-----===[[[ A I D S w i r e D I G E S T 05.24.93 ]]]===----- May 24, 1993 More Terminally Ill Patients Turning to Insurance for Cash * Knight-Ridder (05/24/93) In a new industry trend, many people want to cash in their life insurance policies while they are still alive. Prudential Insurance Co. and Jackson National are considered the leaders of more than 150 insurance companies that have begun offering some type of accelerated benefit in recent years, said Janel Patterson, spokeswoman for the American Council of National Life Insurers in New York. "The whole purpose is to help people maintain their standard of living. People are living longer, AIDS has come on the scene, and it's become the situation where people become financially strapped in the latter stages of their life," said Prudential spokesman Jim Longo. In addition, life insurance companies have extended the option to compete with the growing number of so-called viatical settlement companies, which buy life insurance policies from terminally ill patients for less than the face value of the policies. More progressive life insurance companies charge no additional premium for the accelerated benefits option. Companies also vary on how much they will accelerate, ranging from 25 percent to 100 percent of the face value of the policy. Viatical settlement companies have more liberal policies, typically accepting as many as two years life expectancy, but paying between 20 percent and 40 percent less than the face value of the policy. Viatical settlements are not as profitable as accelerated life insurance benefits, and are considered taxable income by the Internal Revenue Service. Accelerated life insurance benefits, however, are not taxable. Thousands March in San Francisco to Mourn AIDS Victims * Reuters (05/24/93) San Francisco--Thousands of people participated in a candlelight march Sunday night to honor the more than 10,000 AIDS patients in San Francisco who have died of the disease. The mile-long procession of people holding candles walked from the predominantly-homosexual Castro District to the Civic Center, where they heard speeches in memory of the people who died of AIDS and calls for aggressive efforts to fight the disease. Several marchers wore red ribbons, symbolizing the need to raise AIDS awareness. According to police estimates, there were 7,000 people in the crowd. Sunday's march marked the 10th year that such an event has been conducted in San Francisco, and organizers said similar event were being held in other cities across the nation. Organizer Paul Boneberg said two things had changed since the march was first initiated: "The community is organizing and the epidemic has gotten as bad as we thought it would." Participants in the march said the goal of the event was not only to commemorate people who have died of AIDS but to recommit themselves to defeating the disease. AIDS in Rural America Bares Fear, Ignorance * Los Angeles Times (05/23/93), P. A13 Anthony, Ted Although the AIDS epidemic is spreading throughout cities as well as rural areas, small towns are ill-prepared to deal with the disease because of the moral or political issues involved. Some rural areas are responding to the epidemic by establishing support groups, but other areas refuse to address the issue of AIDS in the community. "In general, rural communities are about two years behind cities," said Jeremy Landau, executive director of the National Rural AIDS Network in Santa Fe, N.M. Landau's organization teaches small-town officials, doctors, and clergy about AIDS. In many small towns, few doctors are familiar with AIDS, and money for high-maintenance care is lacking. Landau said, "People get affected by AIDS and have no way of dealing with it because the community is in denial." He added that cases of AIDS per capita are increasing faster outside of cities. But even support services or AIDS education programs in rural areas cannot always keep pace with those in the cities, and privacy can be nonexistent in areas where county health departments are the only places that offer HIV testing. Anthony D'Augelli, a professor of human development at Penn State University and an expert on the disease, said AIDS' urban identity may be an obstacle to teaching about it elsewhere. "I don't think there's any clever way we can make somebody in a small town have the same sensitivity as someone living in a city neighborhood where half the people are HIV- positive." He said the biggest fear surrounding AIDS is not entirely medical, but stems from homophobia. Tainted-Blood Risk Was 1-in-4, Court Told * Toronto Globe and Mail (Canada) (05/21/93), P. A18 Downey, Donn The Toronto man who contracted HIV from a tainted blood transfusion in 1985 had a 1-in-4 chance of receiving the contaminated blood when he underwent cardiac-bypass surgery and received 46 units of blood, according to a U.S. AIDS expert. Dr. Donald Francis, a regional AIDS consultant with the U.S. Public Health Service in San Francisco, said at a trial of a civil suit in Toronto that in 1985 any heart-bypass-surgery patient would have had the same risk of contracting HIV. Dr. Francis based his estimate on a 1985 Abbott Laboratories report, which is an exhibit in the trial. The man who became infected from the tainted transfusion, Kenneth Pittman, subsequently died in 1990, not knowing that he had AIDS. His widow, Rochelle Pittman, and their four children are suing the Canadian Red Cross Society, the Toronto Hospital, and Pittman's doctor, Stanley Bain, as a consequence of his death. Pittman's family claims that he received an HIV-infected blood product supplied by the Red Cross while he was in the Toronto Hospital for his surgery. Dr. Bain learned Pittman might be infected with HIV in 1989 but never told him. The study by Abbott Laboratories tested 3,000 anonymous serum samples from blood donors in the Toronto area and attained the half-of-1-percent statistic. A total of 17 of those tested HIV-positive by the Western Blot test, which works out to be a risk of .57 of 1 percent. Dr. Francis said, "That means that one out of 200 units would be infected. Therefore, if you receive 200 units, your odds would approach unity as far as being infected. If you received 50 units, we are talking approximately a 1 out of 4 chance." "WHO--AIDS" Associated Press (05/21/93) (Geneva) Approximately 14 million people worldwide are HIV- positive, according to the latest report by the World Health Organization. Previously, WHO estimated that 13 million people were infected with HIV since its discovery a decade ago. The agency's most recent report renewed warnings that the total number of cases of HIV infection could increase to as many as 40 million by the year 2000. This statistic includes people who have died of AIDS. The agency said sub-Saharan Africa remains the area with the highest prevalence of infection in the world, with more than 8 million people who have contracted the deadly virus. However, WHO said, "the most alarming trends of HIV infection are in south and southeast Asia where the epidemic is spreading in some areas as fast as it was a decade ago in sub- Saharan Africa." The report said that more than 1.5 million people are believed to be infected with HIV in the region, with most of them living in India and Thailand. Another 1.5 million people are infected with HIV in Latin America, and the epidemic has also emerged in previously unaffected areas in the Middle East and North Africa, said WHO. AIDS Victim Launches Testing Campaign * United Press International (05/22/93) (Jensen Beach, FL) Only two weeks after revealing that she contracted HIV from her dentist, 18-year-old Sherry Johnson has launched a national media campaign to push for mandatory HIV testing of health-care workers. On May 7, Johnson announced that she was the sixth person infected with HIV by Dr. David Acer, a Stuart, Fla., dentist who died of the disease in 1990. She has given interviews to People magazine and other news groups, and has appeared on the ABC news show "Good Morning America" since her disclosure. Johnson's attorney, Robert Montgomery, said that she is currently in the anger phase of AIDS. He said that he expects her to pick up her campaign once anger gives way to acceptance, much like what happened to his former client, Kimberly Bergalis, who also contracted HIV from Acer and died of AIDS in 1991. Montgomery has filed suit on Johnson's behalf against CIGNA Dental Health of Florida, the insurance company that directed Johnson to Acer. Johnson had her teeth cleaned and cavities filled by Acer between 1987 and 1989. She never underwent any invasive procedures, but a needle was used on her to inject a local anesthetic. Johnson never received a blood transfusion, and all of her sex partners have tested HIV-negative. Federal investigators said Johnson most likely contracted HIV from the dentist because of the similarities in the strain of the virus she carried. Congress Agrees to New NIH Office for AIDS Programmes * Nature (Great Britain) (05/13/93) Vol. 363, No. 6425, P. 101 Macilwain, Colin A compromise between the Senate and the House has facilitated the way for an autonomous Office of AIDS Research (OAR) to appropriate the $1 billion that the National Institutes of Health (NIH) spends annually on the disease. However, the bill will not take effect until Congress resolves a debate over whether foreigners infected with HIV should be admitted into the United States. This is the only issue preventing the passage of a bill to reauthorize NIH programs. The new OAR will be headed by a full-time director with authority to distribute NIH's AIDS budget among its institutes. Currently, each institute is funded directly by the NIH director. AIDS activists have requested the change as a way to boost the government's efforts, and it is opposed by NIH officials, who consider it an unnecessary additional layer of bureaucracy. If the bill passes, the OAR will be one of two new components in the federal fight against AIDS. The other is the "AIDS Czar," who has not yet been appointed and who will work directly for President Clinton in the White House. AIDS activists are worried that the debate over the NIH bill may delay AIDS spending for the 1994 fiscal year that begins on October 1. However, a spokeswoman for the National Institute of Allergy and Infectious Diseases said that those plans are ready to be initiated, that financial planning for 1995 is already under way, and that the budget for fiscal year 1996 would be the first under the authority of the new OAR director. AIDS Virus Detected in Single Cells * Chemical & Engineering News (05/17/93) Vol. 71, No. 20, P. 31 HIV has been detected in individual blood cells by polymerase chain reaction (PCR) amplification of viral genetic material in addition to the flow cytometry. Steven M. Wolinsky and colleagues of the Northwestern University Medical School in Chicago used PCR to amplify HIV-1 proviral DNA--the DNA copy of the viral RNA genome that is integrated into the infected individual's DNA--and HIV-1 messenger RNA sequences inside infected blood cells. The scientists subsequently hybridized the amplified DNA and mRNA inside the cells with complementary fluorescein-labeled oligonucleotide probes. They also used flow cytometry, which can separate cells that fluoresce from those that do not, to identify cells infected with HIV-1. The researchers found that in HIV-1-infected patients, 4 percent to 15 percent of peripheral blood lymphocytes were infected with HIV-1. The percentage of these cells that contained HIV-1 mRNA, an indicator of viral replication, ranged from less than one percent to eight percent. The findings suggest that in HIV-1- positive individuals, a significant proportion of peripheral blood lymphocytes are infected with HIV-1. However, the virus is in a latent state in the majority of these cells. How Should We Teach Our Children About SEX? * Time (05/24/93) Vol. 141, No. 21, P. 60 Gibbs, Nancy Sex can be quite a confusing issue for American youths because of the mixed messages they receive from their parents, educators, and the media. The moral standards society once generally obeyed, or at least paid lip service to, were overcome by the sexual revolution and eventually AIDS. Ten years of fear of AIDS and furor over society's values made it hard for people to agree on the ethical issues and emotional context that used to be part of sex education. Health experts were more concerned with the potential spread of a deadly disease. According to federal statistics by the Centers for Disease Control, by the time young Americans are age 20, three- quarters have had sex; one-fourth of teens contract some sexually transmitted disease each year. Roughly 20 percent of all AIDS patients are under age 30, meaning that a large percentage were infected with HIV as teenagers. Although only three states mandated sex education in 1980, today 47 states formally require or recommend it, and all 50 support AIDS education. Dr. Joycelyn Elders, President Clinton's nominee for Surgeon General, said that she advocates an extensive sex education program. Elders said, "Proper sex education would be teaching kids how to develop relationships and about the consequences of their behavior. Kids can't say no if they don't first learn how to feel good about themselves." In the inner cities the lack of jobs and hope for the future lures teenagers to seek pleasure with little consideration of the risk. Formulating Reform: The Administration Readies Its Health Care Reform Package. But Where Do People With AIDS Fit In? * Advocate (05/18/93) No. 629, P. 25 Bull, Chris The federal health care reform package expected to be released soon has AIDS advocates questioning how the plan will address the unique needs of AIDS patients. Members of the health care reform task force presented a general outline on April 12 that said all U.S. citizens would qualify for a basic health benefits package. But the package's content would be decided by Congress and an independent national health care policy board. Private insurers would continue to play a major role in providing health care but would no longer be permitted to refuse coverage to anyone based on preexisting medical conditions. The plan would be administered by the state and regional health care groups much like health maintenance organizations and would be funded through new taxes, price controls on hospital fees, and patient fees for those who could afford to pay them. AIDS advocates say they are aggressively lobbying the task force to pay close attention to AIDS because treating the disease demands extensive and advanced medical care, thereby having a large financial impact on the national health care system. The Centers for Disease Control projects that health care for AIDS patients comprises about 1 percent of annual medical spending in the United States, and the percentage is increasing. A study conducted in March by Lambda Legal Defense and Education Fund, a gay legal organization, found that about 25 percent of people with AIDS and 50 percent of asymptomatic HIV-positive people lack any form of medical coverage and are treated at public hospitals where poor medical care is often provided. May 25, 1993 Bar on H.I.V.-Infected Immigrants Retained in Final Test in Capitol * New York Times (05/25/93), P. A18 (Hilts, Philip J.) A final battle was lost in allowing HIV-positive foreigners admittance into the United States as Congress supported continuing a ban prohibiting entry of infected travelers and immigrants. The decision emerged as conferees approved and sent both the Senate and the House a bill reauthorizing the National Institutes of Health and allotting $7 billion of its $10 billion budget for the 1994 fiscal year. Although President Clinton supports measures allowing HIV-positive persons to enter the country, the Senate voted 76 to 23 endorsing the bill that prohibits such measures. The Senate added language to the NIH bill ordering the health secretary to consider HIV infection a dangerous "communicable disease of public health significance." Likewise, the House voted 356 to 58 in support of the same provision. Consequently, HIV-positive foreigners would be denied entrance into the United States unless they win waivers, which can be difficult and time-consuming. According to an official with the U.S. Department of Health and Human Services, Secretary Donna E. Shalala was disappointed by Congress' move to exclude those infected, "but the votes were simply not there in Congress." Dr. Jonathan M. Mann, head of the Harvard AIDS Institute and former director of the World Health Organization's global AIDS program, said that such a ban is "unconscionable and wasteful." He and other health officials argue that HIV is not spread by casual contact and is not a contagious disease, and contend that HIV testing for foreigners who seek admittance into the United States could be ineffective because only a few infections might be prevented. Procordia Unit Says It Takes Partial Blame in Contamination Case * Wall Street Journal (05/25/93), P. A10 A Swedish pharmaceutical company said it was partially responsible for allowing four hemophiliacs to contract HIV in 1985. The company, Kabi Pharmacia AB, part of Procordia AB, sold the product Preconativ to the hemophiliacs. All four patients were infected by blood plasma from an HIV-positive blood donor. Vice President Lars Ingelmark said Kabi was to blame, but indicated that an inquiry commission established by the company found no negligence, and no indication that profits were put before patients' safety. The national health department is expected to release a report on the matter in two weeks. In August 1985, Kabi Pharmacia ignored a report from outside virus experts that said filtering might not guarantee that HIV was eliminated from the plasma. The four HIV-positive hemophiliacs have each been awarded $48,000 in compensation under a mandatory Swedish health care insurance fund. According to a Kabi executive, the company most likely won't face additional financial liabilities, even though he said discussions about a further, voluntary financial settlement "on humanitarian grounds" are being conducted with the four patients and their lawyers. The company's inquiry commission, headed by Stockholm Court of Appeal Justice Thorsten Cars, said Kabi Pharmacia "trusted its own testing methods too much." Rebuffing the Scare: AIDS Questions Prompt Safer Techniques * Washington Post (05/25/93), P. B5 Stonesifer, Jene New rules for safe grooming in manicures have been established as a result of fears surrounding the threat of HIV infection. Because nail salons are essentially self-regulating, it is the client's responsibility to learn about safety precautions and products that their nail technicians and salons are using. Even though most salons have tools visibly soaking in what appears to be anti-infectious solutions, customers still are concerned. Kent Taylor, a spokesman for the Centers for Disease Control, said, "There has never been a reported case of HIV linked to a manicure." He added that the risk of contracting HIV through casual contact such as a manicure is "extremely low." Taylor said, "The HIV virus itself is extremely fragile so it would more than likely die or not be infectious for any length of time that it is on the instrument," noting that "there would have to be blood-to-blood contact." However, the potential of blood-to-blood transmission is always present, says Gerri Cevetillo, a member of the safety and standards committee of the Nail Manufacturers Council of the American Beauty Association. Although many state cosmetology boards still allow the open glass jars in which the nail instruments stand in cotton saturated with alcohol or a blue sanitizer, Cevetillo says they're "totally ineffective because organisms can still grow on and climb up the handle [which extends beyond the solution]." Cevetillo said that both the technician and the client should wash their hands with antibacterial soap before the manicure, and clients should ask for information about the solutions in which the instruments soak. AIDS Housing * Associated Press (05/21/93) (San Francisco) A prominent AIDS service organization has been ordered to stop issuing housing for AIDS patients because a city audit revealed poor bookkeeping. None of the Shanti Project's clients will be displaced, however, and the organization said it would continue to provide practical and emotional support for AIDS patients. In March, a municipal investigation disclosed that the group's books were inaccurate. Auditors also concluded that Shanti officials were unable to fully account for how they spent $311,000 of city funds. Shanti officials concede they billed the city for expenses that were not approved under the terms of its housing contracts and has agreed to repay the money. The San Francisco Department of Health's AIDS office is responsible for monitoring the switch of housing contracts to another provider. Another city audit of the group is scheduled to be finished in three months. City officials hope the transfer will provide Shanti with a chance to remove itself from its housing accounting problems, renew public confidence, and improve its ability to raise money for its other support services. Shanti is one of the leading AIDS service organizations in the nation and provides housecleaning, shopping, and transportation services to people with AIDS. Irish Court Clears Condom Commercials * Reuters (05/24/93) (Dublin, Ireland) A government anti-AIDS advertising campaign encouraging condom use as a means of preventing HIV infection has been approved by an Irish court. The commercials, featuring Irish celebrities, will be screened later in the week. Dublin city councilor Richard Greene has argued against the campaign in the Irish High Court, claiming efforts to promote the use of condoms would spread HIV, not prevent it. However, Health Minister Brendan Howlin said, "The idea is to make people aware that AIDS as a health menace has not simply gone away, and potentially affects anybody who is engaged in sex with somebody who is not a partner with themselves, or is not celibate." Howlin previously overruled misgivings about the tone of the advertising campaign raised earlier this month by senior executives in RTE, the state-backed television and radio network. In addition, he published legislation allowing condoms to be available in vending machines for the first time in predominantly Roman Catholic Ireland. HemaCare Scientific Advisory Board Meets * Business Wire (05/24/93) (Los Angeles) HemaCare Corp. announced on Monday the first meeting of its newly organized scientific advisory board, which addressed topics that included a review of current and future AIDS therapies and an analysis of HemaCare's Passive Hyperimmune Therapy (PHT) clinical trial and drug-manufacturing plans. Dr. Joshua Levy, HemaCare's medical director and principal investigator of its PHT research project, said, "The gathering of some of the leading experts in AIDS research and immunology provided us with invaluable input on the future direction of our research." On May 20 and 21, Levy presented HemaCare's Phase I/II PHT results at an international symposium in London. The issues discussed included anti-viral therapy, immune modulation, combination therapies, opportunistic infections, and ethical issues involving AIDS research. In July 1992, the HemaCare Phase I/II clinical study of PHT in the treatment of AIDS was completed. The drug was found to be non- toxic and possibly improve immune competency and survival in recipients. The company is currently awaiting approval by the California State Department of Health Services, Food and Drug Branch for Phase III extension of the PHT study. AlloDerm Processing Inactivates HIV; Shareholders Elect Seven Directors * Business Wire (05/21/93) (The Woodlands, TX) Biotechnology company LifeCell Corporation announced Friday that the proprietary process for producing AlloDerm, the company's dermal skin replacement, is also able to inactivate HIV. Chairman Paul M. Frison said, "LifeCell's proprietary process for AlloDerm is designed to remove the human antigens that cause tissue rejection." He added, "An outside reference laboratory has confirmed that the AlloDerm process also inactivates a concentrated solution of HIV. Although human tissue donors are regularly screened for transmissible diseases, we believe the ability of our tissue processing solutions to inactivate HIV is an added safeguard in the transplantation of AlloDerm." AlloDerm consists of processed human donor skin intended for grafting to patients who suffer full-thickness skin injuries, including burns and pressure ulcers. Aetiology of AIDS * Lancet (Great Britain) (05/08/93) Vol. 341, No. 8854, P. 1222 Schechter, Martin T. et al. Professor Peter Duesberg's contention that HIV is not related to AIDS and that the cause of the disease stems from other risk factors like recreational drug use has been disproved, write Martin T. Schechter et al. of the University of British Columbia and St. Paul's Hospital in Vancouver, Canada. Duesberg challenged any researcher to prove that HIV-negative individuals who have used drugs for 10 years never develop AIDS. Therefore, the researchers report on their study of 78 HIV-negative men who reported recreational drug use at every one of their study visits. Among the 78 men, 71 reported regular use of nitrite inhalants, and their mean dose intensity, derived from each subject's average over the entire follow-up period, was 21 uses per month. Despite this longstanding exposure to agents that Duesberg claims are responsible for AIDS, not one of these 78 subjects had ever experienced AIDS-related symptoms. In addition, their exposure to drugs spans an even longer period since they all reported previous drug use at their enrollment visit. The researchers also examined the CD4 counts of these 78 HIV-negative subjects, which were found to be stable over the entire follow-up with an average rate of CD4 change that was not significantly different from zero. Also, the researchers found 19 HIV-positive men who reported no recreational drug use of any kind between enrollment and December 1986. But termination date of 1986 was chosen to eliminate any possible effects of AZT during this period of decline. The researchers' hospital was the only one which distributed AZT at that time and none of these men received the drug, they conclude. Liposomal Daunorubicin Treatment of HIV-Associated Kaposi's Sarcoma * Lancet (Great Britain) (05/15/93) Vol. 341, No. 8855, P. 1242 Presant, Cary A. et al. The drug liposomal daunorubicin may become the treatment of choice for AIDS patients with Kaposi's Sarcoma, write Cary A. Presant et al. of the Los Angeles Oncologic Institute and St. Vincent's Medical Center in Los Angeles, Calif. While conventional chemotherapy can be heavily toxic, using liposomes loaded with therapeutic agents is less toxic and more effective in experimental tumors in vivo. The researchers have examined the efficacy and toxicity of liposomal daunorubicin in 25 patients with HIV-related Kaposi's Sarcoma of poor prognosis. In 24 evaluable patients, there were 2 complete remissions and 13 partial remissions. A total of 5 of 11 patients with doxorubicin-resistant Kaposi's sarcoma had partial remissions. Median duration of response was 12 weeks. Quality of life improved after treatment with a response rate of 71 percent for physical performance and 74 percent for emotion. Myelosuppression was the most common side effect. Vomiting, stomatitis, and alopecia were rare and mild. Liposomal daunorubicin was found to have a high rate of tumor regression, as well as a high rate of improvement in the quality of life. Moreover, the treatment is effective in patients who are resistant to previous chemotherapy for Kaposi's Sarcoma, the researchers conclude. Apoptosis and Disease * Lancet (Great Britain) (05/15/93) Vol. 341, No. 8855, P. 1251 Carson, Dennis A. and Ribeiro, Joao M. Apoptosis is a structurally distinct programmed cell death pathway which may have a role in the aetiology of AIDS, cancer autoimmune diseases, and degenerative diseases of the central nervous system. By manipulating apoptosis through certain drugs, it may offer new possibilities for the prevention and treatment of these illnesses, write Dennis A. Carson and Joao M. Ribeiro of the University of California--San Diego in La Jolla, Calif. In HIV-1-positive individuals, depletion of CD4 T-cells leads to lymphopenia and immunodeficiency. AIDS may be regarded as a pathological imbalance between the rate of CD4 cell loss and cell replacement. The mechanisms of lymphocyte depletion HIV-1 infection are complex. But CD4 T-cells from asymptomatic HIV-1-infected people die by apoptosis after stimulation with mitogens. Acute HIV-1 infection of normal peripheral blood mononuclear cells also induces apoptosis. These effects may be mediated by the HIV-1 gp120 glycoprotein which binds to the CD4 antigen. Incubation of normal CD4 cells with HIV-1 gp120 followed by crosslinking makes the cells susceptible to apoptosis when they are stimulated by antibodies against the T-cell receptor for antigen. These results concur with a virally induced abortive activation model of apoptosis. If apoptosis really is a mechanism of lymphocyte depletion in AIDS, blocking an essential metabolic step in apoptosis might postpone the onset of AIDS, the researchers conclude. May 26, 1993 FDA Issues Warning About AIDS Drugs From 'Buyers Clubs' * Washington Post (05/26/93), P. A3 Schwartz, John Some AIDS drugs not approved by the Food and Drug Administration and sold through "buyers' clubs" may be unsafe, the FDA wrote in a letter sent yesterday to about a dozen of the clubs. The agency has long permitted HIV-positive persons to import unapproved treatments under a "personal use" policy. Consequently, the underground buyers clubs have emerged to satisfy that demand and to act as information clearinghouses for treatment alternatives. Drugs available in the buyers clubs are usually obtained from foreign countries. These drugs include DDC, Immunex, and hard-to-find herbal medicines such as Chinese bitter melon. The FDA's letter did not specify drugs or treatments that the agency believes are hazardous, but outlined three areas of concern: the lack of physician's involvement in some of the groups; "the sale of injectable products of unknown purity, sterility, and strength"; and the promotion and commercialization of "unproven and potentially dangerous products." The letter did not impose regulatory action on the clubs but noted that "illegal importations are subject to enforcement action under the Federal Food, Drug, and Cosmetic Act. FDA will continue to evaluate closely the activities of 'buyers' clubs' and others who import drug products." Since the buyers' clubs first started selling imported treatments from Israel more than 10 years ago, the FDA and the underground operations have maintained a civil relationship. But last year the federal agency began investigating the clubs as a result of concerns about unfounded product claims, promotion, and drug bootlegging. Related Stories: New York Times (05/26) P. A18; Los Angeles Times--Washington Edition(05/26) P. A5. U.S. Blacks, Africans Cite Grim AIDS Data * Philadelphia Inquirer (05/26/93), P. A10 Fritz, Mark A summit of black Americans and Africans was held yesterday in Libreville, Gabon, where stories of AIDS ravaging through communities were told. At the summit, AIDS was cited as the leading killer of New York women between the ages of 14 and 55, and Africa was identified as the world's leader in the number of HIV-positive people. Debra Fraser-Howze, director of New York's Black Leadership Commission on AIDS, said, "Multiple generations are being simultaneously wiped out by AIDS on two continents. We have a lot in common with our brothers and sisters here on the continent." Fraser-Howze said she had to fight to get a special workshop to be conducted at the conference, even though she told of the alarming statistic of AIDS among New York women. According to Betty Adams, a member of the commission, many black men still consider AIDS a disease of homosexuals. But even American AIDS activists were surprised at the poor health profile in Africa, which has an estimated 8 million of the world's 13 million people with HIV. Experts at the summit said that the Uganda railroad has a 15 percent annual turnover in employees because of death and sickness caused by AIDS. AIDS patients account for 70 percent of the hospital beds in the Tanzanian city of Bujumbura, and some villages have a 90 percent infection rate. The focus on the devastation by AIDS in Africa has largely overshadowed the extensive spread of tuberculosis, to which AIDS patients are especially susceptible. House Passes Research Bill That Bans Immigrants With HIV * Philadelphia Inquirer (05/26/93), P. A11 Ball, Karen The House of Representatives yesterday approved a medical research bill that bans HIV-positive foreigners and permits fetal tissue research. With a 290-130 vote, the House returned to the Senate a bill that authorizes $6 billion for the National Institutes of Health and directs new research money for breast and ovarian cancer, contraception, and fertility. Some of the legislators who opposed the AIDS ban ended up voting for the bill, claiming women's health research was too important to be neglected any longer. Although President Clinton promised to lift the ban on HIV-infected foreigners in his campaign, he is likely to sign the measure. The Senate is expected to send it to him later this week. The original bill was sidetracked in the Senate in February, when legislators upset with Clinton's plans to lift the immigration ban tacked the ban onto the fetal tissue research bill. The House overwhelmingly voted to accept the Senate language when the bill went to conference before the House-Senate team that works out differences between the two chambers. The vote yesterday was on the negotiated version of the bill. The HIV-positive ban was the only significant difference. Legislators who supported the ban on HIV-positive immigrants noted that it could cost $100,000 a year to care for an AIDS patient, and that America's health care system is already overwhelmed. Related Story: Washington Post (05/26) P. A3; Baltimore Sun (05/26) P. 16A. Peace Corps Workers Are Infected With AIDS Virus Abroad * New York Times (05/26/93), P. A13 Holmes, Steven A. An increasing number of Peace Corps volunteers have been found to have contracted HIV during their tours of duty even though they received thorough AIDS education, according to a study released at a Paris conference sponsored by the Society for International Travel Medicine. The study, conducted for the Peace Corps by Dr. Thomas Eng, an epidemiologist from the Centers for Disease Control, indicated that 29 volunteers had been found to be infected with HIV since 1987, when the Corps began testing applicants for the virus and turning away applicants who were HIV-positive. The report said that among the 29, eight had definitely become infected while volunteering in the Corps, and four of them within the last year. A total of seven of the eight had been assigned to Africa, which has the highest rate of HIV infection in the world--estimated at 14 million HIV-positive people. Six of the eight infected volunteers were in their mid-20s, the study said. It also said the volunteers "indicated that they were most likely infected as a result of having unprotected sex with host-country nationals and did not perceive themselves to be at risk." Although the number of people who became infected is a small percentage of the nearly 6,000 current volunteers and the more than 18,000 people who have entered the Corps since 1987, some Peace Corps officials say they were surprised that four volunteers were found to have become infected last year. What was most alarming to Peace Corps officials was the low rate of condom use among volunteers even in countries where the prevalence of AIDS is high. AIDS Quilt Ceremony to Recall, Honor 3 * Boston Globe (05/25/93), P. 22 Kong, Dolores Three employees of the Massachusetts Department of Health who died of AIDS were expected to be honored this week at an AIDS quilt ceremony. The three employees are Sidney W. Borum Jr., an AIDS educator who died last year of the disease; Duane Draper, director of the state's AIDS bureau, who died in 1991; and Phil Carrozza, who worked with the state bureau of substance abuse services. Because of the three employees' commitment to AIDS when they were living, scores of co-workers, Lt. Gov. Paul Cellucci, Secretary of Health and Human Services Charles Baker, friends, and family members are expected to attend a ceremony at the department to remember the contributions of the three men. Two AIDS quilts in memory of Borum and Draper will be revealed and displayed alongside a quilt that already stands in the lobby of the department in memory of Carroza. The quilts will serve as a reminder of the men's dedication to AIDS issues and the work that remains to be done, according to organizers of the ceremony. Canada Recommends Inquiry Into Blood System * Reuters (05/25/93) (Ottawa, Canada) The Canadian government requested Tuesday that its provinces examine their blood supply procedures, after discovering that more than 1,000 Canadians contracted HIV through tainted blood transfusions. A parliamentary subcommittee previously issued a report calling for an investigation into the country's blood supply system after finding that more than 1,000 people contracted HIV in the 1980s after receiving blood transfusions and blood products. In 1990, the federal government began compensating each of the 1,000 infected Canadians with about $95,000, said Janice Hopkins of Health and Welfare Canada. However, hemophiliacs and others are pressing for an inquiry into the extent of infection among recipients of blood and blood products, and for additional compensation from the provinces, which share with Ottawa the responsibility of ensuring a safe blood supply. Health Minister Benoit Bouchard said provincial health ministers must be consulted before a public inquiry is implemented, but once specifics are determined it should take about six to nine months. The country's blood distribution system is funded by the provinces, regulated by the federal government, and managed by the Canadian Red Cross Society. Va. Student Hands Out 300 Condoms: Safe-Sex Crusade Draws a Suspension * Washington Post (05/25/93), P. C5 Brown, DeNeen L. A student from a Fairfax County, Va., high school who distributed more than 300 condoms to fellow students was suspended last week as a result. Nathan Hurto, a junior at Edison High School, said he handed out the condoms during school last Thursday "to let people know if they are going to do something that puts them at risk, they need to minimize that risk." Hurto said he was not a member of any AIDS service organization. He said that at the end of the day on Thursday he was told that he was suspended for five days for "disrupting the educational process." Under school regulations, no student is permitted to distribute anything that is not first approved by the principal. Hurto said he believed he would be punished for deviating from school norms, but could not understand why he was suspended for five days. "Five days is what you get for having drugs at school. Whether you agree with me or not for handing them out, they are equating something potentially lifesaving, in the instance of HIV, to something that could destroy your life, like alcohol or another drug." The only school systems throughout the Washington, D.C., area that allow the distribution of condoms are those within the city limits. In Fairfax County, condoms are addressed in sex education classes in grades seven through 12. Hurto said he did not force anyone to take the condoms, "I just said, 'Here's a condom; do you want it?" He added, "Most people just said thanks and just took them and put them in their pocket." CDC Chokes on AIDS Treatment Proposal * Science (05/14/93) Vol. 260, No. 5110, P. 883 Stone, Richard Although celebrated physician Henry Heimlich claims that malaria may be a potential treatment for AIDS, the Centers for Disease Control strongly disagrees. Dr. Heimlich, inventor of the lifesaving Heimlich maneuver, has been giving malaria therapy to sufferers of cancer and Lyme disease for years. Patients are injected with the malaria parasite which is intended to stimulate an immune reaction that kills other foreign organisms. However, Heimlich's findings on the malaria treatment remain unpublished. On April 29, the CDC responded to several inquiries from the scientific community and the media regarding Heimlich's work. The agency criticized Heimlich's proposal to inject malaria parasites into 10 HIV-positive volunteers. The CDC said that "the use of induced malaria infection in HIV-1 infected individuals cannot be justified." Heimlich said that his proposal was an "inhouse draft" that "by no means was to be circulated." Heimlich also said that the CDC reneged on an agreement to assist his work. Heimlich mentioned a September 1986 letter from Robert Kaiser, head of CDC's parasitic diseases division, who wrote that CDC "would make available certain strains" of malaria parasite for use in Heimlich's malaria therapy for cancer. But Kieser referred inquiries to Carlos Campbell, head of the CDC's malaria branch, who rejected Heimlich's claims. "We weren't prepared to offer him parasites until we saw some evidence that there was an approved protocol," said Campbell. Heimlich says he has no established timetable for proceeding with the research. WHO: Combined Forces Against AIDS * Lancet (05/22/93) Vol. 341, No. 8856, P. 1336 McGregor, Alan United Nations agencies will coordinate efforts in a more aggressive global fight against AIDS to be headed by the World Health Organization. The move stems from a resolution sponsored by some 40 countries and adopted unanimously by the World Health Assembly at the end of its two-week session in Geneva. Under the auspices of the Inter-Agency Advisory Group on AIDS and the Task Force on AIDS Coordination--whose leaders are based within WHO--the first goal is to have a study ready for the January meeting of WHO's executive board. It will concentrate on expected growth and consequences of the epidemic over the next two decades. The study will highlight the potential level of available resources in the next 10 years, and how the new program will be organized and managed. Moreover, it will focus on "the need to have global leadership for a coordinated international response to the pandemic." At a recent newsconference, Dr. Michael Merson, director of the WHO AIDS division, dispelled the published contentions that the spread of HIV in Africa was to some extent a myth. "This is a terrible epidemic, no myth. No one country is spared," Merson said. He added that about $2.9 billion a year will be needed for all possible preventive measures proposed. However, WHO's budget for 1994-95 is only $1.8 billion. May 27, 1993 Mass. AIDS Rate Triples That of '92 * Boston Globe (05/26/93), P. 1 Kong, Dolores There has been a three-fold increase in the number of AIDS cases reported in Massachusetts so far this year, compared with the same period in 1992, according to state figures issued yesterday. State officials did not expect such a high increase in AIDS cases despite the new, more-inclusive federal definition. The statistics show that for the first time, the number of IV-drug users being diagnosed with AIDS now surpasses the number of gay and bisexual men being diagnosed with the disease. IV-drug users constituted 40 percent of all AIDS cases reported in Massachusetts so far in 1993, whereas gay and bisexual men accounted for only 34 percent of all cases. This new trend indicates the epidemic will affect women and minorities in even higher numbers. Between January and April of this year, 1,124 AIDS cases were reported in the state, compared with 323 for the same period in 1992. Most of the increase, but not all, can be attributed to the new federal definition of AIDS that went into effect Jan. 1. Pulmonary tuberculosis, cervical cancer, recurrent pneumonia, and low counts of T-cells were all added to the definition, thus increasing the number of people who qualify as having AIDS. Other explanations for the rise in cases include improved reporting of AIDS cases and early treatment, which for some people has delayed the onset of AIDS until now. The new state statistics also suggest an increasing spread of AIDS among minorities. Under the new definition, minorities accounted for 46 percent of the cases reported so far in 1993. But minorities accounted for 33 percent of all AIDS cases ever reported to the state under the old definition. Better AIDS Pneumonia Treatment Has More Side Effects * Reuters (05/26/93) (Boston, MA) The more effective a drug is in treating AIDS- related pneumonia, the more side effects it may cause, according to two studies, published in Thursday's New England Journal of Medicine, that compared different drug treatments for the opportunistic infection. In the first study, a team of French researchers found that the combination of the drugs dapsone and pyrimethamine worked about as well as conventional treatment with aerosolized pentamidine in preventing pneumonia. However, several people had to stop taking the drugs because they could not tolerate the side effects. Approximately 24 percent of the dapsone-pyrimethamine recipients had to stop treatment, compared with less than two percent of those were administered pentamidine. Yet the French researchers, led by Dr. Pierre-Marie Girard of the INSERM research institute in Paris, also discovered that the two-drug combination "drastically reduced" the risk of toxoplasmosis, a parasitic infection that can be deadly for a person with a weakened immune system. The second study was conducted by Dr. Walter Hughes and colleagues of the St. Jude Children's Research Hospital in Memphis, Tenn. The researchers compared the combination of trimethoprim and sulfamethoxazole with the newly approved drug atovaquone. Atovaquone was ineffective in 20 percent of the patients, compared with only 7 percent receiving the combination of trimethoprim and sulfamethoxazole. But atovaquone had fewer serious adverse effects, with only 7 percent of recipients switching to another drug, compared with 20 percent of those who took the combination. North American Biologicals Gets Euro Patent * Reuters (05/26/93) (Miami, FL) Blood plasma supplier North American Biologicals Inc. announced Wednesday it was given a patent from the European Patent Office for its proprietary globulin, HIVIG, and the process to produce it. North American Biologicals said HIVIG is a globulin, or a group of proteins, that may block the spread of HIV from infected pregnant women to their unborn infants. The patent will provide North American Biologicals with product protection in all Western European countries, the company said. North American Biologicals already has patents for HIVIG in New Zealand and Australia, and intends to file patent applications in various other countries. Polydex Reports Results of Toxicity Tests * Business Wire (05/26/93) (Boynton Beach, FL) Polydex Pharmaceuticals Ltd. revealed on Tuesday the first results of toxicity tests on its Cytochalasin-D, an agent in a new AIDS drug currently under development by the company. Trials on animals were conducted at doses substantially higher than the recommended dose level for humans. Drs. Lionel Resnick and Mariano Busso of Mt. Sinai Medical Center in Miami, who are monitoring the tests for the company, disclosed that no toxicity was found at such a high dose level. Consequently, the company will continue testing at the even higher dose levels required for a pre-IND filing with the Food and Drug Administration. The tests should be completed by the end of July. The trials, prerequisites for the filing of an IND by Polydex Pharmaceuticals, are being conducted in an FDA-registered testing facility in Rockville, Md. Survey: Crime and AIDS Top Concerns for the 90s" * United Press International (05/25/93) (New York) Violent crime and the threat of AIDS were the leading concerns among men and women nationwide, according to a poll published in Self magazine on Tuesday. The Gallup poll involved 1,003 adults and was conducted between March 31 and April 11, 1993. The number one concern among the participants was crime and violence in the United States, but AIDS was the second leading concern among 83 percent of women and 77 percent of men surveyed. Indiana Man to Head Major Private AIDS Agency * United Press International (05/26/93) (Indianapolis, IN) The nationwide AIDS service organization, the Gay Men's Health Crisis (GMHC), has elected a new leader who is head of Indiana's Family and Social Services Administration. Jeff Richardson will be leaving his job next week and will begin his new job with the GMHC in August. Richardson said being gay and losing so many friends to AIDS that makes him feel honored to work to help people who are infected with HIV/AIDS. GMHC President Jeff Soref said the board unanimously chose Richardson over 250 candidates after reviewing his Indiana background. "If he has any enemies in the state of Indiana, we never found them," said Soref. While serving as head of the social services administration, Richardson pressed for improved mental health services, helped expand in-home services to the elderly, and advanced the Step Ahead program of immunizations and related services for indigent children. In his new job, Richardson will oversee a $24-million budget, 230 employees, and 2,300 volunteers. The GMHC serves 4,800 clients nationwide, with services ranging from daily hot meals and home health care to legal and financial advice. HIV-2 Cultured From Blood 16 Days After Death * Lancet (05/22/93) Vol. 341, No. 8856, P. 1342 Douceron, Herve People who have died of an AIDS-related condition can still have active virus living in their bodies several days after death, write Herve Douceron et al. of the Hopital Henri Mondor in Creteil, France. A West African patient with AIDS died from acute myelomonocytic leukemia in a hospital. He was found to be infected with HIV-2 but not HIV-1. After his death, the body was kept at 2 degrees Celsius. Due to difficulties in repatriation, the researchers had the opportunity to collect samples of blood or pericardial effusion up to 16 days and 12 hours after death. HIV-2 was cultured as described. A total of 4 out of 15 samples were cultured positively for HIV-2, positivity being detected 27-36 days after the start of culture. All other samples could not be evaluated because of contaminant growth. Positive samples included pericardial effusion removed 9.5 days after death, and blood removed 10.5, 11.5, and 16.5 days after death. Because HIV-2 grew in culture 16 days and 12 hours after death, it is in agreement with data showing recovery of infectious HIV from an aqueous environment after 15 days. The long delays before detection of positivity suggested low viral concentration and, possibly, low infectivity. But it was still impossible to determine when the body of an AIDS patient could be manipulated without the risk of HIV transmission. Those who should keep this risk in mind include pathologists, necropsy room assistants, people who care for AIDS patients, and people from countries where ethnic or religious preparation of dead bodies is practiced, the researchers conclude. Inadvertent Reuse of Bronchoscope Used on AIDS Patient in Lung- Transplant Recipient Without Sterilization * Lancet (05/22/93) Vol. 341, No. 8856, P. 1343 Lewis, David L. It is highly unlikely that HIV is transmitted through remotely possible modes such as deep kissing, write David L. Lewis et al. of the University of Georgia in Athens, Ga. A double-lung- transplant recipient underwent bronchoscopy with an endoscope used the previous evening on an AIDS patient with candidosis and pneumonia. The AIDS patient was also infected with hepatitis B and cytomegalovirus (CMV), but did not develop CMV pneumonia. Although a doctor unknowingly used the infected bronchoscope to take the biopsy specimens from the transplant patient, he was subsequently notified that the endoscope had only been cleaned and not gas-sterilized. The transplant recipient was diagnosed with CMV three months after the incident. The patient, a 43-year-old woman, was CMV negative before her transplantation, and the donated lungs and all blood units she received also tested HIV-negative. The CMV infection may have originated with the contaminated endoscope, from non- traceable community sources, or from an unrecognized CMV- positive blood transfusion given to the organ donor. The patient also developed Pneumocystis carinii pneumonia, but not until eight months after the incident with the tainted endoscope. However, the patient remained free of HIV infection until her death about a year after the incident, as indicated by the absence of HIV proviral DNA in genetic material extracted from the patient's blood and amplified by polymerase chain reaction. For those worried about the risk of HIV through kissing, it may be reassuring to know HIV was not transmitted even accidentally when a bronchoscope previously used on an AIDS patient was not sterilized before passage through the next patient's mouth and into the lung, Lewis concludes. Drug Researchers See Stock Prices Soar on Rumors of Treatment * Nikkei Weekly (Japan) (05/17/93) Vol. 31, No. 1569, P. 1 Kageki, Norri Japanese companies doing AIDS research have attracted investors, pushing up stock prices. Over the past five years, Japanese firms have invested in AIDS-related research and development by financing biotech firms, conducting research on peripheral AIDS-related drugs, and studying ways to cure AIDS. Nippon Zeon Corp. has provided money to U.S.-based Viral Technologies Inc. and to Japan-based Eisai Co., a pharmaceutical company that works with American Isis Pharmaceutical Inc. Viral Technologies is developing an AIDS vaccine while Isis Pharmaceutical concentrates on treatments for AIDS-related infectious diseases. Two major Japanese pharmaceutical companies, Daiichi Pharmaceutical Co. and Takeda Chemical Industries Ltd., are pursuing research on AIDS-related drugs. Both are conducting clinical testing on drugs for Kaposi's sarcoma. Despite these investments, Japanese firms have made few advances on drugs designed to cure AIDS, according to Tsukasa Sashihara, a senior analyst with Nikko Research Center Ltd. Pharmaceutical companies in Japan concentrate on diabetes and osteoporosis, which afflict more Japanese. Some analysts claim that Japanese AIDS research affects the stock market more than the disease. "Budget Brouhaha: The White House Proposes a Steep Hike in Federal AIDS Spending, but Congress May Have Other Ideas" Advocate (05/18/93) No. 629, P. 23 (Bull, Chris) Even though President Clinton has proposed to increase the federal AIDS budget by 28 percent, it is likely to encounter stiff congressional opposition. On April 8, Secretary of Health and Human Services Donna Shalala announced that the president had requested an additional $600 million in AIDS program funding for 1994, a sum that would raise total federal AIDS expenditures from $2.1 billion in 1993 to $2.7 billion in 1994. The new budget consists of an 89 percent increase in spending--$310 million more than 1993--for the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE), which provides AIDS funding for cities. It also includes an 18 percent increase in spending-- $227 million more than in 1993--for AIDS research conducted by the National Institutes of Health, and a 12 percent increase in spending--$45 million more than in 1993--for AIDS prevention, testing, and surveillance programs conducted by the Centers for Disease Control. Although Congress has until September to decide on the budget recommendations, representatives from other disease groups are going to be fighting to divert money from AIDS, says Steve Morin, an aide to House labor and HHS appropriations subcommittee member Rep. Nancy Pelosi (D- Calif.). But AIDS advocates are also optimistic that AIDS will receive more funding and attention under the Clinton administration, despite the congressional obstacles. Morin said, "The real story here is that the last two presidents have not wanted to do anything about AIDS and Congress has had to work around them to get anything done. This time the leader is the president and he has to keep Congress up to speed. That bodes very well for the fight against AIDS." May 28, 1993 Vaccine From AIDS-Like Virus Is Found to Protect Monkeys From Infection * New York Times (05/28/93), P. A11 Altman, Lawrence K. Vaginal infection with an AIDS-like virus can be prevented in animals through the use of a new vaccine derived from the monkey version of HIV, according to a study being published today in the journal Science. The study received praise from many experts who hope that a similar vaccine can prevent the transmission of HIV through human heterosexual sex. However, they warned that it would take years of additional study to develop a human AIDS vaccine, if one can be produced. Although experimental vaccines had previously demonstrated protection in monkeys, none had attempted to test heterosexual transmission. The study was headed by Dr. Preston A. Marx of the New Mexico Regional Primate Laboratory and involved colleagues from New Mexico, Alabama, and Georgia. The researchers used new technology and strategies to immunize the monkeys against simian immunodeficiency virus (SIV), an AIDS-like virus. They discovered that a vaccine consisting of a chemically-killed virus prevented transmission of SIV when it was introduced into the animals' vaginas. In the study, five of six monkeys were protected against vaginal transmission when the doses of chemically-killed SIV were injected into the muscles and then a booster was administered orally or in the lungs. Oral immunization alone did not safeguard them against the virus. The booster vaccine was made of microscopic-sized beads less than one-thousandth of an inch in diameter that contain a highly diluted inactive form of SIV and allow slow release of the vaccine. Related Story: Philadelphia Inquirer (05/28) P. A1; Baltimore Sun (05/28) P. 3A; USA Today (05/28) P. 1D Diversity but Conflict Under Wider AIDS Umbrella * New York Times (05/28/93), P. B1 Navarro, Mireya New York City's largest AIDS organization, the Gay Men's Health Crisis (GMHC), is under fire for not providing equal attention to other groups with AIDS besides homosexuals. The GMHC was established eleven years ago when the AIDS epidemic primarily affected homosexuals. But now the disease is spreading to other groups including IV-drug users, heterosexuals, and women. The organization has attempted to broaden its services to include these newer groups of AIDS patients, but has found it to be quite a difficult task--their clients often have little more in common than the virus itself. Many gay clients say they are uncomfortable mixing with IV-drug users, some of whom heckle them. But at the same time, female and heterosexual clients say that the agency still caters mostly to the needs of gay men and that they often have to go elsewhere to obtain adequate services. While the GMHC concedes it cannot do everything well, it is forming partnerships with other groups to duplicate some of their popular services, like the "buddy" program that connects volunteers to people with HIV for moral support and help with daily chores. The agency's breakdown of clients has changed from almost exclusively white homosexual men to 10 percent who are female, 22 percent IV-drug users--of whom a third are also gay, lesbian, or bisexual--and 44 percent minorities. The GMHC has responded by creating new programs like a day-care service for children, support groups for women, and substance-abuse counseling, among others. However, designing some of the services for new groups has managed to anger many original GMHC clients. AIDS Activists Blame State Cuts in Funding for Big Jump in Cases * Boston Globe (05/27/93), P. 35 Kong, Dolores The severe increase this year in Massachusetts' AIDS cases, especially among IV-drug users, can be attributed to the state's underfunding of prevention and treatment programs, according to AIDS activists. The rise in cases, reported Tuesday by the state Department of Public Health, can be blamed in part on a $12-million cut in drug treatment services three years ago and a continually underfunded AIDS budget, activists and advocates of drug treatment said. Charles D. Baker, Massachusetts' secretary of health and human services, said yesterday that some of the blame rests with the Legislature. He claims that Gov. William Weld has called for an increase in AIDS spending every year he has been in office, but the Legislature has not always gone along with the governor's requests. Drug treatment and AIDS activists said yesterday that heroin addicts now must wait as long as three months to enter a methadone maintenance program and that AIDS patients can become homeless or hospitalized while awaiting one of only 20 state vouchers available to pay for housing for people with AIDS. The state statistics on AIDS show that the number of cases has more than tripled since the same period last year, from 323 to 1,124. Michael Savage, co-chairman of Project ABLE (AIDS Budget Legislative Effort), and executive director of the Fenway Community Health Center said, "In the last four years, there has been a 115 percent growth in the epidemic, but there's only been a 35 percent growth in AIDS funding." Most Speakers at Alexandria Hearing Want Condoms in School * Washington Post (05/28/93), P. D6 Bates, Steve The Alexandria, Va., School Board was asked by speakers Thursday night to distribute condoms to high school students who want them because the threat of AIDS transcends any moral questions that the proposal raises. Some speakers at the public hearing wore symbolic red AIDS ribbons and stressed that abstinence among teenagers is not enough protection against the disease. Roughly 40 people spoke at the hearing, and advocates of the proposal outnumbered opponents by about three to one. One proponent of the condom issue said, "We're dealing with a lost generation, a generation that is on the verge of killing itself." The School Board has not scheduled a date for action on the proposal, which the city PTA Council put forward in December. In the Washington, D.C., area, the District school system is the only group currently allowed to distribute condoms to students upon request. While backers of the proposal dominated the hearing Thursday night, those who objected to the condom distribution plan were just as zealous about their beliefs. One speaker said that if the proposal is endorsed, "the school would certainly be giving the indication that sexual activity is expected." She added, "We are taking a defeatist approach to the teen sexual crisis." The proposal for the Alexandria school system requires expanding the AIDS curriculum and instituting a program for educating parents about the disease. The condom proposal, however, has incited the most debate. PRI--AIDS-Aging-Medicine * Associated Press (05/27/93) Researchers are aware that the older an AIDS patient becomes, the more rapidly the disease develops in that individual. The reasons for this progression, however, remain unknown, and scientists still do not know how to halt the disease. These two problems are the subject of intense research at the National Institutes of Health. Researchers consider the master immune cell, CD4, the key to AIDS and aging. Dr. William Adler, chief of NIH's clinical immunology program, said that HIV probably destroys CD4 cells at the same rate, regardless of age. "Our hypothesis is ... in the older patient, they're not being replaced by normal cells," said Adler. The theory is based on how long it takes people with severe burns to regenerate CD4 cells. "A 30- to 40-year-old takes twice as long as a 20-year- old," said Adler. Nevertheless, no one has proved the theory in AIDS patients yet, because researchers haven't studied older patients for long periods of time. If the scientists can prove the theory, the next step would be to artificially regenerate CD4 cells. Regeneration might be more successful for older patients than using anti-viral drugs like AZT to try to thwart the disease because those drugs seem to have severe adverse effects in older patients, said Adler. He added that little research has been done on the adverse effects of anti-viral drugs in older patients. Refugees With HIV Refusing Medicine * United Press International (05/27/93) (Miami) The majority of HIV-positive Haitian refugees held at the U.S. Naval base in Guantanamo Bay, Cuba, are refusing to take medication that will prolong their lives. Dr. Peter Weiss, an AIDS expert who arrived at the base three weeks ago to care for the refugees, said all but two or three of the 146 infected residents had refused to take the prescribed drugs. Reasons for their actions include mistrust of the military doctors, whom they see as captors. Others don't believe that they actually are HIV-positive, and consider the tests results a racist strategy to keep them imprisoned. Still others have realized that the best way to obtain freedom is to become severely ill. Referring to the recent U.S. District Court ruling that requires the sickest of the refugees to be brought to the United States for medical care, one refugee said, "They said they will take us out of here when our T-cells are down." He added, "they told us we have HIV and they put us in a concentration camp. They never did that to other nationalities." The U.S. Coast Guard picked up the Haitians at sea while they were trying to reach the United States illegally. Some have been at the naval base for as long as 20 months. Weiss' announcement that the Haitians were refusing medication could strengthen arguments from attorneys and refugee advocates who are campaigning to bring them to the United States for treatment. A lawsuit over the refugees' fate is pending before U.S. District Judge Sterling Johnson in New York. Searching for a Cure * Federal Times (Supplement) (05/10/93) Vol. 29, No. 13, P. S4 Laurent, Anne In 1981, drug technician Sandra Ford discovered AIDS through a series of events that occurred as she managed a refrigerator full of unlicensed drugs. Although the drugs often saved lives, they were rarely used, discouraging companies from investing the $1 million needed for licensing. One of the drugs she distributed to doctors was pentamidine, a treatment for pneumocystis carinii. Usually physicians would ask for the drug for patients with suppressed immune systems. Ford would register the vital statistics of the patients and the reasons for the suppressed immune system. In April of 1981, Dr. Jeffrey Greene asked for a 14-day supply of the drug to treat a patient, but requested more 15 days later. Ford questioned the request considering no doctor had asked to repeat treatment of pentamidine since 1967. Ford's curiosity increased further when she asked Greene for a diagnosis of the patient and he could not give her one. Later in a telephone conversation, Ford spoke with Dr. Larry Downs who wanted her opinion about a study involving Kaposi's sarcoma in homosexual men, sparking her concern even more. Ford has since become a source of information about AIDS. The AZT Fire Storm * Advocate (05/28/93) No. 629, P. 29 Gallagher, John Although a recent eight-paragraph letter in the Lancet medical journal indicated that AZT was not effective in delaying full- blown AIDS, it was not a formal report on completed medical research. Many scientists and AIDS activists made their own conclusions from the letter, which was written by British researchers to the editor of the journal. They reported preliminary results in the AZT study, known as the Concorde trial, of which the completion date is uncertain. Peter Staley of the Treatment Action Group, an AIDS research organization, said, "The pro-AZT camp has gone out of its way to trash this study before there is enough information to go on. And the anti-AZT crowd finally has what it thinks is its smoking gun and is leaving the impression in the media that people shouldn't take AZT." The Concorde researchers reported they had followed almost 1,800 HIV-positive asymptomatic patients. One group was administered AZT, and the other was given a placebo. The researchers concluded that both groups progressed to AIDS at the same rate. But some doctors said that the findings neglected to provide enough information to allow them to judge its conclusions. Dr. Marcus Conant of San Francisco, whose practice consists primarily of AIDS cases, said, "It is difficult to manage a serious life-threatening disease when we have science reported by press conference and major studies summarized in eight paragraphs." Moreover, Staley said that the report did not address how AZT works during other stages of HIV infection. In fact, a one-year study involving 1,300 HIV- positive patients conducted in 1990 by Dr. Paul Volberding of San Francisco General Hospital found that AZT helped people with low T-cell counts. Heroes of Health Care * Omni (05/93) Vol. 15, No. 9, P. 34 Menagh, Melanie Margaret Heagarty, the director of pediatrics at Harlem Hospital in New York City, takes a unique approach to treating pediatric AIDS patients. She believes that these children need compassion and companionship. "We've been forced to confront an entirely new phenomenon with virtually no resources, so we've had to use great ingenuity and creativity," said Heagarty. In addition to hospital care, the program involves outpatient and psychological services, a hospice for infants in a converted convent, and a research arm in conjunction with several medical schools and teaching hospitals in the area. The coordinators of Harlem Hospital's unit have discovered that the best method is to assign the doctor treating the child with AIDS to treat the entire family with medical care and psychological counseling, thus becoming the family doctor. In the United States, a total of 4,051 AIDS cases have been reported among children aged 13 years and younger. Among those, about 7 percent were a result of tainted blood transfusions, and about 86 percent of them were a result of transmission from an HIV-positive mother. Many of the children with AIDS at the ward come from families which cannot properly care for them. Heagarty said, "AIDS is a human problem, and we must 'treat' the humanity of these children and their families--not just their medical problems." She also said, "This nation claims that we are all created equal; if we turn our backs on these children and their families, that makes us hypocrites. And for our lack of response to this epidemic and to urban poverty in general, I fear that history will judge us very harshly." 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 05.24.93 ]]]===----- .