-----===[[[ A I D S w i r e D I G E S T 11.08.93 ]]]===----- Biopharmaceutics Buys Stake in Hungarian HIV Research * Journal of Commerce (11/08/93) P. 7A Biopharmaceutics Inc. will buy a half interest in an HIV compound developed by a Hungarian institute that has inhibited the virus in human cells. In a 30-day test, the compound induced complete, irreversible inhibition of the virus while showing no toxicity in cell structures. The institute plans to conduct human clinical trials in Hungary within a year and a half. For a total of $5 million, Biopharmaceutics will immediately pay $100,000 to the Hungarian Academy of Sciences' Central Research Institute for Chemistry and, after evaluating the institute's work, make five installments for the remaining $4.9 million. Attitudes Clash on Jobs and AIDS * New York Times (11/07/93) P. F25 Noble, Barbara Presley A survey conducted by the National Leadership Coalition on AIDS yielded conflicting attitudes about how workers perceive tolerance of the disease in the workplace. When asked how their employers would treat an HIV-infected employee, 78 percent said that person would be treated like any other person with an illness, and 89 percent that they should be treated like any other employee. But when asked if co-workers would feel comfortable working alongside an infected colleague, two-thirds said they would not, and a quarter said they should not feel comfortable. A third said the employee would be dismissed or placed on disability at the first sign of sickness, and a quarter agreed that this was an appropriate action. The discrepancy is attributed to the fact that people know what they are supposed to believe but, when asked about co-workers, they were able to voice their true feelings while placing those feelings in the context of another person. "They could project it onto someone else," explains Patrick May, communications director for the coalition, a group that advises the work force on AIDS-related issues. "It's probably closer to how people themselves feel." The coalition will sponsor a conference tomorrow and Wednesday in Washington, D.C., where various business, labor, and public health organizations will discuss this issue and others. Hearing for AIDS Researcher Is Postponed * New York Times (11/07/93) P. D24 Today's public hearing to review misconduct charges against AIDS researcher Dr. Robert Gallo has been postponed. The delay was requested by the Office of Research Integrity, which brought the allegations against Gallo, head of a laboratory at the National Institutes of Health. After a review board of the Department of Health and Human Services found one of Gallo's scientists not guilty of similar charges, the office said that the acquittal may have "significant implications" in the Gallo case and that the agency needed more time to re-evaluate its plans. Gallo and Dr. Mikulas Popovic were accused of making false statements in a pioneering AIDS paper published in 1984. Popovic, however, was cleared of the charges last week when the HHS review board concluded that the entire case was nothing more than differences in the interpretation of a few words and data points in the context of a long article. The HHS announced that a review board hearing will be postponed until at least Nov. 15. AIDS Fear Shadows Blood Supplies * Boston Globe (11/06/93) P. 2 Nullis, Clare From flourishing West Europe to the world's most indigent countries, the possibility of AIDS-contaminated blood supplies has caused a panic that life-saving transfusions could lead to death from AIDS. Disclosure that a German company distributed blood products that were, in fact, tainted sent other nations rushing to check their supplies. According to the World Health Organization, the actual chances of contracting the AIDS virus through contaminated blood are low in wealthy countries and high in areas of the Third World. "Globally, between 5 and 10 percent of cases are estimated to be due to transfusion-transmitted infection through blood and blood products," cited Dr. Jean Emmanuel of WHO's global program on AIDS. Emmanuel noted, however, that industrialized nations have the technology to destroy viruses in blood products, the resources to test all supplies for HIV, and the infrastructure to ensure a safe blood supply. Inconsistent testing procedures, lack of technology and expertise, and the expense of sterilizing blood products has made the risk of HIV infection through transfusion a continuing problem in developing countries, said Emmanuel. Swiss Play Down AIDS Scare Over Imported Blood * Reuters (11/04/93) Berne--The Swiss government sought to quell public fears that blood products imported from Germany may have been contaminated with the AIDS virus. According to a government official, Swiss hospitals had bought blood products from two companies that were supplied by UB Plasma, the company shut down by German police last week on charges of inadequate HIV screening. Franz Reigel, head of the department of immuno-biological products within the Swiss federal office of health, said the two companies would have destroyed any HIV when processing the blood supplied by UB Plasma. "I would not recommend anyone to take an AIDS test unless someone is very nervous and wants to be calmed," he said. Are We Our Workers' Teachers * New York Times (11/07/93) P. F25 A question that arises from the issue of AIDS in the workplace is whether employers should bear the burden of teaching Americans about the disease. Yes, says Patrick May of the National Leadership Coalition, who says that work is like school. And just as school is now the place where many adolescents learn about safe sex, May contends that the workplace "should be a place to teach adults about sexually transmitted disease." May finds no reason to avoid workplace education. "AIDS affects people who are sexually active," he asserts. "The bulk of the work force is 25 to 50. That's people who are sexually active, and that's why it's a workplace issue." The coalition encourages employers not only to provide medical information about AIDS, but to cultivate a life-affirming environment for infected employees, an effort that often involves confronting stereotypes and prejudices. "J. Schmalz, 39; Wrote About AIDS" Philadelphia Inquirer (11/08/93) P. A8 Jeffrey Schmalz, a New York Times journalist who, with insight and passion, covered stories about AIDS and the people infected and affected by it, died Saturday from complications of the virus. Schmalz, a Times journalist for 20 years, discovered in 1990 that he had AIDS. He spent a year away from his job while he battled AIDS-related conditions, then returned to the paper, where he began his beat on AIDS and homosexual issues. "To have AIDS is to be alone, no matter the number of friends and family members around," he wrote. "Then, to be with someone who has HIV, be it interviewer or interviewee, is to find kinship." AIDS Babies Get a Little Love in Soweto * Reuters (11/05/93) Tucker, David Soweto--The Salvation Army in Soweto has opened Bethesda House, a mercy clinic for South African children with HIV who have been abandoned by their families. Salvation Army Captain Lini Jwili says the mothers and communities who desert infected children simply do not understand what AIDS is. She says the suspicion and ignorance surrounding the disease is so strong that some black South Africans actually believe it was created by apartheid as a measure to preserve white rule. Denis Lorimer, a Salvation Army Major, agrees, adding that people with HIV and AIDS are virtual outcasts in South Africa because of the ignorance and lack of AIDS-awareness education. "The World Health Organization estimates there are about 10 million children orphaned by AIDS in Sub-Saharan Africa," says Lorimer. "We can look after 12." The children at Bethesda House are able to play with uninfected youngsters at a creche on clinic grounds. The children, some of them as young as two years, are being educated about AIDS. "The children are encouraged to interact with the HIV children," says Lorimer. "In about 10 to 15 years, we hope that these [infected] children will be able to cope with AIDS in a way many of their parents cannot." Princess of Wales Concert for World AIDS Day * Reuters (11/04/93) London--In recognition of World AIDS Day on Dec. 1, pop musicians George Michael, k.d. lang, and Mick Hucknell of Simply Red are scheduled to appear in the "Princess of Wales Concert of Hope." The event, which will take place at London's Wembley Arena, will benefit Britain's National AIDS Trust and Crusaid charities created to fight AIDS. Medical Briefs * Advocate (11/02/93) No. 641, P. 34 In 1994, a new kind of condom will be available for men. Polyurethane condoms will be offered in addition to traditional latex condoms. The new prophylactic features improved sensitivity and user acceptability because of a stronger, but thinner, clearer, and odorless film material. Researcher Reports 'A Sense of Enthusiasm' * Washington Blade (10/29/93) Vol. 24, No. 46, P. 26 Brinkley, Sidney The Sixth Annual National AIDS Update Conference, Oct. 19-23, featured over 100 workshop sessions covering a variety of topics. One of them identified a growing group of HIV-negative homosexual men who are suffering from "survival guilt" in terms of AIDS. Psychotherapist Thomas Moon said more attention should be paid to this psychological epidemic in which "men feel that being gay and being HIV-negative is 'cheating' and...unconsciously, some men feel that having AIDS is like being part of a club, a club they want to join." Often, relapses into unsafe sex are motivated by this ambivalence about the right to live while others are dying, said Moon. If the community is serious about reducing HIV infection, Moon said support and therapy groups, counseling, and workshops targeting this group should be adopted. In another workshop, on lesbian issues, panelist Dr. Barbara Herbert shocked the audience by flat-out refusing to accept some safe sex guidelines recommended to lesbians, specifically the use of dental dams. "For people who are worried about HIV transmission at any given moment of time, I think they know that dental dams are a cruel joke," said Herbert. "We have no evidence that dental dams prevent anything." She concluded that the devices give gay women a false sense of security and that anyone recommending them is doing the lesbian community a disservice. AIDS Treatment * National Law Journal (10/11/93) Vol. 16, No. 6, P. S20 Isbell, Michael The most litigated disease in history, AIDS has been the center of a flurry of suits against self-insured health plans limiting the benefits of people with AIDS-related illness. Clinton's health plan could alter the legal terrain for AIDS-infected Americans, according to Michael Isbell, director of the AIDS Project of the LAMBDA Legal Defense and Education Fund. Isbell identifies ways in which health reform might improve care for people infected with the AIDS virus. If enacted, Clinton's plan would remove the need for litigation by including several mandates, such as the obligation of corporate alliances to offer equal benefits and options to all consumers. The Clinton plan includes generous coverage of pharmaceutical products, allows Isbell, but AIDS patients often rely on "off-label" uses of prescription drugs, an issue the plan fails to adequately address. To protect patients, the health package should outline strict federal guidelines mandating comprehensive coverage of medically necessary drugs, including off-label products and costly new AIDS drugs. The fate of confidentiality protection laws for people with HIV remains unclear in Clinton's plan, but if disease surveillance is not clearly separate from medical records, the plan may discourage people from voluntarily learning HIV status, says Isbell. November 9, 1993 Heterosexuals Limiting Number of Partners * Washington Post (Health) (11/09/93) P. 5 Squires, Sally As heterosexual transmission of HIV continues to mount, most heterosexuals have limited themselves to monogamous relationships, according to a report from the National AIDS Behavioral Surveys. An estimated 10 percent, however, still have two or more sexual partners and continue to participate in other behavior that places them at high risk for HIV infection. The surveys of nearly 11,000 people compared a national sample of heterosexuals with a group extracted from 24 high-risk cities. Nine percent of the national sample and 12 percent of the high-risk group had more than one sexual partner within the past year. Of those, men were more likely to have multiple partners, as were unmarried individuals. Similarly, adults aged 18 to 29 were five times more likely than adults aged 60 and older to have two or more partners. In most instances, heterosexuals with multiple partners increased risk for HIV infection by neglecting to consistently use condoms with primary and secondary partners. Only 11 percent of the national sample and 17 percent of the high-risk group used condoms during sex. The study is published in the current issue of Family Planning Perspectives. AIDS Message in a Subway Comic Strip * New York Times (11/09/93) P. B1 Barron, James The New York City Health Department is trying a new tactic to reach young Hispanics who officials fear are ignoring other AIDS education resources. The new attention-getter is an informative comic strip called "Decision," that is strategically placed--in both English and Spanish versions--on trains in the city's subway system. With five episodes displayed so far, "Decision" is one quarter soap opera, one quarter language instruction, and mostly AIDS education. The Health Department has also published the first four segments in a comic book, which it provides to the public free of charge. "Decision" began in 1989 with a $60,000 grant from the Centers for Disease Control for public service announcements, and initially appeared both in comic strip form and in 30-second commercials. When the advertising-agency contract ended, the Health Department continued the project on its own. Now, before each episode, health official Ann Sternberg meets with a half-dozen other officials who all brainstorm for story lines that will maintain a dramatic pace while presenting a serious public health message. The next strip, "Decision V," is scheduled to appear within the next 90 days. Australian 1981 AIDS Case May Have Been Asia's First * Reuters (11/08/93) Sydney, Australia--Tests conducted on the tissue of a 72-year-old Australian who died in 1981 indicate that he was infected with HIV at least a year before the disease was identified by American doctors and scientists. The man died of pneumocystis pneumonia, a respiratory disease that is now often associated with AIDS. The virus was found in the man when tests were conducted on tissue samples kept for over a decade by baffled doctors who couldn't fathom why the man had such a severe form of pneumonia when he had no apparent immune disorder. The patient was admitted to the hospital in February 1981, just one month after deaths from the disease began being reported in America. Tests on tissue from a 1980 prostate operation showed that the man was already infected at that time. His death came two years earlier than the first known AIDS diagnosis in Australia, according to a spokeswoman for the National Center for HIV Epidemiology and Clinical Research. She added that the find is the first recorded AIDS death and probably the first detected HIV in the Asia Pacific area. It is not known how the man contracted the virus. German Researchers Develop New, Fast AIDS Test * Reuters (11/05/93) Munich, Germany--Researchers in Germany say they have developed a new AIDS test that can identify the AIDS virus in less than 10 minutes. According to the team at the respected Fraunhofer Society, the test uses a biosensor to recognize HIV antibodies in blood. Because it is fully automatic, contend researchers, there is no risk of infection to the test administrator. The research team concludes that the new test is significantly faster, easier, and cheaper than the current methods, which take several hours to test a blood sample. In addition, the institute claims the test can be used to screen blood products shortly before use. In the wake of Germany's contaminated blood scandal, thousands of Germans have postponed operations and refused blood transfusions. The research team gave no indication as to when the test would become available on the market. Officials Warned in 1987 About Blood Firm-Magazine * Reuters (11/06/93) German magazine Der Speigel reported in its Monday issue that officials responsible for monitoring UB Plasma, the pharmaceutical firm at the core of the country's AIDS scandal, warned authorities about the company six years ago. "The authorities were told of serious medical deficiencies and possible crimes at the Koblenz firm as far back as March 1987," but the warnings were filed away with no action taken, reported the magazine. UB Plasma was closed down and four employees arrested last week following allegations of inadequate testing and fears that contaminated plasma may have been distributed throughout Europe. In another report, Focus newsmagazine disclosed that two hospitals delayed informing authorities for months that three patients had become HIV-infected through UB Plasma products. "The laboratory head at Frankfurt's Northwest Hospital said prompt notification might have brought the AIDS-blood scandal at UB Plasma into the public domain three months ago," reported Focus. German Doctors Warn Against Mass AIDS Panic * United Press International (11/06/93) Doctors and medical officials in Germany hoped to calm citizens there, asserting that fears caused by a major AIDS scare were not justified. Medical experts blamed Health Minister Horst Seehofer for the mass hysteria, saying that he neglected to inform the public that the risks of infection from untested batches of blood plasma were limited. Karsten Vilmar, president of the federal medical association, lambasted Seehofer and said he was fearful that more people might now die from refusing blood transfusions than from contracting HIV. Lives at Risk as Germans Refuse Blood Transfusions * Reuters (11/07/93) Bonn--Officials in Germany have warned that the hysteria following the country's widening HIV scandal is threatening to claim lives because thousands of patients, afraid of receiving contaminated blood products, are refusing to undergo transfusions. More people are likely to die as a result of rejecting treatment than through actual infection, said Sabine Bergmann-Pohl, junior health minister. Evidence that UB Plasma, a Koblenz-based firm, failed to test plasma products for the AIDS virus has caused a panic to take hold of millions of former patients who fear they may have been infected through routine surgery. Norbert Weise, the prosecutor conducting the investigation of UB Plasma, said that it will be well into next year to clear up the company's affairs. He said that 20,000 blood-product samples need to be screened, and 5,000 blood donors have to be interviewed. So far, only three cases of actual transmission through UB Plasma have been documented. "I don't want to cause panic, but I can't rule out that further cases of infection will be revealed," he said. The hysteria has spread to other European countries such as Italy, Switzerland, and Austria, which have all recalled blood products from UB Plasma. U.S. Embassy in Bonn Sets Up AIDS Recorded Message * Reuters (11/06/93) Bonn--The U.S. Embassy in Bonn has activated a recorded telephone message for the estimated 185,000 American citizens living in Germany and the 1.25 million tourists who visit the country each year. The tape recording does not provide safety guidelines, but promises that advice would be available as soon as the facts were clear. "The embassy has been following media reports about possible HIV infected blood supplies in Germany," says the message. "We are constantly in contact with German officials concerned with the issue and are seeking comprehensive and accurate information." Hysteria has gripped the entire country after a pharmaceutical company was accused of neglecting to adequately screen blood products for the AIDS virus. Hospitals, doctors, and health agencies were inundated with phone calls from panicked patients asking if they need AIDS testing. France Urges Citizens Not to Worry About Blood * Reuters (11/07/93) Paris--French officials urged citizens not to worry about blood products, saying that the country's ban on two products in the wake of the German HIV scandal is nothing more than a precautionary measure. The French Health Ministry Saturday provisionally banned the sale of Feiba and Tissucol, two products manufactured by Immuno GmbH, because of uncertainty as to whether they were derived from plasma marketed by German company UB Plasma. Although the health ministry said France has not imported any blood plasma from UB Plasma, sale of the two Immuno products were being halted pending an inquiry into the source of the plasma. "I want to reassure French people and tell them we are constantly doing all we can to check all products," said Health Minister Simone Veil. Partner Notification for Control of HIV: Results After 2 Years of a Statewide Program in Utah * American Journal of Public Health (10/93) Vol. 83, No. 10, P. 1418 Pavia, Andrew et al. Contact tracing, or partner notification, is the attempt by infected patients or health authorities to locate, inform, counsel, and treat individuals who have been exposed to a sexually transmitted disease. Partner notification has been instrumental in controlling syphilis and gonorrhea since the 1940s and, now, some have called for contact tracing for partners of HIV-infected patients. They assert that this practice could target interventions to those at high risk, notify unsuspecting female partners to prevent perinatal HIV transmission, to treat asymptomatic persons, and to counsel those who cannot be reached through other educational messages. High cost, difficulty in locating partners because of the long HIV incubation period, confidentiality concerns, and lack of proven efficacy, however, have led others to oppose the practice of contact tracing. A Utah study sought to evaluate the utility of partner notification, and to identify subgroups in which it might be particularly effective. All persons diagnosed with the virus between October 1, 1988 and September 30, 1990 were interviewed. Personnel costs, including benefits added up to about $62,500 per year. The study concluded that partner notification was acceptable to most HIV-positive patients, and identified a group with a high HIV seroprevalence. It was most effective among populations that are difficult to reach with other interventions, such as drug users, women, and minorities. The benefits appear to outweigh the negatives, but the precise role of contact tracing is yet undetermined. AIDS, by Regions * Industry Week (10/04/93) Vol. 242, No. 19, P. 33 AIDS is the leading cause of death among males between the ages of 25 and 64 in Buffalo, Minneapolis, and Orlando, according to a report published in the Journal of the American Medical Association. The report also found that, in San Francisco, AIDS accounts for 61 percent of deaths of men aged 25 to 44. In Baltimore, 43 percent of female deaths are attributable to the deadly disease. Natural History of AIDS Related Sclerosing Cholangitis: A Study of 20 Cases * Journal of American Medical Association (10/13/93) Vol. 270, No. 14, P. 1686 Forbes, A. et al. A study of AIDS-related sclerosing cholangitis by Forbes et al. shows that the infection does not have an overall impact on prognosis, but does reverse an unusual inverse correlation between age and survival in HIV infection. For at least 10 months, or until death, 20 consecutive patients, aged 27 to 50, with AIDS-related sclerosing cholangitis were tracked. Seventeen patients of those died at an average of seven months, and three are still living without sclerosing cholangitis symptoms. Controls for age, CD4, and infection had virtually the same end result of average survival at 7.5 months and expected worse prognosis with increasing age. Growing older, however, seemed protective in AIDS-related sclerosing; this striking phenomenon cannot be explained by either disproportionate immunosuppression or opportunistic infection. November 10, 1993 Blood Tests Urged for GIs in Germany * Washington Post (11/10/93) P. A29 Vogel, Steve In response to widening panic caused by Germany's snowballing HIV-screening scandal, U.S. military officials in the country are now recommending that all American soldiers and members of their families who have received blood transfusions from German hospitals in the past 15 years seek AIDS testing. Officials said it is likely that hundreds of American service members received transfusions, although they believe the actual number put at risk is probably minimal. "We do not want to minimize the risk of infection," said Maj. Gen. Vernon Chong, European command surgeon. The U.S. military in Germany has its own blood collection and processing services, which are licensed by the Food and Drug Administration and certified by the American Association of Blood Banks. Sometimes, however, Americans are referred to German hospitals for medical treatment. The military has requested that its blood banks review records as far back as 1985 to determine if any plasma was purchased from UB Plasma, the Koblenz-based firm at the center of the HIV scandal and, if so, for what purposes. H.I.V. Found in Blood Seized in Germany * New York Times (11/10/93) P. A7 German investigators have confirmed the presence of HIV infection in two batches of blood seized from UB Plasma, the firm around which the country's negligent screening scandal is revolving. Prosecutor Norbert Weise said scientists had checked only 2,000 of 25,000 confiscated batches of blood when they discovered the two cases of infection. UB Plasma is suspected of, for more than a decade, failing to properly screen blood products, which were supplied to more than 80 hospitals. This revelation unleashed widespread concern among millions of people in Germany, who fear they may have been infected with the AIDS virus during routine operations. German health officials and the German Red Cross have urged residents not to worry. They insist that the proportion of blood products processed by UB Plasma is small, and the probability of anyone being infected is tiny. Second German Company in AIDS Scare * Financial Times (Great Britain) (11/10/93) P. 2 Genillard, Ariane As Germany's largest medical scandal continues to mushroom, a second German company has been implicated. Blood products from Haemoplas, in Lower Saxony, have been recalled from 64 hospitals under suspicions that they were not regularly tested and may be tainted with the AIDS virus. All hospitals and medical centers in the country using the products have been ordered to return them to local authorities. Meanwhile, investigations of the first blood products firm to be implicated, UB Plasma, yielded confirmation of two instances of HIV infection in blood samples seized from that company. The scare has prompted tens of thousands of concerned Germans to swamp hospitals and medical centers with calls asking advice or seeking AIDS testing. Many Fear Mouth-To-Mouth Resuscitation, Survey Finds * United Press International (11/09/93) Atlanta--According to a University of Arizona survey, many people are refusing to administer cardiopulmonary resuscitation (CPR) due to an unwarranted fear that they could contract a disease. The study found that 45 percent of the 975 respondents would not perform mouth-to-mouth resuscitation because they would not want to breathe into another person's mouth. Seven percent of the sample recalled being in a situation where CPR was needed, but admitted that they failed to act. "It's a fear without any substantial basis and it is very tragic, if not disappointing, that such a fear has evolved, because I believe numerous lives are being lost because of it," said Dr. Nisha Chandra of Francis Scott Key Medical Center in Baltimore, Md. Chandra said that although "AIDS has been out there for 10-plus years, and we have been actively resuscitating thousands and thousands of patients during this time period," no case of CPR-related HIV transmission has ever been documented. Fund-Raiser Will Pay $3,000 Under Agreement With Attorney General * PR Newswire (11/09/93) Harrisburg, Pa.--The operators of a Philadelphia business have agreed to pay $3,000 to settle allegations that they violated the state's Charities Act while raising money purportedly to be donated for AIDS research. According to Attorney General Ernie Preate Jr., the agreement prohibits Jerrald B. Silverman and Stanley Snyder, the operators of Lectra Products Co., from conducting fund-raising activities in Pennsylvania for the next decade. Lectra apparently placed canisters in thousands of stores last summer, supposedly to solicit money to benefit the American Foundation for AIDS Research (AmFAR). The agreement, "an assurance of voluntary compliance," contends that the business violated the Charities Act by failing to register with the Department of State before soliciting funds, failing to obtain required contractual permission from AmFAR, and neglecting to submit to the state a written contract with AmFAR. Silverman and Snyder did not admit to wrongdoing, but agreed to pay $500 in penalties and fines and $500 in investigation costs to the state, as well as $2,000 to be distributed by the office of the Attorney General to a charity "whose stated charitable purpose is consistent with the representations made to contributors." Investigators, although uncertain of the exact amount of money raised by Lectra, believes that funds solicited were less than $2,000. Disease Detection International, Inc., Signs Exclusive Distribution Agreement for Seven-Minute AIDS Test for Argentina * PR Newswire (11/09/93) Irvine, Calif.--Disease Detection International, Inc. (DDI) of California has signed a three-year deal with Miami's Bio-Diagnostica, Inc. for the exclusive sale and distribution of the company's SeroCard HIV tests in Argentina. DDI's CEO, H. Thad Morris, expressed his confidence in Bio-Diagnostica as an "experienced marketer of numerous medical products and equipment," and projected that his company expects to ship more than 1,500,000 tests for sale in Argentina. DDI has already received 40,000 of the tests, and plans to begin shipments in 1994. Tony Blanco, DDI's director of distribution for South America, commented that "the use of the SeroCard HIV-1 test is ideal in medical settings where the availability of sophisticated instrumentation and trained personnel is limited." The rapid, whole blood test has a seven-minute format that requires no instrumentation to obtain an accurate test result, and has proven to be 99 percent accurate. The device is smaller than a credit card, which allows for significant savings in the screenings of individuals by using a single drop of blood from a finger prick, as opposed to more complex and expensive procedures. Symposium on Clinical Care of the AIDS Patient to Be Hosted by UC San Francisco * Business Wire (11/09/93) San Francisco--The University of California at San Francisco will host a three-day symposium, Dec. 13-15, for practicing doctors on the clinical care of AIDS patients. The conference will focus on practical issues in managing care for all stages of HIV disease. Topics to be addressed include guidelines and initial workup for the patient, neurological complications due to HIV, bacterial infections, antiretroviral therapy, gender-specific issues, terminally ill patients, and pediatric AIDS. The symposium will also include workshops on health care worker exposures and infections, HIV nursing, and HIV education and prevention, among others. The program will be led by UCSF faculty who are leaders in research and patient care, and their colleagues from around the globe. It is designed for practicing physicians, internists, infectious disease specialists, and other primary care physicians. So as Not to Forget Those Lost to AIDS * Philadelphia Inquirer (11/08/93) P. B3 Yaskin, Joesph A statue of two men arm-in-arm stands upon a wooden base with rows of brass nameplates mounted upon it--Bill Cole's backyard memorial to the friends and acquaintances who have been lost to AIDS. Although the memorial is tucked away behind his house, Cole, a retired math teacher, has brought the disease to the forefront of his former profession. Cole first got involved in AIDS education in 1987 when he discovered that he had HIV. When his companion of more than a decade died of AIDS in 1989, Cole made the work his life mission and, in 1991, retired from teaching to dedicate himself on a full-time basis. His message to teachers--and everyone else--is simple and clear. "We all need to talk honestly about AIDS, including in the classroom," he says. "Then we can replace the stigma with compassion." Cole also urges teachers to do whatever is possible to help students achieve self-esteem, because "peer pressure is a very powerful force, and a sense of self-esteem makes a kid less likely to give in to dangerous behavior." For his work in educating other teachers about AIDS at schools and conferences in South Jersey and elsewhere, Cole was last year presented one of 14 national "Pathfinder" awards, an honor bestowed by a consortium of national organizations led by Congress and the Centers for Disease Control and Prevention. When AIDS Strikes Parents * Time (11/01/93) Vol. 142, No. 18, P. 76 Gorman, Christine The problem of children who have lost one or both parents to the AIDS virus is becoming all too common in the United States. Statistics indicate that some 30,000 youngsters have seen their mothers or fathers, or both, die in the epidemic. By the year 2000, that figure is expected to at least triple. Because the majority of AIDS mothers are single parents, there often is no father to fill the void following the mother's death. Many women will move from large cities back to their hometowns, where relatives can take in the children. Often, however, stigma associated with AIDS may prevent families from caring for these kids, leaving perhaps half of all AIDS orphans either on the streets or in the overflowing foster care system. While the death of a parent is always traumatic, the pain is even more profound when the cause of death is AIDS. These kids feel isolated in their shame, and with no outlet for the rage and grief, they often get into trouble at school, or with the law. Teens often engage in casual sex and intravenous drugs, in defiance of the virus. In response, many community organizations are trying to avoid future tragedy by initiating support groups for children who are orphaned, or soon-to-be orphaned because of AIDS, and social and health agencies are attempting to reach more parents with AIDS before they die so that their children can be better prepared. AIDS Deaths Shift From Hospitals to Home * American Journal of Public Health (10/93) Vol. 83, No. 10, P. 1433 Kelly, Janet J. et al. As part of the AIDS Mortality Project initiated by the Centers for Disease Control in 1989, researchers monitored trends in place of death of AIDS patients as measures of health care usage and terminal health care of HIV-infected persons. Sixteen health departments gathered death certificates for some 55,186 individuals with AIDS who died throughout 1991. Place of death was categorized as hospital, home, hospice or nursing facility, or other. Analysis of the data showed that the number of AIDS deaths in hospitals dropped significantly from 92 percent in 1983 to 57 percent in 1991. Hospital deaths were more frequent--91 percent--in the Northeast region of the country, while deaths at home were more common--27 percent--in the West. The study concluded that AIDS deaths at home or in hospices have increased since 1983, and that these trends may reflect changes in hospital use for the final stages of AIDS disease. Decreasing hospitalization, while increasing outpatient services and home care, will lower costs and may allow HIV-infected individuals an improved social support system. News Wire: California * Advocate (11/02/93) No. 641, P. 20 The California AIDS office spends too much money on AIDS education efforts targeting heterosexuals, and not enough money on campaigns aimed at homosexual men, said a study released Sept. 18 by researchers at the University of California, San Francisco. Brief Report: Fatal Seronegative Ehrlichiosis in a Patient With HIV Infection * New England Journal of Medicine (10/14/93) Vol. 329, No. 16, P. 1164 Paddock, Christopher D. et al. Paddock et al. reported an HIV-positive woman with a fatal case of ehrlichial infection. Ehrlichia chaffeensis is a bacterium that causes febrile illness associated with cytopenia. It was only recently identified in the Western Hemisphere in 1986 and, although about 300 cases have been reported, none have been diagnosed in persons with HIV. The significance of this case, say Paddock et al., is that the initial manifestations of ehrlichial infection copied the clinical characteristics of other opportunistic infections more common to AIDS patients. The 41-year-old woman displayed symptoms consistent with a diagnosis of pneumocystis cariini pneumonia, and with pancytopenia associated with zidovudine treatment. When treatments for these infections were unsuccessful, further investigations focused on types of fungal, bacterial, and viral organisms that often affect AIDS patients. Although E. chaffeensis is treatable with tetracycline and was eventually detected, it was not done soon enough to alter treatment, and the patient died. Intact T cell function is an important host defense against diseases like E. chaffeensis that fall into the Rickettsiacae family. Paddock et al. suggest that, due to the rapid and severe progression of the infection in their patient, the infection should be added to the list of potentially life-threatening opportunistic infections in people with HIV. November 12, 1993 AIDS Vaccine Are Ineffective in Key Lab Tests * Philadelphia Inquirer (11/12/93) P. A16 Candidate AIDS vaccines that once showed promise have failed critical laboratory tests, an event that may delay large-scale trials, according to researchers. Three vaccines had produced neutralizing HIV antibodies in tests against laboratory strains of the virus. When tested against fresh virus taken from the blood of actual patients, however, the vaccines did not lead to disease protection. The second tests are considered a more realistic evaluation of candidate vaccines because the general population contracts HIV strains that differ slightly from the ones used in lab tests. Antibodies that attack one strain may not be as effective against another variant, and the AIDS virus is known for its ability to mutate rapidly. Studies of the three vaccines were conducted by Duke University, Walter Reed Army Institute of Research, and the Chiron Corp. in California. State Supreme Court Hears Challenge to 1989 AIDS Law * Chicago Tribune (11/11/93) P. 1-3 ady, William) The Illinois Supreme Court Wednesday heard arguments for and against a state AIDS law penalizing infected persons for deliberately spreading the virus. The 1989 legislation allows prosecutors to file criminal felony charges against anyone who is aware of their positive HIV status and participates in any activity that contributes to transmission of the virus, including intimate contact, blood donation, or sharing of dirty needles. "There is no rational basis for what the legislature did here," contended Michael L. Closen, a professor at John Marshall Law School in Chicago and an attorney who also challenges the constitutionality of the AIDS law. Closen said the language of the statute is so ambiguous that HIV-infected people could face charges for seeking medical care. Gerry Arnold, a staff lawyer for the state appellate prosecutor's office, noted that two defendants had been charged with violating the law by having sex, and countered that the statute was not vague in terms of that behavior. "Sexual intercourse is generally acknowledged as a means of transmitting HIV," he said. Only a handful of people have been charged under the law and, thus far, judicial review has been mixed. Canada AIDS Toll Is Highest Ever * Boston Globe (11/11/93) P. 15 Statistics indicate that a record number of Canadians died from AIDS in 1992, and experts warned that the incidence of infection continues to increase. Nationally, 1,078 people died from the disease last year--the first time since the country's first AIDS diagnosis in 1979 that the annual death toll has topped 1,000. "Those who thought the epidemic was leveling off and going away were mistaken," said Don Sutherland of the Laboratory Center for Disease Control in Ottawa. Data gathered by that institute indicates that a total of 5,801 Canadians have been lost to AIDS. French Group Fighting AIDS Wasted Money, Auditor Says * Toronto Globe and Mail (Canada) (11/11/93) P. A18 The French Agency for the Fight Against AIDS squandered funds, bungled a condom-distribution program, and paid executives inflated salaries, disclosed state auditors yesterday in a report leaked to newspapers. According to the auditors, the organization used money designated for hemophiliacs to cover its own expenses, and two of four chairmen received salaries far above legal standards. The report also said that the government agency, which was established in 1989, had ceased to maintain accounts by early this year. The information sparked anger in anti-AIDS groups, and a dozen activists stormed and wrecked the agency's office. Agency head Jean de Savigny dismissed the findings, explaining that his accountant has been on leave since early 1993, that the money from the hemophiliac fund had been borrowed for a few weeks with the knowledge of the health ministry, and that his $200,000 salary had been approved by the ministry. He also denied that the organization was forced to destroy 400,000 condoms last year after health officials deemed the brand as substandard. "The report mainly mentions sins of the agency's youth, its first two years," said de Savigny. "What is important is the prevention of AIDS, and, thanks to the AFLS and my predecessors, we have a wide mobilization in France." Blood Scandal Closes 2nd German Company * New York Times (11/11/93) P. A3 The closing of a second blood products company in Germany helped to advance the country's scandalous HIV scare. The reported failure of the Osterode-based Haemoplas company to test all plasma units has resulted in the HIV infection of at least two people. The firm was ordered to suspend operations the day after its products were recalled from 69 hospitals. Walter Hill, the Social Welfare Minister of Lower Saxony, said that there is no evidence to support claims that Haemoplas knowingly sold contaminated plasma. But state officials assert that the company neglected to test each plasma unit, as is required by law. One state health official said that common practice at Haemoplas was to screen only the first unit donated by any given commercial donor. Haemoplas director, Frank Giesbert, reported that his company was responsible for infecting three patients. Since 1989, a total of six German cases of infection have been transmitted through blood products tainted with the AIDS virus. Related Story: Toronto Globe and Mail (11/11) P. A18. 2,000 Video Stores Gear Up for 'Penny for AIDS' Fundraising Drive * Chicago Tribune (11/11/93) P. 2-3 Liebenson, David This month, all video retailers and industry-related companies are being asked to participate in "A Penny for AIDS," a fundraising effort that asks for a one-cent donation for each videocassette or laserdisc rented or bought between Nov. 24 and International AIDS Awareness Day, Dec. 1. "It's not a gala fundraiser," says campaign chairman Larry Klingman. "We've designed it so that everybody can make a contribution without any one major group carrying the load." Klingman projected that, with 50 percent participation, the organization could raise $1 million. Over 2,000 retailers have committed to the project, which is being sponsored by the Video Industry AIDS Action Committee. They will join studios, vendors, distributors, and manufacturers. Even cable and broadcast TV--which compete directly with the video industry--will get involved by airing public service announcements featuring celebrities such as Mario Van Peebles, Hulk Hogan, and Fabio. The AIDS Action Committee was founded in 1989 in response to what was perceived as inaction by the government against the disease. It services 35 national and community-based AIDS organizations, for which it has raised some $500,000. Poll Trends: AIDS--An Update * Public Opinion Quarterly (Spring 1993) Vol. 57, No. 1, P. 92 Rogers, Eleanor Singer et al. Rogers et al. gathered over 100 national AIDS surveys and analyzed the data, which fell between January 1987 and July 1992. The resulting summary of public opinion about AIDS reflects several major trends of the past decade. One is the steady increase in public knowledge and concern about AIDS, with almost 100 percent of the population now understanding how the virus can and cannot be transmitted. Concern about the disease as a personal health threat, however, has not increased since the mid-eighties. Secondly, Americans have altered behavior--including increased condom use--because of concerns about AIDS. The third trend suggests that attitudes about who should be tested, including immigrants, prisoners, couples applying for marriage licenses, people in high-risk categories, food handlers, hospital patients, tourists, and children entering school, have remained relatively stable over the years. But, the percentage of people urging sexual partner tracing increased steadily, as did the percentage of people who had themselves been tested. A shift in public perception of AIDS as a community health problem rather than a civil rights issue indicates a fourth trend. There has been a decline in the number of people who feel infected individuals should be quarantined. Three in four in 1991 felt that employees with AIDS should be allowed to continue working--a 65 percent increase from 1985. Rogers et al. identify a fifth trend that marks a change in attitudes toward people with AIDS and funding of AIDS research. From 1987-89, a prevalent attitude was that AIDS was punishment for declining moral standards; that percentage dropped slightly in 1991. Also, people were less inclined to feel compassion for infected persons if they contracted the virus through homosexuality or drug use. Finally, the vast majority of people feels that public spending on AIDS should be increased. The Clinical Challenge of the HIV Epidemic in the Developing World * Lancet (Great Britain) (10/23/93) Vol. 342, No. 8878, P. 1037 Gilks, Charles F. The developing world now carries the greatest burden of the HIV epidemic and will continue to do so in the future. Clinical research and surveillance in such countries revolve around AIDS--an approach which can breed powerlessness and hopelessness. By contrast, it is early death from HIV disease, not rapid progression to AIDS, that is most common in developing countries. If focus is shifted from AIDS to HIV, a different analysis emerges. Finally, a positive message can be relayed that something can be done, for many HIV-related diseases can be effectively treated in even the poorest of countries. This switch on concentration should also boost counseling, and raise staff morale and motivation. Mortality rates can be reduced if health caregivers focus on improving the outcome of all patients ill with common treatable infections, whether they are HIV-positive or HIV-negative. To accomplish this, health ministries need to reappraise goals and reallocate resources accordingly. Other suggestions include delegating hospital priority to those with treatable infections, and encouraging those with specific symptoms to seek treatment early. Are HIV-Infected Injection Drug Users Taking HIV Tests? * American Journal of Public Health (10/93) Vol. 83, No. 10, P. 1414 Reardon, Juan et al. Regardless of sexual orientation, intravenous drug users account for 14.8 percent of AIDS cases in California. HIV testing for these drug users has been recommended as a strategy for curbing the spread of the virus. To evaluate infection knowledge among infected IV drug users and acceptance of confidential testing among that population, Reardon et al. conducted a study of 810 injecting drug addicts entering treatment in Costa County, Calif. The researchers gathered data on acceptance, previous testing, drug use, and demographics. Of the sample, 105--or 13 percent--were infected, and 58 already knew they were infected. The other 47 were infected but did not realize it. Black injection drug users represented a higher rate of infection, but were less likely to already know of their infections. Reardon et al. concluded that "in-clinic" HIV testing is highly acceptable, and most infected patients in treatment will learn their HIV status. Voluntary testing is, however, very likely to yield significant underestimates of the true rate of infection among the intravenous drug population. AIDSLine * Advocate (11/02/93) No. 641, P. 33 Cohan, Gary R. For AIDS patients who suffer from nausea, abnormal weight loss, or abnormal loss of appetite, the drug dronabinol may relieve these symptoms. Prescribed under the brand name Marinol and approved by the Food and Drug Administration since 1985, the drug is a synthetic version of THC, the active ingredient in marijuana. In several clinical studies, Marinol improved appetite, decreased nausea, and increased weight by more than four pounds after eight weeks. The "high" associated with marijuana use was quite mild and lasted only four to six hours, although the appetite-stimulating effects lasted for 24 hours or more. The drug is produced in capsule form so that it is taken orally, not smoked. Many patients claim to feel better only after smoking actual marijuana, and there is currently a movement before the FDA to lighten restrictions on the drug so that doctors can prescribe it for medical purposes. Dr. Gary R. Cohan says that, while it's true that smoking marijuana does allow more THC to enter the bloodstream, smoking is not a healthy activity, particularly for a person who has immunocomprimised lungs. HIV-Related Knowledge and Precautions Among Michigan Nurses * American Journal of Public Health (10/93) Vol. 83, No. 10, P. 1438 Schillo, Barbara A. and Reischl, Thomas M. Schillo and Reischel undertook a study to determine HIV-related knowledge and precautionary behaviors in registered nurses in Michigan. The random sample of 1,530 RNs completed surveys in 1989. The results indicated that, while almost all of the respondents were well-informed of known viable routes of HIV transmission such as needlesticks, many reported misconceptions about unproven avenues of transmission like skin-to-skin contact or being sneezed on by an infected patient. In terms of universal precautions, more than a quarter of the sample said that they did not use gloves each time they handled blood and body fluids, or treated a bleeding patient. Most failed to wear protective eyewear and gowns, but nearly all reported use of puncture-resistant containers for disposal of sharp instruments. Less than half of nurses who used needles to treat patients followed the proper procedure for recapping needles, and one out of 10 reported sticking themselves with used needles. This lack of universal precautions may be explained by respondent complaints of barriers that make it more difficult to use protective measures. The nurses said protective equipment was awkward, poorly constructed, not readily available, and that gloves were not the right size. These findings support the need for continued and intensified efforts to educate nurses so that they may provide quality care while engaging in precautionary behavior and being aware of risk of exposure to the AIDS virus. Quantitative Detection of HIV-1 Drug Resistance Mutations by Automated DNA Sequencing * Nature (10/14/93) Vol. 365, No. 6447, P. 671 Larder, B.A. et al. Larder et al. conducted comparisons of manual and automated DNA sequencing to determine the ability of each in distinguishing mutation detection in mixtures of HIV-1 sequences. Use of an automated system with fluorescent-labeled sequencing primers proved most effective in detecting mixtures of HIV-1 drug resistance mutations. The technology has a wide range of possibilities for clinical research, including the identification, quantitation, and visualization of heterozygote mixtures, as well as the analysis of drug resistance mutations and other heterozygote analyses involving DNA sequencing. 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 1993, Information, Inc., Bethesda, MD. -----===[[[ A I D S w i r e D I G E S T 11.08.93 ]]]===----- .