-----===[[[ A I D S w i r e D I G E S T 06.14.93 ]]]===----- AIDS Conference Spawns Closer Look at Long-Term Survivors as Key to Cure * Wall Street Journal (06/14/93), P. B3B Chase, Marilyn The Ninth International Conference on AIDS in Berlin concluded Friday with controversy surrounding two clashing AIDS patient profiles: people with devastating immune destruction and long-term survivors. Among the disputed ideas were an emerging view of how HIV depletes the immune system and the resurgence of an old and risky model of "live virus" vaccines. The predominant concept now emerging from many labs depicts AIDS as a primary infection with HIV, leading to hybrid symptoms: part infectious disease, part immune depression, part autoimmune disease with the body attacking itself. Therefore, polio vaccine discoverer Jonas Salk projected, it will be much more difficult than polio or rabies to immunize against. Long-term survivors, HIV-positive people who appear healthy, are subjects of intense scrutiny as researchers examine the secrets of the immune control system. Jay A. Levy of the University of California--San Francisco said these patients are protected by high levels of so-called "suppressor" (or CD8) cells which should be exploited for clues to treatment. Although findings presented at the conference showed the use of AZT in early HIV infection was ineffective, Swedish researcher Lars Kallings said, "AZT is still the mainstay of treatment." He added that new drug studies should be linked with emerging knowledge about different virus types, genetic mutants, and stages of the disease's development. Test Results for New AIDS Drug Called Promising, But a Small Step * Journal of Commerce (06/14/93), P. 5A Collins, Huntly A new anti-AIDS drug that attacks HIV inside infected human cells has shown promise in human trials conducted in France, the United Kingdom, and Italy, according to reports by researchers at the Ninth International Conference on AIDS in Berlin, Germany. The trial's findings have been eagerly awaited because they are the first involving a new class of AIDS drugs known as protease inhibitors, which attack HIV at a different location than AZT and its chemical counterparts. The protease drugs are intended to inhibit an HIV enzyme, called protease, that is essential for an infected human blood cell to produce new HIV. The Hoffman-LaRoche trial involved 61 HIV-positive people in France, 49 in the United Kingdom, and 92 in Italy. Patients in the three countries were in different stages of HIV infection and received different doses of the drug. The most promising results were found in Italy, where three groups of patients received various combinations of AZT and the protease drug. These were compared with people who received AZT alone and those who received the protease drug alone. The combination therapy demonstrated the greatest effect in increasing the number of CD4 cells, said Dr. Stephano Vella, a virologist at the Instituto Superiore di Sanita in Rome. Researchers said those who were administered only the protease drug showed an initial increase in CD4 cells, but the number started dropping after four weeks. "It should be emphasized that these studies are small and do not prove that [the drug] will impede or slow disease progression," said officials from Hoffman-LaRoche. AIDS Epidemic Poised to Sweep the Developing World * Financial Times (Great Britain) (06/12/93-06/13/93), P. 3 Abrahams, Paul While the AIDS epidemic is a serious problem in the Western world, attendees at the annual AIDS conference in Berlin last week were repeatedly told that the epidemic is going to affect the developing world with disproportionate force. Approximately 90 percent of the 14 million people projected by the World Health Organization to be infected with HIV live in developing countries. The WHO estimates that most of the 40 million people infected by the end of the decade will be in the developing world. Africa's health-care workers dismissed the suggestions that the extent of the epidemic in the continent has been exaggerated. But although the rate of AIDS cases is well- documented in Africa, the most rapid increases in the rate of cases are occurring in other developing regions. "While Africa suffers the explosion of AIDS cases as a result of infections ten years ago, it is in south Asian and southeast Asia that we are seeing a rapid increase in infection," said Dr. Michael Merson, director of the WHO's global program on AIDS. WHO predicts that there are 1.5 million HIV-positive people in southeast Asia, and 1 million in south Asia--mostly in India. WHO says the world's chief priority must be to prevent the epidemics in the developing world from spiralling out of control. It has called for $2.5 billion a year to invest in anti-HIV programs in developing countries--a 10-fold increase over current spending. The health agency calculates this funding could lead to $90 billion in savings in direct and indirect costs by the end of the decade by preventing 4 million infections in Africa, a similar number in Asia, and 1 million in Latin America. In Rural Areas, AIDS Patients Find Little Compassion or Health Care * Washington Post (06/13/93), P. A21 Booth, William Although the world's top AIDS researchers met in Berlin last week to discuss cutting-edge AIDS treatments, people with the disease who live in rural America are happy just to find a physician who is willing to treat them. The epidemic has spread in America's small communities and farmlands, requiring many AIDS patients to travel to distant counties to obtain needed drugs. This is because they either are wary of gossip in their own communities or are searching for one of the few doctors who will accept them. In addition, the high-tech experimental AIDS treatments in big cities, along with their social support services, seem worlds away in rural America. In rural southeast Georgia, patients hold garage sales to raise money for expensive drugs like AZT. Also, even the best, most compassionate doctors are not specialists. Most are family doctors with only one or two AIDS patients. Michael Saag, director of the University of Alabama outpatient clinic in Birmingham, said that his AIDS patients regularly experience discrimination, even from their own families. Despite beliefs that the disease is spreading only among gay men, AIDS in rural America is now affecting women, heterosexuals, and blacks. Ted Holloway, Georgia's district health director, said that in the counties for which he is responsible in southeast Georgia, about 45 percent of AIDS cases are now among women, and while the population is 30 percent black, 60 percent of all AIDS patients are black. Holloway added that many of his patients became infected when they traded sex for drugs. In NBA, AIDS Appears to Faze Few * Washington Post (06/13/93), P. D1 Brubaker, Bill Despite basketball star Magic Johnson's announcement in November 1991 that he tested positive for HIV, many professional basketball players have mixed feelings about whether his disclosure had any impact on their sexual behavior. Washington Bullets forward Harvey Grant said, "Some guys still exchange phone numbers of groupies; I've heard a lot of that going on." He added, "A player will call a friend on another team and say, 'We're going to be there tomorrow and the next day. Do you have any numbers for me?'" While some players volunteered to educate teammates about HIV infection, others viewed the disease as something that would not affect them personally. Shaquille O'Neal, the NBA's rookie of the year, said after he heard federal government estimates that one of every 250 Americans is infected with HIV, "One out of 250? That ain't that bad. It's bad but not that bad." Johnson's revelation that he contracted HIV after a decade of unprotected sex with "as many women as I could" was widely viewed as a wakeup call to the promiscous athlete. However, while doctors from the Johns Hopkins School of Public Health were visiting the NBA's 27 teams demonstrating proper condom use and urging players to get tested for HIV, the message seemed at times ignored. However, two retired NBA players called the association's AIDS hotline this winter to disclose that they tested positive for HIV, although their identities have not been revealed by doctors. Unlike Magic Johnson, the two players have developed clinical symptoms of AIDS. Dispute Over Money May Foil US AIDS Vaccines Trial * Nature (Great Britain) (05/27/93) Vol. 363, No. 6427, P. 294 Macilwain, Colin The National Institutes of Health may back out of a trial of three therapeutic AIDS vaccines because it cannot afford to pay $10 million to MicroGeneSys, the manufacturer of one of the vaccines. Frank Volvovitz, president of MicroGeneSys, claims that his company will provide its gp160 vaccine at cost because "we're a small firm and we can't afford to do it otherwise." The two other drug manufacturers--Genentech and Chiron--have promised to provide their gp120 vaccines free of charge. The comparative trial cannot proceed without MicroGeneSys because Congress last fall stipulated a "large-scale clinical investigation of the gp160 vaccine," and the Connecticut company is the only U.S. producer of gp160. The Army had initially expected to conduct a trial of MicroGeneSys' vaccine alone, but AIDS activists and federal researchers objected to a trial involving only one vaccine. An agreement was made between NIH and the Department of Defense to allow NIH to perform a comparative trial of three competing vaccines. If NIH does renege on its agreement with the Department of Defense, the $20 million will be given to the Army's AIDS research budget, allowing the Army the right to proceed with a single vaccine trial. Sources close to the negotiations said recently that NIH might withdraw from the trials "any day now." India Moves Ahead Cautiously on US AIDS Project * Nature (Great Britain) (05/27/93) Vol. 363, No. 6427, P. 294 Jayaraman, K.S. and Macilwain, Colin As a result of fears about a collaboration with U.S. researchers on a preventive AIDS vaccine, India's leading medical research official has said that the trials will not be conducted without permission of the Indian government. At Pune, in the state of Maharashtra, where the joint project is now identifying nearly 2,500 people at high risk of HIV, concern has been expressed that the sample may be used for tests of vaccines and other treatments that are not permitted in the United States. The U.S. National Institutes of Health, which is funding the project, denies the accusations. Pune is one of nine locations in poor countries chosen by NIH last fall to receive $3 million in the first year of its Preparing for AIDS/HIV Vaccine Evaluation (PAVE) program. The Pune project is a joint effort the newly created National AIDS Research Institute of the Indian Council of Medical Research (ICMR) and researcher Robert Bollinger of Johns Hopkins University. Bollinger and the ICMR will combine their respective researchers to prepare samples of the population for trials to begin as early as mid-1994. The Indian government has reaffirmed its policy prohibiting any vaccine to be tested in India unless it has first been tested in the country of its origin. Bob Fisher, an international health official dealing with PAVE at NIH, said that "nothing we do overseas won't be done in the U.S." Also, ICMR Director General S.P. Tripathy said that the decision to prepare the sample does not indicate permission for the trial. According to Bollinger, PAVE is a series of preparations, not a clinical trial, and he said that Indian agencies maintain control of the project despite $800,000 in U.S. funding. Does ADA Bar Coverage Denials? Employer Freedom at Stake in Suit * Employee Benefit News (05/93) Vol. 7, No. 5, P. 1 Delmar, Diana The Mason Tenders District Council Welfare Fund, in a suit filed against two of its participants and the U.S. Equal Opportunity Commission, has asked the court to rule that the Americans With Disabilities Act does not require the fund to reinstate HIV, AIDS, and AIDS-related disease coverage. The fund claims that the ADA has not been violated because the coverages were cut without specific, conscious intent to discriminate against HIV-infected fund participants. The fund also says that because it falls under Employee Retirement Income Security Act regulation, it can place prudent limits on coverage. Benefits attorney Michael J. Lotito advised that until the case is settled, employers should review and find economic justification for all specific exclusions in coverage. June 15, 1993 Haitians With H.I.V. Leave Cuba Base for Lives in U.S. * New York Times (06/15/93), P. A20 Rohter, Larry A total of 27 HIV-positive Haitian refugees were released from the U.S. Naval base at Guantanamo Bay, Cuba, yesterday after almost 20 months of confinement. The release is the result of a federal judge's June 8 decision that the U.S. policy of prohibiting immigration of HIV-positive refugees even when they qualify for political asylum was "outrageous, callous, and reprehensible." Judge Sterling Johnson Jr. of the Federal District Court in Brooklyn also chastised the Clinton administration for inflicting on the Haitians "the kind of indefinite detention usually reserved for spies and murderers." The departure of the group of 21 adults and six children was the first step toward closing the military detention center, as ordered by Judge Johnson. Col. Raymond A. Barbeau, commander of the camp, said he expected the remaining 113 Haitian refugees to depart for the United States "in the next 10 days to two weeks." Despite claims by the refugees and many others who visited the camp that it was a "HIV prison camp," Col. Barbeau said it was equipped with a chapel, a beauty shop, weight room, and playground. Still, residents complained of being confined by barbed wire, which they said was removed over the weekend in anticipation of a visit by the media yesterday. One refugee said, "Being sick is not a crime. We have done nothing to deserve this treatment." Many of the HIV-positive Haitians also questioned whether they were actually infected with the virus. Some believe they were victims of a U.S. government plot, and hope that once they arrive in the United States they will be able to learn their true medical status. Related Story: Washington Post (06/15) P. A1. Conference Ends With Little Hope for AIDS Cure * New York Times (06/15/93), P. C1 Altman, Lawrence K. The Ninth International Conference on AIDS held last week in Berlin did not reveal any cure for the disease, and researchers say the only way to avoid the malady is through prevention practices like safe sex. Dr. Lars O. Kallings, a Swedish AIDS expert, said to colleagues at the meeting, "The AIDS epidemic is an emergency, but society is responding as if it were not." Health-care professionals have stressed the multiplier effect of prevention: each case prevented reduces the chance of further spread and additional deaths. The most powerful argument for prevention is a humanitarian one. However, for political leaders who are concerned about cost, the economic aspect of prevention is critical, as each case costs tens of thousands of dollars to treat. Dr. James W. Curran, who heads the AIDS program at the Centers for Disease Control, recommended that a national meeting concentrating entirely on prevention be held in the United States. The meeting could unite many of the various groups devoted to family planning, treatment of sexually transmitted diseases (STDs), HIV prevention, and public health, which all have a similar goal but work separately. Another objective would be to emulate successful programs and identify deterrents to prevention. Although AIDS researchers still have much to learn about the disease, experts feel confident that they have accumulated more than enough evidence about steps that can significantly reduce the risk of HIV transmission. Accusations of Bias Divide AIDS Groups * Boston Globe (06/14/93), P. 17 Hohler, Bob HIV-positive IV-drug users in Boston claim that a state social service AIDS agency has discriminated against them because they are not homosexuals. Last week, nearly a dozen recovering IV- drug users infected with HIV and allied with the National AIDS Brigade presented this picture, alleging that the AIDS Action Committee of Massachusetts disregarded them because they were drug users rather than homosexuals. While the AIDS Action Committee ardently denied the claims, several AIDS activists said the complaints signify growing tensions between the two groups most profoundly affected by AIDS. Stephanie Turlo, an AIDS patient and a volunteer for the National AIDS Brigade, said, "The disease may not discriminate, but unfortunately people infected with it often do." The recovering drug addicts' complaints have emerged after a bitter fund-raising dispute between the AIDS Action Committee and the National AIDS Brigade, a grass-roots group that distributes clean needles to IV-drug users. The AIDS Brigade was accused of "deliberate fraud" by the AIDS Action Committee for collecting donations at the recent annual AIDS Pledge Walk, sponsored by the committee. Jon Parker, the brigade's director, said that the AIDS Action Committee did not use much of the money raised for AIDS-related matters, and added that the committee is dominated by homosexuals who "blatantly discriminate" against the HIV- infected IV-drug users. However, Larry Kessler, director of AIDS Action, said that about a third of the AIDS action committee's 1,400 clients are IV-drug users. AZT Protection Incomplete in Accidental Exposures * Reuters (06/14/93) Mikkelsen, Randall (Philadelphia) The antiviral drug AZT, used to treat AIDS, provides incomplete protection at best against HIV in occupational exposures, according to a report in the Annals of Internal Medicine by researchers from the Centers for Disease Control. Health-care workers studied by the CDC have increasingly taken AZT after accidental exposures to HIV. However, a health-care worker involved in the study tested positive for HIV after being exposed to the virus and taking subsequent treatments of AZT, or zidovudine. "If zidovudine is protective, any protection afforded is not absolute," the report said. The research is part of a long-term project by the CDC in which health-care workers have voluntarily reported accidental HIV exposures since 1983. The report said that four of 1,103 workers in the study who were accidentally exposed to HIV later tested positive for HIV. One of those four was pricked by a tainted needle and became infected despite taking AZT two hours after the injury. Also, the report said the CDC was aware of eight cases where AZT failed to prevent infection with HIV after an accidental exposure. Preventive use of the drug by health-care workers is rising rapidly. Among those followed by the federal project, use of AZT after an occupational exposure increased from five percent in late 1988 to between 40 and 50 percent after 1990. An accompanying editorial said, "Those considering treatment with zidovudine should be fully informed about its unproven value in this setting. Fortunately, most exposed health-care providers can be reassured that the statistical risk for infection is low." A Personal Side for Many in Pledge Walk for AIDS * St. Louis Post-Dispatch (06/14/93), P. 3A Kirkland, Stephen The fourth annual St. Louis AIDS pledge walk on Sunday involved about 5,000 participants and raised more than $200,000 for local AIDS groups, according to event organizers. Several participants had family, friends, or co-workers infected with HIV. "I just want to help find a cure so other people don't become ill with this terrible disease," said one participant. Those involved in the event walked, skated, jogged, pedaled bicycles, and pushed carts or baby carriages. "What makes this different from other fund-raisers is that the money stays in St. Louis," said Roseann Weiss, president of The AIDS Foundation of St. Louis, which organized the walk. The foundation has dispersed more than $700,000 since 1988 for AIDS education, treatment, and counseling. In the St. Louis area, more than 2,000 AIDS cases have been documented, and the disease has caused 863 deaths since it first emerged more than a decade ago. Researchers Urged to Address Ethical and Social Issues Before Initiating HIV Vaccine Trials in Developing Countries * Business Wire (06/10/93) (Berlin) Before large-scale trials of HIV vaccines are launched in developing countries, important social and ethical issues must be addressed by researchers, government leaders, and drug companies, according to a team of international scientists. The group, led by Dr. Peter Lurie, a health policy analyst at the University of California--San Francisco Center for AIDS Prevention Studies, provided vaccine testing guidelines last Thursday at the Ninth International Conference on AIDS in Berlin. Because developing countries are being targeted for the vaccine trials, the international group is intervening so that the tests will not only be effective from a research standpoint, but acceptable to the host countries and conducted ethically. Both therapeutic and preventive vaccines are expected to be tested in major trials. The group of researchers cautioned that subjects in vaccine trials might prematurely consider themselves protected from HIV and not take risk behavior precautions, so they urged frequent and thorough counseling and education for all individuals participating in the studies. In addition, the group advised that widespread information campaigns be conducted before the start of any trial to guarantee that recruitment efforts include all segments of the population and ease worries about vaccine testing. They also suggest that the scientists in developing countries be actively involved in all phases of the trial. Moreover, effective vaccines should be offered to citizens of the host country free of charge or, at least, at significantly reduced prices. The four locations proposed by the World Health Organization for the vaccine trials are Brazil, Uganda, Rwanda, and Thailand. Mystery to AIDS Virus Spurs Studies * Reuters (06/10/93) Johnson, Cynthia (Berlin) Questions about why some people seem to have a natural resistance to HIV were raised last week at the Ninth International Conference on AIDS. Dean Mann, of the U.S. National Cancer Institute in Frederick, Md., thinks the rate HIV-positive patients develop full-blown AIDS depends on their tissue type. "There appears to be a protective haplotype that slows the progress of the virus," said Mann. A haplotype is a combination of molecular markers known as human leukocyte antigens (HLA), widely used to determine tissue compatibility between transplant recipients and donated organs. He said, "Our study suggests that HLA typing may be useful to identify people who are at risk of rapid disease progression and who would be candidates for aggressive treatment.... It also suggests that interpretation of therapeutic trials may be confounded if the HLA type is not considered.... Even before HIV had been identified as the AIDS virus, we wanted to see if there were genetic elements that influenced the progression of the disease." Genes that encode the HLAs exist in multiple forms, called alleles. This multiple allelism allows for each HLA to exist in many varieties, so that the number of possible HLA combinations, or haplotypes, reaches into many thousands. Another study has found that 24 out of 265 prostitutes researched in Nairobi have remained free of HIV even though they had continually been exposed to the virus. The researchers in this study believe that the resistant women had a certain type of allele which appeared to make them five to six times less likely to contract HIV. British AIDS Funding: Garbled Story Reaches U.S. * AIDS Treatment News (05/21/93) No. 175, P. 7 James, John S. Reports that large cuts in AIDS funding are set in the United Kingdom have reached the United States, where the fear is that the cuts could spread to this country. Some attendees at the International Conference on AIDS are reportedly changing their airline tickets so they can demonstrate in London on the way home. However, the cuts are not as drastic as rumored. According to AIDS writer and activist Edward King, two proposed events have been confused. One is a new policy setting a 150,000 pound limit per year in "Section 64" government funding to a voluntary organization. The limit will have a serious affect on the Terrence Higgins Trust, the U.K.'s largest AIDS service organization, which will see a drop from 450,000 pounds to 150,000 pounds over the next three years. Only three voluntary organizations in the nation are large enough to be affected by the limit. The other, unrelated, policy change involves U.K. AIDS education programs, which will move away from urging everyone to practice safe sex to just urging high- risk groups to do so. The policy change is related to the fact that the disease has not broken out in the general heterosexual population as expected. Slowing the Spread of HIV: Agenda for the 1990s * Science (05/28/93) Vol. 260, No. 5112, P. 1266 Merson, Michael H. The AIDS pandemic continues to grow 12 years after it was first described, writes Michael H. Merson for Science. But HIV, which can be prevented from spreading, is probably more well- understood than any other virus. In the 1990s, the question is whether prevention efforts should be continued, but on a wider scale, or whether scientists should combat the virus from a new angle. Slowing transmission of HIV can limit the AIDS pandemic because AIDS is primarily a sexually transmitted disease. According to the World Health Organization, by mid-1993, over 13 million young people and adults will have contracted HIV since the pandemic began, while about 1 million children have become infected perinatally. HIV infections, amounting to more than 8 million in Saharan Africa and more than 1.5 million in North America and Europe, are on the rise in the Caribbean, North Africa, the Middle East, eastern Europe, and central Asia. Asia, especially the southern and southeastern parts, are seeing the steepest rises. Paying for the care of infected AIDS patients is proving to be a problem, as are the indirect costs of the epidemic. Consequently, while it is important to find treatments for HIV infection, writes Merson, it is important to prevent further spread of the virus, for instance through vaccines, through changes in sexual behavior, and through care of sexually transmitted diseases. The scientific community, Merson concludes, must overcome challenges involving education, objectivity, priority prevention research, and research agendas before it can adopt an expanded AIDS research and intervention effort. June 16, 1993 In Some Cities, AIDS Found Top Killer of Young Adults * Washington Post (06/16/93), P. A3 AIDS and its related opportunistic infections have caused more deaths among young adults in several U.S. cities and states than accidents, cancer, and heart disease, according to a report published by federal researchers in Wednesday's Journal of the American Medical Association. By analyzing 1990 mortality data, the researchers found that AIDS and illnesses connected with it were the leading killer of young men in five states and 64 cities nationwide. AIDS and related conditions were the number one killer of young women in nine cities, the researchers reported. Richard M. Selik and colleagues from the Centers for Disease Control examined the underlying causes of death for adults ages 25 to 44 by using data from the National Center for Health Statistics. It was revealed that 18,748 people died of AIDS-related illnesses nationwide in that age group in 1990. Most of the deaths were a direct result of AIDS, but a few were caused by related infections that had not yet progressed to AIDS. Throughout the United States, AIDS and related infections were the second-leading cause of death among young men, after unintentional injury. AIDS and related conditions were the leading cause of death among young men in California, Florida, Massachusetts, New Jersey, and New York, and caused 61 percent of deaths among young men in San Francisco. AIDS was the leading cause of death among women in several cities, including Stamford, Conn.; Miami and Fort Lauderdale, Fla.; Jersey City, Newark, and Patterson, N.J.; and New York City. Related Story: Baltimore Sun (06/16) P. 3A. HIV Carrier Unaware of Wrongdoing, Trial Told * Toronto Globe and Mail (Canada) (06/15/93), P. A3 Hess, Henry A London, Ontario, court heard additional testimony on Monday that a local man accused of infecting three women with HIV through unprotected sex didn't know he was doing anything wrong. Charles Ssenyonga continued to have unprotected sex, even though his doctor and public health officials had warned him against it, because he couldn't understand that anything was wrong with him due to a mental disorder, Toronto psychiatrist Dr. Robert Wood-Hill testified. The mental condition could have been caused in part by the disturbing news that he had contracted the deadly virus. Dr. Wood-Hill's argument backed testimony by an earlier defense witness, psychologist Ronald Langevin, who diagnosed Ssenyonga as having a condition called post-traumatic stress disorder. Dr. Langevin said the disorder, which is incited by some unusually traumatic or life-threatening event, can cause a person to block out information he can't handle. But Crown Attorney Geoff Beasley disputed Dr. Langevin's diagnosis, and noted that his specialty is sexual disorders, not anxiety disorders. He also said a report from a Crown-ordered psychiatric examination concluded that Ssenyonga was not suffering from post-traumatic stress disorder. Ssenyonga did not exactly forget he was infected with HIV while having sex with the three women, Dr. Langevin testified during cross examination by Beasley, "but it's not available to his memory at that time. He's telling himself, 'I'm normal; I'm healthy; I have no symptoms; look at me." Worcester Holds 1st AIDS Walk * Boston Globe (06/15/93), P. 22 An AIDS service organization in Worcester, Mass., reported that it raised $148,000 in pledges from its AIDS walk on Sunday. The money will benefit 10 area organizations, and exceeded its goal of $70,000. More than 2,500 people participated in The Walk for Life on Sunday, which was sponsored by AIDS Project Worcester. Irish Begin to Liberalize Laws on Sex and Family * New York Times (06/16/93), P. A10 Clarity, James F. As a result of the growing problem of AIDS in Ireland, the country has decided to liberalize laws involving families and sex, in an action that is generally opposed by the Catholic Church. The government said the new law that requires more widespread condom distribution was incited by the need to control the spread of HIV infection. Condoms were previously only available in hospitals and through pharmacies, where young people were embarrassed to purchase them. The Irish government said condom dispensing machines would be installed in secondary schools. Health Minister Brendan Check Howlin said Ireland had recorded a total of 1,368 people infected with HIV, 341 cases of full-blown AIDS, and 150 deaths. Among the 12 European Community countries, Ireland ranked 11th in the total number of AIDS cases. Jim Cantwell, the director of the Catholic information office, said bishops did not object to a new government television advertising campaign that urges people to use condoms to prevent HIV infection. However, he said the bishops believed the campaign's emphasis was wrong, and that "it might encourage casual sex." AIDS Notification Bill Dies in Committee * New York Times (06/16/93), P. B6 A New York Assembly committee voted yesterday to postpone action on legislation that would require the notification of parents whose newborn babies test positive for HIV. The outcome of the 10-to-9 vote would kill it for the year, but legislators expect to address the issue again next year after it is examined by the state's AIDS Advisory Council. Currently, the state performs universal and anonymous HIV testing for all newborns. However, the testing is used only to accumulate a statistical base for studying the AIDS epidemic. There is no mandate that the parents must learn of positive test results. An HIV-positive newborn would indicate that the mother is also infected. Yet because infants are born with their mother's antibodies and do not develop their own for months, a positive result does not always mean the baby is infected with HIV. Civil libertarians and some AIDS activists maintain that the bill would require mandatory testing and disclosure for all mothers, making them the only group in New York State-- including inmates and doctors--to be subjected to such a policy. Dimethaid Announces Joint Venture * PR Newswire (06/15/93) (Markham, Ontario) Dimethaid Research Inc. revealed yesterday that it has agreed to a research joint venture with Dr. F.W. Kuehne and his group of companies, including Oxo Chemie AG, a pharmaceutical company based in Switzerland. Dr. Kuehne is a West German scientist who has been searching for an effective AIDS treatment. As a part of the agreement, Dimethaid has incorporated a new company called OxoPharm Inc. OxoPharm will have exclusive rights for the Canadian, American, and Mexican markets to develop and market certain products developed by Oxo. One of the products, WF-10, is a new drug formulation for AIDS patients. WF-10 serves as an immune modulator with direct and indirect anti-viral activity. WF-10 has been designed for intravenous administration and contains a unique oxidizing agent that incites the immune system to a high level of activation in the presence of hemoglobin. The major cellular defense systems of phagocytosis and killer systems are stimulated by WF-10, thereby exerting the indirect virucidal effect. Laboratory studies conducted in Europe and Asia on more than 500 patients have demonstrated that WF-10 eliminated the infectivity of extracellular HIV particles by modifying the outer envelope glycoprotein gp120, thereby rendering the viral particle incapable of infecting a target cell. AIDS patients who have received WF-10 have shown a substantial reduction in symptoms such as night sweats, weight loss, fever, opportunistic infections, and lethargy. Overall, the quality of life of the AIDS patients was improved to the extent that most of them could return to normal daily activities. Health Professionals Announced That Initial Results Indicate CSI's Immune Reconstitution Program for Persons With AIDS Is Feasible and Well Tolerated * Business Wire (06/15/93) (Fort Lauderdale, FL) Health Professionals, Inc. has announced that its subsidiary, Center for Special Immunology, Inc. (CSI) presented findings at the Ninth International Conference on AIDS in Berlin that suggest its Immune Reconstitution Program for AIDS patients is promising and well tolerated. CSI presented interim results on the safety and tolerance of a salvage treatment protocol that is designed to directly boost weakened immune systems in AIDS patients with late stage disease. The treatment protocol involved 16 patients with late stage AIDS, multiple opportunistic infections, and an average CD4 cell count of 25. They were treated with monthly infusions of partially matched lymphocytes from healthy HIV-negative people. The researchers believe this is the first study to report the administration of this combined modality technique. Patients received standard anti-AIDS drugs as well as prophylactic and therapeutic treatments for opportunistic infections. HIV hyperimmune plasma was taken from asymptomatic HIV-positive donors by plasmapheresis and chemically treated to inactivate HIV and other infectious organisms. The plasma, rich in HIV antibodies, was administered in order to clear free HIV and protect subsequently transfused noninfected lymphocytes. The patients enrolled in the study have received monthly transfusions of plasma and lymphocytes for one to six months. A total of 67 cell transfusions have been performed so far and no "host versus graft" or "graft versus host" reactions have been recorded following the cell transfusions. The ability to use partially matched lymphocytes greatly increases the potential of finding suitable cell donors for each AIDS patient. Fusion Toxin, New Kind of Potential AIDS Treatment, in Early Clinical Trial * AIDS Treatment News (06/04/93) No. 176, P. 7 James, John S. Clinical trials are being conducted in Boston and Baltimore to test a new kind of anti-HIV treatment that treats diseases by targeting and selectively killing harmful cells. The treatment, known as fusion toxins, is made by Seragen Inc. and will be tested on asymptomatic HIV-positive patients who have CD4 cell counts between 300 and 600. Qualified participants cannot be taking any antiretrovirals, and must have a positive p24 antigen test showing viral activity. A fusion toxin is a single molecule, produced by genetic engineering, with one end designed to selectively attach to certain kinds of cells, while the other end is a toxin to kill those cells. The fusion toxin is intended to target activated immune system cells, those expressing what are known as high-affinity IL-2 receptors; HIV infection causes the cells to express these receptors. In laboratory tests, the drug kills only HIV-positive cells. There is a risk that the drug might kill not only HIV-positive cells, but also activated cells which are part of the body's response to infection. This could reduce the immune response to HIV itself, or to opportunistic infections. To reduce the risk, the trial is being restricted to patients at an early stage of HIV infection; and the drug will only be given for five days at a time, with a two-week rest in between. Also, blood work will be carefully monitored so that problems can be detected if they occur and the trial stopped if necessary. The Young and the HIV-Positive * Advocate (06/15/93) No. 631, P. 79 Network soap operas are expected to air an episode on June 21 in which HIV-positive characters are represented, as an attempt at promoting AIDS awareness. Neil Tadken thought up "A Day of Compassion" with openly gay HIV-positive actor Michael Kearns after they appeared together in an AIDS-themed episode of Life Goes On last year. He said that the effort does not mean the main characters will develop AIDS. So far, ABC's Loving has disclosed its story line which will feature a pediatric AIDS theme involving "baby holders"--people who cuddle babies with AIDS. "I hope other shows will display more courage," Kearns said. "AIDS programming 24 hours a day still wouldn't be enough to get the message across. But we'll take all the compassionate moments we can get." Budget Breathes Life Into Ailing Children's, Prevention Programs * Nation's Health (05/93-06/93) Vol. 23, No. 5, P. 1 President Clinton's spending package proposal for fiscal year 1994 focuses most attention to AIDS, tuberculosis, childhood immunization, women's health, and preventive care. AIDS would receive $600 million more this year at the Public Health Service for a total of $2.7 billion. The president's plan also provides $60 million to tuberculosis programs, while treatment and prevention of drug abuse will receive $2.1 billion. At the National Institutes of Health, a large amount of funds would go to research for AIDS and the health of minorities and women. The president proposed to fund NIH AIDS research at $1.3 billion, an increase of $227 million from last year. Also, the budget proposal for the Centers for Disease Control would increase funding for AIDS prevention efforts by 9 percent to $543 million. Moreover, the Clinton budget will provide the Health Resources and Service Administration with full funding of its Ryan White CARE Act. The administration is requesting $695 million, a significant rise from last year's $585 million, for providing primary health services to communities and states with disproportionately high HIV/AIDS cases. But $200 million of additional 1993 funding for Ryan White was eliminated after Congress rejected Clinton's economic stimulus package. June 17, 1993 Epidemic Fueled by Wide Inequity in Relationship * Philadelphia Inquirer (06/17/93), P. A1 Collins, Huntly Because women in developing countries tend to have less power than men in relationships, they are becoming a group that is increasingly at risk for HIV infection. For such women, protecting themselves from HIV infection is not just challenging, but requires a social revolution. Jonathan Mann, chairman of the Global AIDS Policy Coalition at the Harvard School of Public Health, said, "Vulnerability to HIV and AIDS is directly linked with the inequality of women and the lack of respect for their rights." Widespread discrimination against women in education and in the workplace restricts their income and limits their freedom to leave men who refuse to practice safe sex. Elizabeth Reid, who oversees AIDS prevention programs at the United Nations Development Program, said that in sub- Saharan Africa, where more than four million women are believed to be HIV-positive, at least 50 percent "had no risk factor other than being faithful to their husbands." Of the 14 million people estimated to be infected with HIV, about 36 percent are women, according to the World Health Organization. However, women accounted for almost half of the individuals diagnosed with HIV last year. In some African countries, the number of women infected now exceeds the number of HIV-positive men. Therefore, AIDS experts are now calling for new strategies to encourage HIV prevention among women. The experts are attempting to expedite research on vaginal microbicides--creams that would kill HIV in the vagina and give women more control in protecting themselves against HIV infection via heterosexual intercourse. Wife Allegedly Shoots Man Over HIV * Washington Post (06/17/93), P. D1 Beyers, Dan A woman from Woodbridge, Va., who allegedly shot her husband four times at a Maryland military base, said she did it because he was infected with HIV, an FBI spokeswoman said yesterday. Deborah Ann Callahan was arrested Tuesday morning soon after her husband was shot and critically wounded in a parking lot outside the barracks at Fort George C. Meade in Anne Arundel County. Callahan told arresting officers that her husband, Army Sgt. Timothy Callahan, had tested HIV-positive. The man was shot once in each shoulder and twice in the abdomen with a .38 caliber handgun. Yesterday, he was in critical condition at the University of Maryland Shock Trauma Center in Baltimore. Deborah Callahan, who was arrested and indicted with attempted murder, had blood on her clothes and body, and police found nine .38 caliber bullets and an empty gun holster in her car, according to charging documents, the Associated Press reported. More HIV Cases Expected in Study * Toronto Globe and Mail (Canada) (06/16/93), P. A5 Fuller, Ann More former patients may be found to be infected with HIV at the Hospital for Sick Children in Toronto as a $100,000 study of children who received blood transfusions continues into the fall, according to a doctor from the hospital. Susan King, who heads the study, said Tuesday that six children who were received transfusions at the hospital between January 1980 and November 1985 have tested HIV-positive, but only one has shown symptoms of AIDS. The hospital recommended HIV tests last April for 1,700 former heart-surgery patients who received blood transfusions before the Canadian Red Cross Society began screening blood for HIV. Dr. King said that each of the six HIV-positive patients stayed at the hospital at different times, so they probably all received blood from different donors. As a result, other children also could have received HIV-tainted transfusions, she said. But Dr. King could not predict how many others may be infected because the number of children who receive blood from one donation may vary from one to five. If the study proves to be a success, the hospital is expected to notify other patients who could be at risk of HIV infection because they received transfusions during other medical procedures. AIDS Epidemic Leads to Skyrocketing Cancer Rate * United Press International (06/16/93) (San Francisco, CA) The cancer rate in San Francisco has escalated 22 percent over the last decade, particularly among residents in the predominantly homosexual Castro District of San Francisco, according to a report released on Wednesday. Dr. William Wright, chief of research and surveillance for the California Cancer Registry, said the substantial increase was "almost solely attributable to the AIDS epidemic." AIDS patients who suffer from cancer are frequently infected with Kaposi's sarcoma and non-Hodgkin's lymphoma. In addition, Wright said there was some question about whether liver cancer thrives in an immune system weakened by AIDS. The report's data was taken from the California Tumor Registry, and revealed that in 1981, a total of 3,650 cases of cancer were diagnosed in San Francisco. But in 1990, the number of cases had increased to 4,638. State health officials reported last March that cancer is most prevalent among white males in San Francisco--about 660 out of every 100,000. Overall in California, the rate among white males was 372 out of 100,000. State health officials did not find any evidence of environmental factors contributing to high cancer rates, but believe that preventing HIV infection would help bring the rates back to levels consistent with the rest of the California. Dental Chain Settles AIDS Discrimination Case * United Press International (06/16/93) (Los Angeles, CA) A chain of dental clinics in Los Angeles agreed Wednesday to educate its employees on how to treat HIV- positive and AIDS patients, as part of a settlement of a lawsuit alleging that it violated the city's AIDS discrimination law. Deputy City Attorney David Schulman said the civil settlement calls for Western Dental Services Inc. to conduct training sessions on caring for patients who are infected with HIV. Also, it must develop written policies on non-discrimination and confidentiality in treating AIDS patients. The company was also accused in a 1992 civil lawsuit of refusing to treat four men at its Hollywood clinics. City Attorney Jim Hahn said the chain of breached the nation's first AIDS anti-discrimination measure. As part of the settlement, Hahn dismissed his legal action, but he is permitted to seek an injunction against the chain if the agreement is violated. The settlement was filed in Los Angeles Superior Court on Wednesday. Kids are Target of NIH AIDS Vaccine Trial * Nation's Health (05/93-06/93) Vol. 23, No. 5, P. 10 The National Institutes of Health has launched the first trial of experimental HIV vaccines for infected children. A total of 90 children nationwide will participate in the trial, which will compare the safety of three vaccines. The trial will target asymptomatic HIV-positive children aged 1 month to 12 years. The study, known as AIDS Clinical Trials Group 218, is intended to demonstrate whether the vaccines can strengthen existing HIV-specific immune responses and stimulate new ones. "The trial will provide the first insight into how the immature immune system responds to candidate HIV vaccines," said Daniel Hoth, director of the National Institute of Allergy and Infectious Diseases' division of AIDS. He added, "We need this information to design trials to test whether experimental vaccines can prevent HIV infection in children." The study will assess two doses each of the three experimental vaccines made from recombinant HIV proteins. These so-called subunit vaccines, each genetically engineered to contain only a piece of the virus, have so far proved well-tolerated in ongoing trials in HIV-positive adults. If the vaccines are found to be safe in the children, the NIH will proceed with more advanced questions about their therapeutic potential in Phase II trials. Implants Eyed for CMV Retinitis * Journal of the American Medical Association (06/09/93) Vol. 269, No. 22, P. 2831 Cotton, Paul Implants that release drugs directly into the eye may produce better therapy for AIDS patients with cytomegalovirus (CMV), according to Dr. Jay S. Kuker, associate professor of ophthalmology at Tufts University Medical School. The drug- delivery system, which is aimed at giving the eye more medication with fewer side effects linked to body absorption, has begun Phase III trials. CMV destroys retinal cells that do not regenerate, leaving blind spots that eventually lead to complete blindness. About 25 percent of AIDS patients develop CMV, and experts predict that number will rise. Currently, doctors treat CMV with intravenous ganciclovir or foscarnet sodium, which are expensive. Also, these drugs take time to administer, a problem for working AIDS patients. Patients need permanent catheters, ganciclovir lowers white blood cell counts, and foscarnet decreases kidney function. The disease resurges in 50 percent of patients within two months or in 75 percent of patients within four months. Kuker notes that Phase I study of 22 people showed an almost 90 percent success rate with the implant. Also, CMV only resurfaced in 12 percent of the cases. AIDS Activists and Pharmaceuticals: The Struggle for Common Ground * Public Relations Quarterly (Spring 1993) Vol. 38, No. 1, P. 31 Moravick, Ann Pharmaceutical companies have become more open to AIDS activists' complaints while AIDS activists have become more professional in negotiating with drug firms, writes Ann Moravick. Bristol-Myers Squibb, Burroughs Wellcome, and Hoffmann-La Roche have contributed to this change in climate. However, to continue a solid working relationship with AIDS activists, drug companies must adhere to certain rules. Public relations professionals of pharmaceutical manufacturers should be able to influence senior management regarding AIDS policy, involve senior management in discussions with activists, and communicate a trust in the company to activists. When a firm enters Phase II clinical trials of a possible AIDS drug, company officials should consult with activists, particularly concerning the issue of protocol design. Also, AIDS leaders can offer valuable information to drug companies. Pharmaceutical firms should also have discussions with all AIDS activists because each group has its own problems, solutions, and procedures. Finally, drug companies should understand that activists are dying, and that their only hope is in potential new drugs. Fight Against Tuberculosis Intensifies * Federal Times (06/07/93) Vol. 29, No. 17, P. 14 Winsten, Ed The U.S. Postal Service wants to develop a policy to implement tuberculosis screening for its employees, according to the postal service's national medical director, David H. Reid. The incidence of TB has increased, especially on the East and West coasts. In 1993, at least two postal service employees in the Washington, D.C., area have come down with active cases of the disease. An employee working in the Newark post office was diagnosed with an active case, but no one else there has tested more than positive. Positive test results can indicate exposure to TB, but do not mean that the patient will definitely develop an active case. Two cases have been reported in Los Angeles, according to a spokesperson. Additional testing found no other active cases in Los Angeles. A worker at the postal service headquarters in Washington, D.C., said officials are considering a plan to test all future postal service employees for TB prior to hiring them. Postal officials emphasized that contagious postal service workers pose no danger to the general public because the spread of TB requires someone to be in close contact with an infected person over a long period of time. June 18, 1993 Steps Towards Vaccines * Financial Times (Great Britain) (06/18/93), P. 11 Griffith, Victoria Although no cure for AIDS is expected in the near future, two U.S. biotechnology companies have made significant strides in developing a preventive vaccine for the disease. The biotech firm, Chiron, in a joint venture with Switzerland's Ciba, and Genentech have designed vaccines consisting of genetically engineered proteins from the surface of HIV. Both groups have completed trials on small numbers of healthy volunteers, who subsequently developed antibodies against the virus. The National Institutes of Health is scheduled next year to launch a large-scale clinical trial of the vaccines on about 10,000 healthy volunteers. The new vaccines are encouraging, but are not without flaws. The Chiron vaccine has adverse effects that include redness, soreness, and mild flu-like symptoms. Also, neither vaccine has proven to have any effect after a patient has contracted the disease. Even if the vaccines are successful, they would have profound limitations. For example, a vaccine for the strains of HIV found in North America would be unlikely to have much of an effect on strains of the virus found in Asia or Africa. The vaccine would probably have to be changed each year to target the constantly mutating virus. Chiron and Genentech claim that they do not believe they will see any prevalent use of the vaccines immediately, even if they are effective in the next set of clinical trials. Chiron said, "But among high-risk individuals, like spouses of infected people, health-care workers, and intravenous drug users, this could be a very welcome aid." B.C. to Offer Compensation to Those Given HIV-Tainted Blood * Toronto Globe and Mail (Canada) (06/17/93), P. A4 Mickleburgh, Rod Following the lead of the Canadian province of Nova Scotia, British Columbia decided to offer financial compensation to people who contracted HIV through tainted blood transfusions in the early 1980s. Health Minister Elizabeth Cull revealed the decision in the B.C. Legislature, emphasizing the importance of taking action "to redress the suffering of both individuals and their families as soon as we can." British Columbia is the fourth province to follow Nova Scotia's lead two months ago to provide compensation for those who contracted the virus through blood transfusions or blood products before mandatory testing of blood began in late 1985. Cull indicated that she has not yet determined how much compensation the government will allot, and said she hopes an agreement will be made at next week's conference in Ottawa of deputy health ministers. Cull said 115 B.C. residents have been found so far to have become infected with HIV from the blood supply. A total of 80 were hemophiliacs, while more than half of those infected--65 people--are still living. Cull said in her remarks that "even though a specific test...was licensed in March" of 1985, the testing did not begin until November. Critics have accused both provincial blood officials and the Canadian Red Cross for the eight-month delay of implementing the mandatory testing. Cull noted that Health Ministry officials will start negotiations as soon as possible with representatives of the B.C. chapter of the Canadian Hemophilia Society. Man With AIDS Can't Explain Why He Failed to Protect Lovers * Toronto Globe and Mail (Canada) (06/17/93), P. A7 Hess, Henry An HIV-positive man from London, Ontario, told a court on Wednesday that he did not know why he continued to have unprotected sex with various women after learning of his condition. Charles Ssenyonga, who is charged with three counts of criminal negligence causing bodily harm, testified that even after a test confirmed he was HIV-positive, he did not consider himself a danger to anyone. "I do not have a satisfactory answer," he told Justice Dougald McDermid of the Ontario Court's General Division in response to questions from his lawyer. "If I was able to explain this fully, I probably would not be sitting here," he added. "I was aware of the issue of HIV," said Ssenyonga, and even discussed it with some of the women he had sex with, but considered it something that "pertained to someone else." In addition, he said, "If I had thought I was a threat to them, I never would have done it." Reaffirming testimony from a psychologist who told the court that Ssenyonga was suffering from a mental condition called post-traumatic stress disorder that prevented him from realizing that he was endangering his sexual partners, he said that when he was with the women the reality of his infection "was not available to my mind." Moreover, Ssenyonga acknowledged that he had deceived public health officials and lied to his attorney by telling them he was no longer having sex, and he said he is now "in closer touch with reality." The trial was expected to continue yesterday. FDA's Oncology Advisory Committee Reviews Clinical Data on Vestar's Daunoxome for Treatment of Kaposi's Sarcoma * PR Newswire (06/17/93) (Washington, DC) Vestar Inc. announced Thursday that an advisory committee to the Food and Drug Administration has reviewed its summary of safety and efficacy data on DaunoXome (R) in the treatment of AIDS patients with Kaposi's sarcoma for whom conventional chemotherapy has failed. The drug is Vestar's liposomal formulation of the anti-cancer drug daunorubicin. The Oncologic Drugs Advisory Committee voted not to recommend approval of the drug at this time. "It is clear from the committee's extensive deliberations how difficult it is to evaluate the effects of therapy in this disease, and while we are obviously disappointed by the outcome of the meeting today, we believe their review was affected by apparent discrepancies in the analysis of the data," said Roger J. Crossley, MD, Vestar's chairman, president, and CEO. DaunoXome is made up of an anthracycline drug, daunorubicin, encapsulated inside microscopic spheres known as liposomes, with walls similar to those of cell membranes. Once inside the liposomes, DaunoXome is selectively taken up by cancer cells, resulting in a 10-fold increase in the amount of active drug accumulated in the tumors. The selective destruction of cancer cells does not come with an increase of the drug in normal cells, and thus may lead to increased clinical benefit without an increase in toxicity. Second Plane Full of HIV Haitians Arrives * United Press International (06/17/93) (Miami, FL) The second group of HIV-positive Haitians who were detained at the U.S. Naval base in Guantanamo Bay, Cuba, for as long as 20 months were flown to Miami Thursday, and federal officials hoped to free all of the refugees from the naval base by the end of next week. The flight carried 46 Haitian refugees, all of whom are HIV-positive, said Ron Tomalis, a spokesman for the Justice Department's Community Relations Service in Washington, D.C. "Those that will be staying in the south Florida area will be taken to the voluntary agencies to be reunited with their families. The others will be flying on today to join relatives or sponsors in other states," said Tomalis. A total 67 Haitians remain at Guantanamo Bay--all but one are infected with HIV. "I think we're going to have two more flights. The final flight should be some time next week, by Wednesday," said Tomalis. The refugee camp in Guantanamo Bay is being closed following an order from U.S. District Judge Sterling Johnson of New York who called it "an HIV prison camp." Dinkins Opens His Administration's First AIDS Home * United Press International (06/17/93) (New York, NY) New York City Mayor David N. Dinkins cut a ribbon to open his administration's first AIDS housing site on Thursday. The housing consists of a 15-bed facility in the Lower East Side of the city. Although the facility is not ideal for AIDS patients because of its steep stairs and two shared bathrooms on each floor, it is seen as an improvement for the residents. Most of the residents have moved from homeless shelters or off city streets. The first four or five residents are scheduled to move in on Monday. The facility is intended to house up to 15 people for 30 to 90 days, providing them with nursing care and counseling until they can be placed in permanent housing. An additional 18 housing projects are currently in the pipeline, including two other transitional and one permanent AIDS housing site with a total of about 200 beds. The projects are expected to open in October. The new housing facility is being funded with a $160,588 federal grant for renovation and will be run by Dr. Joyce Wallace of the Foundation for Research on Sexually Transmitted Diseases (FROSTD). The foundation is also providing a five-year $500,000 contract with the city Human Resources Administration to operate the unit. What If a Cure Is Far Off? * Newsweek (06/21/93) Vol. 121, No. 25, P. 70 Cowley, Geoffrey and Hager, Mary Because it has been more than a decade without a cure for AIDS and none is expected in the near future, AIDS experts believe their best hope is prevention of the disease. The World Health Organization estimates that 14 million people have contracted HIV since the epidemic began more than a decade ago, and more than 2 million have developed AIDS. If these trends continue, both figures will triple by the year 2000. The billions of dollars that developed countries now allot for AIDS research won't affect the trends anytime soon. Despite this fact, there are cheap, proven strategies for curbing the spread of HIV. Dr. Michael Merson, head of WHO's Global Program on AIDS, told the recent Ninth International Conference on AIDS that by adapting AIDS educational campaigns to local communities, distributing condoms and clean needles, and treating sexually transmitted diseases (STDs) that facilitate the spread of HIV, health organizations could quickly reduce the rate of new infections by half throughout the developing world. IV-drug users, their sex partners, and their children are the people at greatest risk for HIV infection. Various studies have proven that by implementing a clean needle exchange program, rates of HIV infection could be cut by half. However, more than 40 states still have laws against the possession of drug paraphernalia, thereby preempting any needle exchange programs. Another issue that has been avoided is the spread of STDs, which are inexpensive and easy to treat. STDs ease the transmission of HIV by causing breaks in the genital tissue. If STDs can be prevented, the transmission of HIV infection could be as well. Insurance Associated With AIDS Mortality Rates * Journal of the American Medical Association (06/09/93) Vol. 269, No. 22, P. 2832 Randall, Teri HIV-positive patients who rely on government-funded insurance for their health care have higher mortality rates than infected individuals with private insurance, according to a recent study released at the American Federation for Clinical Research annual meeting held last month in Washington, D.C. The publicly insured patients were found to have a median survival period of 868 days from the time they presented for diagnosis or treatment at the facility, whereas the privately insured survived for a median of 1,012 days. Epidemiologist Sana Loue, JD, PhD, presented the research at the meeting, which was conducted with colleagues from the University of California-- San Diego School of Medicine. She said that once the researchers adjusted for changes in insurance over time and other variables, the effect of mortality was reduced but still statistically significant. The team examined 1,794 HIV-positive patients who were seen at the facility between July 1, 1986, and December 31, 1990. Among the participants, 604 were privately insured at the time they were first seen, 805 were publicly insured, and 385 were uninsured. The study found that publicly insured patients had a mortality rate 20 percent higher than the privately insured patients. The research confirms a long-held belief that HIV-positive patients who receive public insurance may not, for several reasons, fare as well as patients with private insurance. However, the findings do not prove or disprove that this contrast is due to a differential in access to health care, said Loue. New Research Center Added to Fight Against AIDS * Journal of the American Medical Association (06/09/93) Vol. 269, No. 22, P. 2838 Cotton, Paul Funding from public and private sources has allowed for a new $45 million basic AIDS research center to be built in San Francisco. The Gladstone Institute of Virology and Immunology is on the campus of the San Francisco General Hospital and is affiliated with the University of California--San Francisco (UCSF). The staff of 45 researchers working in five teams constitutes the second largest center for basic scientific research on AIDS in the nation, surpassed only by the U.S. National Institutes of Health in Bethesda, Md. Dr. Warner C. Green, the director of the new facility, said that due to the limited amount of effective anti-AIDS drugs, it is basic science that must "identify the best viral targets for new drug design." One of the research teams is examining whether the Nef protein may be HIV's Achilles' heel because the virus appears to proliferate in T cells when this protein is present but is rarely able to grow when it is absent. "If we could block the action of Nef, we might be able to freeze the virus," Greene said. Approximately $12 million in funding was made available by the state of California for the construction of the institute. An additional $5 million came from the city of San Francisco. Another $28 million was provided by the J. David Gladstone Foundation, Los Angeles, Calif., to support its daily operations for five years, after which, says a spokeswoman, "the grants will presumably be renewed." Dr. Raymond Baxter, director of San Francisco's Department of Public Health, said, "This is the best possible location for the institute. We have some of the world's most qualified researchers and physicians in one location working toward a common goal--to eradicate this deadly disease." 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 06.14.93 ]]]===----- .