine. American Adults' Knowledge of HIV Testing Availability * American Journal of Public Health (04/93) Vol. 83, No. 4, P. 525 Valdiserri, Ronald O. et al. Even when people are given sufficient information about the availability of HIV testing sites, socio-demographic characteristics are likely to influence preferences for HIV counseling and testing, write Ronald O. Valdiserri et al. of the Centers for Disease Control in Atlanta, Ga. To determine the American adult's knowledge of HIV testing availability, the researchers collected data during 1990 by random-digit-dialing telephone surveys of adults in 44 states and the District of Columbia. Among the 81,557 respondents, almost two-thirds identified medical doctors as a source for HIV testing, which suggests that physicians will increasingly be called upon to provided HIV testing and counseling services to their patients. A total of 14 percent named public sites, and 12 percent said they weren't sure where to go for HIV testing. Those people who were older, less educated, and who had lower incomes were more inclined to not know where they could go for testing. This finding concurs with other studies that show that older persons and persons with fewer than 12 years of education are less knowledgeable about AIDS. But information alone will not ensure that people have access to needed prevention services. The study found that persons who were black and earned less than $20,000 per year were more likely to identify public sites as testing options; both of these characteristics have been linked with persons who lack adequate health care coverage. In order to meet the year 2000 goal of increasing the percentage of HIV-positive persons who have been tested for the virus, people must learn where these services are provided, the researchers conclude. Condom Ads Flout Spanish Court * Advertising Age (04/19/93) Vol. 64, No. 17, P. I-6 Klosky, Deborah The Spanish Ministry of Health & Consumption is proceeding with a $3 million anti-AIDS campaign that promotes condom use despite a high court decision that ruled a similar campaign in 1990 violated advertising laws. The advertising campaign from Contrapunto that was launched last month shows a condom near a red ribbon, representing solidarity in the fight against AIDS. The message says, "We're going to stop AIDS," followed by the line, "Let live and live." In addition, the TV ads discuss condom use as a means to prevent HIV infection. While no lawsuits have been filed over the new ad effort, an earlier $5 million effort by Contrapunto for the Ministry for Health & Consumption and the Ministry of Social Affairs prompted debate. The 1990 ad showed a condom with the message, "Put it on, put it on them," a play on words in Spanish. However, the National Catholic Confederation of Students' Parents took the issue to a Madrid high court arguing that the ads encouraged promiscuity. The court discovered that the ad violated truth-in-advertising laws because it didn't indicate that abstinence and monogamy are the best means of avoiding sexually transmitted diseases. The ministries lost the suit but weren't fined, and are appealing the decision. The court ruled the ads couldn't be used anymore, but the new ad effort was planned before the ruling on the previous campaign, said a Ministry of Health & Consumption spokeswoman. She said the ministry "never considered stopping the campaign," which started the week before the ruling. But parents' organization President Carmen de Alvear said the group may take action if the new ads are found to have the same problems as the initial campaign. Asking Questions Pays Off * American Medical News (04/26/93) Vol. 36, No. 16, P. 21 Primary care physicians too frequently miss detecting HIV infection in patients, according to a report in the Western Journal of Medicine. The study, which involved 44 U.S. practices, was conducted by the Centers for Disease Control and the Ambulatory Sentinel Practice Network Inc., a large network of primary care physicians. Among the 116,712 patients aged 15-49, 268 were HIV-positive, but 128 of those infections, or 48 percent, went undetected by doctors, the study discovered. The researchers said that in order to provide appropriate medical care and prevent the transmission of HIV, primary care physicians must be more aggressive at determining high-risk behavior among patients. Patients with risk factors should undergo HIV counseling and testing. The researchers suggested that improved risk assessment is particularly important for women. While the rate of HIV was four times higher in men in the study, 57 percent of the infections in women had gone undetected, compared with 33 percent of infections in men. Sentinel Surveillance for HIV-2 Infection in High Risk U.S. Populations * American Journal of Public Health (04/93) Vol. 83, No. 4, P. 515 Onorato, Ida M. et al. Sexually transmitted disease (STD) clinics serving clients from HIV-2 endemic areas should test persons with high risk behaviors for both HIV-1 and HIV-2, write Ida M. Onorato et al. of the Centers for Disease Control in Atlanta, Ga. In order to determine the presence and extent of HIV-2, the researchers conducted sentinel surveillance in persons with high risk behaviors. Sentinel surveillance for HIV-2 was conducted by testing 31,533 anonymous blood specimens from patients at STD clinics, injecting drug users at treatment centers and clients at HIV counseling and testing sites in 14 U.S. cities where West African immigrants often reside. Blood samples were tested by HIV-1 and HIV-2 whole virus and synthetic peptide enzyme immunoassay and confirmed by HIV-1 and HIV-2 Western blots. Approximately 10 percent of 31,533 blood samples were positive for HIV-1. Two black heterosexual males were infected with HIV-2. One of the HIV-2-positive specimens did not cross react on HIV-1 enzyme immunoassay screening. The researchers maintain that HIV-2 infection remains rare in the United States. HIV-2 will most likely enter U.S. populations through heterosexual transmission and, if spread by sexual contact to IV-drug users, it could accelerate. Sentinel surveillance for HIV-2 infection should continue by testing blood samples collected for STD clinics and drug treatment centers in selected areas to detect the spread of HIV-2 in the United States, the researchers conclude. NOTE: Compilation by Michael Tidmus : AIDSwire. All rights reserved. Permission is granted to republish on electronic media for which no fee is charged, provided the complete text of this notice is attached to any republished portion or portions. * From the AIDS Daily Summary. The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse has made this information available as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold. Copyright 1992, Information, Inc., Bethesda, MD. -----===[[[ A I D S w i r e D I G E S T 04.26.93 ]]]===----- .