I GAY AND L:: :E~S~:SSOCIATION

Transcription

I GAY AND L~~:~~: :E~S~:SSOCIATION

This Newsletter is published by the National
Coalition or Gay Sexually Transmitted Disease
Services (NCGSTDS). Although errorts will be
... made to present accurate, ractual inrormation,
the NCGSTDS, as a volunteer, nonprorit organiza...... tion, or its orricers, members, rriends, or
...... agents, cannot assume liability ror articles
... published or advice rendered. The Newsle~ter
...... provides a rorum ror communication among the
......
nation's gay STD services & providers, and
......... encourages literary contributions, letters,
... reviews, etc. The Editor/Chairperson reserves
VOLUME 7:5
JUNE/JULY,
1986
.
... the right to edit as needed, unless specif.ic
****************************************************************; requests to the contrary are received. Articles
ror the Newsletter, or inquiries about membership or sUbscriptions may be addressed to Mark P.
Behar, PA-C, Chairperson, NCGSTDS, PO Box 239, Milwaukee, WI 53201-0239 (414/277-7671). Please
credit the NCGSTDS when reprinting items rrom the Newsletter. We're eager to hear rrom you
and will try to answer all correspondence! The NCGSTDS is the proud recipient or the Natio~al
Lesbian/Gay Health Education Foundation's JANE ADDAMS-HOWARD BROWN AWARD, ror outstanding errort
and achievement in creating a healthier
.
.
THE
OFFICIAL
NEWSLETTER
OF
......
...
'::
::
THE
NATIO,NAL COALITION
OF
GAY STD SERVICES
i
a
...
...
...
...
S
:~~~~~~::~!':':~~~'!:::~:~:1r:~:*;:~~r::~;*~~~:*;!;*;::~;***'~~ II )( I
GAY AND
L~~:~~: :E~S~:SSOCIATION
**********************************************************************************************************************************.*
T~~~~
QE ~!~~!§
ACLU Publishes Pamphlet-19
AIDS Blood Screens-44
AIDS Epi/Surveillance Update-64
AIDS in Prison-17
AIDS Peril Great for Blacks-16
AIDS Show in SF/London-20
AIDS Vigil-46
AIDS Virus Mutates-62
Aloe Vera Plant-Based Drug-6
Alternate Test Sites-60
Alumni Reunion at LALGCSC-13
AMFAR Awards Grants-42
AMFAR Has More PSAs-20
Animated Kids Video-19
Atlanta Black &White Men-15
BARE Facts Debuts Campaign-3
Bathhouses Sued by LA County-57
Behind Scenes in Paris-24
Bike-A-Thon in SF-8
Billboard Fundraising Proj.-56
Bitten Cop: Attempted Murder-52
Black Civil Rights Org.-16
Blacks Hold National Conf.-14
Bone Marrow Frozen &Banked-6
Bone Marrow Registry-4
Boston Forms PWA Coalition-17
Boston Walk for Life-8
Calif. Governor Cuts Funds-54
California Vote on LaRouche-55
Canadian Efforts-22
Chicago Compo Prevo Prog.-53
Chicago Women's AIDS Project-18
Chilling Predictions-41
Chronic Hep B Carriers-50
CIRID Medical Updates-62
City Approves Malpractice-42
Columbus Seeks Director-18
Comics Teach About Sex-22
Condition Not Crisis-5
Conference: Homosexuality-2
Congressional Right Wing-57
Personal Safe Sex Saapler-50
Legal Journal Has Article-19
Core Physician Educators-20
Police
Forces Ab Test-54
Legal
Rights,
AIDS
Pamphlets-23
Cosmetics Cover KS Lesions-50
Positions
Available-18
'Lesbian/Gay
Caucus
of
APHA-2
Cuba Okay's Mom's Visit-47
Price
Tripled
on Ribavirin-56
Lesbians
Suffer
AIDS
Bias-52
Daily Interfaith-49
Prison
AIDS
Pop.
Rising-17
DC Gay Men Practice Safer Sex-3 London Helpline-22
Prisoners
with
AIDS-52
Lutheran Pastoral Care-21
Docs Refuse to Report Cases-58
Promising Report, Paris-23
Man Sues Over Ab Test-U
Doctor with AIDS Fired-52
PWA
Coalition Newsline-22
Mariposa
Award
to
Brad
Truax-43
Donors Blood to be Traced-43
PWA
Switchboard-43
Media
eampaign-20
Dynasty Actor Has AIDS-47
Racisa, HOIOphobia-17
Editorial: Infected vs. Diag.-7 Megaraffle in NYC-12
Rate
of AIDS Transaission-60
Minneapolis
Site
of
AAPHR
Mtg-6
Education Grants by CDC-9
Red
Cross
&PHS Offer-21
MMWR: Ab-Military, 35:26-37
Effects: Learning Ab Status-60
Red
Cross
Film: Beyond Fear-21
MMWR: Alt Sites, 35:17-25
'Electric Billboard Flashes-20
Reflect:
Sadness/Laughter-13
MMWR: Classification, 35:20-27
Eliz. Taylor Seeks Funding-13
Rising Costs of Liabi 1;ty-11
MMWR: Dialysis, 35:23-32
Federal Porno Report-9
Saliva Test-56
MMWR: Fatigue/EBV, 35:21-30
Future of NCGSTDS-4
Sanitation Workers in NYC-52
MMWR: HBV-Jet Gun, 35:23-31
Genetically Engineered HBV-49
Schools Should Have Educ.-53
MMWR: Herpes, 35:24-36
Guide to Illness &Health-53
Social Pressures Blaaed-47
H.S. Pupils Don't Know Facts-14 MMWR: Mycobacterium, 35:28-39
Spanish
AIDS Hotline in LA-15
Haitians Relisted as At-Risk-5 MMWR: NANB Hepatitis, 35:24-35
St.
Louis
Effort-20
MMWR:
Rx
Resistant
GC,
35:19-26
Health Center/Sydney-22
Tax
EX8lpt
Groups Can Lobby-18
MMWR:
Transfusion,
35:24-33
Health Officials Admit-12
TB Skin Test Advised-50
Mobilization Meaorials-43
Healthy Transm. of Herpes-60
Texas Approves Nation's First-51
Mother's Book-19
Hepatitis &AIDS Vaccines?-49
Touring AIDS Exhibition-51
NAN Offers Assistance-8
Hormonal Look Alike-64
Transfusion
Trial 8egins-24
Nat. AIDS Network Newsletter-7
Human Trials in Testing-42
Treatment
of
Adrenal Insuff.-63
Nat.
Minority
AIDS
Council-15
Humorous Approaches-16
Uganda
Sexuality-48
Natural
Therapies
for
Viruses-6
Immunity &Stress Linked-61
United Way Shortchanges SF-56
Navy Court Martials Sailor-57
Int. Health Research Fnd-47
Virus
Transmitted: Neg. Bld.-64
NCGSTDS
Operates
at
Loss-3
Justice Dept. Opinion-9
Walk in NYC-8
NCGSTDS Semi-Annual Meeting-2
Kaposi's Linked to Poppers-51
Wash. Archbish. Names Priest-50
Ne,w IlIIIIIUne Booster?-58
Kennedy Ctr Shuns Play-54
Washington DC Opens 4th Home-56
Next Newsletter-59
Kidney Problems-62
Nondeadly AIDS Virus: Hope?-48 Who's Who in Sexology-19
Killing Viruses-63
World Health Org. Challenged-7
Now I Know Better-13
Knowing Is Better?!-44
Oral Sex May Be Safer-53
LaRouche-55
Las Vegas AIDS Photo 10 Card-54
Law Student Sues NBC-54
~***********
'
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.
***** PAGE
2
*
THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNErJULY, 1986 *****
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NCGSTDS SEMI-ANNUAL MEETING AT APHA, SEPTBIBER 29TH
The National Coalition of Gay Sexually Transmitted Disease Services (NCGSTDS) will be hosting its semi-annual meeting in
conjunction with the American Public Health Association's Annual Meeting, at the Lesbian &Gay Caucus Suite in the
Paddlewheel Hotel, Las Vegas, Monday, Sept. 29, 9am-12. Among the agenda items are: corporate status, tax-exempt
status, board of advisors, guidelines &recommendations for healthful gay sexual activity, proposed paddlewheel boat
fundraiser on the Mississippi River in conjunction with the AAPHR annual meeting (August, 1987), reports from member
services, and future direction of the Coalition. Any additional agenda items must be brought to the attention of the
NCGSTDS, POB 239, Milwaukee, WI 53201. Coalition Chair Mark Behar will also be staying in the Paddlewheel Hotel.
**************************************************
LESBIAN. GAY CAUCUS OF PUBLIC HEALTH WORKERS ANNOUNCE PRELIMINARY ACTIVITIES
The Lesbian &Gay Caucus of Public Health Workers of the American Public Health Association is planning a full schedule
of activities at the upcoming APHA Conference in Las Vegas, September 28 through October 2, 1986. The Caucus'
Hospitality Suite will be in the Paddlewheel Hotel, and most of the sessions will be held in the Convention Center. The
following is a preliminary schedule of LGC activities (asterisk .*" indicates sessions sponsored by the Caucus):
~~~g~~L ~l~~, 9- 12 PI NCGSTDS SEMI-ANNUAL MEETING AT THE CAUCUS SUITE; 2-3:30, Session ~320, Risk for AIDS Among IV
Drug Users; 2-3:30, Session 1343, AIDS Education: Program Examples*; 2-3:30, Session ~350, Suicide: ACrisis for
Youth &Adults; 2-3:30, Session ~363, Strategies for Improving Services to Women, Teenagers, &Families; 4-5:30,
Session 1097, Occupational Health &Safety: AIDS in the Workplace;
4-5:30, Session 1413 Gay Health Care--Past,
Present, &Future*; 6 pm Joint Social Hour with the Women's &Socialist Caucuses;
!~!!~ ~l~~, 12pm, Caucus Business Meeting; 2-3:30, Session 15~ Alcohol, Drugs and the Sexual Transmission of AIDS; 23:30, Session 1596 Health Education Response to Kids at High Risk; 2-3:30. Session 1597, Persons with AIDS and Their
Families: New Service Patterns; 2-5:30, Session 1617, Behavioral, Social, Legal and Youth Issues in AIDS and HTLV-III
Testing*; 4-5:30 pm, Session 1649, AIDS Patients: Health, Mental Health &Social Concerns
~!~~!!~~~L l~ll, 8:30-10, Session 1742, Lesbian Health Care Issues*; 2-3:30, Session 1835, Guidelines for Healthful Gay
Sexual Activity*; 4-5:30, Session 1914, Computer Applications in School Health
~:11 e~L ~D~~l ~~~~~~ E~D~r~i~!D9 QiDD!r
Ih~~!~~~L lql~, 8:30-10, Session 1973, AIDS Education and Surveillance in High Risk Communities; 8:30-10, Session 1976,
AIDS in the Schools.
For additional information about membership in the Caucus, write to: Alex Tonkinson, Treasurer, L&G Caucus, 3262
Redstone Lane, Boulder, CO 80303. For more information about Caucus activities, contact Brian Dobrow, L&G Caucus
Chair, 90 Yukon St., San Francisco, CA 94114.
**************************************************
CONFERENCE: HOMOSEXUALITY, WHICH HOMOSEXUALITY? IN AMSTERDAM, DECEMBER 15-18, 1987
An international and interdisciplinary academic congress entitled "Homosexuality, Which Homosexuality· will be held at
the Free University of Amsterdam, December 15-18, 1987, and is being organized by the Research Group of Gay/Lesbian
Studies at the Free University with the Schorer Foundation. The aims of the congress are: To review and discuss the
current state of gay and lesbian studies research and the dilemmas facing the differing orientations to it, particularly
the constructivist and essentialist approaches; To promote international collaboration in the development of academic
research and documentation projects in the field of gay and lesbian studies; and to assess the practical applicability
of various academic views of homosexuality in fields such as social work and equal rights policy.
Workshops in four
areas of study--history, social sciences, literature and art, and theology--will be formed at the congress, and a fifth
section will be devoted to current issues such as social work, legislation, and government policy. In the sections on
social sciences and current issues, the Schorer Foundation will coordinate workshops on theory and practice of aid to
lesbian women and gay men. The closed' workshops on December 16-17 will be either integrated or segregated by sex,
depending on participant's wishes. In addition to those presenting papers, these workshops may be attended by a limited
number of interested researchers. Acontribution, payable on registration, will be requested" for participation in the"
workshops. On December 18, lectures pertaining to the theme of the congress will be held by internationally known
researchers in gay and lesbian studies and will be open to the public. In order to properly coordinate the editing,
translation, and distribution of the submitted papers, congress organizers must have abstracts a considerable amount of
time in advance. Therefore, a typed abstract in English of not more than 300 words summarizing the paper you would like
to submit is due "by October 1, 1986. The first draft of the paper will be due by February 1, 1987 if the abstract is
approved. For additional information, contact: Homosexuality, Which Homos,exuality, Free University Bezinn5ngscentrum,
P. O. Box 7161, 1007 MC Amsterdam, THE NETHERLANDS (international telephone: Free University Researph Group of
Gay/Lesbian Studies--20/548-3812; Marty van Kerkhof--20/258-029; Schorer Foundation--20/246-318; Anja van Kooten
Niekerk--20/276-269).
**************************************************
***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 * PAGE 3 *****
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'B.A.R.E. FACTS DEBUTS CAMPAIGN
with thanks to £~!~, (Computerized AIDS Information Network), 4/23/86
Bare, bathhouse and restaurant employees in Los Angeles County announced they will be launching a grassroots AIDS
education campaign flying under the banner 'B.A.R.E. Facts' (Bar, Bath & Restaurant Employees).
The effort is
cosponsored by the C.A.R.E.S. Team of the Los Angeles Gay &Lesbian Community Services Center and Aid for AIDS. The
project originated by concerned employees who work in a variety of community businesses. 'These individuals wished to
volunteer their time and effort to:
1) Involve and educate owners, managers and employees of any business where
individuals 'at risk' might gather; 2) Provide these businesses with a method of showing their concern by having an
informed staff member and educational materials available to customers; and 3) 'Encourage businesses to promote AIDS
risk-reduction and provide a 'safer environment for concerned individuals to gather and meet like-minded people,' says
Hugh Rice, director of the CARES Team program. BARE Facts will be holding seven regional presentations throughout metro
LA, with two hour presentations delivered by AIDS authorities and will include general information, signs &symptoms,
how the virus is or isn't transmitted, antibody testing information as well as information on risk reduction techniques.
Co-sponsoring organizations will also provide the participating bars, bathhouses, and restaurants with a variety of
collateral materials including posters, brochures, and cards. At the completion of the training session, a certificate
of acknowledgment will be awarded to the participating owners to display in their places of business.
For more
information, contact: CARES Team, BARE Facts Campaign, 213/464-2273.
**************************************************
DC GAY MEN PRACTICING SAFER SEX, HAVE LESS ANORECTAL GONORRHEA
with thanks to !h! ~~!h!~g!~ ~l~~!, 7/25/86
Dr. Peter Hawley, volunteer medical director for Washington, DC's Whitman-Walker Clinic, said he believes declining
rectal gonorrhea rates demonstrate that many more area gay men are not=w practicing safer sex. Between July 1981 and
1983, said Hawley, the Clinic's VD treatment program diagnosed an average of 312 rectal gonorrhea cases every six
months. During the past 6 month period, January to June, 1986, the Clinic diagnosed 110 cases. 'Anal sex [without
condoms] is the highest risk for AIDS transfer,' said Hawley. Hawley noted that the number of diagnoses per six months
has been declining steadily since 1983. However, statistics also show that while cases used to be evenly divided
between white and black men, they are now 'more predominantly black,' said Jason Whiddon, medical services director for
the Clinic.
Whiddon said that while the Clinic does not keep statistics on the racial breakdown of persons who test
positive for' gonorrhea, a recent breakdown of those visiting the VD clinic included 68% blacks, 28% whites, 3% hispanic,
1% others.
**************************************************
NCGSTDS OPERATES AT LOSS FOR FISCAL YEAR 1986
The NCGSTDS, for the first time in its 7 year existence, operated at a $204.55 loss in fiscal year 1985-86. Although
income from membership was up almost 30% from $6770 in 1984-85 to $9392 in 85-86, the cost of the public~tion and
distribution of the Newsletter doubled, partially because of increased costs, but mostly because of increased size of
the publication.
Total number of pages of Newsletter last year was 251 (average 50.2 per issue), compared with 284
pages (average, 71 per issue) this year, excluding the present issue volume 7:5. From July 1, 1985 to June 30, 1986:
Income: Membership--$9392; Guidelines &Recommendations brochure--$694 (total distributed nationwide was 4000 during
thi~--fiscal year); donations--$518; miscellaneous--$125; Subtotal Income--$10,729.
~~e~n~~~~
Newsletter $8052
(printing--$5139, postage--$2800, miscellaneous--$113); Guidelines brochure--$409 (printing--$384; shipment--$25); Fact
Sheet--$238; General postage--$224.86; Airfares for two yearly meetings--$306; Computer supplies--$172;
Telecommunications via CAIN--$231; Long Distance Telephone via Allnet--$612; Donations/Subscriptions to
Organizations/Newspapers, etc.--$285; Misc.--$404 (includes envelopes, rubber stamps, typesetting of fact sheet, PO Box
reQtal, typewriter supplies, etc.); Subtotal Expenses--$10,933. Bank Account Savings--$3745.
~~l~n~~ ~b~~! (rounded to nearest dollar)
1979-80 1980-81 1981-82 1982-83 1983-84 1984-85 1985-86
year
$10729
$12485
$9967
$8278
$3329
$2328
tot inc $526
10933
12068
8817
7604
tot exp 372 751 2877
- 205
+ 1150
+ 416
+ 674
+ 452
+ 1578
+ 154
Net
The only one item that is not included in the above financial report is the estimated 'in-kind donations' of volunteer
services of the Chairperson/Newsletter Editor. This amounts to an average of 20 hours weekly, or 1000 hours yearly.
This amounts to a conservative $15,000 donated time per year (@$15/hour is conservative, since it includes estimated
benefits as well; $15/hour is based on the estimated salary of AIDS service agencies directors, without benefits).
Anyone having ideas how we can improve our finances, please contact the NCGSTDS, PO Box 239, Milwaukee, WI
53201.
Remember that the Coalition is a loosely knit organization, without a concentration of working volunteers in one
location. In order to undertake new projects, funds must be obtained to pay for a full-time director. Any ideas?
**************************************************
***** PAGE 4 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 *****
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FUTURE OF NCGSTDS-tlHERE TO FROM HERE?
by Ron Vachon, PA, (New York City) March, 1986 with cOMMents by Dennis James, PAC (Boston) &Editorial
eo.ents by Mark Behar, PAC
At the recent meeting of the NCGSTDS members in Washington, DC [at the National Lesbian Gay Health Conference/National
AIDS Forum, March, 1986], many questions were raised about the state of the Coalition and its future. *How can we
better serve the needs of the membership? *How is the change of focus of gay STD services to AIDS-related services
impacting on NCGSTDS? *Can our unique and widely acclaimed Newsletter be improved and how can we market it more
extensively? *Shou1d we incorporate and become a not-for-profit organization to give us access to funding?
Our
decision at that meeting was to bring these questions to you, the membership/Newsletter subscribers, for your ideas and
input. This article is an attempt to outline the answers to these questions, as I see them. Your reaction to what
follows is of utmost importance. NCGSTDS has always existed as a mechanism for collaboration and communication. Any
changes in the ways we collaborate and communicate must reflect the needs of us all.
!b!
!!~!£~ ~f ~!Q§~ Increasingly, as evidenced by your communications through the Newsletter, gay STD services and
providers have by necessity focused their programs on AIDS. This seems to be occurring both because of the decreasing
need for STD services (the impact of safer sex) and the increasing demand for AIDS services, both education and medical
services. When the Federation of AIDS Related Organizations (FARO; now renamed AIDS Action Council, AAC) was born in
1983, NCGSTDS was asked to temporarily assume responsibility for communications through our Newsletter.
The AIDS
section of the Newsletter that appeared thereafter has steadily grown to the point that the latest editions are almost
entirely filled with AIDS-related articles. With FARO's (AAC's) recent decision to rebuild its national resource center
for AIDS education and service delivery, the National AIDS Network (NAN), it is obvious to me that NAN will gradually
become THE· mechanism for collaboration and communication between AIDS service organizations: NCGSTDS's membership.
Even though NAN has stated that it does not wish to reinvent the ~el, they will be publishing a bimonthly newsletter,
the ~~~ ~~Di~~~, a necessary part of building their network/organlzation.
~£§§!Q§ M!~~l!~~!~~ Our Newsletter has been widely acclaimed as the best single source of information on AIDS and grass
roots activities on AIDS in the country. Even at the small circulation of approximately 700 copies, the quality and
extent of the information in this Newsletter is undoubtedly helpful in networking and in the sheer convenience of a
central source.
In addition to AIDS, the Newsletter continues to serve its original role in dissemination of
information about STDs. Some have suggested that the title :!b! Qffi£i!l ~!~~l!~~!~ Qf ~b! ~£§§!Q§: is one of the
handicaps in marketing it to the AIDS service community. Another growing handicap may be the dramatic increase in
recent months of AIDS newsletters, many of whom are much more 'slick' than ours.
Q~~liD! Qf ! ~l!D Qf £b!D9!~ 1) Incorporate the organization as a private, not-for-profit national education membership
corporation, with STD and AIDS education as its primary purposes, with !ll health education as secondary.
[Dennis
James: Health education is very seriously missing around issues of STDs, gay &lesbian health and is not being done by
anyone at present, including the National Lesbian Gay Health Foundation. AIDS education is being done but there is not
coordinated effort or a common curriculum established by all the organizations] 2) Change the name of the organization
to something like the 'National Coalition of Gay &Lesbian Health Services.' [Dennis James: I think the present name
is fine! ED NOTE--Some have suggested that we omit all references to 'gay/lesbian' altogether from the name, to enhance
our marketability to readers, skittish agencies, or potential funders.]
3) Continue the role of
collaboration/communication as the focus of the organization. [Dennis James: We must continue in this role.] 4)
Increase the focus of the Newsletter to include all lesbian/gay health issues by locating individuals around the country
to serve as 'topic editors' and regional or local correspondents. For example, a substance abuse editor, parenting
editor, AIDS editor, etc. [Dennis James: This a good idea, but finding persons to take this on may not be easy.] 5)
Formalize affiliations with NAN, National Lesbian &Gay Health Foundation, caucuses of national health groups (like
APHA) , etc., offering to either provide them with our Newsletter as their official communication piece (one way would be
to provide them with space in each issue for their organizational info), or provide them with the 'guts' of each issue,
with their own cover page(s).
It's Your Turn. The questions raised here and the outline of some potential answers need to be addressed
or attend membership meetings.
stake in what becomes of NCGSTDS. Please send your comments, alternative ideas and views on the future
Mark Behar, PO Box 239, Milwaukee, WI 53201i he will forward your comments to my office in New York.
ever, we need your input.
**************************************************
BONE MARROW REGISTRY PLANNED
with thanks to ~~!~, 8/1/86
;h;th;r-you-~niy read the Newsletter,provide materials for publication,
by all of you,
We all have a
of NCGSTDS to:
Now more than
WASHINGTON (AP) The first national bone marrow registry in the United States is expected to be operating early next
year with medical profiles on more than 50,000 people that American Red Cross officials describe as heroes.
(Continued)"
***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME, 7:5 * JUNE/JULY, 1986 * PAGE 5 *****
***********************************************************************************************************************
~g ~8~ 8g~!§I8YL ~~!iQ~~
"The
real heroes in this effort will be the men and women who agree to be listed on the registry, who will
consider donating bone marrow to a person they've never met," said Dr. Jeff McCullough, director of the St.
Paul, Minn., Red Cross, where the national registry will be located. "That's about as large a voluntary cOllitl8nt as
society can ask of anyone," he said. "The people who are willing to do it, with no aotive
of personal gain
whatsoever,
will make this
program possible." The registry is necessary because marrow comes with different
characteristics that must be closely matched between donor and recipnt to prevent rejection. The best candidates
for donating marrow are brothers or sisters, preferably an identical twin. 'But if no sibling is available. the odds of
a match with a random stranger are about one in 10,000, the Red Cross said. Typing bone .arrow can cost $100 per test.
With odds of one in 10,000, no one could afford to search for a-donor to match a -particular
patient.
The only
feasible way is the registry, in which volunteers can be typed in advance and kept on file, for future cOlparison with
patient needs. Dr. Alfred Katz, vice president for research and development at the Alerican Red Cross, told a recent
news conference that the national registry in St. Paul will build on a regional operation established in
Minnesota
in 1982. About 3,000 marrow donor volunteers are on file there. The Minnesota files will be suppleeented with bone
marrow donor files from 30 other Red Cross blood regions and 23 non-Red Cross organizations. By the tile the full
registry is under way, he said, the Red Cross hopes to have more than 50,000, typed volunteer donors on file. "The
registry
has the capability of greatly increasing the number of bone marrow transplants now being perforaed,"
Katz said. "The program will make transplantation a viable option for thousands of patients with leuk8lia and bone
marrow failure' that has been impossible up_ to now." The government's Office of Naval Research awarded the $3.4
million contract in July to establish the registry, run by
the Red Cross in collaboration with the Alarican
Association of Blood Banks and the Council of Community Blood Centers. Once operational, the registry's cost will be
covered through an administrative fee paid by the marrow recipient or his insurance. While the figures are not firm,
McCullough said, the fee probably will be less than $1,000. Bone marrow transplants are not routine. But donating bone
marrow the soft tissue inside bones that produces red and white blood cells can be more critical in saving a life than
donating blood. It is a possible cure when leukemia or other blood disease has destroyed the marrow's cell-producing
capability. Red blood cells live only a few weeks; white blood cells only a day or less. When .arrow breaks down,
there are no white cells to fight infection and soon, no red cells to carry oxygen. Healthy
transplanted marrow
sometimes can replace
the
diseased marrow. But the process of donating healthy marrow is not as simple or
painless as donating blood. It usually involves one or two nights in a hospital and a linor surgical procedure using
general or local anesthetic. The donor receives all medical services free and is reimbursed for
travel expenses.
During the operation, four to eight small incisions are made in the back of the hip, and 20 to 30 extractions 'are
made by a needle inserted into the hip bone through the incisions. The process takes about 45 minutes. The donor
loses 3 percent to 5percent of his or her marrow, an amount the body replaces naturally within two weeks, the Red
Cross said.
Donors suffer no ill effects other than a sore back that may linger for days. The marrow itself is
transfusel into the recipient's blood, where it migrates naturally to the bones and, the doctors hope, takes the place
of the old, diseased marrow. Success rates are about 45 percent to 70 percent, the Red Cross said.
**************************************************
HAITIANS RELISTED BY CDC AS RISK GROUP
by Jon Nordheimer, with thanks to Ih! ~~ y~~~ Ii!!!, 7/28/86
With clusters of AIDS showing up in Florida that do not match the pattern elsewhere in the nati~n the federal Cen~ers
for Disease Control is preparing to put Haitians back into a special risk classification. They wlll beCOIe .the flrst
group listed at risk by heterosexual transmission, governmental medical officials say. Agrea~ number ~f Ha1tians have
contracted AIDS from people other than those who are considered at high risk: homosexually act1ve men, 1ntravenou~ drug
users, and blood product recipients. At the same time, federal epidemiologists have noted a.small but stati~t1c~11y
significant rise in cases of AIDS in non-Haitian heterosexuals infected by having sex~a~ relat1~s with people 1n h1ghrisk groups. Dr. Harold Jaffe, chief of the epidemiology section of the CDC AIDS Act1v1ty, sald.it was not completely
understood why poor, recent immigrants from Haiti appeared to be vulnerable to heteros:xual tra~sm1s~ion.other than that
AIDS has already been firmly established in Haiti where, as in central Afrlca, it 1S prlMar1ly a disease of
heterosexuals.
**************************************************
CONDITION, NOT CRISIS--A NEED FOR VIEWING AIDS IN A DIFFERENT LIGHT
by Kevin Scahill, with thanks to Honolulu's bif!liQ!!, The Life Foundation, July, 1986
Achange is needed in our thinking about AIDS. Up until now, we've been dealing with AIDS as if we were in a short-term
crisis situation. All of our energies were being devoted to AIDS education, AIDS research, AIDS support, etc.
The
general consensus was that if we did all that we could do, the crisis would get solved sooner and our friends would, stop
dying. That's not happening. What is happening is that many of us are getting burned out from working all the time at
crisis-level energy. The change that's needed is for us to start seeing AIDS as a £g~Qi!ig~, not a crisis. AIDS is
going to be with us for a long, long time to come. We need to start seeing AIDS as just another challenge for us to
live with. Our focus needs to shift from the short-term to the long-term. Our focus is not only on AIDS;
it's on
lifec Let us keep remembering to smell the roses and to do the best we can.
**************************************************
** ***** PAGE 6 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY. 1986 *****
********'************************************************************************************************************
JlI..EAPOlIS SITE OF AAPHR JlEDICAL JlEETUI6S IN AU6UST. 1981
The Alerican Association of Physicians for HUlin Rights (AAPHR) will be hosting its annual lIeting and medical
conference August 3-6, 1987 at the. Hyatt Regency Hotel in Minneapolis. General medical, psychological. and social
topics, as well as AIDS. Additional information regarding presentation of papers, workshops. etc., will be forthcoming.
AAPHR's '1986 lIdi9al conference and annual Jeeting will be held in London in August.
If you are interested in
additional infor.ation and are not a member of AAPHR or the NCGSTDS (you will be receiving regular updates in the
Newsletters of those two groups), contact: 1987 AAPHR Annual Meeting Committee, 4617 E. 36th St., Minneapolis, MN
55406.
**************************************************
IQCE-JIARROW FROIB • BMKED FOR FUTURE USE
abstrlcted frOi In Idvertillllnt in the ~!! !2~~ ~!~!y!, 1/14/86
[reported here for your interest--no Cllill are .ade about authenticity! Caveat Elptor!]
The cryotechnology for long term bone marrow storage from healthy persons is now available, according to claims by the
New York City .Marrow-Tech Incorporated.
Presently healthy individuals (such as gay men not infected .with the AIDS
virus, HIV/HTLV-III/LAV/ARV) may oow have a s~ll quantity of bone marrow aspirated from their hip, frozen to -196
degrees Centigrade, and stored in two separate locations indefinitely (as long as the costs are maintained). If needed
later, as with any disease or condition that severely incapacitates the immune system (AIDS, cancer, chemo- or radiotherapy, toxic chemical exposure, etc.), !n~ if ~h! ~!9hn212g~ f2~ ~!21i9!~!ng ~b! 2~!9Y~!2~ im!Yn! !~!~!m 9!11! i!
~!y!122!~' the marrow can presumably be used for helping to reconstitute that crippled immune system.
Individuals who
do not store their bone marrow now but become ill in the future may not be able to avail themselves of the replication
technology if their bone marrow has become diseased. The inventors of the process, called "Marpax," are research
hematologists and have published numerous research papers in hematology and related areas. Cost of the service is as
follows: aspiration of marrow--$150; maintenance &storage of marrow for first year--$600; annual fee every year
thereafter--$100. Recent articles regarding the possible use of bone marrow transplants for AIDS victims indicate that
costs Just to find an appropriate donor for typing would be between $600-1000. It is important to stress that no one is
claiming that bone marrow transplants are a cure for AIDS. If some day the technology is fully developed, then having
some of your healthy marrow stored now could prove to be extremely beneficial for you. Avideo-tape describing the·
process is available from Marrow-Tech Incorporated, and staff members are available to speak to you and/or your
physiCian. For additional information, contact: Marrow-Tech Inc., New York Medical Building, 251 E. 33rd St., New
York, NY 10016 (212/213-2204).
**************************************************
NATURAL THERAPIES FOR CHRONIC VIRAL DISEASES
The Journal of Holistic Health and the Human Energy Church are cosponsoring a series of talks on "natural" therapies for
AIDS, herpes, cytomegalovirus (CMV), epstein-barr virus (EBV), and hepatitis viruses. These talks are deSigned for
professionals as well as the general public. Because of the complexity of this subject, two meetings will be going on
simultaneously--one for professionals and one for the general public. The professionals will have an opportunity to
share research with fellow practitioners while the public will learn what factors predispose to virus infection and how
nutrition affects the immune system. Speakers will present theories and research findings about the immune system and
chronic viral diseases from the perspectives of medicine, nutrition, homeopathy, acupuncture, herbology, psychology and
spirituality. "The Talks" will be held August 23-24 at The Cathedral Hill Hotel in San Francisco. The cost of the
Talks ranges from $85-$175 for the two days depending on your professional status; registration fees increase after
August 1. For extra fees, one of three special intensive sessions from 3-5 hours are available: nutrition and the
immune system, choosing, growing,· and .preparing "live foods," and teaching practical study design and methods for
clinical and homeopathic research. For additional information, contact: The Human Energy Church, 370 W. San Bruno Av.,
Suite D., San Bruno, CA 94066 (415/873-0139).
**************************************************
ALOE VERA PLANT-BASED DRUG RUJIIORS STIMULATE DALLAS COMPANY'S STOCK
by Craig C. McDaniel, with thanks to the ~!! !2~~ ~!~1Y!, 5/19/86
Rumors that a Dallas company is onto a possible cure for AIDS have driven the price of its stock up more than 700% in
the last year. Stock in Avacare has climbed to 30.25, from 3.75 last May, Q~ll~~ !im~~ ~~~~lg columnist Irwin Frank
says. Company president Clinton Howard told Frank that he can't think of anything else behind the rise in stock price,
except the speculation that Avacare might find a drug that could help cure AIDS. In fact, the stock rise comes despite
several negative financial statements in the company's annual report. Howard's'company has been working on a drug it
calls Carrisyn, which is based on the tropical aloe vera plant. While not making any promises, Howard says the drug
could stimulate the immune system. "We are talking purely speculatively, and I don't want to give the impression that
we have a cure or a treatment for anything. This is all research," he ~aid. "In AIDS you're talking abqut a damaged
immune system. Obviously, if you had a safe stimulant to the immune system, there would be potential there,of fighting
that disease, too," Howard said, adding, "The status of this company right today is we're investigating the possibility
that Carrisyn may be a safe immune stimulant and, of· course, we're very, very excited about it.'
**************************************************
***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5" * JUNE/JULY, 1986 * PAGE 7 *****
***********************************************************************************************************************
EDITORIAL: NUMBER OF PEOPLE INFECTED VS. DIAGNOSED
by Mark P. Behar, PA-C, NCGSTOS Chairperson/Newsletter Editor
Since the recognition of this terrible epidemic in 1981, health workers have been morbidly keeping track of the 'box
score' of those people diagnosed with AIDS and those dying of diseases secondary to the syndrome, in the same way we
kept 'score' of the fatalities during the Vietnam 'War.' For those of us in smaller communities, this in part has
contributed to an active denial process among those members of risk groups who could not personalize the disease process
because they did not have any close friends or acquaintances who were ill. In many ways unfortunately, it is still
being considered a disease of the coasts, the big cities, of gays &drug users, of someone else, and therefore safer sex
practices aren't necessary for me. This double problem, of the box-score mentality; and of the depersonalization of the
victim (I don't mean to imply that people with AIDS are helpless, passive 'victims') is quite an obstacle to overcome by
public health workers in areas where AIDS is still not taken very serious1y. It is now time to magnify the problem in
the minds of the gay community, and begin talking about not the numbers or people diagnosed with AIDS, or mortality
rate; we must now begin saying how many people are thought to be i~f!£t!~. CDC epidemiologists have often stated that
approximately 10 times the numbers of those diagnosed, reflect those who have AIDS related conditions, and 10 times that
number are thought to be actually infected with the AIDS virus, and extrapolating even further, perhaps 10 times that
number are thought to be members of high risk groups (heterosexually active men &women and homosexually active men,
along with IV/needle drug users, blood or blood product recipients, sex partners of any of the above, or infants born of
mothers who are "infected). The goal of safer sex guidelines and risk reduction education is to e~!y!~t fy~tb!~ !~eQ!y~!
~~Q i~f!£tiQ~ with the virus, and in those already infected, to prevent exposing others and to maintain self-health and
minimize further exposure to anything adversely affecting the immune system. Thus, it makes sense to talk of not just
22,000 already diagnosed (with about a 50% mortality), but 2,200,000 infected, i.e., 1 out of every 100 Americans!! (To
those who are critical of such an estimate, remind them of those who died of AIDS-associated diseases before medical
people in your locality even thought of AIDS; they were never included in the official AIDS statistics, which therefore
underestimat; the scope and severity of the problem.) When people think of epidemics, they usually mention influenza,
cholera, smallpox, syphilis, tuberucosis, leprosy, polio or measles, since all of these diseases devastated many, many
people and adversely affected society. But AIDS seems to pale when compared to the bubonic plague, which literally
wiped out as much as half of the inhabitants of medieval Europe. We do not wish to instill panic and irrational
hysteria among the rest of the population, for we have already seen attempts to implement draconian disease intervention
strategies (and in many cases by well meaning public health colleagues, untested and incompletely thought out
strategies)
such as quarantine and tatooing which would do little to contain this public health crisis. We must,
however, get to those members of high risk groups and convince them that safer sex is here to stay, and that gay
sexuality is still okay and fun when safer sex is religiously practiced. We must also communicate that the epidemic is
growing--over 2 1/4 million are now infected! And between 10-40% of those are expected to develop AIDS or ARC within
the next 3-5 years. Can we afford to deal with more panic among our gay communities? Or are they so numb already, that
this message won't even register? Will we have the strength to be pallbearers for more of our friends 2 or 3 years from
now because we haven't been successful in breaking down those barriers of denial?
**************************************************
WORLD HEALTH ORGANIZATION CHALLENGED AGAIN
with thanks to Chicago's ~i~~~ ~i!~
Ii!!!,
5/29/86
Stating that "AIDS is no more a United States gay problem than radiation is strictly a Soviet problem,' Miami activist
Bob Kunst has challenged the World Health Organization (WHO) to seize the lead in the campaign to find a cure for AIDS
and :0 put money behind research into the world wide health problem.
According to the !b! ~!!~l~ ~!!!, Kunst's
sent,ments were echoed by U.S. Health Secretary Otis R. Bowen who told delegates attending a two-week health conference
that Americans are ready to cooperate fully in action against the AIDS "menace."
**************************************************
NATIONAL AIDS NETWORK PUBLISHES THE
~!!QB
AND RECEIVES GRANT
The National AIDS Network (NAN) is publishing the bimonthly MQ~itQ~, a professionally printed newsletter that will help
to align AIDS services and providers in spirit with their colleagues elsewhere in the country, and will hope to fill in
many of the gaps which exist as this new field continues to evolve. The MQ~itQ~ will contain a digest of news and
features spotlighting the people, programs, and opportunities which presently make up the National AIDS Network. NAN's
efforts to establish a national information clearinghouse for its members advanced when the Pacific Mutual Foundation of
California awarded $25,000 for the program. The Foundation is funded by the Pacific Mutual Life Insurance Company.
According to Pacific Mutual's Public Affairs Coordinator, Suzanned Gilbert-Hoehl, "We thought that NAN's communications
programs represented the kind of important, long-range program we wanted to fund." The grant will provide NAN with a
computer system and support personnel. Ultimately, NAN will be able to provide its member agencies with an information
bank that will help them to more effectively facilitate the delivery of programs and services. The Pacific Mutual grant
is part of a growing trend on the part of private and corporate foundations to makes AIDS a priority recipient of their
largesse. "For additional information about NAN, or to receive the NAN MQ~itQ~, write or phone: NAN, 729 Eight Street,
SE, Washington, DC 20003 (202/546-2424).
**************************************************
****************~~~***************************************************************************************************
BOSTON IALl FOR LIFE RAISES OYER $300,000
by Ki. ""'i.r, with thanks to Boston', §!y ~!:!1!Y ~!!!, 6/U/86
Approxillte1y 3000 people participated in the June AIDS walk organized by Boston's AIDS Action Committee (AAC).
Oroanize~s esti.ate that participants in the six li1e walk raised between $300-350,000.
Fifty percent of the proceeds
will go to the AAC.with the remainder being split equally among the Fenway Community Health Center's AIDS services, the
New England H8IOphi1ia Association, Elizabeth Kub1er-Ross's AIDS Babies Hospice, the National AIDS Network/AIDS Action
Council of Washington, DC, and the National Association of Persons with AIDS.
**************************************************
WALK IN NEW YORK CITY ATTRACTS 6000, RAISES $700,000
with thanks to !b! !!!h!!:!a!9!:! @l!~!, 5/23/86
Pedestrians from every walk of like turned out May 18 for the "AIDS Walk New York," a fundraising project for the Gay
Men's Health Crisis. An estimated 6000 people walked 10 kilometers, and included Mayor Ed Koch, activist Virginia
Apuzzo, performer Peter Allen, and actor Joel Grey. Aspokesperson for GMHC said that the wa1k-a-thon raised nearly
$700,000.
**************************************************
BIKE-A-THON IN SAN FRANCISCO ATTRACTS 650 RIDERS, RAISES $225,000
with thanks to !h! !!!h!!:!9!9!:! @l!~!, 5/23/86
One of the biggest AIDS fundraisers in San Francisco was organized by a bicycle club in May, according to ~!Y ~~~!
8~~~~~!~. An estimated 650 bikers rode through the rainy streets of the city, escorted by a women's motorcycle club,
Leather &Blue. Bicyclists--which included a 25 person contingent from the San Francisco Police Department--covered 25
and 100 miles and raised an estimated $225,000, which will be distributed to eight AIDS service organizations in the
area.
**************************************************
NATIONAL AIDS NETWORK OFFERS TECHNICAL TRAINING WORKSHOP, SPECIAL EVENT FUNDRAISERS
The National AIDS Network (NAN) is offering a traveling two day Technical Training Program designed for smaller AIDS
service organizations, that will provide participants with training in donor solicitation programs and special event
planning.
In addition, the format includes a forum for evaluating existing programs, and discussing AIDS in the
workplace and AIDS in the minority community. The program provides the opportunity for the AIDS service provider to
develop many of the skills necessary to administer a successful program. The schedule and topics are flexible, and
optional topics include "the politics of AIDS" and "the press and AIDS.' Cost of the traveling seminar is a requested
$250 fee plus travel expenses, however financial cons,derations should not stand in the way of your ability to host the
workshop. NAN is working out alternative means of financing the cost of the workshop and will design the final format
in consultation with the host organization and will provide all training materials. The tentative schedule includes the
following topics: establishing of goals for the program; how to develop a case statement for your organization for use
in donor solicitation; working lunch break where small groups will develop an outline for a case statement during
lunch; AIDS in the minority community and in the workplace; special event planning; erotic safer sex educational
workshop; agency sharing one of their patient service delivery programs with the workshop participants; critical review
of agency's pamphlets.
This is new program ~hould go a long way to cut down on the duplication of efforts by AIDS
service providers. If interested in hosting the workshop contact Jay Coburn, Administrative Aide, National AIDS
Project, 729 8th St., NE, Suite 300, Washington, DC 20003 (202/546-2424).
NAN is also hosting a series of special event fundraisers. Casey Donovan, the erotic film star known for this classic
~ey~ !!:! ~h! §!!:!g, is now featured in the new Gay Men's Health Crisis safer sex video £h!~£~ ef ! b!f!~!m~ and in the
recently released Inevitable Love.
Donovan has graciously consented to appear as the guest of honor at fundraising
cocktai1 parties thr~~gh~~t-the ~~~~try 9~!~!~' during the coming year. These fundraisers will help publicize safer sex
educational programs and to help identify new donors to local AIDS service agencies as well as helping to raise funds
for NAN and the local AIDS service organization sponsor. Such events are usually held in private homes for 50-100
guests with a ticket price in the $50 to $150 range. Sponsoring groups should be dues-paying members of the National
AIDS Network and assume responsibility for coordinating the event. NAN will make arrangements with Donovan and provide
local agencies with technical assistance in planning special events. Sponsoring agencies are also asked to cover
Donovan's air travel and lodging expenses, and split the net proceeds of the event, 70:30--10cal agency:NAN. Nan will
help group the events together regionally, so that sponsoring agencies may share travel costs. If interested in holding
such an event, contact Jay Coburn at NAN.
**************************************************
***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7':5 * JUNE/JULY, 1986 * PAGE 9 *****
***********************************************************************************************************************
EOOCATION GRANTS MADE BY CDC
with thanks to It!! ~!!h1!!!l~~ ~l!~!, 5/23/86
The federal Centers for Disease Control made public $9.4 million in AIDS education grants to 55 states and
municipalities, and announced a call for applications in another $9 million for HTLY-III antibody testing.
CDC
officials said the education grants also include some antibody'testing programs, which the agency has urged state and
local governments to promote as a means of motivating behavior changes in people at risk for AIDS. That approach has
long been strongly disputed by AIDS activists who say it detracts from direct education funding and carries threats to
civil liberties. According to coe grants management officer Leo Sanders, Maryland was granted $149,728, which includes
funds to test approximately 1000 people at VD clinics, '200 working prostitutes' in'the city of Baltimore, and for 8000
antibody testing kits for the state lab. Grants ranged from a low of $59,000 to Wyoming to a high of $749,000 in two
grants to the city and state of New York. With those funds, New York City' will for the first time sponsor a large-scale
testing program directed at drug-users and prostitutes. New York State will spend money promoting the antibody test and
on AIDS education in a variety of settings, including a suggested curriculum for public schools.
**************************************************
FEDERAL PORNO REPORT CONDEMNS ADVOCATE, PREGNANT LESBIANS, MEN KISSING
by Lou Chibbaro Jr. with thanks to It!! ~!!hi!!!l~~ ~l!~!, 7/11/86
Gay Rights leaders joined civil liberties advocates in criticizing the final report prepared by Attorney General Edwin
Meese's special commission on pornography. The text of the 1,906-page report did not include specific sections on gayrelated pornography or homosexuality, but it did contain the names of gay adult-oriented magazines among its list of
more than 3000 publications found in 'adults only' bookstores in six cities. The report also included the name of the
gay news magazine Ib~ ~gYQ~~~~ among those publications, claiming that its failure to distinguish a gay publication that
specializes in news and feature stories from publications specializing only in sexual matter shows that the commission
is biased against gays. In a section in which it provides details of the contents of magazines and films found in
'adults only' bookstores, the report includes graphic descriptions of sex acts between gay men and between lesbians as
well as between heterosexuals. In one of its descriptions, the report describes a photograph which depicts 'two naked
caucasian males standing together kissing.'
The commission describes another photograph depicting 'two obviously
pregnant, partially clothed, caucasian females, kissing with their tongues, and their distended abdomens touching.'
Jeff Levi, executive director of the National Gay and Lesbian Task Force, said he is concerned that the commission's
recommendation that citizen's groups form to file complaints, place pressure on prosecutors, and boycott merchants in an
effort to crack down on sexually-explicit literature could have a spill-over effect on gay publications.
Levi and
Carole Vance, a Columbia University anthropologist who has followed the pornography commission's deliberations, said
such citizens committees may view gay-oriented literature in general as 'obscene' even though such literature may
contain little or no sexually-explicit material. Washington gay/lesbian bookstore owner Deacon Maccubbin said he would
'go to jail' rather than obey any censorship restrictions that may emerge from the porno commission's recommendations.
Three of the key figures involved in the commission, called the Attorney General's Commission on Pornography, ~~ve been
involved in police investigations of gays in the Washington area. The commission's chairman, Henry Hudson, prosecuted
employees of gay male escort services on prostitution charges while he served as Arlington County Commonwealth's
attorney. Two of the commission's investigators, DC police Detective Joseph Haggerty and Arlington police vice
Detective Edward Chapman,also have investigated gay escort services and made arrests of gays on prostitution-related
charges.
**************************************************
JUSTICE DEPARTMENT OPINION THAT AIDSPHOBIA &DISCRIMINATION NOT ILLEGAL
by Jim Kiely, with thanks to Boston's §!~ ~Qmm~!!!~~ ~!!!, 6/29-7/5/86 and
by Rick Harding, with thanks to It!! ~!!h!!!!l~~ ~l!~~, 6/27/86
!n a June 20 memorandum to the Dept. of Health and Human Services, the Justice Department stated that federal civil
rights laws do not protect people with AIDS or others at risk of contracting the illness from discrimination by
employers. Making a distinction many activists regard as facetious, the memorandum states that it would be illegal to
fire or exclude a person from a federal program or federally funded entity solely because they have AIDS or are at risk,
but it would not be illegal if the person was feared to be capable of transmitting AIDS. The decision, which greatly
differs from earlier recommendations made to the Justice Dept. by legal and medical experts, has been met with a flurry
of protest. In preliminary'recommendations to the Department two weeks before the June 20 opinion, staff lawyers
suggested that PWAs be recognized as handicapped because of the severe physical toll the illness takes, and that they by
protected from job discrimination under Section 504 of the Federal Rehabilitation Act of 1973. The Act protects the
handicapped from discrimination in federal programs or by schools, hospitals, employers, etc. that receive federal
funds. Citing previous reports from the Centers for Disease Control and other health organizations, the lawyers deemed
the risk of transmission of AIDS in the workplace to be negligible and therefore, invalid as grounds for dismissal from
employment. In the Justice De~t. opinion, only one of these recommendations was followed. Although the memo stated that
PWAs may be considered handicapped, and thus, protected under Section 504, it also concluded that 'an individual's (real
(Continued)
***********************************************************************************************************************
~~§!!~~ ~e~8~! gf!~!9!L Qgn!inY~
or perceived) ability to transmit the disease to others is not a handicap within the meaning of the statute, and
therefore, that discrimination on this basis does not fall within Section 504. The CDC and DHHS have consistently
stated that AIDS is not spread through casual contact. However, the Justice Dept. appears to have, interpreted the
medica1.data as 'medical uncertainty.' The opinion states that any person alleging discrimination on the grounds they
have AIDS or are at risk for AIDS must prove they pose no threat. 'The risk of medical uncertainty must be borne' by
the person alleging discrimination. In a joint statement released immediately after the Justice Department decision,
the CDC and DHHS reiterated the position that 'employees, employers and others can be assured that (HTLV-III] is not
transmitted by casual contact within the workplace or school. Reaction from lesbian/gay civil rights activists to the
Justice Dept. statement has also been swift. Leonard Graff, legal director of the San Francisco-based National Gay
Rights Advocates, told §~~ the opinion is clearly 'based on politics rather than jurisprudence ... The Justice Dept. does
not want to seem to be catering th homosexuals, so it has--against the advice of its own 1awyers--p1ayed up a chance of
transmitting AIDS through casual contact. It's legitimized homophobia,' Kevin Cathcart, executive director of Gay &
Lesbian Advocates and Defenders of Boston, concurred, calling the decision 'a means by which an employer could keep gays
out of the work force ... by trumping up concern for employees health.' Responding to the Justice Dept. 's admission that
a 'real Q~ ~!~£!iy!g threat of AIDS transmission would be grounds for firing, Sarah Wunsch, director of the Cambridge,
Mass. Human Rights Commission, called the opinion 'absurd.' 'If the decision were to be applied to other people who are
protected from discrimination, its absurdity would be obvious ... Can you imagine an employer saying, 'I don't hire
blacks ••• because (I'm scared] they may transmit sickle cell anemia to our employees?'·
While activists agree the
opinion fuels workplace discrimination and adds to the misinformation about AIDS transmission, its legal impact remains
debatable. The opinion is not a legal ruling, but an interpretation of the law that can be superseded by judicial
In addition it would not affect workplaces that receive no federal funds. According to Abby Rubenfeld,
decisions.
legal director for Lambda Legal Defense and Education Fund in New York, the opinion actually carries little weight
because it has not yet been tested in a court of law and because it 'blatantly contradicts health findings of both the
Centers for Disease Control and the Dept. of Health and Human Services.' In New York, where Attorney General Robert
Abrams issued a press release condemning the Justice Dept. memo;/ state civil rights laws prohibiting discrimination are
expected to prevail, according to his office. Abrams' press release accused the Justice Dept. of adopting a 'tortured
reading' of Section 504 'in order to exclude a disfavored group from coverage.' In Boston, the City Council adopted a
resolution on June 26 by a vote of 8-4, that emphasizes the strength of state and city law to protect any person facing
discrimination.
The resolution, drafted by gay councilor David Scondras, 'advises employers to adhere to guidelines
established by the City and State Departments of Health and the CDC regarding employment.' However, in an allusion to
the possible effects of the Justice Dept. 's statement, the resolution concludes, 'until the Justice Dept. clarifies its
ruling so as to indicate that people with AIDS are those perceived to be at risk are protected from discrimination,
those who undergo AIDS-related diagnostic procedures should seriously consider the need for absolute anonymity.'
The legal significance of the opinion has been greatly overemphasized, according to to legal experts familiar with
government anti-discrimination policies. The memo does not preclude people with AIDS, AIDS-related complex, or the HTLVIII antibody who are fired from their government or government-funded jobs due to the illness from filing handicap
discrimination suits. Nor will the weight of the Justice opinion necessarily make it more difficult to win such suits,
the experts say. But the experts agree with gay and AIDS activists and health officials that the real significance of
the document is its message to the public that AIDS might be transmitted through casual contact and, therefore, that it
is permissible to discriminate against PWAs. According to one federal attorney who handles discrimination complaints
for the government, the Justice Dept. opinion will be used by government lawyers to justify firing people with AIDS, if
they can win cases with it. The attorney, who refused -to be identified, said that government lawyers use 'the ~Q~~!~ as
our guide,' and noted that 'there are plenty of Justice (Department] opinions sitting around out there that we no longer
use because they are absurd.'
DC attorney David Shapiro, who has represented numerous federal employees in
discrimination claims against the government, said he feels that judges will find the opinion illogical. The opinion,
written by Assistant Attorney General for the Office of Legal Counsel, Charles Cooper, asserts that although AIDS itself
may be a handicap, a person's ability to transmit the disease to others is not a handicap, and employers can fire people
with AIDS as long as their reason for doing so is fear of transmission.
By producing eminent witnesses, including
government researchers, who agree that AIDS is not transmitted through casual contact, Shapiro said he feels it would be
'easy' to discount the Justice Dept. reasoning. Government researchers and public health officials have condemned the
Dept. 's opinion which they say refuels public hysteria over AIDS. A statement on which the Justice Dept. opinion
pivots, and which is considered especially controversial by health officials and AIDS Activists reads, 'It has been
suggested, however, that conclusions of this character (that AIDS cannot be transmitted through casual contact] are too
sweeping.'
The memo cites two footnotes for the statement which some feel were taken out of context. The first'
footnote quotes an article by John Parry in the Mental and Physical Disability Law Reporter as saying, 'Those ,experts
who have attempted to give the public the impression that the medical profession is certain how AIDS is
transmitted ... may have gone too far in attempting to quell the public's fears.' The citation fails to include, however,
the sentence which immediately follows it in the article that says, 'Those individuals who have asserted that'there are
reasonable dangers of exposure in public places have definitely gone too far in the other direction, need1ess1y'stirring
up public fears.' The second footnote quotes Harvard research scientist Dr. Myron Essex as saying, 'The CDC •.. has been
trying to :nform the public without overly alarming them .... Bu~ we outside the government are freer to speak, .The fact
is that the dire predictions of 'those who have cried doom ever since AIDS appeared haven't been far off the mark.' !b~
***********************************************************************************************************************
~~§!!~~ ~~eA8~~~! Qe!~!~L ~~~inY~
H!~ yg~~ !!~!! M~g~!!~!
article from which the quote was drawn, however, does not mention casual transmission but
instead goes on to elucidate Essex's belief that AIDS can be transmitted through heterosexual contact. Justice Dept.
Attorney Gary Lawson, who conducted research for the Department's opinion and prepared the memo's footnotes, said that
the Dept. 's feels that the footnotes were not taken out of context. "We made no attempt to say that actual transmission
of AIDS is possible," Lawson said. "We just said that, theoretically, it is not impossible."
**************************************************
JUSTICE DEPARTMENT IGNORED AGAIN
by Peg Byron, with thanks to !b! ~!!h1ng~gn
with thanks to the ~!! Y2~~ ~!~1!!, 7/21/86
@l!~!,
7/18/86 and
State and local officials around the country continue to denounce the recent U.S. Justice Dept. opinion that AIDS does
not fall under federal protections from employment discrimination. New York City Human Rights Coamissioner Marcella
Maxwell said at a recent press conference that since the Justice Dept. announced its opinion her office has received
"numerous calls" asking whether discrimination against people with AIDS was still illegal. The Justice opinion affects
the federal government and employers receiving federal money but is not binding on state and local hUMan rights
"The Commission wants to reassure the people of this city that AIDS-related discrimination will not be
policies.
tolerated," Maxwell said. New York City Health Commissioner Stephen Joseph joined her, and criticized the Justice
Department for "undermining AIDS education efforts and ... inadvertently fostering the irrational fears of the public at
large." In Minnesota on July 2, the state's Dept. of Employee Relations (DOER) issued a statement declaring that "AIDS
will be treated the same as any illness in the workplace." In pointed contrast to the Justice Dept. view, the Minnesota
DOER adopted the guidelines of another federal agency, the Centers for Disease Control, emphasizing that AIDS is not
transmitted through normal workplace contact. Just two week s earlier, the OOER issued another state workplace
protection which forbade harassment on the basis of sexual orientation. The protection in state employment already
existed for a range of categories including race, creed, religion, sex, and disability. In Metropolitan Washington,
DC's Montgomery County and "Alexandria officials have already announced that AIDS will continue to be treated as a
disability for the purpose of discrimination protection. The District of Columbia has not yet offered an interpretation
of the Justice Department opinion.
Others have ~onde~ned the Justice Dept. opinion. The Boston City Council said that the opinion "only serves to
exacerbate. lrratl0n~1 fear and fosters a sense of distrust among groups whose voluntary cooperation is critical in the
battle agalnst AIDS." Boston and Massachusetts law still offers protection from discriaination. The commissioner of
New :ork S~ate's Division of Human Rights, Douglas H. White warned that the opinion does not release the. fro.
compllance wlth that state's human rights law. The National Coalition of Lesbian and Gay Elected Officials issued thei
first ~t~teme~t since their conf~rence in West Hollywood last November, and called the decision "a calculated attack ~
the. Cl~ll .rlghts of peopl~ wlth AIDS and those perceived at risk" and "counter to the interests of public hedlth and
soclal Just~ce. The ~e~01utl0n.urges those concerned to contact the Department of Health and Human Services and insist
that they lssue an 0~lnl0n forbldding AIDS-related discrimination. Address mail to: Secretary Otis Brown, Dept. of
Health and Human Servlces, 200 Independence Av., SW, Washington, DC 20201 (202/245-6296); copies of correspondence are
asked to be sent to:
Elected Officials Call to Action, National Gay and Lesbian Task Force 1517 UStreet NW
Washington, DC 20009.
'
"
**************************************************
RISING COSTS OF LIABILITY INSURANCE FORCES AGENCIES TO SELF-INSURE
with thanks to the ~2! ~g!l!! !i!!! §!~!1g!, 7/20/86
Al~n Rodda, vice-president for human resources at the American National Red Cross said that because of the AIDS scare,
the Red Cross expected to lose all insurance coverage for its blood programs and was planning to self-insure. The Red
Cross has never been sued in connection with its disaster relief activities, Rodda said. But it has seen a sharp
increase in its liability rates for its water safety instructional programs, and its "biggest challenge" is expected
with its blood bank operations. Executives of the national organizations of several youth service agencies--including
the YMCA, Girls Clubs of America, Camp Fire Inc., and 4-H, say the soaring cost of liability insurance is driving some
of them to consider self-insurance or to cancel some of their more risky youth activities. ABoy Scouts of America
official said Los Angeles scouts had imposed a special $20 a troop surcharge to help pay a national liability insurance
bill that has gone from $2.7 to $9.8 million in the last year. Even with the surcharge, higher risk programs, such as
scuba diving and aviation had to be dropped. Marge Gates, national executive director of the Girls Clubs of America
said that despite having 250,000 participants in its programs at 240 nationwide operating centers, they decided they
were too small to self insure. She said the organization was considering joining other groups in forming an insurance
company to provide liability coverage at wholesale rates.
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,
"
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MEGARAFFLE IN. NEW YORK TO BENEFIT 6 AREA AGENCIES
A clever fundraiser dss:gned to support 6 New York area gay/lesbian agencies in their efforts to meet the medical,
legal, political, educational, cultural, and social needs of the community. Some of the prizes include $5000 cash, a
one week vacation for 2 by air to Puerto Rico, a show jacket from Lily Tomlin, compact disc player, and dinners,
clothes, home furnishings, original art works, books, flowers, champagne and thousands of dollars worth of additional
prizes.
The funds will benefit: Gay Men's Health Crisis Inc., The Institute for the Protection of Lesbian and Gay
Youth, Inc. and the Harvey Milk School, Lambda Legal Defense and Education Fund, Inc., The Lesbian and Gay Community
Services Center, Inc., The National Gay/Lesbian Task Force--The Fund for Human Dignity (national gay/lesbian crisisline
&AIDS hotline), and Senior Action in a Gay Environment (SAGE). Megaraffle coupons only cost $2.00 each, with a book of
6 coupons for $10.00, with the drawings scheduled for July 13th. For additional information, contact: IPLGY, 112 East
23rd Street, 4th Floor, New York, NY 10010 (212/473-1113).
**************************************************
HEALTH OFFICIALS ADMIT PHS ASKED FOR TOO LITTLE MONEY
by Peg Byron, with thanks to !h! ~~!hing!Qn
~l~g!,
7/4/86
During a tense moment in a congressional hearing on AIDS treatment research, recently, federal health officials admitted
that the government was not doing all it could to find a cure for the usually fatal condition due to a lack of funds.
The acknowledgment came only a day after the same officials, with new Assistant Secretary for Health Robert Windom, held
a press conference announcing a five-year, $100 million treatment evaluation program. Dr. Walter Dowdle, coordinator of
the Public Health Service AIDS Task Force said under questioning at the hearing that his agency could effectively spend
more on AIDS research if it had the funds, and even with money added by Congress to the amounts requested by the Reagan
administration funding is insufficient. The Health and Human Services Dept. has requested $213 million for AIDS in
fiscal year 1987; it initially asked for $126 million last year and received $247 million. Dr. Anthony Fauci, director
of the National Institute of Allergy and Infectious Diseases (NIAID), who also chairs an interagency task force on
experimental AIDS drugs, admitted at the hearing that 5 out of 19 qualified applicants to the new treatment evaluation
program went unfunded. 'We probably would be able t~ use more than the 14' treatment evaluation centers that received
grants recently, said Fauci. Rep. Sander Levin (D-Michigan) asking Fauci to be candid, questioned why more facilities
were not being utilized. Fauci responded, after Levin rephrased the question several times, 'One of the reasons
probably could be the limited resources.' 'Money?' Levin asked. 'Yes,' Fauci said. Fourteen medical centers around the
country were awarded contracts to study the effects of experimental drugs on AIDS patients. The program will spend $20
million in its first year, involVing up to 1000 patients in controlled clinical trials, and linking researchers with a
computerized database system. Fauci estimated it would cost an additional $10 million to fund the other five qualified
grant applications. According to PHS estimates, 3000 people are in drug trials now, out of about 10,000 surviving
people with AIDS. Over 12,000 people have died since 1979. The hearing, before Rep. Ted Weiss'(D-NY) Subcommittee on
Intergovernmental Relations and Human Resources, also strongly criticized the government's withholding of experimental
drugs from people with AIDS who are not in research programs, and the use of placebos in studies where a drug shows some
promise.
Paul Popham. a founder and past president of the Gay Men's Health Crisis. one of the country's first AIDS
service organizations. testified about the frustration of patients and doctors who cannot get timely and accurate
information about experimental AIDS drugs. Many people with AIDS, said Popham, 'feel there is a point of time where
they may go past the point of no return' in their illness while waiting to get into a drug research program.
Popham,
who has recently been suffering from AIDS himself, criticized the lack of information coordination between drug
companies, scientists, and private physicians. Popham was joined in his testimony by a man from Ohio, identified with
the pseudonym 'John Smith,' who testified from behind a screen. Because he is from an area with relatively few--about
160--AIDS cases Smith said he was 'unable to secure any experimental drugs that might prolong my life. 'I am sure you
agree, that it makes no sense to restrict the availability of drugs when a person is terminal ... And I, for one, do not
want to physically decline to a point when I can no longer get out of bed without help before a drug becomes available
on a compassionate basis,' said Smith. Compassionate use of experimental drugs, widely practiced for cancer patients,
allows treatment with promising drugs by physicians outside of research programs. Weiss asked Smith if he or anyone he
knew would take an experimental AIDS drug, even at risk of worsening rather than improving his condition. Smith said he
and 20 others in an AIDS group in the Cleveland area would be 'quite willing' to take such a risk. A panel of
scientists, including Dr. Mathilde Krim of the American Foundation for AIDS Research (AmFAR), and Dr. Robert, Levine, a
Yale medical ethics expert, criticized as inhumane the lack of drugs available on a compassionate use basis. Krim
called the scarcity of quantities of experimental drugs such as AZT (azidothymidine), produced by Burroughs-Wellcome
Pharmaceuticals, 'artificial' and 'farcical.' Federally-funded AIDS drug studies usually use placebo controls, but are
being increasingly criticized as cruel for withholding potentially helpful treatment from people who are terminally ill.
'Placebo-controlled trials in patients with fu1l-blown·AIDS are morally unacceptable,' Krim said. "A physician's first
obligation is to the life and well-being of his patients, not to 'objective clinical data','
**************************************************
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ALUMNI OF LOS ANGELES GAY &LESBIAN COMMUNITY SERVICES CENTER REUNION
with thanks to Ih! ~!Q!!~ ~!!!, of the LAGLCSC, July-August, 1986
Have you been a staff member, board member, or volunteer at the Los Angeles Gay &Lesbian Community Services Center
during the last 15 years? If so, you are invited to attend the Center's 15th anniversary celebration this fall. For
additional information, contact Ron Shigaki, 213/464-7400 x251.
**************************************************
'NOW I KNOW BETTER •.• •
anonymous letter to the editor, with thanks to
In!
~!!n!ng!~n @l!~!, 7/4/86
Up until this morning, I was operating under a very dangerous and foolish misconception about so-called 'safe sex' that
I feel I must share in the hope that it will enlighten and inform others. Being basically a 'top,' I was under the
false impression that while it was imperative that condoms be used at all times, I honestly understood it to mean only
after intercourse was well underway and nearing climax, that it was perfectly fine to indulge in sex initially
unprotected [without condom], as long as no climax was reached. Imagine my shock when I was diagnosed with a classic
case of frontal gonorrhea--all the while expressing amazement to my doctor that yes, of course I always used condoms!
What I didn't tell him was that I did not use them upon the initial insertion. Please note for your own safety and that
of your partner--absolutely, positively no insertion can be allowed without a condom, not even for five seconds. I
always considered myself extremely well-versed and well-read on safe sex, but somehow this little tidbit slipped by me
completely. Surely if the VD [germ] can be transmitted in this way, so too can the AIDS virus. Now I know better--and
so do you.
**************************************************
REFLECTIONS ON SADNESS AND LAUGHTER
by Allen Pugh, PWA Activities Specialist
with thanks to e!~~l! ~!!n ~!Q§ ~~~!!! from Shanti Project and San Francisco AIDS Foundation, July, 1986
On many occasions, my Emotional Support 'Client' and I get into some really heavy conversations. We talk about getting
in tough with his fears about death and dying, physical concerns, and getting his affairs together. As I talk with
other people with AIDS, their family members, friends and 'significant others,' some of those same fears are shared. I
am often reminded of a poem by Viola Meakin, entitled: 'Laughter.'
'My heart is like a little lake,
Sun kissed and laughing in the light,
With banks full brimmed, whose rushes shake
With mirthful murmurs day and night:
Whose breeze-blown waters flow before
To lap the wild and wooded shore
With little gurgles of delight.
'So may my soul, when days are gray,
Reflect the smiles of God and men,
Though sorrow may upstir the day
By waters wide of lake and fen.
So may I face the winds of fate
With joyous faith articulate,
And ripple into laughter then.'
So, when days are gray, I try reflecting on the beauty of nature, that friendly smile from a stranger, that friend who
is always there, and try to open up and allow the healing experience of laughter to take its course. [For more
information about e!Q~l! ~!!b ~!Q§ ~e~~!!, contact: Shanti Project, 890 Hayes St., San Francisco, CA 94117 (415/5589644).
**************************************************
ELIZABETH TAYLOR SEEKS AIDS FUNDING FROM SENATE
with thanks to In! ~~!h!ng!Qn ~l~~!, 5/9/86
Actress Elizabeth Taylor was the star on Capitol Hill, testifying before a Senate appropriations subcommittee to urge
'very significant increases' in funding the AIDS and other biomedical research for fiscal year 1987. Taylor, founder
and national chairwoman of the American Foundation for AIDS Research (AMFAR), called on the Senate to approve $50
million for the development of an AIDS vaccine and a '10-fold expansion' of federal programs to develop drugs to treat
AIDS. Speaking to the Senate appropriations subcommittee in a packed hearing room, Taylor said that since her friend,
actor Rock Hudson, died of AIDS last year, she has 'become familiar with the tragedy of AIDS and acutely aware of
research funding needs." Taylor said that her own foundation could only fund 'a fraction of the [150] worthy' AIDS
research proposals it has received: Taylor criticized the Reagan administration's budget proposal for FY '87, as 'making
no sense.' Reagan has called for $213 million for AIDS programs in FY '87--about $30 million less than approved for FY
, 86.
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BLACKS HOLD NATIONAL AIDS CONFERENCE
by Rick Harding, with thanks to !h!
~!!ning~Qn ~l!~!,
7/25/86
The reluctance of blacks to recognize the extreme effects of AIDS upon their won community, and the scarcity of AIDS
programs targeting directly to blacks has led to an inordinate number of blacks contracting the fatal disease, said
speakers at a national 'AIDS in the Black Community' conference held July 18 in Washington's Convention Center. Health
officials told the over 400 conference participants that the latest statistics show that blacks comprise 25% of the
country's AIDS cases, but only 12% of the overall U.S. population. The rest of the nearly 12 hour conference, the first
of its kind in the nation, discussing what has caused those disturbing statistics and what to do about it.
In his
opening remarks, Gil Gerald, executive director of the National Coalition of Black Lesbians and Gays (NCBLG), which
sponsored the conference, said that AIDS is an issue that the black community has "kept in the closet.'
The black
community's hatred of gays, he said, has caused a denial of the epidemic's existence int he black popu1at.ion. Gerald
said that even thought the AIDS crisis is now five-years-01d and is affecting blacks in such great numbers, no major
black organization would agree to endorse the Conference. Besides the black community's own denial of the crisis,
another major factor causing an escalation of the disease among blacks, according to Gerald and other conference
speakers, is the lack of AIDS programs directed specifically at blacks. According to panelist Dr. Benny Primm,
president of the Urban Resource Institute in New York City, AIDS is the second leading cause of death in Harlem.
But
'not one program exists for education or prevention of AIDS in Harlem,' he said. Panelists in a workshop session on
AIDS education for black gay men agreed that white gay-dominated AIDS education organizations are not reaching blacks.
Many blacks who are gay identified with black culture rather than gay culture, said California psychologist Dr. Julius
Johnson, and consequently are not reached by educational strategies directed specifically at the gay community. Other
panelists said that many black men have sex with other men but do not consider themselves gay and therefore, feel they
do not have to concern themselves with a "gay problem," such as AIDS:. The panelists also said they believe only those
who understand black culture can adequately reach blacks with AIDS education. Henry Chinn, founder of Black Men's
Association in Boston, said he believes it is essential for AIDS organizations to elicit the help of black churches in
distributing AIDS information. 'Black gays are the bastions of the church,' he said. 'They are the choir members, the
deacons, the leaders," Chinn said. Moreover, heterosexual women church members often prove helpful in getting AIDS
education into the churches. Tim Offutt, a member of Chicago's AIDS education organization, the Kapuona Network, said
his group has successfully sponsored "safer-sex parties," modeled after Tupperware parties, in which 10 to 12 friends
are invited to a private home and an AIDS education organization makes a safe-sex presentation. Several panelists
suggested that public service announcements on television and radio have been shown to be effective in reaching the
overall black community, including black women and IV drug abusers who are also at high risk for AIDS. The panelists
emphasized that black organizations and white organizations with a sufficient number of black staff members are the only
groups that can reach blacks with AIDS education, and that those groups require government funding to operate effective
programs. In a speech before the entire conference, D.C. Mayor Marion Barry said that he recognizes the importance of
funding minority AIDS education efforts and that the District has granted a contract for that purpose to a local
communications group together with two black gay organizations. When asked about the grant by a reporter after the
speech, however, Barry said he did not know why the minority education contract has not been signed, four months after
applications for the contract were turned into the city, or why the amount of the contract and its provisions have not
been announced. !~~ ~~~~i~g!Q~ ~Q~! reported that it had learned the city was spending $92,874 on the contract.
Organizers of the. conference said they believe leaders of AIDS groups with effective black education strategies were
able to reach others at the conference who needed information. NCBlG's conference organizer, Craig Harris, said that
among the over 400 conference participants from 30 states and Brazil were numerous employees of mainstream AIDS groups
and over 30 members of the clergy. Harris also noted that extensive coverage by mainstream media, including newspapers
and television stations from Washington, Philadelphia, and new York, helped communicate the urgency of the situation to
the public and legislators. [ED NOTE--Reports of the conference were also distributed nationwide by news agencies.)
NCBLG Director Gerald and several other AIDS activists met with Surgeon General Dr. C. Everett Koop about increasing
AIDS funding for minority education. Harris said he hopes the success and publicity of the conference will encourage
major black organizations, such as the' NAACP, the National Urban League, and the Southern Christian Leadership
Conference--all of whom refused to endorse the conference, to address the AIDS crisis among blacks and to sponsor
efforts to combat it. [ED Note--E1sewhere in this Newsletter, the Southern Christian Leadership Conference (SCLC) is
reported to have sponsored a national forum on the AIDS crisis and the black community.]
**************************************************
HIGH SCHOOL STUDENTS DON'T KNOW AIDS FACTS
with thanks to Detroit's ~~~f!!, 7/23/86
Most high school students are misinformed and have 'scientifically unfou~ded" worries about AIDS, a new ~~le University
survey shows. And 80% of the 349 Connecticut students surveyed admit they don't know much about ·the disea,se and lIIould
like more information.
'Kids are reflecting information or misinformation that they've received from parents," says
Christopher C~nnon, Bridgeport, Connecticut, health director. The study shows 55% thinks AIDS victims shouldn't teach,
and 45% say students with AIDS should be kept out of .school.
.
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SPANISH AIDS HOTLINE IN LOS ANGELES
with thanks to the ~!~ YQ~~
~!!i~!,
7/7/86
Los Angeles City Councilmember Michel Woo has won approval for funding a Spanish-language AIDS hotline. The funding
will cover the operation of a 24-hour hotline for six months. The hotline is part of the AIDS Project/los Angeles.
Funding is part of the total budget for the city during fiscal 1986-87. Woo pointed out that an estimated 13% of the
AIDS cases reported in LA are from the Hispanic community, andOthat approximately 5000 of the calls received by the
present hotline each month are from Hispanics, according to ~eq~!~·
**************************************************
NATIONAL MINORITY AIDS COUNCIL
by Stephanie Poggi, with thanks to Boston's
§!~ ~Q~~i!~ ~!!!,
6/28/86
A National Minority AIDS Council was formally established here, June 10, at the conclusion of a two-day meeting on
people of color and AIDS sponsored by the National Institute of Mental Health and the National Lesbian and Gay Health
Foundation,
According to black gay Reverend Carl Beam, a member of the new council and director of the Minority AIDS
Project in Los Angeles, the Council will serve as a vehicle to 'express and address the needs' of people of color with
AIDS,
Beam stated that despite the 'millions of dollars generated to deal with AIDS,' most people of color still lack
information about the illness. He added that while AIDS continues to be perceived as 'white gay disease,' it is
disproportionately hitting communities of color. Not only are gay men of color disproportionately affected, but 75-80%
of women with AIDS are of color and 60% of infants with AIDS are black. Craig Harris, coordinator of the upcoming
national conference, 'AIDS in the Black Community,' scheduled for July 18 in Washington, also commented on the high
numbers of women and children of color with AIDS. He said, 'Gay people of color are as concerned about the children and
(heterosexual] women who have AIDS as they are about the gay people' who have the disease. Harris said it would be the
work of the council to undertake coalition-building between communities of color, national organizations such as the
National Coalition of Black Lesbians and Gays, local gay organizations and local groups of people of color, government
agencies and health workers of color, government agencies and health workers of color. He added that networking will
help groups to share information about existing programs and to expand services. Beam said the council also intends to
produce 'culturally sensitive' material to reach communities of color and to lobby that funds for AIDS education go to
'people who know what the issues are (in our communities.]'
**************************************************
ATLANTA BLACK &WHITE MEN TOGETHER HELP EDUCATE COMMUNITY ABOUT AIDS
by Richard Bono, with thanks to !~! 4Q~~~!1 Qf ~!~ ~!l!~!!, May, 1986
Central to AID Atlanta's (AIDA) efforts to educate blacks about the spread of AIDS is the cooperation it receives from
the Atlanta chapter of Black and White Men Together (BWMT). With 115 members, the local group has produced an active
AIDS education committee that has conducted risk reduction 'parties' and disseminated news releases and broch~~es about
AIDS throughout the gay and straight black communities of Atlanta. "I believe BWMT has a genuine concern about what
happens in the gay community,' said Duncan Teague, chairman of the AIDS education committee. 'Because of our concern
for the lack of information reaching the minority community,' he said, 'it wasn't hard forming this committee and
getting a lot of support.' Established a year ago, BWMT's AIDS education committee has been able to reach Atlanta's
black gay community in ways other groups have not. 'BWMT has done quite a bit,' said AID Atlanta Director Rev. Ken
South. 'They have provided AID Atlanta with many suggestions on how to reach the black gay community. We could not
have made the inroads we have without BWMT." Teague says part of BWMT's success is due to the fact that 'there is
nowhere else to turn if you want to reach black gay men (who are] organized.' He nonetheless laments that even their
best efforts to educate black gays often hit a dead end. 'Many black gays are ignorant of the facts that concern them,'
he said. 'I think because the same creativity that has been used to get the message to white gays has not been used to
get the message to black gays, that there is a misconception among a large group of black gays that AIDS is not
something they should be concerned with--that it is somehow a white man's disease.' Recent statistics from the CDC
reveals that black Americans account for 25% of all American AIDS cases, compared to making up only 12% of the
population. Other roadblocks BWMT has encountered involve those black men in the straight community who engage in
occasional homosexual behavior, but do not consider themselves gay. "These are the people that are very heard to
reach,' said Teague. 'If a brochure about AIDS has the word 'gay' on it, they think they have no reason to pick it up.
Or they are even repelled at the idea." The often negative reaction of the straight black community to BWMT limits the
group's impact, Teague said. 'Making inroads into the larger black community in Atlanta is difficult,' he said. 'It
isn't always comfortable for our members to make their gayness known or their involvement with BWMT." Teague says the
blacks that compose roughly half of BWMT membership are not necessarily estranged from the larger black community, but
they do not travel in those circles.'
In fact, Teague said, 'In our particular organization, I have found,
paradoxically, that our white members often have inroads into the black community where our black members do not.' BWMT
is an interracial group wh~se membership Teague related amusedly "is so diverse you wouldn't believe.' The chapter's
membership includes doctors, lawyers, students, laborers, performers, and said Teague, 'to people who wait tables and
dream impossible dreams." ,
'
°
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°
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HUMOROUS APPROACHES TO AIDS PREVENTION EDUCATION SOUGHT
with thanks to CAIN, (Computerized AIDS Information Network), _/19/86
Anyone knowing of any approa-cnes or citations of educational materials or campaigns for AIDS prevent jon education, using
humor to get the messages across, please contact NCGSTDS/Ron Mazur, PO Box 239, Milwaukee, WI 53201 or leave electronic
mail directly lo: RMazur.
**************************************************
BLACK CIVIL RIGHTS ORGANIZATION HOLDS AIDS FORUM IN ATLANTA
by Rick Harding, with thanks to Ih! ~!!hing~2n ~l!~!, 6/6/86
The Southern Christian Leadership Conference (SCLC) sponsored a national forum on the AIDS crisis and became the first
major black civil rights organization to discuss the epidemic and how it affects the black community. The May 30 forum,
which was held in Atlanta, featured presentations by health care and medical research officials as well as
representatives as well as representatives of the gay community. National Coalition of Black Lesbians & Gays (NCBlG)
Executive Director Gil Gerald told the group of over 100 health care workers, government agency officials, and concerned
members of the community attending the event that the SCLC's "actions come at a time when there are other prominent
black organizations who will not touch the subject of AIDS because of its association with the taboo topic of
homosexuality.'
Gerald said that he hopes the SCLC initiative will prompt other black organizations, which have
remained silent on the AIDS issue, to begin addressing the crisis. He said SClC's 'jumping in' should make it easier
for others--inc1uding such major organizations as the NAACP and the National Urban League--'to jump in too.' SClC's
Projects Director Sandra McDonald, said the attitude of many of the major black organizations parallels the attitude of
much of the black community as a whole, which, she said, doesn't 'want to talk about AIDS and link (themselves] with
gays.' Like Gerald, McDonald is confident that the other groups will 'come in with us' now that the SCLC has 'taken the
first step.' McDonald said the SCLC has approached the National Black Consortium, an association of most of the black
civil rights groups in the country, to 'come together as a groyp to talk about the AIDS problem in the (black] community
and what can be done to combat it.' McDonald said she did hot think it was ironic that SCLC--which was founded by the
Dr. Martin Luther King Jr. and represents members of many conservative black churches--should be the first to address
the AIDS issue. 'It is fitting,' she said. 'If we are true Christians, we will accept people who are mistreated for
any reason.' Gerald said SCLC President, the Rev. Joseph Lowery, voiced his position on gays at the forum, saying 'we
are all God's children,' regardless of race, sexual orientation, or other incidental factors. McDonald stressed that it
is not solely the gay issue and the controversy surrounding it that has caused the black community to move slowly in
addressing AIDS. She said the media perception that AIDS is predominantly a white disease still permeates the attitudes
of many blacks. 'It is still quite rare to see a black person featured in a news interview or a documentary on AIDS,'
she said. According to statistics released at the forum, blacks make up 25% of reported cases in the U.S., but only
represent 12% of the nation's population. McDonald said the SCLC will continue to challenge blacks' misperceptions of
AIDS and is 'in the process of securing funding' to sponsor additional forums in other cities with large black
populations and large numbers of AIDS cases, including Washington, DC, and New York City.
**************************************************
AIDS PERIL GREAT FOR BLACKS
with thanks to the
~!!h!ng~9~ ~9!~ §!~y!£!,
7/20/86
Mandatory blood tests of US military recruits show that blacks test positive for exposure to the AIDS virus at a rate
four times as high as whites, public health experts say. Experts cite Defense Department figures as new evidence that
AIDS has joined 'the list of other diseases, including cancer, tuberculosis, and hypertension that disproportionately
affect blacks in this country. 'Black men are at high risk for everything and AIDS is no exception,' said Henry Chinn,
founder of the Black Men's Association of Boston. The military figures, released by the Walter Reed Army Institute of
Research, are the result of blood tests of 308,076 recruits conducted from October 1985 through May 1986. Among the
237,586 whites tested, the rate of exposure to the virus was 0.9 per 1000 recruits; among the 55,185 blacks, the rate
was 3.9 per 1000. The rate of positive tests for the 15,305 recruits of other racial groups was 2.6 per 1000. Although
blacks test positive for antibody to the AIDS virus at a higher rate than whites, white males still account for the
majority--60%--of those who have already. developed the disease. Blacks account for 25% of the nearly 23,000 cases of
AIDS in the nation, according to federal figures. Public health experts frequently use the results of military recruit
testing of indicators of certain aspects of health, but note that comparisons cannot be made with the general
population. AIDS exposure among those donating blood tot he Rec ·>oss, for example, is four cases per 10,000 donors,
compared with 15 cases per 10,000 military recruits of all races, said Walter Dowdle, AIDS coordinator for the US Public
Health Service. However, the military population would be expected to have more cases because most recruits are young
men, according to recent Congressional testimony of William E. Mayer, assistant secretary of defense for health affairs.
Males account for 92% of all US AIDS cases according to officials at the Centers for Disease Control. Experts at a
national conference on AIDS and blacks in Washington, DC, theorized that there may be a greater incidence of bisexual
activity and drug use that could account for the larger rate of black recruits testing positive for exposure to AIDS.
Representatives of the National Coalition of Black lesbians &Gays, which organized the conference, also ,met with
Surgeon General Everett Koop to discuss ways of devoting more federal attention to the problems of AIDS among nonwhites. 'There are major problems with blacks and IV' drug abuse and AIDS nationwide,' said Wayne Greaves, chief of
infectious diseases at Howard University Hospital.
**************************************************
***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY. 1986 * PAGE 17 *****
**~********************************************************************************************************************
BOSTON FORMS PWA/ARC ORGANIZATION
Boston PWA/ARC is an independent organization forming to meet the growing needs of the Boston community of people with
AIDS or AIDS related conditions. Because of the strong need for an informal group of people with AIDS to voice concerns
and criticisms to the growing numbers of service-providing 'institutions. the group was formed. For more information.
contact: BOS-PWA. 661 Boylston Street. Boston. MA 02116.
**************************************************
PRISON AIDS POPULATION NEARING 1000
with thanks to Miami's Ih!
~~l~ ~!!!,
and
Ih!
§!1!!!Q~! §!~ ~~p!~,
·July, 1986
Anew survey has found 766 people with AIDS who are in. or have been in American Jails and prisons. Federal officials
said the high number of cases is due to intravenous drug abuse by the inmates prior to their being locked up. Those
officials say they believe AIDS is not being spread in prison. The survey found about 70' of the AIDS cases in prisons
and Jails were in three states. New York. New Jersey. and Pennsylvania. Of the 766 cases. 322 died in custody, 265 were
released. and 179 are still in prison.
**************************************************
AIDS IN PRISON
a letter to the editor by Mark Kostopoulos. with thanks to Boston's
§!~ ~~!~~ ~!!!,
6/28/86
The los Angeles· lavender left. a group of lesbian and gay activist. has recently become concerned about the issue of
AIDS in our nation's prisons. While there is a lack of care, preventive education and growing discrimination in society
in general. conditions in the prisons are. as usual. much worse. There are numerous AIDS related groups doing MUch
needed and worthy work but their own biases have led them to almost universally ignore the needs of prisoners. We would
like to address the issue in our work. We are depending on prisoners for information to help forlUlate our plans and
policies. We would like to hear from anyone with experiences or thoughts about AIDS in the prisons. our attention was
first focused on this area when we learned that condoms are not routinely provided to prisoners. We are particularly
interested in learning about these policies.
The hypocrisy of prison officials who wish to subject prisoners to
mandatory HTlV-III antibody testing while not providing prisoners with the basic tools to protect their health is a
particular outrage to us. We would like to know concretely wha~ ~: >:.~g on in terms of condoms, clean needles. health
care. discrimination. information and education around AIDS. How is this affecting life inside the prisons? What sort
of political activities and campaigns could gay liberation groups undertake to improve the situation? We are especially
interested in hearing from people int he California system. Our limited resources means that we will not be able to
answer all letters. We will present a summary of the responses we receive in a letter to §~~.
Address letters to:
lavender left. PO Box 17241. Los Angeles. CA 90017.
**************************************************
RACISM &HOMOPHOBIA KEY IMPEDIMENTS TO AIDS PREVENTION AND CARE AMONG PEOPLE OF COLOR
with thanks to Ih! §!1~!!9~! §!~ ~~e!~, July 1986
In a speech delivered on May 31 to the Southern Christian leadership Conference's (SClC) National Conference on AIDS.
Gil Gerard. Executive Director of the National Coalition of Black lesbians and Gays (NCBlG) called on the black
community to recognize racism and homophobia as key impediments to AIDS prevention and care among blacks. The SCLC
Conference on AIDS was the first AIDS conference organized by a major national black organization in the United States.
In his remarks, Gerald charged that, as blacks. "we somehow remove ourselves from lesbian and gay people and then dare
to celebrate the lives and contributions of James Baldwin. Audre Lorde. Langston Hughes. Bayard Rustin, Alain Locke.
Countee Cullen. Bessie Smith. Porter Grainger. lorraine Hansberry. Wallace Thurmond. Bruce Nugent. and Sylvester--all
people we love and appreciate for their contributions to community life." Gerald noted that he was extremely encouraged
by the reception he received at the SClC event. According to Gerald. Dr. Joseph Lowery's remarks that "God does not
discriminate against people because of sexual orientation." were just the kind of words we need to hear from religious
and civil leaders at this time of increased stigmatization against lesbian and gay people.
lowery succeeded SCLC
founder Dr. Martin Luther King Jr.. as head of that organization shortly after his murder in 1968. Gerald was
particularly pleased at the SCLC proposal to call for a larger convocation of national black organizations, "including
NCBlG." to deal with the issue of AIDS in the black community and eliminate the myth that AIDS is a white gay male
disease. "This conference was an important prelude to the futu~e which includes the NCBlG National Conference on AIDS
in the Black Community. scheduled for July 18th at the Washington Convention Center." added Gerald. NCBLG, a network of
3000 people. is the only autonomous black lesbian and gay organization in the United States. with chapters in San
Francisco. New Orleans. Washington. DC. and Minneapolis. For additional information: NCBlG. 930 F Street. NW. Suite
514. Washington. DC 20004 (202/737-5276). The publications Committee of the NCBLG is proud to announce the premier of a
new quarterly newsmagazine. ~l~£~lQ~~. which replaces their former publication, ~~~~~i:Q~f~~~i. In addition to news and
views of interest to the international black lesbian &gay community. ~l~£~lQ~~ will include reviews, interviews.
poetry, short fiction, a prisoner penpal listing, resources. and announcements. Cover price per issue is $2, with a
year's subscription for $6: Address editorial inquiries to ~l~£~LQ~!, POB 2314, Philadelphia. PA 19103; subscription
requests should be directed to NCBlG offices in Washington (address above).
i,
i·
k
***********************************************************************************************************************
POSITIONS AVAILABLE IN SAN FRANCISCO, BOSTON, NEW ORLEANS
ED NOTE:
The NCGSTDS frequently receives job listings for positions in AIDS service organizations or STD
clinics/services, 'but because of application deadlines prior to the Newsletter's anticipated date of publication, we are
reluctant to print them.
The San Francisco AIDS Foundation recently sent a packet of job listings for
skilled/professional and unskilled (e.g., receptionist, accounting assistant, marketing administrative asst./secretary,
accountant, educational events assistant, etc.) positions with the application deadline of July 21. These are part and
full time positions. If you are interested in any AIDS service work, we urge you to contact whatever AIDS service
agency exists in that particular location, since turn-over of staff is occasionally high. San Francisco AIDS
Foundation, 333 Valencia St., 4th Floor, San Francisco, CA 94103.
Boston's AIDS Action Committee is seeking an AIDS service coordinator/client advocate and an administrative assistant
with computer and clerical experience.
Send letters of inquiry or a resume and cover letter to: . Director of
Administration-SW2 [for AIDS service coordinator/client advocate] or -CSA [for administrative assistant], AIDS Action,
661 Boylston St., 4th Floor, Boston, MA 02116.
The New Orleans AIDS Task Force (NO/AIDS Task Force) is seeking qualified candidates for the position of executive
director. Qualifications include ability to function within a community non-profit agency, organizational &managerial
skills, fundraising experience, budgeting &accounting skills, exquisite ability to communicate and work with community
religious people, health department &elected officials, and numerous other special interests. Letters of application
and resumes should be sent to: Mr. William C. Crawford, P.O. Box 2616, New Orleans, LA 70176-2616.
**************************************************
COLUMBUS SEEKS EXECUTIVE DIRECTOR
Stonewall Union, a nationally recognized lesbian/gay rights organization in Columbus, Ohio, is seeking a full time
professional executive director. Responsibilities include office management, community, media &legislative relations,
budgeting/fiscal affairs, program/policy development and implementation, volunteer coordination, membership development,
and fundraising.
Qualifications required include a bachelor's degree, two years' experience in a non-profit
organization preferred; equivalent combination of education/experience acceptable. One year of experience in working
with gay/lesbian rights in either a salaried or volunteer capacity is required.
If interested, send a resume with
three references, nominations, or requests for information to: Stonewall Union Search Committee, PO Box 8355, Columbus,
OH 43201 (614/299-7764) by September 1, 1986 (postmarked).
**************************************************
TAX-EXEMPT GROUPS CAN LOBBY FOR POLITICAL/LEGISLATIVE CAUSES
According to the Internal Revenue Service (IRS), 501(c)(3) tax-exempt not for profit groups and organizati~ns may cho~se
an "election H' which legally permits them to influence legislation with financial contributions or 10bbYlng. Sectl0n
501(h) applies to only certain tax-exempt groups (excluded are religious organizations) and after tax year 1976.
An
organization may lose its exempt status if its lobbying expenditures exceed the permitted amounts by a ce~tain amount.
According to gay political leaders, some tax-exempt organizations have pooled their resources to lega~ly hlre a fulltime lobbyist to work for their agencies. For more information, contact a tax attorney, your local l1brary, or the IRS
(review sections SOl(h). S01(c)(3), 4911, and 6033,' and request forms S768 and 990).
**************************************************
CHICAGO WOMEN'S AIDS PROJECT
by Tracy Bairn, with thanks to Chicago's
~!~~~ ~!~~ !!~~~,
5/29/86
While women, both gay and non-gay, are working answering phones, being support managers, and doing other activities
around AIDS, there are also women who have formed the Chicago Women's AIDS Project. The project is a feminist-oriented
response to AIDS. Of particular concern to the group is the lack of educational and prevention resources available to
Chicago women, especially prostitutes. In addition to the lack of educational information 'available, the organizers
also voice concern that a feminist presence has not been a part of the Chicago reaction to this disease. The group has
several purposes: to educate the women's community in relationship to the politics and homophobia surrounding this
Marge Cohen of the Women
disease, as well as to the medical facts; and to educate social service groups about AIDS.
Organized for Reproductive Choice and who works at Cook County Hospital, said women considered at high risk for the
disease include women of color, drug-users and prostitutes. She said the project feels female prostitutes have been
victimized, labeled as spreaders of AIDS when actually they themselves are at high risk and their civil liberties are
being threatened.
The project hopes to schedule a forum on women 'and AIDS for this summer,' and possibly a large
conference for next spring. 'There are many ways in which AIDS effects women, Cohen said.
For e~ample, with
artificial insemination, sexual contacts, and ·drug use. 'But women also need a perspective [on AIDS] that ;s not
oppressive, not Victim-blaming.' For additional informatipn, contact Cohen: 312/186-0036.
II
**************************************************
,**********************************************************************************************************************
ANIMATED AIDS VIDEO FOR KIDS
In the last issue of the Newsletter, we reported about a half-hour animated videotape on AIDS aimed towards school
children from cartoonist Charles Thompson of Charlottesville, Virginia. We inadvertently omitted a reference as to how
to inquire about ordering, etc. Please contact the following for additional information:
Health' Alert Division,
Creative Media Group, Inc., 123 Fourth Street, NW, Charlottesville, VA 22901 (804/296-6138). The AIDS Alert Video is
available for $124.9S (VHS, Beta; $149.9S for 3/4" U-Matic); it is also available in 'filmstrip or slides' cassette, and
may be previewed for a small rental.
**************************************************
ACLU PUBLISHES Al0S PAMPHLET
with thanks to Detroit's
~~Yl!!,
6/2S/86
Recognizing that the rise of AIDS has broad and serious implications for civil liberties, the American Civil Liberties
Union of Northern California has published a comprehensive 4-page policy gUide, ~!Q§ !n~ ~iYil ~i2!~!j!!. The guide
represents public policy and practice as the ACLU believes it ~hou1d be and not as it currently is. The doculBnt covers
testing, employment, public schools, quarantine, surveillance and compulsory tracing, as well as insurance, prisons, and
military. Copies of the ACLU-NC AIDS Policy are available free of charge by writing: ACLU-NC AIDS Policy, 1663 Mission
Street, #460, San Francisco, CA 94103.
**************************************************
MOTHER'S BOOK: 'THE SCREAMING ROOM'
with thanks to Portland Maine's Ib!
~!Q§ ~~gJ!e! ~!!!,
May, 1986
!b!
§~~!!~i~g BQQ~ by Barbara Peabody is the factual account of the author's 28 year old son's struggle with AIDS.
Based on Peabody's journal, the title refers to the author's outlet for her anguish and stress over her son's losing
battle: she would scream in the shower where no one could hear her. The publisher calls the book a riveting story told
without sensationalism: "No one has given the public a human look at the illness, what happens to people who suffer
from it, and to their family and friends, how they deal with it and each other, and how they work with medical staff to
relieve suffering." Published by Oak Tree Publishers of San Diego, CA, the book's list price is $15.9S.
**************************************************
WHO'S WHO IN SEXOLOGY REFERENCE BOOK
The first edition of Ib! tQ~!~Q!!i~Q!l ~b~:! ~bQ iQ §!~QIQ9~ is a project of the Exodus Trust, a California non-profit
trust which has as its sole and exclusive purpose to perform educational, scientific, and literary functions- relating to
sexual, emotional, mental and physical health. The purpose of the first edition was to provide an introduction to the
people who are principle in or related to the field of sexology. The hope is that this first edition will demonstrate
the breadth of the emerging professional area, and that the publication will stand as an invitation to those who would
like their work recognized by colleagues and peers. The book, although not all inclusive, lists over 1S00 names and
organizations from S2 countries dealing in some way with the area of human sexuality/sexology. The book is available
from Specific Press, 1523 Franklin Street, San Francisco~ CA 94109, for the cost of $45, plus $4 postage/handling. For
additional information, contact Jean Amos, Editorial Staff, 41S/928-1133.
**************************************************
LEGAL JOURNAL FEATURES AIDS ARTICLE: A REVIEW/COMMENT
by Ed Sikov, with thanks to the ~!! !q~~ ~!!lY!, 6/16/86
"AIOS: Wrong Without Remedy," the cover story of the June 1 ~~~ ~~Y~Q!lL Ib! b!~~:~ ~!9!~lQ! is a better article than
its silly title would suggest. (Only a legal magazine would think to describe disease in terms of crime.) The writer,
David M. Freeman, makes a solid effort to remain rational on the subject of AIDS, and the result is a reasonably
informative discussion of civil rights and civil liability problems. Of course, Freeman confuses the detection of
antibodies to HTLV-III with the detection of the virus itself, and he unquestioningly accepts the word of 'scientists'
that HTLV-III is the sale cause of AIDS. Moreover, considering the magazine's readership, it is strange that Freedman
doesn't mention Dr. Luc Montagnier's lawsuit against Dr. Robert Gallo over patent rights surrounding the isolation of
HTLV-III. The real gem, however, is a supplemental article describing the results of a poll conducted for the magazine
by a New York public opinion research firm. The headline reads, "Lawyers oppose most AIDS-related discrimination."
Encouraging news, until one sees what kind of discrimination some lawyers li~!. ,According to the pollsters, 41% of
American lawyers think that health and life insurance benefits should be denied to persons with AIDS (Though the
published results do not reveal whether these hypothetical "AIDS victims" some gay activists fear, "AIDS victims" could
be broadly defined as meaning anyone testing positive for antibodies to HTLV-III). Almost a quarter of American lawyers
think job discrimination is dandy, a fifth approve of public accommodation discrimination, 13% would like to deny city
services to people with AIDS, and 10% want to prevent AIDS patients from receiving medical services.
Some
encouragement!
**************************************************
"
***** PAGE 20 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7;5 * JUNE/JULY, 1986 *****
***********************************************************************************************************************
"CORE PHYSICIAN EDUCATORS" TO BRING DOCTORS "UP TO SPEED"
with special thanks to !h! ~!~ ~~gJ!~; ~!~ of Portland, Maine, July, 1986
~!Q§ ~gll£~ § b~! (volume 1:9,
5/21/86), report that the American Medical Association is going t? be st~rting.a pilot
program to train physicians on AIDS issues. "The program will identify 'core physician educators who w111 br1ng local
doctors 'up to speed' on AIDS issues." Plans are to have such a program in place in 46 states by the year's end.
**************************************************
ELECTRIC BILLBOARD FlASHES AIDS EDUCATIONAL MESSAGES
by Doug Hinck1e, with thanks to !h! ~!!hl~g;gQ
gl!~!,
6/6/86
As subway riders approach Washington's Dupont Circle subway escalator, they are dazzled by an electric billboard display
that flashes advertising and public service announcements in bright green letters. According to Marci Weis, director of
Dupont Action Lights which operates the billboard, says that some 2300 AIDS-related messages cross the board each week,
at a cost of $150 per week. The $7800 annual bill is paid for by 14 area businesses, who sponsor 169 different messages
every week put together by the city's Whitman-Walker Clinic. Allen Hotlen, program director for WCLY Radio, said
"Classy 95" helps pay for the massages because the station markets itself towards the middle and upper-middle class
members of the 24 to 44 year old age group and because the station 'has made a commitment to help support a variety of
public service announcements." Lewis Gertz of Crown Liquors thinks it's a good idea to support the messages, since many
of his customers and several of his employees are gay, and that he is concerned about AIDS. And he adds, 'It was a
chance to do a public service announcement at a good price." Other sponsors included bars, bookstores, record stores,
video stores, realty company, restaurants, outfitter's store, and a radio station.
**************************************************
MEDIA CAMPAIGN IN CALIFORNIA
with thanks to Ih!
~!!h!~g;g~ gl!~,
7/4/86
The producers of-two television shows, !h~!:! !~£~!~!~l! and 8!~1 ~!g~l!, have apparently beat out the producer of the
gay/lesbian documentary ~g~g !! ~~! in the bid to produce California's media campaign on AIDS, according to !b!
~gyg£~!!! Adair Films, which produced the gay documentary, was one of four bidders on the state contract to produce
public service messages, signed a contract with the state's AIDS Mental Health Program in February. But Adair had
apparently been awarded the contract without competitive bidding, and the state ordered the company to stop work after
it had already spent about $10,000 in production. The state went on to award the contract to Landsburg Productions, a
Hollywood-based firm which produces the two television programs which air unusual stories.
**************************************************
AIDS SHOW IN SAN FRANCISCO & LONDON
with thanks to Boston's §~~ ~~~1!~ ~!~!, 6/29-7/5/86
Graphics, video, film and still photographs by community organizations and individual artists responding to the AIDS
crisis are currently being sought for entry into this San Francisco/London exhibition.
Interested contributors are
asked to write as quickly as possible: J.Z. Grover, 3739 N. Kenmore, Chicago, 11 60613.
**************************************************
AMFAR HAS MORE PUBLIC SERVICE ANNOUNCEMENTS ON AIDS
with tbanks to Pat Meredity and !b! g!l;l!g~! §!~ ~!~~, June, 1986, and Ib! ~!!~l~ ~!!!, Miami
The American Foundation for AIDS Research (AmFAR), a group headed by Elizabeth Taylor, has distributed more than a dozen
new public service announcements to television stations across the country. The new PSAs join two earlier commercials
distributed in its effort to spread medically accurate information about AIDS. The new announcements feature, among
others, Brooke Shields, Matthew Broderick-and Judd Hirsch. In the announcement in which he appears, Hirsch said, 'AIDS
is a problem most people don't want to think about, but it's worth knowing the facts.
There's no point in being
afraid,and if you're sexually active, the~e's no point in being stupid.'
**************************************************
ST. LOUIS EFFORT FOR AIDS ESTABLISHING BROCHURE LIBRARY
St. Louis Effort for AIDS (EFA) is currently setting up a reference library of brochures, pamphlets, posters,
newsletters and other materials from AIDS organizations nationwide. EFA hopes to coordinate information gathering for
the development of educational materials for dissemination to the public and to solidify communication between EFA and
other AIDS organizations. Although individual organizations are primarily concerned with the impact of AIDS' in their
immediate regions, we are confronted with the nationwide impact as well. For example, the recent Justice -Department
ruling regarding discrimination of PWAs and the Chicago court case demanding that a bisexual father produce_~vidence of
a negative HIV antibody test before reinstatement of child visitation privileges. EFA win send copies of its
educational literature in exchange for your agency's literature. For additional information, contact: Mike Royal, RPH,
Secretary, St. Louis Effort for AIDS, 1120 Dolman, St. Louis, MO 63104 (314/421-3914).
**************************************************
***********************************************************************************************************************
RED CROSS AND PUBLIC HEALTH SERVICE OFFER PUBLIC EDUCATIONAL RESOURCES
Shellie Lengel, Director of the Public Health Service's Office of Public Affairs recently announced the availability of
several resources that may assist local AIDS educational efforts.. 'Facts About AIDS' is an 8 panel brochure in English
or Spanish recently revised in the spring, and may be reprinted without permission. PHS also has available for purchase
or free loan, three recently updated videotapes: 'AIDS: Fear &Facts' targeting the general public; 'What If the Patient
Has AIDS?' geared to health care workers; and 'AIDS and Your Job,' aimed at emergency nonmedical first responders such
as police and fire fighters.
For more information about the brochures, contact: PHS, Office of Public Affairs,
Washington, DC, 20201. To purchase one or more of the videos [ED NOTE: view first for free!!], write: NAVC, 8700
Edgeworth Drive, Capitol Heights, MD 20743-3701, Attn: Customer Service Section (301/763-1896). To order one or more of
the tapes for free loan, write: Modern Talking Picture Service, 5000 Park St., North, St. Petersburg, FL 33709, Attn:
Film Scheduling (813/541-5763). Red Cross and PHS created a poster featuring singer Patti LaBelle that promotes use of
the PHS's toll-free hotline for recorded accurate information about AIDS. Additional posters can be obtained by
contacting a local Red Cross Chapter, or by writing to: InterAmerica Research, 1200E North Henry Street, Alexandria, VA
22314, Attn: Clint Jones. Also available are public service announcements for radio and tv, and nine leaflets about
AIDS directed to specific audiences: 'AIDS and the Blood Supply;' 'AIDS, Sex, and You' about safer sex; 'AIDS and
Health Care Workers;' 'AIDS and Your Job--Are Their Risks?' 'Caring for the AIDS Patient at Home;' 'AIDS and Your
Children;' 'If Your HTLV-III Antibody Test Is Positive;' and two additional leaflets, one for gay and bisexual men, and
another one on IV drug use and the respective risk reduction messages for these two groups.
Contact your local Red
cross Chapter for additional information about these resources.
**************************************************
RED CROSS: BEYOND FEAR EDUCATIONAL FILM
with thanks to !h! ~1!!!9~! §!~
~!e!~,
June, 1986
Community leaders and members of the press and media were given a preview of the new Red Cross AIDS Documentary, ~gn~
E~~~, at a breakfast meeting at the Baltimore Regional Red Cross Headquarters.
§!~gn~ E!!~ is a~ 60 minute documentary
that provides an in-depth look at the AIDS crisis in terms that the general public can understand. Narrated by actor
Robert Vaughn, the film features three basic segments. 'The Virus' focuses on the known facts about the AIDS virus, and
uses animated computer graphics and interviews with top researchers, explaining how the virus works and how it sabotages
the body's immune system. 'The Individual' focuses on the risk factors of the disease, identifying who is at risk. how
to avoid infection, and clearly emphasizing that casual contacts do not transmit the virus. The final segment, 'The
Community,' examines how some cities have responded to the AIDS crisis through education and patient services and
considers some of the public policy issues that each community must face. §!~gn~ E!!~ is thoughtful and sensitive to
the complex issues involved in the AIOS crisis, and presents the known facts in a positive and non-judgemental fashion.
One of the key messages of the film comes through loud and clear: AIDS is a disease, not a moral issue, and its victims
are entitled to the same care, support and respect that is due to anyone else. §!~gn~ E!!~ is a part of the American
Red Cross' 'AIDS Public Education Program,' comprehensive effort to educate the public about AIDS and how to prevent
its spread. The film and supporting information are available on loan to businesses, schools, and other community
organizations. Contact your local Red Cross for additional information.
**************************************************
LUTHERAN CHURCH ISSUES REPORT ON PASTORAL CARE TO PWAS
~~H!!!,
June 18, 1986
AIDS is a challenge to the church, according to a useful new 8 page report from the American Lutheran Church (ALC) and
its Division for Mission and Service in America. The report has been sent to ALC congregations and pastors in an effort
to provide information and to stimulate discussion on the serious and frightening disease that has become a worldwide
concern. The disease 'calls for an enormous amount of sanity, sensitivity, compassion, and level-headedness on behalf
of the church and the society-at-large,' according to Rev. James Siefkes, Director of the division's Mission Discovery
project. The report was developed with information from the Centers for Disease Control, Lutherans Concerned/North
America (a Christian ministry for gay/lesbian understanding), and a number of AIDS service centers, hospices, chaplains
and doctors. Along with the research summaries of facts, figures, and myths of the disease in the paper. it also
addresses theological and pastoral issues. 'The congregation through its members and its pastoral ministry can offer
reconciliation, support, and consolation. The spiritual needs for faith, hope, forgiveness, reconciliation, human
caring and nonjudgmental, unconditional love are present •... For the pastoral care provider. the response to people with
AIDS should be the same response as to anyone in pain and distress from serious or terminal illness. Since the majority
of the patients with AIDS have thus far been gay men, clergy and church people must come to terms with both the diseases
of AIDS and homophobia; that is, fear, distress, and hostility toward gay and lesbian people.' The paper offers
several useful sections including: Facts and Myths, Some Reassuring Facts About Transmission, Pastoral Issues, The
Question of the Common Communion Cup, Things We Can Do, Recommendations for Reducing Exposure to AIDS. and a full page
of resources, references, bibljography and hot-line numbers. Copies of the report are available by writing to: Mission
Discoveries,. Division for Service and Mission in America, The American Lutheran Church, 422 South Fifth St.,
Minneapolis, MN 55415.
**************************************************
***********************************************************************************************************************
PWA COALITION NEWSLINE
by Michael Hirsch. Director. PWA Coalition, New York
We are the People With AIDS Coalition. Founded in April 1985 by a small group of people with AIDS arid ARC, and our
friends and suppo~ters, we are a volunteer, non-profit organization, whose main purposes are to gather and disseminate
information pertinent to PWAs/PWARCs and the community at large, and to foster and encourage the philosophy and practice
of personal eMpowerment to those diagnosed with AIDS and ARC. In our efforts to educate the community as to the needs
and experiences of PWAs/PWARCs, and to express our own feelings regarding our conditions, we have just successfully
published the 13th monthly issue of the f!A ~9~1!!!9~ M!!!li~!. The M!~li~! is a powerful tool, serving 3000
PWAs/PWARCs with an open forum to air their views and feelings, an up-to-date calendar on community events, resource
information, and traditional and holistic medical news and developments. Although we are New York-based, the issues
addressed in each M!!!l!~! are of universal appeal to the AIDS community nationwide. We are sure you will find the
material applicable to your organization and the people you serve. Because the information contained in each issue is
so vital. we are now making the monthly M!!!l!~! available at bulk subscription rates as follows: 12 copies per issue
for $50 per year; 25 copies for $70/yr; 35/$90; 50/$130; 75/$170; 100 copies/$225 per year. Individual subscriptions
may be acquired for a minimum donation of $20/year; PWAs/PWARCs, especially those receiving disability or assistance,
are not expected to contribute. For additional information, write: PWA Coalition, 263A West 19th St., #125, New York,
NY 10011.
°
**************************************************
CANADIAN EFFORTS CONTINUE TO RELEASE AIDS DRUGS
with thanks to the ~!! Y9~~ ~!!!y!. 6/16/86
Persons with AIDS Coalition (PWAC) is continuing its efforts to convince the Health Protection Branch (HPB) to release
experimental drugs for treatment of AIDS. Physicians who treat PWAs are frustrated because they cannot do more for
them. Dr. Hillary Wass is concerned that drugs illegally imported from Mexico may be of inferior quality and there is
no medical supervision of those taking them. Health and Welfare Canada will release drugs on 'compassionate grounds,'
providing there is a viral testing lab in British Columbia set up to monitor the blood samples.
Warren Jensen, the
founder of PWAC in Vancouver, reports that the STD Control Center in that city informed him that, after a committee
meeting. it was agreed that a lab site ought to be set up. No official word has come as to when this might take place,
reports Rob Joyce in Toronto's Ib! §9~~ f91i!i£. Jensen formed the Coalition March 18, and the group held a 'March on
Victoria" March 28. Currently volunteers are out on the streets collecting signatures for a petition that will be
delivered in June to the HPB. Jensen said people's response to the petition drive has ben supportive. PWAC needs help.
For information, contact Jensen at PWAC, Box 136, 1215 Davie Street, Vancouver, British Columbia, V6E lN4 Canada
(604/681-2789).
**************************************************
HEALTH CENTER BEGINS AIDS EDUCATION IN SYDNEY
with thanks to the New York Native. 6/30/86
The Albion Street Center of Sydney:--Aust~;iia began its campaign of posters for AIDS education, May 21. The posters
encourage people to call the center's AIDS hotline and information service. Aimed at teenagers, the posters feature a
popular drag queen troupe, T.H.E.M. The posters read "T.H.E.M. can read, can you?" The group is pictured reading AIDS
literature.
Jeffery Jackson, who organized the project, stated, "The posters are not designed to advocate antibody
screenings," but to encourage young people to seek information on AIDS and know where they can get advice and
counseli ng, reporOts the §~~!!!!~ §~~~ QE~!!~Y!!~.
**************************************************
COMICS TEACH ABOUT SEXUAL HEALTH ISSUES IN AUSTRALIA
by Kendall Lovett, with thanks to Boston's §~~ ~9~!:!!!!!~ ~!!!, 6/28/86
The Redfern and Marrickville Community Legal Centres have issued a comic book in the Streetwize series that deals with
sexual health issues for your people. This latest publication includes heal a dozen comic-style strips covering how to
avoid STDs and get treatment, the transmission of AIDS and AIDS prevention--as well as coping with getting your period
for the first time and the use of tampons: Streetwize lesbian cartoon artist Prue Borthwick said the ideas for the
comics come from young people and youth workers who also comment on the comic drafts before artwork is produced.
Intended to be humorous and down-to-earth, Streetwize hopes to provide easy access to information without the usual
requisite dose of moralizing.
**************************************************
LONDON AIDS HELPLINE FUNDS CUT IN HALF
with thanks to the New York Native, 6/30/86
The Terrence Higgins Trust,--Engl;nd's-~ajor AIDS helpline, has received only half the money they applied for'in May.
The Trust applied for 200,000 pounds, but only received 100,000. Tony Whitehead, chair of the trust, was "grateful'; for
the money, but criticized the government for "failing to recognize the urgency of the AIDS crisis." The grant. will be
used for staffing and administrative costs, as well as counseling services. In response to the hck of gevernment
funding, the United Kingdom AIDS Foundation was formed. as a charitable organization to encourage AIDS funding from
private and corporate sources. The foundation is a collaboration of the trust, doctors involved in AIDS research, and
the Body Positive Group, reports John Marshall in §~~ I!~!!.
**************************************************
***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7':5 * JUNE/JULY, 1986 * PAGE 23 *****
***********************************************************************************************************************
e8Q~!§!M§ 8~eQ8!§L §bQ~Y e!~!~8~
,
1M
e~81~
by Michael Helquist, with thanks to the ~~~bi~g~Q~ ~l~~~, 7/4/86
by MIchael Helqulst
PARIS, FRANCE-As Ihe AIDS
epidemic takes hold in every nalion,
researchers, health offICials, aod the general
public hope for some breakthrough advanCA:
that will signal the beginning of lhe end for
some breakthrough advanCA: thai wiU signal
lhe beginning of the eod for the devastating
disease. That hope was severely cIuollenged
during an international conferena: on
AIDS· held in Paris last week A few
promising reports of possible trea~ents and
vaccines brighlened an otherwise gloomy
picture of the disease spreading rampandy
througloOUI Africa, increasing stesdily in
Western nations, and threatening new risk
groups.
Nearly 3,500 resean:hers,. health care
professionals, and healtheducatorsattcnded
the three-day international conferenCA:,
sponsored by the Pasteur Institute and the
French government to scrutinize current
efforts to combat AIDS. ConferenCA:
organi.... said that more than 400
registrants from the United States had
C8nCA:Ued their plans to attend the gathering;
nevertheless, American and French
participants dominated the meetings.
Representatives from Asia, Australia
Africa, and South America-as weD as ~
few researchers from Eastern European
nations-also participated in the scienlific
SCS'lions. This gathering also marked the
grealest parlicipation and release of
information by African health officials and
rtsearchers.
Hopeful reportl oa 1....._1
American r....rchers provided some
gUnuner of hope with reports of early tests
with bone marrow USnsplants and with the
drugs AZT and rihavirin. Anlbony S. Fauci,
MD, head of the National Institule of
Allergy and InfecOOw; Diseases in Bethesda,
Maryland, announced that for Ibe first lime
a person with an immWlc system ,severely
damaged by AIDS had apparently regained
his notmal health and had been able to
return to work.
Fauci said Ihal the successful treatment
involved a combination of a bone marrow
transplant,lransfusions oflymphocytes, and
an anti-viral drug. He cautioned thai the
therapy has been effective for only one of
Ibree patients 10 receive it and that the
possible recovery has been sustained for'
only 10 monlhs to dale. The dev.\opmenl is
nevertheless important, he nuintained.
because il indicates for the firsl time the
possibilily of resloring an AIDS-damaged
immune system.
P12cticalapplicationsofthe treatmenl are
severely limited. Transplanting bone
marrow is extremely difficull due 10 the
need for close matches between thelissue of
donors and thai of recipienl<. The mosl
successful transplants occur between
identical twins; matches between .other
siblings or non-relatives offer much-reduccd
odds for succcs.<. Fauci himself advised
whether lhe AZT trials should becontinued.
"If lhe panel fmds a greal posilive
differenCA: belween lhose receiving the drug
and those receiving the pla""bo, then the
uial wiD be expanded to include more
palients," Broder told reporlen. If there is
nol a great differenCA:, he said, the more
Umited lrial wm continue. Broder refused to
name an approximate time for release of this
preliminary review, although he indicated
::::~::u;:,~tt~::=w~ ~~~
Broder also said thai two relatives of
AZT, named dideoxycytidene and
dideoxyadenosine, have also been shown to
block replication of the AIDS virus as well
as other reuoviruscs in viuo. Both were
shown to be "orally absorbable" during tests
with two laboralory dogs. R.... rche..
explain thai the eventual AIDS lreaunenl
would be much more convenient if it could
be administered in an onolform. Broder said
he hoped to have dideoxycytidene ready for
the forst pha.. ofclinicaltrials this summer.
The American researcher emphasized
that his studies involve subjects diagnosed
with fuD-blown cases of AIDS.
"I think it is very important to challenge
AIDS first in a fulminant stage," he said. "I
believe AIDS itself is a curable disea..."
Other r.... rchers have suggested thai it
may be 100 late to offer much help to people
with AIDS itself rather thin those with
symptoms, a condition termed ARC. or
AIDS-related complex.
C.S. Crumpacker, MD, of Boston
repofIed that the drug ribavirin was found
belpful to patient' in a firsl-phase study he,
conducted. During lbe eighl-week study,'
6ve patients with AIDS and 6ve with
IOseve~ ARC" were given oral doses of
ribavirin. Seven of the subjects became
virus-negative during the trial; when the
drug was stopped. all but two subjects
developed the virus apin. Crumpacker
noted that nbavirin was able to cross the
blood-brain banier and thus offered some
hope thai it will beabletocurtaa theactivily
of the virus in the brain. He added Ihat no
patient developed opportunistic infections
during the trials, that the presence of thrush
in the patients declined, and that side e(fects
were minimal.
Crumpacker said he was aware lhal
many people with AIDS and ARC have
obtained n'bavirin from sou""," in Mexico
and that they are self-administering the
drus, sometimes under the sopervision of
lheir private physicians. Although he said he
was wiDing "to give any advice he can" to
these patients' physicians, he said he thinks
tne DCSI proCA:dure for someone who wants
ueatment is "10 get into a properlyconUOUed, properly..upervised study."
Similar updates on drus trials were
presented by researchers looking at such
drugs as isoprinosine, HPA-23, interferon,
cyclosporine, rifabutin, and foscamet. All
continue to need further study to determine
their eventual usefulness.
Dr. Max Hirsch, AIDS reswcher from
physicians to discourage their patients (rom
80510n. attempted
seeking similar therapy until further testing
encouraging drug trial reports in a proper, if
sober. rontex!.
"lIt'fore we gel 100 excited ahoul Ibe
...ults from riba';rin or AZT." IIi"""
warned his rolleagucs, "I would remind you
of the enlhusiasm with which we greeted
suramin dum. last year's oonference in
Atlanta."
Trials with thai drug have been
discontinued due to the high toxicily il
presented 10 many subjects.
can occur.
Of much greater appticability were Ibe
reports of preliminary sucoess with the
experimental drus azidodeoxythymidine or
AZT. Samuel Broder, MD. ofthe National
Caner Instilule, said the 6rst evaluation of
the AZT trials currendy in progress will
occur later this summer, probably in
Augw;t The mulli""nter trials involve 260
American AIDS patients in double-blind,
placebo-controlled six-month studies.
Broder explained thai an independent
review panel will determine this summer
to place these
**************************************************
LEGAL RIGHTS &AIDS PAMPHLET AVAILABLE FROM NGRA
with thanks to
Ib~ ~~~biQ9!Q~ ~l~~~,
Reports of voedne developmenl
Two. biolechnology 6rms, both based i~
the Uruted States, announced al Ihe PAns
confe,renCA: .Ihal they h~d cond.ucted
ex~ments In test tubes WIth genetiCallyenglnee!"d
agents tha~ su~fully
protected ~uman cells from In~ by the
A IDS vnul. Representallv~s from
Genentech Inc. of San F~ a~
Oncogen orSeattleandothenworkl~wlth
TnuI"IIene of Strasbourg, France, said the
new experiments were encounging stepa
toward the. ev,:"tuaI development of &10
AIDS vleane.
Luc Montagnier, MD, of the Pasteur
Instilute, discoverer of .the AIDS virus
named LA V, cautioned that it will be along
time beforea vaccine can be put into general
use by man. Montagnier explained that the
development of tbe neuustizing antibodies
that resulted from the recent experiments
would fint have to be tested in animals
sensitive to the human viris, that is,
chimpanzees. He said the simian
experiments should be,concluded by the end
of the year.
Africans acknowledge AIDS .....
Noting lhat AIDS was first reported in
Africa in 1983, Dr. B.M. Klpita of
Kinshasa, Zaire, told his colleagues that the
disease was present almost everywhere in
Africa, but especially in ""nlral Africa.
"The scope of AIDS in Africa is not yel
known,~ Kapita said, "and the reason for
this is at least in pari because of Ibe
indifference of some African governments."
Although African nations from Algeria to
South Africa have reported more than 900
AIDS Clses to the World HeaUh
Organization, Kapita critici..d those
nations that have still not given any
in.ormation. He suggested that a more
significant approach to understandins
AIDS in Africa would be to IooIc at the
prevalenc:e or infection rather than just the
actual ca ... of the disease. Other researchers
remarked that non-African health olflCials
should reali.. that disease surveillance is
difficult in African nalions; they explained
that many governments do not undertake
significant moniloring of Jll8laria eithor. .
Earlier in June the World Health
Organizalion (WHO) estimated thai alleast
50,000 Africans may have contracted
AIDS since 1980 and a pooaoble one to two
million people on the continenl may be
symplomless carriers of the virus believed to
ca.... AIDS. In North and South American
and in Europe, more than 25,000 cases of
AIDS have been repoc1<d. R.... rchers
believe thai from one to two miUion people
in the United States may be infected.
As recendy as last November, during the
first international conference on African
AIDS held in Brussels, many African
nations resisted the e(forts to descn'be the
extent of the disease on the continent. In
Paria, however, a sipiflClJll proportion of
Ihe papers submitted .delailed the
prevalence of inrection amona risk groups
and othen in African nations.
J.B, Brunet, MD, of WHO referred to a
new category or COIDItries, "the preepidemic nations," characterized by a low
number of case, evidenCA: of low prevalence
or inf~on among high-risk groups, and
low public awareness of the seriousness or
the dise....
''1lois scenario holds uue for Eastern
.Europe, parts of Asia, and parts or
OCA:ania," Brunei said.
The WHO offICial said he considered the
spread of AIDS infection among oeedlesharing IV drus use" "Ihe mosl rerna rkable
evenl of 1985" in the .....oing story of
AIDS. He noled thai while AIDS primarily
slrikes Gay men -in northern Europe, the
majority of cases in southern Europe ocx:urs
among drus users. Brunei oommented lhal
Ihe numher of cases in Europe has been
doubling every -eighl months, and he
estimaled Ihallhe European nalions will see
more than 30,000 AIDS cases by the end of
1988.
Psychosocial .....rch
More than 1,000 !CientiflC papers were
presented in Paris, a number three times
greater than what was offered allast year's
conferena:. The broad range oflopicsofthe
variow; papers revealed how AIl.JS has
louched nearly every aspect of social and
scienti6c ronduct. Notable at th~ year's
ronferen"" was the importance given not
only 10 virology aod cUnical research but
also to psychosocial r....rch studies.
Several r....rcbers noted an increasing
number or AIDS patients with various
symptoms of damage to the cenusl nervou.<
system and the brain. Paul Volbetding, MD,
of San Francisco General Hospital
commented thai hospitals and health
resources could race a severe crisis if more
and more AIDS patients develop dementia
and other symptoms of brain damage.
Richard W. Price, psychosocial AIDS
researcher from New YDrk, estimated that
as many as 90 percent of patients will
develop some degree of cognitive disorder
as a result of their infection with the AIDS
virus. The symptoms ItIOSI frequendy
encountered include poor concenustion,
forgetfulness, loss of balance, leg weakness,
and social withdrawal. For ,Some AIDS
patients, Price observed, dementia is the
primary-and sometimes the oolymanifestalion of lbeir infection.
In another area of psychosocial research,
Jeffrey S. Mandel, PhD, MPH, of San
Francisco, reported that two out of three
Gay or bisexual men who are seropositive
or have ARC have not discussed their health
concerns with family members or
employers. This lendency also holds uue for
one out or three men with AIDS, accotditij
to the San Francisco stody. Mandel
emphasized that this reluctance to disclose
one's health status correlates with hesitancy
to be open ahout one's .. xual orientation.
"These men may be endangering their
health by delaying needed and timely
medical care," Mandel obeervul '"Many
delay seeking help until theonsetofan acute
medical or psychiatric crisis.~
Veteran Gay advocate Stuarl Nichols,
MD, of New York's Beth 1....1 Medical
Center, commented during a plenary
session of the conferena: that AIDS has
fOrced society to examine its ..xuality and
sexual practices, a process that has been
oonfusing and f/USlr8ting 10 many,
"EventuaUy I believe that we will
de~1op an advanced understanding and
appreciation or sexuality'" Nichols
observed.
Nichols suggesliOd that AIDS also causes
a psychological crisis for both those
immediately affected and for society at
large. Nichols said his work with people
with AIDS has convinced him that they can
serve as valuable role models for everyone.
The three days or meetings in Paris follow
the first such gathering held in Adanta in
April 1985. Recognizing that AIDS will
challenge the scientifIC community for some
years to come, conference organizers
scheduled next year's international meeting
for Washington, D.C. The 1988 meeting
will be held in Stockholm, Sweden,
followed by a conference in Montreal in
1989.
7/25/86
The National Gay Rights Advocates announced the availability of a free 8 page pamphlet designed to help non-lawyers
understand a number of legal issues they might be faced with after being diagnosed with AIDS, The pamphlet, entitled
"AIDS and Your Legal Rights,' answers such questions as: 'Can I be evicted from my apartment because I have AIDS?' 'What
public benefits can I ge\?" 'Who will make my financial and medical decisions if I'm too ill to make them for myself?'
"and 'Can my insurer refuse to pay AIDS or ARC-related claims?' To obtain a free copy, send a self-addressed stamped
envelope to National G9Y Rights Advocates, 540 Castro Street, San Francisco, CA 94114,
**************************************************
***********************************************************************************************************************
TRANSFUSION TRIAL BEGINS
with thanks to
g~!M,
7/29/86
SAN FRANCISCO .(AP)
A blood bank that provided contaminated blood given to a woman who died of AIDS was more
concerned about profits than patients, an attorney for the victim's family recently said. "Irwin (Memorial Blood
Bank) was concerned that if it began
to publicize
the AIDS threat of the high risk group, it would lose
donors ... which would cut down on the amount of blood it could sell and the amount of profit," said attorney
Fred
G. Meis, representing the family of Frances Borchelt. Mrs. Borchelt, 72, died on June 17, 1985, almost two years
after receiving blood transfusions during elective hip surgery. Her husband Robert filed a $2 million lawsuit
blaming
the San Francisco blood bank, the Medical Society of San Francisco and Seton Medical Center in Daly City
for his wife's death. Orthopedists
Clifford Raisbeck and Charles Owen and anesthesiologist Gordon Clees also
were named in the suit. As early as 1982, Meis said, blood bank officials became aware AIDS could be spread through
blood transfusions from
high-risk groups that included sexually active homosexual men. But he said the ·blood bank,
which provides blood to at least 45 Northern California hospitals,
was negligent
in
its
blood screening
process. He said a test developed during that period could have been used to detect the AIDS virus in donated blood,
but that the blood bank did not use that test because it was too expensive. Meis said the blood bank's donors were
supposed to fill out questionnaires regarding their medical histories so blood from high-risk groups would not be
taken. But he said the card from "Donor C," whose blood was given to Mrs.
Borchelt,
was
not properly
completed. The man was later identified as a homosexual who had had at least 50 sexual partners a year. Attorney Duncan
Barr, representing the blood bank, countered that there were no effective tests for AIDS at the time, and that the only
real hope of eliminating the virus from donated blood was if high-risk volunteer donors did not give blood. Barr said
"Donor e" had originally told the blood bank he was not a member of a high-risk group. He said the blood bank found
out that he was a homosexual only after Mrs. Borchelt contracted AIDS and the blood was traced. He said the bank did
not do the test for AIDS suggested by Meis because it was "ridiculously expensive" and had not been proven effective.
"Everything
Irwin did was not only within the standard of care of the time, but it went beyond the standard of
care ... They were a leader," Barr said. Meis also said that during
Mrs.
Borchelt's
surgery,
the
anesthesiologist gave her the transfusion needlessly because she only lost about 750 cubic centimeters of blood, not
enough to require a transfusion. Attorney David Lynch, representing Raisbeck and Owen, said she lost about 1,900
cubic centimeters of blood, or about 35 to 40 percent of her total volume.
**************************************************
BEHIND THE SCENES IN PARIS
------ ---by-Michael Helquist, with thanks to the ~~~h!ng~Qn §l~~!, 7/4/86
An American obsener of \he Gay
community's efforts 10 cope wilh Ihe
AIDS epidemic for lbe last rour years
migbl have felt. sense of tkja .u while
silling in !he seCond Door oIfrces of
AIDES. Ihe ·Paris-based AIDS
o'llani:ralion last week. Forseveral hours.
during tbe steamy. unseasonably wann
summer f''t'enil18. representatives from
European AIDS OIJanilJllions wrestled
with till' questions of Gay politics. sexual
politics. and A tOS prevention. Should •
statement to be issued durioi the Second
International AIDS Conference in Paris
reneel lhe senlimen" of Gay-identified
organi:rations fighling AIDS? Or are
Ihese grouJl'l professional education
agencies with no Ifliliation.~ to the
predominanl grouJl'l \hey serve? The
questi"" oecomes basic: How important
is it for an organization-based in Ihe
Gay community and fighting I disease
Ibal is devastating \hat population-IO
be seen as an objective. non-aligned
agency working for Ihil' good of Ihe
general public? A leas sober sort might
PUI it this way: "Is it o.k. for our rootJ 10
show?"
Answers 10 Iheae questions come no
more easily to !he Europeans than Ihey
did 10 !heir American counlerpartJ
months. if nol years, earlier.
Representatives from Ihe French group
do nOl want 10 be aligned to a Gay
identity; neitlll'r do the EDllish from Ihe
Terrence Hillin. Trust or the Gennans
from DeutJche AIDS-Hilfe. Tbey reason
Ibat Ihey must serve more \han Gay
people and Ihus Ihey should not limit
Ibeir appeal. Olher groups and especially
the Gay activists want to gain
reCDJIIilion for Ibe hard work of Gay
people fighting a public heallh crisis Ibat
affectJ all. WiD governmentJ provide
fundiDlIO groups that are considered 10
be Gay? Will Gay people support or
liSlen to groups lhat present \hemselves
as sexuaUy neutral?
Tbe wraDlling and negotialing in Ihe
Paris otrrces last week did not seem
irrelevln~ ra\her they seemed part of a
necessary evolution, I painstaki..ly
slow process considering Ihe dimensions
0[ a Ihreal thai grows rampanlly
Ihroughoul Europe.
Tbere was once competition. and
lIOmetimes jealousy, am""g \he AIDS
o'llani7Jltions in !he Unired Stales, but
the challenges 10 coojIerale for Ihe
Europeans are much Kreater than
anythiDl lhe Americans faced. AIDS
workers in Europe represenl nati""al
cultures often sreeped in disrespect for
Iba r neigbbors.
Tbe bollOm tine for the European
AIDS workers is:: as annoyi.. and
vexing as it may be, !here is an absolule
need 10 work togelher. In Ihis ligh~ Ihe
cooperative effortJ \hat have emerged
among the European groups Ire
sWnmeant.
Tbe safe sex postOr developed by Ihe
Gennan AIDS o'llani7Jltion has been
adopled by Ihe E..lish and Ihe French.
Tbe HOI Rubber eampa;,n developed in
Switzerland has now been incorporated
Into French and Gennln efforts, and
other nations are ready to follow suil.
And many of \he European countries
recenlly fonned the European AIDS
Foundation. an organilJltion that faces
considerable challenges if it i" 10
**************************************************
successfully negotiale !he controversies
of so many different inleresls. The
Europeans meet regularly and compare
notes, 51udy each other's brocbures, sare
sex videos, and organi7JltionaJ stnrclures.
Many of"the o'lliJIizalions subsidize
facl-finding trips 10 New York, San
Francisco, and los Angelea 10 leam Ihe
lalest AIDS stralegies in Ihe States. A
few grouJl'l-lbose in Norway. Fmnce,
and Gennany-invile Aliiedcans 10 lour
less of a strange cone<pllO Gay men. and
Ibe drop in STD tBtes provide evidence
of behavior cha..es undertaken.
AI Ihe same time Ibe Europeans ra""
some difficulties Ihal Amerieans have
not encountered. For example,
American groups could not ha ve
developed, and many could nol provide
Ibe services Ihey do !aday. wilhoullhe
conlinuing . effortJ or hundreds of
volunleers. Many European nalions.
their countries to help educate about
however. do not have a cultural tradilion
AIDS preventioti and service needs.
of volunleerism. due paroy 10 lbe sociaJ
welfare policies of Ibar governments.
The Europeans know ahal lhey are
runniDl oul of lime. IhIt Iheir early
advanlaJ< of few eases bulgrealer AIDS
awareness will nol last much longer. If
nOlhiDl dse Ibe Americans have a very
direct, if humble. message for lhe
Europeans-as well as for Ihe
Australians, Asians. Africans, and
anyone else ahal will lisren-"l.earn
from our misraIces: don'l delay; do .n
Ihal you can now 10 prevent !he spread of
Ihis disease."
Afler much more discussion. much
srnokiDl. and a few ultimatums (one
French activist asserl<ld, "I won't silll
anything Ihal refers 10 'Ihe Gay
community'; Ihatlenn i. foreillllO us"),
a state men I WIS finilly drafted.
approved, Ind sillled by more llvin 30
Gay and AIDS OlJlanil.aiions. It. called
upon all governments, Ihe World Heallh
American workers in what has
become !he AIDS industry mighl be
surprised at the similar challenges faced
by Ihe Europeans. The Genna... for
e.ample. musl counleraCl Ihe right-wiDJ
campaigns of followers of' Lyndon
l!!.\!.ouche. The Gennans also face an
administration unwilling to allow
graphic laDlDage in AIDS eduation
brochures it funds.
Tbe French find that many saWII and
back room bar owners are reluctant 10
support AIDS prevention efforts. In fact,
Ibe most popular saunas Ind backrooms
In Paris provide no AIDS education
materials: no posters, no brochures, and
no complimentary rubbers.
By contras~ a casual strolllhrough a
popular bathhouse in Zurich,
Switzerland, resembles I safe sex
classroom as much as it does I sexual
emporium (The Swiss also boast thai it
is now possible 10 walk into any Gay bar
and order a cold beer and a hoi rubber.)
Many Gennan saunas also post AIDS
prevention signs and distnbute free
condoms. The Ge"""". report that
rluring the last year safe sex has become
Organization. the European \Commun~
ity. and the Counc,l of Europe 10 provide
more funds for prevention, education,
and Jl'lychosocial services.
'.
- Mltbael Helquill
CENTERS FOR DISEASE CONTROL
May 2,1986/ Vol. 35/ No. 17
TABLE 5. Alternate testing site activities -
Mtl'lR
MORBIDITY AND MORTALITY WEEKLY REPORT
Area
284 HTLV-III/LAV Antibody Testing at
Alternate Sites
Testing
sites
Pretest
sessions
Persons
tested
Post-test
sessions
Percent
positive"
874
93.917
79,083
55.499
17.3
4
1
19
7
1
0
42
73
0
1,400
308
0
42
429
110
600
695
0
42
53
110
450
214
0
9.5
9.8
2.7
11.8
10.6
8
275
4
7
2,376
7,042
1,844
2.204
1.697
2.032
1.818
1.608
1.254
2.032
246
1.333
9.0
30.7
13.5
10.1
7
9
3
5
30
3.174
3.338
280
2,633
1.050
2.780
827
221
1.897
1.021
2,500
756
0
303
1.010
17.2
18.1
13.1
15.1
12.2
4
11
12
2
2
11
18
1,730
947
1.241
120
4
235
651
1,717
947
1.026
120
4
199
306
1.614
67
851
120
4
141
289
13.8
7.1
18.6
5.0
50.0
24.6
9.8
7
26
2
5
7
93
46
10
23
785
1.586
1.269
687
269
923
1.131
525
6.074
198
1,467
1.235
611
240
711
1,064
554
5.8.11
190
952
1.235
587.
178
461
990
161
3,756
8.1
12.7
19.0
15.1
11.7
18.3
12.0
12.3
21.4
5
5
5
14
417
946
564
150
152
684
518
143
132
513
70
0
17.1
13.0
16.4
18.2
1
7
7
27
120
1.644
711
8.773
106
921
691
7.564
93
695
595
5.379
17.9
23.3
21.4
12.5
7
1
1
10
6
1
21
3
170
137
0
4.252
434
662
216
984
177
'380
39
4.252
243
427
416
458
168
109
1
4.252
170
427
148
63
6.8
e.4
0.0
41.5
17.3
20.1
39.4
13.8
UNITED STATES
New England
Maine
N.H.
Vt.
Mass.
R.I.
Human T-Lymphotropic Virus Type 111/
Lymphadenopathy-Associated Virus Antibody Testing at Alternate Sites
On March 2. 1985. an enzyme-linked immunosorbant assay (ELISA) test to detect antibodies to human T -Iymphotropic virus type III/lymphadenopathy-associated virus (HTLV-IIII
LAV) was licensed by the U.S. Food and Drug Administration to screen blood and plasma collected for transfusion or manufactured into other products. Since it was recognized that many
individuals in groups at high risk for AIDS might want testing to determine their antibody
status. federal funds for alternate testing sites were made available so that HTLV-III/LAV antibody tests could be obtained free of charge outside the blood-bank setting. A primary goal
was to protect the nation's blood.,supply by limiting the potential for donation of falsenegative units. The alternate sites were also needed to ensure that individuals wishing to be
tested would receive appropriate pretest counseling. post-test counseling. and referral for
medical evaluation. if indicated.
Cooperative agreements between CDC and 55 state and .local health departments began
April 26. 1985. The cooperative agreements were for a 90-day period. since they were intended to defray start-up costs only. Most agreements were subsequently extended for an
additional 90 days without additional funding at the request of the individual health departments. Preliminary data on the activities supported by the cooperative agreements were
reported to CDC in September 1985 and January 1986. As of September 6. 1985. at least
one alternate testing site had been established by 52 of the 55 project areas; an estimated
518 sites had been established nationwide; and 21.200 persons had been tested.
Activities increased substantially during the last quarter of 1985. By December 31. 1985.
874 testing sites had been established in 53 project areas (Table 5). This total included 275
sites in New York City located in private physicians' offices. Nationwide. 79.100 persons had
been tested. Pretest counseling had been provided to 93.900 persons. and post-test counseling. to 55.500. A total of 17.3% of the individuals tested at these sites had repeatedly reactive
ELISA tests. No relationship was noted between the number of acquired immunodeficiency
syndrome (AIDS) cases reported in a particular project area and the number of tests performed at alternate sites (Table 6).
Conn.
Mid-Atlantic
Upstate N.Y.
N.Y. City
N.J.
Pa.
E.N. Central
Ohio
Ind.
III.
Mich.
Wis.
W.N. Central
Minn.
Iowa
Mo.
N. Dak.
5. Dak.
Nebr.
Kans.
S. Atlantic
Del.
Md.
D.C.
Va.
W.Va.
N.C.
S.C.
Ga.
Fla.
E.S. Central
Ky.
Tenn.
Ala.
Miss.
W.S. Central
Ark.
La.
Okla.
Tex.
Mountain
Mont.
Idaho
Wyo.
Colo.~~ ~RIt4-rc.M.f.
Erratum: Vol. 35, No. 17
p.285
In the article. "Human T -Lymphotropic Virus Type III/Lymphadenopathy-Associated
Virus Antibody Testing at AHernate Sites." the figures in Table 5 for Colorado are incorrect. The correct figures are: Testing sites-10; Pretest sessions-4,316; Persons tested-4.316; Post-test sessions-4.316; and Percent positive-12.0.
United States, 1985
N.Mex.
Ariz.
Utah
Nev.
'On at least two ELISA tests.
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TABLE 5. Alternate testulg site activities - United States, 1985 (Continued)
Area
Testing
sites
Pacific
Wash.
Oreg.
Calif.
San Fran.
Alaska
Hawaii
Guam
P.R.
V.1.
Pac. Trust Terr.
18
15
51
2
5
1
0
2
0
0
Pretest
sessions
Persons
tested
Post·test
sessions
Percent
positive"
3,136
829
17.121
5.898
824
793
0
595
0
0
2.569
1.435
17.546
5.898
915
658
0
904
0
0
2.330
829
11.552
5.047
77
599
0
351
0
0
12.7
21.2
13.7
19.9
9.3
17.3
TABLE 6. Reported AIDS cases and tests for HTLV-III/LAV antibody performed at alternate sites, for 10 project areas - United States, 1985"
40.7
'On at least two ELISA tests.
Reported by Div of Sexually Transmitted Diseases, Center for Prevention Svcs. CDC.
Editorial Note: Many of the project areas reported they had underestimated the difficulty of
establishing alternate sites on a short-term basis. Start-up delays were common because of
administrative procedures and such factors as general hiring freezes and the development of
systems to assure strict confidentiality of all records related to counseling and clinicallaboratory test results. Moreover, the initial demand for services was less than most areas had anticipated. The number of tests performed in each area depended on many factors. including accessibility of services. perception of the benefits or risks of testing, and awareness of the existence of services by those at risk. The utilization of the sites varied widely in both high and
low AIDS-incidence areas (Table 6). perhaps indicating that demand for testing depends on
the degree to which it is encouraged and made accessible for persons at risk. In one project
area with a high test-to-case ratio. testing was actively promoted by both public health authorities and AIDS risk-group representatives ( 11.
The gO,al of protecting the blood supply by providing alternate sites at which persons
could be tested was achieved. In addition. experience with the HTLV-III/LAV ELISA tests since
licensure in March 1985 has shown them to be remarkably sensitive and specific (2) and to
be useful, not only for preventive purposes. but also for the diagnosis and differential diagnosis of clinical illness. An evaluation of the tests used to screen blood donors in a large metropolitan area showed a specificity of 99.8% (31. Thus. they have value in identifying individuals
who are infected, and who are likely to be able to transmit the infection to others by the established routes of transmission. even if such individuals themselves are asymptomatic.
Accordingly, the U.S. Public Health Service has proposed additional applications to prevent
perinatal transmission (4) and to help reduce drug abuse-related and sexual transmission of
HTLV-III/LAV virus by infected persons (51. The main purpose of the additional applications is
to facilitate identification of seropositive asymptomatic persons. both for medical evaluation
and for counseling to prevent transmission. Reduction of sexual and drug-related transmission
of HTLV-II\(LAV should be enhanced by using available serologic tests to give asymptomatic.
infected individuals in high-risk groups the opportunity to know their status so they can take
appropriate steps to prevent further transmission (6).
The wide network of alternate testing sites that has been established by state and local
health departments. frequently in cooperation with local community groups. may facilitate extension of testing services to selected populations at increased risk for HTLV-III/LAV infection.
References
1. Judson FN. Personal communication.
2. CDC. Update: Public Health Service Workshop on Human T-Lymphotropic Virus Type iii Antibody
Testing - United States. MMWR 1985 ;34:4 77 -8.
3. Ward JW. Grindon AJ. Fiorino PM. Laboratory and epidemiological evaluation of an enzyme immunoassay for antibodies to human T -Iymphotropic virus. type iii. JAMA (in press).
4. CDC. Recommendations for assisting in the prevention of perinatal transmission of human T-Iymphotropic virus type iii/lymphadenopathy-associated virus and acquired immunodeficiency syndrome.
MMWR 1985;34:121-6.731-2.
5. CDC. Additional recommendations to reduce sexual and drug abuse-related transmission of human
T -Iymphotropic virus type iii/lymphadenopathy-associated virus. MMWR 1986;35: 152-5.
6. Handsfield HH. Dunphy CA. 80nin P. Unpublished data.
'
Project area
Reported AIDS cases t
HTlV-lII/lAV tests
2.140
1.923
516
483
460
61
53
33
13
5
2.032
23.444
5.811
7.564
1.818
4.252
2.780
1.435
947
915
New Yorkfity
California
Florida
Texas
New Jersey
Colorado
Ohio
Oregon
Iowa
Alaska
United States
Tests per case
1.0
12.2
11.3
15.7
4.0
69.7
52.5
43.5
12.9
183.0
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8.072
79,083
9.8
'This table shows five project areas with the highest number of reported cases and five project areas
with the highest rates of tests per case.
tprovisional totals reported to MMWR through week 52. 1985.
§Includes the separately funded San Francisco project area.
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CENTERS FOR DISEASE CONTROl.
Mtl'lR
May 16. 1986/ Vol. 35/ No. 19
304 Plasmid-Mediated TetracyclineResistant Neisserkl gonorrhoeae G~orgia. Massachusetts. Oregon
Epidemiologic Notes and Reports
Plasmid-Mediated Tetracycline-Resistant Neisseria gonorrhoea"eGeorgia, Massachusetts, Oregon
CDC has confirmed 79 cases of plasmid-mediated tetracycline-resistant Neisseria gonorrhoeae infection (TRNG) between February 1985, when it was first identified, and March 14.
1986. Three of the 79 cases. all from Massachusetts, have been confirmed as combined
tetracycline-resistant penicillinase-producing N. gonorrhoeae (TRNG-PPNGI. Sixty-five (82%)
of the confirmed TRNG cases were isolated from three states-Georgia (31 cases), Massachusetts (23). and Oregon (101. The Georgia and Massachusetts cases were identified as a
result of a collaborative surveillance with CDC. Georgia's Fulton and DeKalb County health
--.I
<TI
<D
CD
of gonococcal infections (5). Because of the increasing geographic distribution and the complexity of antimicrobial resistance in N. gonorrhoeae and the increasing need for effective surveillance for new cases, CDC is preparing comprehensive guidelines for susceptibility testing,
departments (metropolitan Atlanta) conducted active TRNG surveillance in the fall of 1985.
Massachusetts has an ongoing statewide surveillance program for gonococcal resistance.
The Oregon cases are all from an outbreak among homosexual men in the Portland area, and
a brief report follows.
On October 22, 1985, a 32-year-old homosexual male presented to the sexually transmitted disease (STD) clinic in Multnomah County, Oregon, with a 3-day history of urethral discharge and dysuria. A diagnosis of gonorrhea was made, and because the patient was allergic
to penicillin, oral tetracycline was prescribed. On returning to the clinic 1 week later, the patient was still symptomatic and had a positive urethral culture for N. gonorrhoeae. Sensitivity
testing by disk diffusion demonstrated a zone size to tetracycline of 13 mm (sensitive strains
vyere defined as having disk diffusion zone sizes greater than 30 mm). The isolate was confirmed by CDC as high-level TRNG with a minimum inhibitory concentration of 32 J.Lg/ml.
Bet~een October 22, and December 26, 1985, 'nine other CDC-confirmed TRNG cases
were identified at the Multnomah County STD clinic on the basis of disk-diffusion testing results. All patients were homosexual males infected at rectal (three patients), urethral (two),
rectal and urethral (four), and pharyngeal (one) sites. All four patients treated with tetracycline
alone were treatment failures, and one of these had developed clinical orchitis since his initial
clinic visit. All cases were of the same auxotype and serovar class, suggesting the isolates
were of a clonal origin. Six additional cases of gonococcal disease, including two out-of-state
cases, were diagnosed by contact-tracing. Two cases were tetracycline treatment failures;
two were TRNG on the basis of disk-diffusion testing (zone size less than 20 mm); and two
were not tested. Nineteen contacts, including 15 bathhouse contacts of one patient, could not
be traced due to lack of adequate identifying and locating information.
In response to this outbreak, the Multnomah County Health Department instituted ceftriaxone as the drug of choice for all gonococcal infections among homosexual males. Educational
efforts targeted at both the professional and lay community w!lre intensified toward increas-
References
1. CDC. Tetracycline-resistant Neisseria gonorrhoeae-Georgia. Pennsylvania, New Hampshire. MMWR
1985;34:563-4,569-70.
2. Ashford WA, Potts OW, Adams HJU, et al. Spectinomycin-resistant penicillinase-producing Neisseria
gonorrhoeae. lancet 1981 ;11: 1035- 7.
3. Piziak MV, Woodbury C, Berliner 0, et al. Resistance trends of Neisseria gonorrhoeae in the Republic
of Korea. Antimicrob Agents Chemother 1984;25:7 -9.
4. Rice RJ, Biddle JW, Jeanlouis VA, DeWitt WE, Blount JH, Morse SA. Chromosomally mediated resistance in Neisseria gonorrhoeae in the United States: results of surveillance and reporting 1983-1984.
J Infect Dis 1986; 153:340-5.
5. CDC. 1985 STD treatment guidelines. MMWR 1985;34(suppI4S):75S-108S.
CENllRS FOR DISEASE CONTROl
MtlWR
ing TRNG awareness.
Reported by B Carlson. F Myers, L Mofenson, H George, Massachusetts State Laboratory Institute, G
Grady. MD, State Epidemiologist Massachusetts Dept of Public Health; RW Hill, CP Schade, J Kolden, J
Mitchell. G Sawyer, M Ware. V Fox. J Karius. H Horton. Multnomah County Dept of Human Svcs; R
Poole. R Miller, R Blumberg. DeKalb County Board of Health, Decatur, Georgia; Sexually Transmitted Disease Laboratory Program. Center for Infectious Diseases. Epidemiology Research Br, Div of Sexually
Transmitted Diseases. Center for Prevention Svcs, CDC.
Editorial Note: The geographic dispersion of TRNG strains since the original MMWR report
in September 1985 (1) has .been impressive. The rapid onset of the outbreak in Portland and
the large number of untraceable contacts elicited from several of the patients underscore the
potential for rapid dissemination of new gonococcal strains into a community.
The identification of combined PPNG-TRNG strains in Massachusetts once again demonstrates the ability of N. gonorrhoeae to acquire multiple drug-resistant determinants. This includes such combinations as plasmid-mediated resistance (e.g., PPNG-TRNG)' plasmid and
chromosomally-mediated resistance (e.g., spectinomycin-resistant PPNG) (2,3), or chromosomally-mediated resistance to multiple antibiotics (4).
The largest numbers of TRNG cases were described from areas where active surveillance
programs were in operation. With the exception of testing for f3-lactamase, most areas in the
United States do not routinely perform antimicrobial susceptibility testing on gonococcal isolates. Therefore, the incidence of resistant strains that do not present as treatment failures is
not known.
Tetracycline (doxycycline, minocycline) therapy alone is not recommended for the treatment
May 23,1986/ Vol. 35/ No. 20
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334 Classification System for HTlV-lII/lAV
Infections
Current Trends
Classification System for Human T-Lymphotropic Virus Type 111/
Lymphadenopathy-Associated Virus Infections
INTRODUCTION
Persons infected with the etiologic retrovirus of acquired immunodeficiency syndrome
(AIDS) ( 1-4)' may present with a variety of manifestations ranging from asymptomatic infection to severe immunodeficiency and life-threatening secondary infectious diseases or cancers. The rapid growth of knowledge about human T -Iymphotropic virus type 1111
lymphadenopathy-associated virus (HTLV-III/LAV) has resulted in an increasing need for a
system of classifying patients within this spectrum of clinical and laboratory findings attributable to HTLV-III/LAV infection (5-7).
Various means are now used to describe and assess patients with manifestations of
HTLV-III/LAV infection and to describe their signs, symptoms, and laboratory findings. The
surveillance definition of AIDS has proven to be extremely valuable and quite reliable for some
epidemiologic studies and clinical assessment of patients with the more severe manifestations
of disease. However, more inclusive definitions and classifications of HTLV-III/LAV infection
are needed for'optimum patient care, health planning, and public health control strategies, as
well as for epidemiologic studies and special surveys. A broadly applicable, easily understood
classification system should also facilitate and clarify communication about this disease.
In an attempt to formulate the most appropriate classification system, CDC has sought the
advice of a panel of expert consultants t to assist in defining the manifestlltions of HTLV -1111
LAV infection.
GOALS AND OBJECTIVES OF THE CLASSIFICATION SYSTEM
The classification system presented in this report is primarily applicable to public health
purposes, including disease reporting and surveillance. epidemiologic studies, prevention and
control activities, and public health policy and planning.
Immediate applications of such a system include the classification of infected persons for
reporting of cases to state and local public health agencies, and use in various disease coding
and recording systems, such as the forthcoming 10th revision of the International Classification of Diseases.
"'T1
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DEFINITION OF HTLV-III/LAV INFECTION
The most specific diagnosis of HTLV-III/LAV infection is by direct identification of the
virus in host tissues by virus isolation; however, the techniques for isolating HTLV-Ill/LAV currently lack sensitivity for (selecting infection and are not readily available. For public health
purposes, patients with repeatedly reactive screening tests for HTLV-III/LAV antibody (e.g.,
enzyme-linked immunosorbent assay) in whom antibody is also identified by the use of supplemental tests (e.g., Western blot, immunofluorescence assay) should be considered both infec!cld and infective (8-101.
Although HTLV-Ill/LAV infection is identified by isolation of the virus or, indirectly, by the
presence of antibody to the virus, a presumptive clinical diagnosis of HTLV-Ill/LAV infection
has been made in some situations in the absence of positive virologic or serologic test results.
There is a very strong correlation between the clinical manifestations of AIDS as defined by
CDC ond the presence of HTLV-Ill/LAV antibody (11-141. Most persons whose clinical illness
fulfills the CDC surveillance definition for AIDS will have been infected with the virus ( 12- 74).
CLASSIFICATION SYSTEM
This system classifies the manifestations of HTLV-Ill/LAV infection into four mutually exclusive groups, designated by Roman numerals I through IV (Table 5). The classification
system applies only to patients diagnosed as having HTLV-IlIILAV infection (see previous section, DEFINITION OF HTLV-III/LAV INFECTION), Classification in a particular group is not
explicitly intended to have prognostic significance, nor to designate severity of illness. However, classification in the four principal groups, I-IV, is hierarchical in that persons classified in a
particular group should not be reclassified in a preceding group if clinical findings resolve,
since c!inical improvement may not accurately reflect changes in the severity of the underlying
disease.
Group I includes patients with transient signs and symptoms that appear at the time of, or
shortly after, initial infection with HTLV-III/LAV as identified by laboratory studies. All patients
in Group I will be reclassified in another group following resolution of this acute syndrome.
, Group II includes patients who have no signs or symptoms of HTLV-III/LAV infection. I-'atients in this category may be subclassified based on whether hematologic and/or immunologic laboratory studies have been done and whether results are abnormal in a manner consistent with the effects of HTLV-III!L.AV infection.
Group III includes patients with persistent generalized lymphadenopathy, but without findings that wo~ld lead to classification in Group IV. Patients in this category may be subclassified based on the results of laboratory studies in the same manner as patients in Group II,
Group IV includes patients with clinical symptoms and signs of HTLV-III/LAV infection
other than or in addition to lymphadenopathy, Patients in this group are assigned to one or
more subgroups based on clinical findings. These subgroups are: A. constitutional disease;
B, neurologic disease; C. secondary infectious diseases; D. secondary cancers; and E. other
"The AIDS virus has been variously termed human T-Iymphotropic virus type III (HTLV-III),
lymphadenopathy-associated virus (LAVI. AIDS-associated retrovirus (ARVI. or human immunodeficiency virus (HIVj, The designation human immunodeficiency virus (HIV) has recently been proposed by a
subcommittee of the International Committee for the Taxonomy of Viruses as the appropriate name for
the retrovirus that has been implicated as the causative agent of AIDS (4).
t The following persons served on the review panel: OS Burke, MD, RR Redfield. MD, Walter Reed Army
Institute of Re.search, Washington. DC; J Chin. MD. State Epidemiologist. California Department of
Health Services; LZ Cooper. MD. St Luke's-Roosevelt Hospital Center. New York City; JP Davis. MD.
Stale Epidemiologist. Wisconsin Division of Health; MA Fischl. MD. University of Miami School of Medicine. Miami. Florida;'G Friedlimd. MD. Albert Einstein College of Medicine. New York City; MA Johnson,
MD. 01 Abrams. MD. San Francisco General Hospital; 0 Mildvan. MD. Beth Israel Medical Center, New
York City; CU Tuazon. MD. George Washington University School of Medicine. Washington. DC; RW
Price. MD. Memorial Sloan-Kettering Cancer Center. New York City; C Konigsberg. MD. Broward County
Public Health Unit. Fort Lauderdale. Florida; MS Gottlieb. MD. University of California-Los Angeles
Medical Center; representatives of the National Institute of Allergy and Infectious Diseases. National
Cancer Institute. National Institutes of Health; Center for Infectious Diseases. CDC,
conditions resulting from HTLV-III/LAV infection. There is no a priori hierarchy of severity
among subgroups A through E, and these subgroups are not mutually exclusive.
Definitions of the groups and subgroups are as follows:
Group I. Acute HTLV-III/LAV Infection. Defined as a mononucleosis-like syndrome, with
or without aseptic meningitis, associated with seroconversion for HTLV-III/LAV antibody
(15-161. Antibody seroconversion is required as evidence of initial infection; current viral isolation procedures are not adequately sensitive to be relied on for demonstrating the onset of
infection.
Group II. Asymptomatic HTLV-III/LAV Infection. Defined as the absence of signs or
symptoms of HTLV-III/LAV infection. To be classified in Group II. patients must have had no
previous signs or symptoms that would have led to classification in Groups III or IV.·Patients
whose clinical findings caused them to be classified in Groups III or IV should not be reclassified in Group II if those clinical findings resolve.
Patients in this group may be subclassified on the basis of a laboratory evaluation. Laboratory studies commonly indicated for patients with HTLV-III/LAV infection include, but are not
limited to. a complete blood count (including differential white blood cell count) and a platelet
count. Immunologic tests, especially T-Iymphocyte helper and suppressor cell counts, are
also an important part of the overall evaluation. Patients whose test results are within normal
limits, as well as those for whom a laboratory evaluation has not yet been completed, should
be differentiated from patients whose test results are consistent with defects associated with
HTLV-III/LAV infection (e.g .• lymphopenia, thrombocytopenia, decreased number of helper
[T 4 1T -lymphocytes).
Group III, Persistent Generalized Lymphadenopathy (PGL). Defined as palpable lymphadenopathy (lymph node enlargement of 1 cm or greater) at two or more extra-inguinal
sites persisting for more than 3 months in the absence of a concurrent illness or condition
other than HTLV-III/LAV infection to explain the findings. Patients in this group may also be
subclassified on the basis of a laboratory evaluation, as is done for asymptomatic patients in
Group II (see above). Patients with PGL whose clinical findings caused them to be classified in
Group IV should not be reclassified in Group III if those other clinical findings resolve.
Group IV. Other HTLV-III/LAV Disease. The clinical manifestations of patients in this
group may be designated by assignment to one or more subgroups (A-E) listed below. Within
Group IV. subgroup classification is independent of the presence or absence of lymphadenopathy. Each subgroup may include patients who are minimally symptomatic, as well as patients who are severely ill. Increased specificity for manifestations of HTLV-III/LAV infection.
if needed for clinical purposes or research purposes or for disability determinations, may be
achieved by creating additional divisions within each subgroup.
Subgr~-~ .~ Constitutional disease. Defined as one or more of the following: fever perSisting more than 1 month. involuntary weight loss of greater than 10% of baseline, or diarrhea persisting more than 1 month; and the absence of a concument illness or condition
other than HTLV-III/LAV infection to explain the findings.
Subgroup B. Neu~oIogic disease. Defined as one or more ~f the following: dementia,
myelopathy, or peripheral neuropathy; and the absence of a concurrent illness or condition
other than HTLV-Ill/LAV infection to explain the findings.
~bgroup C. ~condary infectious diaeases. Defined as the diagnosis of an infectiOUS
disease associated with HTLV-III/LAV infection and/or at least moderately indicative of a
defect in cell-mediated immunity. Patients in this subgroup are divided further into two
categories:
'
Category C-l. Includes patients with symptomatic or invasive disease due to one of 12
specified secondary infectious diseases listed in the surveillance definition of AIDS§:
:neu,:,ocystis carinii pneumonia, chronic cryptosporidiosis, toxoplasmosis, extraIOtestlOal strongyloidiasis, isosporiasis, candidiasis (esophageal, bronchial, or pulmona,:), cryptococcosis. histoplasmosis, mycobacterial infection with Mycobacterium
aVlum complex or M. kansasi;' cytomegalovirus infection. chronic mucocutaneous or
disseminated herpes simplex virus infection, and progressive multifocal leukoencephalopathy.
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Category C-2. Includes patients with symptomatic or invasive disease due to one of six
other specified secondary infectious diseases: oral hairy leukoplakia, multidermatomal
herpes zoster. recurrent Salmonella bacteremia, nocardiosis, tuberculosis. or oral candidiasis (thrush).
Subgroup D. Secondary cancers. Defined as the diagnosis of one or more kinds of cancer
known to be associated with HTLV-III/LAV infection as listed in the surveillance definition
of AIDS and at least moderately indicative of a defect in cell-mediated immunity~: Kaposi's
sarcoma. non-Hodgkin's lymphoma (small. noncleaved lymphoma or immunoblastic sarcomal. or primary lymphoma of the brain.
Subgroup E. Other conditions in HTLV-III/LAV infection. Defined as the presence of
other clinical findings or diseases, not classifiable above, that may be attributed to HTLV-III/
LAV infection and/or may be indicative of a defect in cell-mediated immunity. Included are
patients with chronic lymphoid interstitial pneumonitis. Also included are those patients
whose signs or symptoms could be attributed either to HTLV-IIVLAV infection or to another
coexisting disease not classified elsewhere, and patients with other clinical illnesses, the
course or management of which may be complicated or altered by HTLV-III/LAV infection.
Examples include: patients with constitutional symptoms not meeting the criteria for subgroup IV-A; patients with infectious diseases not listed in subgroup IV-C; and patients with
neoplasms not listed in subgroup IV-D.
Reported by Center for Infectious Diseases. CDC.
Editorial Note: The classification system is meant to provide a means of grouping patients
infected with HTLV-III/LAV according to the clinical expression of disease. It will require
periodic revision as warranted by new information about HTLV-IIVLAV infection. The defini-
tion of particular syndromes will evolve with increasing knowledge of the significance of certain clinical findings and laboratory tests. New diagnostic techniques, such as the detection of
specific HTLV-III/LAV antigens or antibodies. may add specificity to the assessment of patients infected with HTLV-III/LAV.
The classification system defines a limited number of specified clinical presentations. Patients whose signs and symptoms do not meet the criteria for other groups and subgroups,
but whose findings are attributable to HTLV -III/LAV infection. should be classified in subgroup IV-E. As the classification system is revised and updated. certain subsets of patients in
subgroup IV-E may be identified as having related groups of clinical findings that should be
separately classified as distinct syndromes. This could be accomplished either by creating
additional subgroups within Group IV or by broadening the definitions of the existing subgroups.
***
Persons currently using other classification systems (6-7} or nomenclatures (e.g .• AIDSrelated complex. lymphadenopathy syndrome) can find equivalences with those systems and
terminologies and the classification presented in this report. Because this classification
system has only four principal groups based on chronology. presence or absence of signs and
symptoms. and the type of clinical findings present. comparisons with other classifications
based either on clinical findings or on laboratory assessment are easily accomplished.
This classification system does not imply any change in the definition of AIDS used by
CDC since 1981 for national reporting. Patients whose clinical presentations fulfill the surveillance definition of AIDS are classified in Group IV. However, not every case in Group IV will
meet the surveillance definition.
*.
Persons wishing to comment on this material are encouraged to send comments in writing
to the AIDS Program. Center for Infectious Diseases, CDC.
References
§This subgroup includes patients with one or more of the specified infectious diseases listed whose
clinical presentation fulfills the definition of AIDS as used by CDC for national reporting.
~This subgroup includes those patients with one or more of the specified cancers listed whose clinical
presentation fulfills the definition of AIDS as used by CDC for national reporting.
TABLE 5. Summary of classification system for hllmlllLI=bmphotropic viNS type III/
lymphadenopathy-associated ViNS
Group I.
Acute infection
Group II.
Asymptomatic infection'
Gr0U9 III.
Persistent generalized lymphadenopathy'
Group IV. Other disease
Subgroup A. Constitutional disease
Subgroup B. Neurologic disease
Subgroup C. Secondary infectious diseases
Specified secondary infectious diseases listed in the CDC surv',illance definition
Category C-l .
for AIDSt
Category C-2.
Other specified secondary infectious diseases
Subgroup D. Secondary cancers t
Subgroup E. Other conditions
'Patients in Groups II and III may be subclassified on the basis of a laboratory evaluation.
tlncludes those patients whose clinical presentation fulfills the definition of AIDS used by CDC for national reporting.
1. Gallo RC, Salahuddin SZ. Popovic M. et al. Frequent detection and isolation of cytopathic retroviruses (HTLV-III) from patients with AIDS and at risk for AIDS. Science 1984;224:500-3.
2. Barn!-Sinoussi F. Chermann JC. Rey F. et al. Isolation of aT -Iymphotropic retrovirus from a patient
at risk for acquired immune deficiency syndrome (AIDSI. Science 1983;220:868-71 ..
3. Levy JA. Hoffman AD. Kramer SM. Landis JA. Shimabukuro JM. Oshiro LS. Isoilltion of Iymphocytopathic retroviruses from San Francisco patients with AIDS. Science 1984;225:840-2.
4. Coffin J. Haase A. Levy JA. et al. Human immunodeficiency viruses [Letter]. Science 1986;232:
697.
5. CDC. Revision of the case definition of acquired immunodeficiency syndrome for national reporting-United States. MMWR 1985;34:373-5.
6. Haverkos HW. Gottlieb MS. Killen JY. Edelman R. Classification of HTLV-III/LAV-related diseases
[Letter]. J Infect Dis 1985; 152: 1095.
7. Redfield RR. Wright DC. Tramont EC. The Walter Reed staging classification for HTLV-III/LAV infection. N Engl J Med 1986;314: 131-2.
8. CDC. Antibodies to a retrovirus etiologically associated with acquired immunodeficiency syndrome
(AIDS) in populations with increased incidences of the syndrome. MMWR 1984;33:377-9.
9. CDC. Update: Public Health Service Workshop on Human T-Lymphotropic Virus Type III Antibody
Testing-United States. MMWR 1985;34:477-8.
T -Iymphotropic virus type III/lymphadenopathy-associated virus. MMWR 1986;35: 152-5.
11. Selik RM. Haverkos HW. Curran JW. Acquired immune deficiency syndrome (AIDS) trends in the
United States. 1978-1982. Am J Med 1984; 76:493-500.
12. Sarngadharan MG. Popovic M. Bruch L. Schupbach J. Gallo RC. Antibodies reactive with human TIymphotropic retroviruses (HTLV-III) in the serum of patients with AIDS. Science 1984;224:506-8.
13. Safai B. Sarngadharan MG. Groopman JE. et al. Seroepidemiological studies of human TIymphotropic retrovirus type III in acquired immunodeficiency syndrome. Lancet 1984;1: 1438-40.
14. Laurence J. Brun-Vezinet F. Schutzer SE. et al. Lymphadenopathy associated viral antibody in AIDS.
Immune correlations and definition of a carrier state. N Engl J Med 1984;311: 1269-73.
15. Ho DO. Sarngadharan MG. Resnick L. Dimarzo-Veronese F. Rota TR. Hirsch MS. Primary human TIymphotropic virus type III infection. Ann Intern Mad 1985; 103:880-3.
16. Cooper DA, Gold J. Maclean P. et al. Acute AIDS retrovirus infection. Definition of a clinical illness
associated with seroconversion. Lancet 1985;1:537-40.
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CENlERS FOR DISEASE CONTROL
MtlWR
May 30,1986/ Vol. 35/ No. 21
350 Chronic Fatigue Possibly Related to
Epstein-Barr Virus - Nevada
Chronic Fatigue Possibly Related to Epstein-Barr Virus -
Nevada
From November 1984 through August 1985, approximately 90 patients evaluated for persistent fatigue were diagnosed as having chronic Epstein-Barr virus (CEBV) disease by a twophysician community internal medicine practice near Lake Tahoe, Nevada. The diagnoses were
made by detecting antibody to the diffuse (EA-D) or the restricted (EA-R) components of early
antigen of EBV, as suggested by two recent studies (1,2).
Because of controversy about whether CEBV disease exists, two serologic studies were conducted to evaluate whether a syndrome of chronic fatigue could be statistically associated with
a specific pattern of antibody titers against EBV. Fifteen "case" patients, felt to be the most
likely to have CEBV, were identified by interviewing 134 of the 139 patients tested for EBV
sElrology in the internal medicine practice between January 1, and August 20, 1985. By definition, these patients had persistent or relapsing unexplained fatigue for at least 2 months, which
forced them to stop usual daily activities for at least 2 weeks. Other less universal symptoms
included intermittent low-grade fever, sore throat, myalgias, arthralgias, and headaches. All 15
patients were white; 13 were female. The median age was 40 years (range 13-52 yearsl.
In the first serologic study, the 15 patients were compared with 118 of the 119 patients
who had serqlogic testing for EBV (the serologic test results on one patient were not availablel.
All 118 of these patients were white; 79 (66.9%) were female. The median age was 36 years
(range 10- 71 years). The case patients were more likely to have reciprocal EA-D titers of 160
or higher {45 .5%, compared with 11.6%; P = 0.014) and EBV viral capsid antigen IgG (VCAIgG) 160 or greater (80.0%, compared with 51.7%; P = 0.033) in the first serum tested. No evidence of acute EBV infection, manifested by positive IgM titers to VCA, was detected in either
the cases or the others tested.
Detailed information on physical findings was obtained for all 1 5 case patients and from 11
of 1 8 other patients whose duration and severity of illness met the clinical case criteria but
who, on review of their medical records, had other possible etiologies. Palpable splenomegaly
was noted at some time during the illnesses of 13 of the 1 5 case patients and two of the 11
other patients (p = 0.00021.
In the second serologic study, blood specimens for EBV serologic testing were collected in
October 198,5 from the 15 case patients and from 30 age-, sex-, and race-matched controls.
The controls consisted of patients and office workers who had no complaints of fatigue and
had not previously undergone EBV serologic testing. The sera were tested simultaneously by
the commercial reference laboratory used by the two physicians, by the EBV laboratory at
CDC: and by a laboratory at Georgetown University in Washington, D.C. Case patients tended
to have higher titers of VCA-lgG and of anti-EA than controls, but the specific test results and
the tests in which the differences were significant varied considerably among the laboratories.
IgG antibody titers to herpes simplex virus (HSV) types 1 and 2 and cytomegalovirus (CMV)
were also measured. Case patients had significantly higher CMV titers than controls, both by
indirect hemagglutination (reciprocal geometric mean titer [GMT] 292, compared with 31, p =
0.046) and by enzyme immunoassay (GMT 276, compared with 74; P = 0.04). Case patients
also tended to have higher titers to HSV-1 (GMT 154, compared with 82) and to HSV-2 (GMT
140, compared with 34).
To help evaluate the reproducibility of the EBV serologic test results within a single laboratory, 1 9 sera, obtained earlier from 12 of the case patients and subsequently frozen, were
retested in the same laboratory. Fourfold or greater variations between the initial and repeated
titers were detected in 17.6% of the samples tested for anti-EA-D, 26.3% tested for VCA-lgG
and 33.3% tested for anti-EA-R. All sera with fourfold or greater changes in anti-EA-D or VCAIgG had a decrease in titer with the repeat testing, and all those with changes in anti-EA-R had
increased titers.
Reported by 0 Peterson, MD, P Cheney. MD, Incline Village, M Ford, MPH, 8 Hunt. Washoe County District
Health Dept, G Reynolds, Acting State Epidemiologist. Nevada Div of Health; Viral Exanthems and Herpesvirus 8f, Epidemiology Office, Divof Viral Diseases, Center for Infectious Diseases, CDC.
Editorial Note: In January 1985, two publications reported the association of a chronic,
mononucleosis-like illness with evidence of persistent active Epstein-Barr virus activity among
young, previously healthy adults ( 1,2). These patients had no other discernible cause for their
illnesses, and many demonstrated an apparently unusual pattern of anti-EBV antibodies when
compared with controls. However, several questions have been raised about these studies,
including whether CEBV actually exists (3-5).
In the Nevada investigation, the 1 5 case patients were more likely to have abnormal EBV
serologic markers than other patients, and, in addition to increased fatigue, were more likely to
have palpable splenomegaly. These findings suggest that, as a group, these patients have an
abnormality, or abnormalities, associated in some way with high antibody titers to EBV and
CMV.
The study highlights several problems associated with the diagnosis of CEBV. First, the
clinical syndrome is comprised of a wide range of nonspecific symptoms, and is inadequate for
diagnosing CEBV without a confirmatory laboratory test.
Second, "elevated" anti-EBV serologic titers do not prove that a chronic illness in an individual is due to EBV. There is a great deal of overlap in the antibody titers of case patients and
the general population, indicating that "normal" titers can vary substantially. In a recently published study, several asymptomatic persons followed for up to 8 years after recovery from
acute infectious mononucleosis maintained anti-EA titers well into the range considered to indicate CEBV (6).
Third, the reproducibility of the serologic tests for EBV is poor, both within and between
laboratories. The currently available indirect immunofluorescence technique for EBV serologic
tests necessitates a subjective measurement of the fluorescence produced and is subject to
variability between cell lots and between individual technicians. Comparability of titers can only
be confirmed by testing specimens in parallel.
Currently available data neither prove nor disprove the hypothesis that EBV activity is'responsible for chronic illness, but it is clear that the diagnosis of CEBV using current clinical and
laboratory criteria in an individual patient is unreliable. Further examinations of immune function
in these patients, as well as studies for other possible etiologies, are needed to define this syndrome and provide a framework for epidemiologic and therapeutic studies.
In the meantime, CEBV should be a diagnosis of exclusion. Physicians evaluating patients
thought to have CEBV should continue to search for the more definable, and possibly treatable,
conditions that may be responsible for their symptoms, such as endocrine and autoimmune
diseases; malignancies; chronic heart, liver, kidney, and pulmonary disease; anxiety and depression; and chronic infectious diseases, such as CMV and tuberculosis.
The patients reported here are only a portion of the cases reported to CDC with chronic,
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often severe, debilitating disease diagno~ed as CEBV. Further etiologic studies are indicated,
including known viruses such as EBV, CMV, and adenoviruses, in addition to viruses which
have not yet been identified. Once the syndrome is better defined, epidemiologic and therapeutic studies can be initiated.
References
1. Jones JF, Ray CG, Minnich LL, Hicks MJ, Kibler R. Lucas DO. Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses: elevated anti-early antigen an'·;'odies. Ann
Intern Med 1985; 102: 1-7.
2. Straus SE, Tosato G, Armstrong G, et al. Persisting illness and fatigue in adults with evidence of
Epstein-8arr virus infection. Ann Intern Med 1985; 102: 7 -16.
3. Armstrong CW, Wetterhall SF. Epstein-Barr virus and unexplained illness [Letted. Ann Intern Med
1985,102: 722.
4. Jones SR. Epstein-Barr virus and unexplained illness [Letter). Ann Intern Med 1985; 102:723.
5. Merlin TL. Chronic mononucleosis: pitfalls in the laboratory diagnosis. Hum Patho11986; 17:2-8.
.6. Horwitz CA, Henle W, Henle G, Rudnick H, Latts E. Long-term serological follow-up of patients for
Ep~tein-Barr virus after recovery from infectious mononucleosis. J Infect Dis 1985; 151: 1150-3,
373
Mtl'lR
376
June 13, 1986/ Vol. 35/ No. 23
Hepatitis B Associated with Jet Gun
Injection - California
Recommendations for Providing Dialysis
Treatment to Patients Infected with
HTLV-III/LAV
Epidemiologic Notes and Reports
Hepatitis B Associated with Jet Gun Injection - California
In March 1985. during routine investigation of hepatitis B (HB) case reports. an epidemiologist at the Long Beach (California) Department of Public Health noted that three HB patients
had each received injections at the same weight-reduction clinic (clinic A) before disease
onset. When review of previous case records and questioning of newly reported HB patients
identified five additional HB cases among clinic attendees. the California Department of
Health Services joined in the investigation of the clinic on July 1. 1985.
Clinic A belonged to a chain of 29 weight-reduction clinics located throughout southern
California. Attendees at the clinics typically received a series of daily parenteral injections of
human chorionic gonadotropin (HCGI. Injections were usually given by jet injectors (Med-E-Jet
Corp. Cleveland. Ohio). although some attendees received injections with single-use disposable needles and syringes. A standard regimen consisted of 30 injections; however. individuals
varied considerably in duration of treatment and number of injections received.
The investigation focused on a cohort of 341 persons who attended clinic A during the
first 6 months of 1985, Clinical history. review of risk factors for acquiring hepatitis B virus
(HBV) infection. serologic testing for HBV markers (hepatitis B surface antigen [HBsAgl. antibody to HB core antigen [anti-HBcl. and IgM anti-HBc) and quantification of parenteral exposures at the clinic were obtained on 287 (84%) of cohort members. For COMparison. 93 new
attendees (after July 1. 1985) at clinic A and random samples of 100 prior attendees and 70
new attendees at the other Long Beach clinic (clinic B) were tested for markers of HBV
infection.
Ultimately. 31 cases of clinical HB were identified among attendees of Clinic A (Figure 11.
Onset dates ranged from January 1984 to November 1985. with the majority of cases occurring between February and November 1985. Only two (6%) of the patients with clinical HB
had other identified risk factors for acquiring HBV infection in the 6 months before their
iIIneSSA!;
The serologic study demonstrated that 21 % of the cohort that attended clinic A between
January 1. and July 1. 1985. had evidence of recent HBV infection. including 27 clinical and
33 subclinical (19M anti-HBc positive) cases. In contrast. none of the 93 new attendees of
clinic A had evidence of recent HBV infection (p < 0.011. When all serologic markers of HBV
infection were examined. 43% of the cohort that attended clinic A between January 1 and
July 1 had evidence of HBV infection. compared with 7% of new attendees at clinic A; 8% of
persons who attended clinic B on or before July 1; and 6% of persons who began attending
clinic B after July 1.
On initial analysis of the cohort members. exposure to the jet injectors and HCG were both
significantly associated with the development of acute HBV infection. However. two lots of
HCG used at the clinic during the outbreak (from February 1985 onward) were negative when
tested for HBsAg. Furthermore. stratification of cohort members who received HCG by type
of parenteral inoculation (jet injector only. compared with syringe only) showed that 24% of
those receiving injections by jet injector had developed acute HBV infection compared with
none of those receiving injections by syringe only (p < 0.01) (Table 1). These two groups had
similar numbers of HCG exposures. with the syringe-only group averaging 31. while the jet
injector-only group averaged 27.
Some patients at clinic A reported that they had sustained lacerations and bruising in the
course of receiving the jet injections. Written protocols at clinic A specified that the Med-E-Jet
injector nozzle be wiped with 70% isopropyl alcohol between injections. and that at the end of
each day. the nozzle retaining cap and the tip be removed and disinfected. As an adjunct to
this investigation. CDC conducted a series of in vitro and in vivo laboratory experiments to
assess the potential for a contaminated Med-E-Jet to transmit HBV from patient to patient
and to assess the potential for HBsAg contamination of this jet injector during actual use.
After contaminating the nozzle tip of the jet injector with a known quantity (0.025 ml) of
HBsAg-containing serum. the injector was fired into separate 1 -dram vials (to simulate downstream transmission) and swab samples were taken of the exterior and interior surfaces of the
nozzle. This procedure was repeated 10 times. A second set of experiments was conducted
using the same procedure but with acetone swabbing to provide mechanical cleaning of the
tip before discharge into the vials. In the first set of experiments (no acetone swabbing) •
HBsAg was found in 80% of the injection fluid vials and 87% of the swabs from the exterior
and interior nozzle surfaces. Swabbing the contaminated tip of the Med-E-Jet with a cotton
ball moistened in acetone did not significantly reduce the' frequency with which HBsAg was
found in any of these sites. However. the Med-E-Jet did not become contaminated during
actual use when five injections were done on an HBsAg-positive chimpanzee. Bleeding did
FIGURE 1. Cases of acute clinical hepatitis B in
onset - California. 1984-1985 .
a weight-reduction clinic. by month of
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1985
APR
1986
this outbreak can be explained only if the jet injector became contaminated repeatedly during
use at the clinic.
Before this outbreak, virtually all epidemiologic observations have indicated that the jetinjector method of administering parenteral fluids, when properly done, is safe and effective.
The current data suggest that, if this type of jet injector (Med-E-Jet) becomes contaminated
with blood, disease transmission can occur and indicate a need for further assessments of the
possibilities of disease transmission by other types of jet guns. Proper design of jet injectors
Reported by R Shah, MD. K Mackey. MPH. H Wallace. DrPH. K Yawata. Long Beach Dept of Public
to minimize risk of blood contamination of the nozzle tips, training in use of guns, and care in
Health. R Roberto. MD. J Meissinget; MSPH. Infectious Disease Br. Ai Ascher. MD. S Hagens. MA. Viral
and Rickettsial Disease Laboratory. J Chin. MD. State Epidemiologist. California Dept of Health Svcs; Div cleaning and disinfection if blood contamination occurs is necessary to ensure the *Continued
of Field Svcs. Epidemiology Program Office. Hepatitis Br. Div of Viral Diseases. Nosocomial Infections safe use of these instruments.
occur at the injection sites, even though injections were carefully done according to manufacturers recommendations.
The jet injectors were removed from use at clinic A on July 2. No cases have been identified among persons treated at clinic A after this date, and no cases associated with any of the
other clinics in the chain have been identified to date. Both the manufacturer and the U.S.
Food and Drug Administration have been informed of these findings.
Laboratory Br. Hospital Infections Program. Center for Infectious Diseases. CDC.
Editorial Note: This is the first reported outbreak of any disease in which any kind of jet
injector has been implicated as the vehicle of transmission. The CDC experiments reported
here suggest that the Med-E-Jet, if contaminated, could transmit HBV but that it does not
become contaminated easily during actual use. Once contaminated, however, the Med-E-Jet
could not be easily cleaned by a simple swabbing technique, probably because of inaccessibility of contaminated surfaces of the nozzle tip and under the nozzle retaining cap. Furthermore,
wiping the nozzle tip with a swab soaked in alcohol or acetone would not be expected to inactivate HBV. To ensure proper decontamination, disassembly and sterilization of the nozzle tip
would be necessary.
Other investigators have attempted to assess the risk of HBV transmission by applying jet
injections, using another model of jet injector, to two human chronic hepatitis B carriers and
evaluating injection sites and the injection nozzle for contamination with HBsAg ( 1 I. All swab
samples from injection sites and the exterior surface of the nozzle were negative for HBsAg.
One other study, however, demonstrated transmission of the lactic dehydrogenase (LDH)
virus between mice by subcutaneous jet injection with a Med-E-Jet (21. In the CDC studies,
the estimated volume of contaminating material transferred in downstream injections was
0.53 ILl (0.53 x 10·3m ll. Therefore, it can be estimated that viruses that circulate in high titers
in blood, such as HBV (10 B/mll and LDH virus (10 7/mll, could be transferred during a procedure if gun contamination occurred. The probability of transferring microorganisms present in
lower concentration « 10 3 / mll would be correspondingly lower.
The extensive transmission of HBV infection in this outbreak appears to have resulted
from the unusual-circumstance of multiple repeated jet gun injections in a cohort of patients.
The initial likelihood of a highly infectious (HBeAg-positive) HBV carrier attending the clinic
was low, but after initial disease transmission from such a carrier, patients incubating disease
could serve as sources of infection for others, amplifying infection risk through several cycles
and ultimately leading to high attack rates in the study cohort. Nevertheless, the magnitude of
TABLE 1. Hepatitis B virus infections in HCG recipients by method of parenteral inoculation - California, 1985
No. ("!o) positive for H BV infection
H BV classification
Jet injector only
(N =239)
Syringe only
(N=22,
24 (10'
57 (24'
112 (47'
0(0'
0(0'
1 (4'
Acute clinical
TOtal acute infections
Total (any serologic marker'
, Jet injector vs. syringe. Fisher's exact test.
Significance'
p
P
P
= 0.11
< 0.01
< 0.01
References
1. Abb J, Deinhardt F, Eisenburg J. The risk of transmission of hepatitis B virus using jet injection in
inoculation. J Infect Dis 1981; 144:179.
2. Brink PRG, van Loon AM, Trommelen JCM, Gribnau FWJ. Smale-Novakova IRO. Virus transmission
by subcutaneous jet injection. J Med MicrobioI1985;20:393-7.
Current Trends
Recommendations for Providing Dialysis Treatment
to Patients Infected with Human T -Lymphotropic Virus
Type III/Lymphadenopathy-Associated Virus
Patients with end-stage renal disease who'are undergoing maintenance dialysis and who
have manifestations of human T -Iymphotropic virus type III/lymphadenopathy-associated
virus (HTLV -III/LAV)' infection, including acquired immunodeficiency syndrome (AIDS), or who
are positive for antibody to HTLV-III/LAV can be dialyzed in hospital-based or free-standing dialysis units using conventional infection-control precautions. Standard blood and body fluid
precautions and disinfection and sterilization strategies routinely practiced in dialysis centers
are adequate to prevent transmission of HTLV-III/LAV.
Soon after AIDS was recognized in the United States, it became apparent that risk factors
for persons with AIDS were similar to risk factors for persons with hepatitis B virus (HBV) infection (1). Prevention measures applied to control HBV infection in health-care institutions were
used as a model to develop infection-control guidelines for patients with AIDS before the identification of the etiologic agent and the development of serologic tests for antibody to HTLV-1II1
LAV (anti-HTLV -III). Isolation of infected patients and non reuse of a dialyzer by the same patient
were initially recommended for patients receiving dialysis in dialysis centers (2). These strategies are not currently believed necessary for preventing HTLV-III/LAV transmission.
No transmission of HTLV -III/LAV infection in the. dialysis-center environment has been
reported (3), and the possibility of such transmission appears extremely unlikely when routine
infection-control precautions are followed (4). The routine infection-control precautions used
in all dialysis centers when dialyzing all patients are considered adequate to prevent HTLV-1II1
LAV transmission. These would include: blood precautions; routine cleaning and disinfection
• An international committee on taxonomy has proposed the name human imniunodeficiency virus (HIVI.
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of dialysis equipment and surfaces that are frequently touched; and restriction of nondisposable supplies to individual patients unless such $upplies are sterilized between uses (2).
The following recommendations take into consideration recent knowledge about HTLV-IIII
LAV and update infection-control strategies for dialyzing patients infected with HTLV-III/LAV:
1. Procedures for environmental control and for disinfection and sterilization of hemodialysis machines have been described (5). The hemodialysis machine pumps dialysis
fluid into the dialyzer (artificial kidney) where circulating blood from the patient is
separated from the dialysis fluid by a membrane. The dialyzer, along with the associated blood lines, is disposable. Strategies for disinfecting the dialysis fluid pathways of
the hemodialysis machine are targeted to control bacterial contamination and generally
consist of using about 500-750 ppm of sodium hypochlorite for 30-40 minutes or
1.5%-2.0% formaldehyde overnight. In addition, several chemical germicides formulated
to disinfect dialysis machines are commercially available. None of these protocols or
procedures need to be altared after dialyzing patients infected with HTLV-lll/LAV.
Chemical germicides used for disinfection and sterilization of devices in the dialysis
center are effective against HTLV-III/LAV (4).
2. Patients infected with HTLV-III/LAV can be dialyzed by either hemodialysis or peritoneal
dialysis and do not need to be isolated from other patients. The type of dialysis treatment (i.e., hemodialysis or peritoneal dialysis) should be based on the needs of the patient. The dialyzer may be discarded after each use. Alternatively, centers that have
dialyzer-reuse programs, in which a specific dialyzer is issued to a specific patient, removed, cleaned, disinfected, and reused several times on the same patient only, may include HTLV-III/LAV-infected patients in the dialyzer-reuse program. An individual dialyzer must never be used on more than one patient.
3. Standard infection-control strategies that are used routinely in dialysis units for all dialysis patients and personnel should be used to prevent HTLV-III/LAV transmission. Specifically, these strategies include blood precautions and barrier techniques, such as the
use of gloves, gowns, and handwashing techniques, that have been described elsewhere (4-8).
4. Precautions against needlestick injuries, as well as the appropriate use of barrier precautions, such as wearing gloves when handling items contaminated with blood or serum,
should be practiced by all personnel caring for all dialysis patients. Such injuries constitute the major potential risk for HTLV-IIIILAV transmission to personnel. Extraordinary
care should be taken to prevent injuries to hands caused by needles, scalpels, and other
sharp instruments or devices during procedures; when cleaning used instruments; during
disposal of used needles; and when handling sharp instruments following procedures.
After use, disposable syringes and needles, scalpel blades, and other sharp items must be
placed in puncture-resistant containers for disposal. To prevent needlestick injuries, needles should not be recapped; purposefully bent or broken; removed from disposable syringes; or otherwise manipulated by hand. No data are currently available from controlled
studies examining the effect, if any, of the use of needle-cutting devices on the incidence
of needlestick injuries.
Reported by Hospital Infections Program, AIDS Program, Center for Infectious Diseases, CDC.
Editorial Note: In a study of 520 dialysis patients, 25 were reactive for anti-HTLV-III/LAV by
enzyme immunoassay (EIA), but only four were confirmed by the Western blut technique (3).
The rate of falsely reactive EIA tests among these dialysis patients was 4%, much higher than
the falsely reactive rate for blood donors (0.17%). The rate of truly reactive tests was 0.8%,
much lower than in high-risk groups but higher than in blood donors. The higher rate of falsely
reactive tests is probably due to the exposure of dialysis patients to H9-cell-associated antigens during blood transfusions that are common among these patients. These antigens are
also present in cell lines used to grow HTLV-lll/LAV for use as reagents in serologic tests for
anti-HTLV -III/LAV (9). Identification of antibody to H9 lymphoid cell lines in the absence of
isolation of HTLV-lll/LAV in dialysis patients with reactive EIA and nonreactive Western blot
tests supports the conclusion that these test results are falsely reactive. The higher rate of
truly reactive tests most likely reflects the frequency of blood transfusion in this patient population before initiation of blood donor screening for anti-HTLV-III/LAV. None of the four infected persons identified in that study were c;lialyzed in the same dialysis center.
CDC is initiating a cooperative study to further assess the prevalence of anti-HTLV-lll/LAV
among patients undergoing chronic hemodialysis. Representatives of dialysis centers who are
interested in participating in such a study and who regularly have more than 60 patients on dialysis should contact the Hospital Infections Program, Center for Infectious Diseases. CDC •.
Building 1. Room 5065. Atlanta. Georgia 30333 (telephone [4041329-3406).
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References
1. Curran JW. Evatt BL, Lawrence ON. Acquired immune deficiency syndrome: the past as prologue.
Ann Intern Med 1983;98:401-2.
2. Favero MS. Recommended precautions for patients undergoing hemodialysis who have AIDS or
non-A, non-B hepatitis. Infect Control 1985;6:301-5.
3. Peterman TA, Lang GR, Mikos NJ, et al. HTLV-III/LAV infection in hemodialysis patients. JAMA
1986;255:2324-6.
4. CDC. Summary: recommendations for preventing transmission of infection with human T-Iymphotropic virus type III/lymphadenopathy-associated virus in the workplace. MMWR 1985;34:681.
5. Favero MS. Dialysis-associated diseases and their control. In: Bennett JV, Brachman PS, eds. Hospital
infections. Boston: Little, Brown and Company,lnc .. 1985:267-B4.
6. CDC. Hepatitis-control measures for hepatitis B in dialysis centers. Viral hepatitis: Atlanta, Georgia:
Center for Disease Control. 1977: HEW publication no. (CDC)78-8358 (Investigation and control
series, November 1977).
7. CDC. Hepatitis surveillance report no. 49. Issued January 1985:3-4.
8. Garner JS, Simmons BP. CDC guideline for isolation precautions in hospitals. Infect Control 1983;5:
245-325.
.
9. CDC. Update: Public Health Service workshop on human T-Iymphotropic virus type III antibody
testing-United States. MMWR 1985;34:471-8.
MtlWR
..... ..
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June 20,1986/ Vol. 35 / No. 24
389 Transfusion-Associated HTLV-III/LAV from a
391
Seronegative Donor - Colorado
Non-A. Non-B Hepatitis Associated with a
Factor IX Complex Infused during
Cardiovas,cular Surgery - Arizona
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402 Genital Herpes Infection - United States.
1966-1984
MORBIDITY AND MORTAUTY WEEKLY REPORT
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Transfusion-Associated Human T-Lymphotropic Virus Type 111/
Lymphadenopathy-Associated Virus Infection
From a Seronegative Donor - Colorado
In November 1985. a blood donor at a Colorado blood-collection center was found to be
seropositive for human T -Iymphotropic virus type III/lymphadenopathy-associated virus
(HTLV-III/LAV)· antibody by both the enzyme-linked immunosorbent assay (ELISA) and Western blot methods. He had previously donated at the center in April and August t 985. when he
had been seronegative by ELISA. Both recipients from the August donation, one of whom had
no other risk factors for acquisition of HTLV-III/LAV, were subsequently found to be seroposi-
m,
tive. Both recipients of the April donation were seronegative. The donor had probably been infected through sexual contact 12 weeks or less before the August donation. This is the first
reported transmission of infection from a blood donor that has occurred despite routine
screening for HTLV-III/LAV antibody in blood banks and plasma centers.
Details of the donor and recipient investigation are as follows:
Donor. The donor was a 31-year-old man who had donated blood at the same center. in
April. August. and November 1985. He was seronegative in April (optical densities of Abbott
ELISA on sample/control = 0.052/0.160) and August (0.034/0.142). but seropositive by
ELISA (0.926/0.173) and Western blot in November. His blood from the November donation
was discarded. and physicians of the recipients from the August donation were notified by
the blood center of the possible transmission of HTLV -III/LAV from these blood products.
When interviewed in April 1986. the donor stated that he had had sexual contact with one
male partner. with the first exposure taking place on May 15. 1985. No condoms were used.
His only other sexual partner was a man in 1974. He denied intravenous (IV) drug use or history of blood transfusion. He had no history of acute viral illnesses or symptoms of acquired
immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) in 1985 or 1986. Physical examination in December 1985 was normal. Repeat ELISA testing in April 1986 revealed
a high absorbency value (> 2.00010.125). and Western blot was once again positive. Attempts at locating previous sera for antibody testing were unsuccessful.
Donor's Partner. The donor's sexual partner was a 22-year-old man who corroborated
the donor's history of their initial sexual contact on May 15, 1985. He had been homosexually
active since 18 years of age. He denied IV drug abuse or history of blood transfusion. After
notification by the donor of his positive antibody status. the partner was tested for HTLV-IIII
LAV In NovemGer 1985 and was seropositive by ELISA and Western blot; these findings
'The Human Retrovirus Subcommittee of the International Committee on the Taxonomy of Viruses has
proposed the name human immunodeficiency virus (HIV) for this virus. (Science 1986;232:697)
were reconfirmed on a separate specimen in April 1986. He had not previously been tested
for HTLV-III/LAV antibody.
Recipient 1. Recipient 1 was a 60-year-old man who underwent surgery in August 1985.
He received from 1 5 different donors six units of packed red blood cells, four units of fresh
frozen plasma, and six units of platelets (including one unit from the previously described
donor). HE} had been married for 30 years and denied extramarital sexual contact. either heterosexual or hompsexual. or any previous blood transfusions or IV drug abuse. In February
1986. he had no symptoms of AIDS or ARC and had a normal physical examination. The
HTLV-IH/LAV antibody test was positive by ELISA and Western blot and reconfirmed on a
separate specimen in March 1986. His wife was seronegative for HTLV-III/LAV antibody in
April 1986.
Recipient 2. Recipient 2 was a 57-year-old man who underwent surgery in August 1985.
He received two units of platelet-poor whole blood (including one unit from the previously described donor! and one unit of packed red blood cells. During the postoperative period, he had
unexplained fever and diarrhea that persisted for 6 weeks and was associated with a
20-pounp weight loss. Stool specimens were negative for bacterial pathogens and ova and
parasites. including cryptosporidia. In October 1985. he was tested for HTLV-III/LAV antibody
for reasons unrelated to the blood transfusion and was positive by ELISA and Westem blot.
which was confirmed on a separate specimen in April 1986. He had been divorced for 12
years and ~as strLctly homosexual since that time. with multiple partners.
Other investigative findings. The blood donated in April 1985 was given to two recipients. and both were seronegative by ELISA when tested in May 1986.
One other person was a common donor to recipients 1 and 2 in August 1985. This person
was retested in April 1986 and was negative by ELISA for HTLV-III/LAV antibody. Of the 13
remaining donors to recipient 1. 11 were seronegative when retested 5 months or more after
the August donations. Two donors reside outside Colorado and have not been retested. Of
the two remaining donors to recipient 2. both were seronegative when retested 6 months or
more after the August donations.
-.
Reported by CA Raevsky, DL Cohn. MD. FC Wolf. MPA, FN Judson. MD. Colorado Dept of Health. Denver
Disease Control Svc. SW Ferguson PhD. State Epidemiologist. TM Vernon. MD. Executive Director. Colorado Dept of Health; AIDS Program. Center for Infectious Diseases. CDC.
Editorial Note: This is the first report of HTLV-III/LAV transmission from a person whose
blood tested negative for HTLV -III/LAV antibody at the time of blood donation. As with previous reports that have documented the presence of the virus in a small number of persons
who have no detectable antibody. this donor appears to have had a recent infection (1,2).
Most infected people develop antibody within 2-3 months of infection (2-6),
The current risk of transfusion-associated infection is small. The prevalence of positive
Western blot tests among units screened by the American Red Cross in early 1985 suggests
that 0.04% of all donated units may have been potentially infectious (7). This prevalence declined to 0.02% in early 1986 (8). Currently available screening tests detect HTLV-III/LAV antibody in the great majority of infected persons. Since antibody may not be detectable in
blood from donors with very recent infections. the safety of the blood supply also requires
deferral of donation by persons at increased risk for HTLV -III;'LAV infection.
Donor-deferral programs. initially implemented in blood banks in March 1983 and subsequently refined. provide all prospective donors with educational information on the practices
associated with an increased risk of HTLV -III/LAV infection. Evidence suggests that most persons at increased risk have stopped donating blood (9-11). but a few such individuals continue to donate. The donor described in this report said he felt he was not at risk for infection
because he had only one sexual partner. Although a steady sexual relationship with a single
partner is generally safer with regard to HTLV-III/LAV infection than relationships with multiple sexual partners. men who have had sexual contact with another man since 1::11 1 mUSl nUL
donate blood ( 12).
Efforts are continuing to assure maximum effectiveness of donor-deferral programs
( 13, 14). As an example. blood collection agencies have agreed to implement procedures in
which prospective donors are asked to sign an expanded consent statement. The statement
indicates that the prospective donor has reviewed and understands the informational material
provided and that donors who are at increased risk for transmission of HTLV-III/LAV or other
infectious agents will not donate blood or plasma for transfusion to another person.
References
1. Salahuddin SZ. Groopman JE. Markham PD. et al. HTLV-III in symptom-free seronegative persons.
Lancet 1984;11: 1418-20.
2. Ho DO. Sarngadharan MG. Resnick L. Dimarzo-Veronese F. Rota TR. Hirsch MS. Primary human TIymphotropic virus type III infection. Ann Intern Med 1985; 1 03:880-3.
3. Anonymous. Needlestick transmission of HTLV-III from a patient infected in Africa. Lancet 1984;
11:1376-7.
4. Tucker J. Ludlam CA. Craig A. et al. HTLV-III infection associated with glandular-fever-like illness in
a haemophiliac. Lancet 1985;1:585.
5. Cooper DA. Gold J. Maclean p. et al. Acute AIDS retrovirus infection Lancet 1985;1:537-40.
6. Esteban JI. Shih J WoK. Tai CoCo Bodner AJ. Kay JWD. Alter HJ. Importance of Western blot analysis in predicting infectivity of anti-HTLV-III/LAV positive blood. Lancet 1985 ;11: 1 083-6.
7. Schorr JB. Berkowitz A. Cummings PD. Katz AJ. Sandler SG. Prevalence of HTLV-III antibody in
American blood donors [Letter]. N Engl J Med 1985;313:384-5.
8. Sandler SG. American Red Cross. Personal communication.
9. Dahlke MB. Designated blood donations [Letter]. N Engl J Med 1984;310: 1194.
10. Grindon A. Efficacy of voluntary self-deferral of donors at high risk of AIDS [Abstract] Transfusion
1984;24:434.
11. Pindyck J. Waldman A. Zang E. Oleszko W. Lowy M. Bjanco C. Measures to decrease the risk of acquired immunodeficiency syndrome transmission by blood transfusion. Transfusion 1985;25:3-9.
12. CDC. Update: revised Public Health Service definition of persons who should refrain from donating
blood and plasma-United States. MMWR 1985;34:547-8.
13. Kalish RI. Cable RG. Roberts SC. Voluntary deferral of blood donations and HTLV-III antibody positivity [Letter] N Engl J Med 1986;314: 1115-6.
14. U.S. Public Health Service. Public Health Service plan for the prevention and control of AIDS and
the AIDS virus. Report of the Coolfont Planning Conference. June 4 to 6. 1986. Washington, D.C ..
U.S. Public Health Service, 1986.
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Non-A, Non-S Hepatitis Associated with a Factor IX Complex
Infused During Cardiovascular Surgery - Arizona
On June 14, 1985, the Division of Disease Control Services, Arizona Department of Health
Services, was notified by infection-control personnel at a local hospital of 13 cases of non-A,
10n-B h.epatitis among patients who had undergone cardiovascular surgery at the hospital
juring the preceding 6 months. All the patients had received factor IX complex produced by
4.lpha Therapeutic Corporation (Brand B) because of bleeding during their surgery
A systematic review of pharmacy records for 1984 and 1985 determined factor IX com::>Iex usage patterns. Between January 1, 1984, and June 3, 1985, 172 patients had received
factor !X complex during cardiovascular surgery (81 Brand A; 90 Brand B; one Brand C).
3raQd B factor IX complex was added to the hospital pharmacy in October 1984.
Cases ,were identified through questionnaires distributed to all physicians involved with
he care of three groups: the cohort of Brand A factor IX complex recipients who survived
nore than 2 weeks following surgery, the cohort of Brand B factor IX recipients who survived
more than 2 weeks, and a sample from the cohort of 1,625 cardiovascular patients who received no factor IX complex during surgery and survived more than 2 weeks (matched to the
Brand B group for age. sex, type of operation, and date of surgery within 1 month). Completed
information was received for 55 (74%) of 74 Brand A factor IX complex recipients, 64 (85%)
of 75 Brand B factor IX complex recipients, and 59 (79%) of 75 in the matched nonrecipient
sample.
A case of postsurgical non-A. non-B hepatitis was defined as a patient who developed an
illness with a discrete date of onset following surgery and characterized by: (1) jaundice
and/or elevated serum aminotransferase (ALT) levels greater than 2'1, times the upper limit of
normal. lasting at least 1 week; (2) negative serologic tests for IgM hepatitis A virus antibody
(anti-HAV) and hepatitis B surface antigen (HBsAg) during illness; (3) no evidence of underlying liver disease or recent history of hepatotoxic drugs in dosages likely to produce liver dysfunction. A probable case was defined as above, but with no or incomplete serologic testing
for markers of viral hepatitis.
The investigation identified 23 cases and seven probable cases of non-A. non-B hepatitis;
27 were among Brand B factor IX complex recipients, and three were among Brand A factor
IX recipients (Figure 1). The most commonly observed symptoms were: fatigue (85%).
3norexia (81 %), nausea and/or vomiting (59%), dark urine (52%). light stools (41 %), and abjominal pains (37%); 19 (63%) were jaundiced. including 17 Brand B factor IX recipients and
two Brand A factor IX recipients. Liver function tests showed median peak ALT of 801.5 IU
:range 153-2,824) and bilirubin 5.3 mg/dl (range 0.4-22.9 mg/dll. Six (22%) patients required
'ehospitalization because of hepatitis-related symptoms; one patient died. with non-A. non-B
lepatitis reported as a contributing cause of death. The incubation period for cases among
Brand B factor IX complex recipients was a median of 7 weeks (range 2-17 weeks) from the
date of transfusion to the onset of symptoms; for Brand A. the incubation period was a
median of 15 weeks (range 1 -1 9 weeks). Peak elevations in serum transaminases occurred a
median of 9 weeks from the date of transfusion.
The attack rate for Brand B factor IX complex recipients was 42% (27/64). significantly
higher than the 5% (3/55) attack rate for Brand A recipients (relative risk = 7.7. p < 2 x 10-5 )
or the 0% (0/59) in non recipients (p < 1 x 10-6 ). The difference in attack rates between Brand
A factor IX complex recipients and nonrecipients was not statistically significant (p > 0.05).
The attack rate for Brand B recipients was about 40%. and that for nonrecipients of factor IX
was 0%, irrespective of quantity of other blood products (Table 1). A similar comparison of
Brand B to Brand A factor IX recipients showed no differences in receipt of other blood products; a stepwise multiple regression analysis of all factor IX recipients showed that receiving
Brand B factor IX was the only risk factor significantly associated with hepatitis (p < 0.0001).
Units of Brand B factor IX complex giv.en to surgery patients came from five different lots.
Each lot was associated with cases and probable cases. Attack rates for single-lot recipients
fanged from 14% to 100% (Table 2).
-;.--
Reported by D Matthews, R Harmon, MD, Maricopa County Div of Public Health, SJ Englender, MD, LF
Novick, MD, Director, GG Caldwell, MD. State Epidemiologist, Arizona Dept of Health Svcs; Div of Field
Svcs. Epidemiology Program Office, Hepatitis Br, Div of Viral Diseases. Center for Infectious Diseases,
CDC.
Editorial Note: Clotting factor preparations have frequently been linked to the transmission
of non-A. non-B hepatitis (1.21. These products are prepared from pooled plasma from multiple donors. Inoculation of nonheat-treated products into susceptible animals (chimpanzees) is
associated with development of non-A. non-B hepatitis, In hemophilia patients who routinely
receive commercial factor preparations. episodes of non-A. non-B hepatitis are common. and
as many as 50% may develop signs of chronic liver disease. probably due to non-A. non-B infections. Studies in first-exposed hemophilia patients and in s'urgery patients who receive
clotting factor preparations suggest the risk of non-A. non-B hepatitis in these patients may
be close to 100% (3.41. Heat treatment of clotting factor products was initiated at about the
time of the outbreak; however. none of the products used in this outbreak received heat treatment. While all factor IX complex and antihemophilic factor preparations are now treated to
reduce the risk of viral disease transmission. the methods currently used do not appear to
inactivate the causative agents of non-A. non-B hepatitis (5,61.
Non-A. non-B hepatitis in the United States is probably caused by at least two different
viral agents (1.71. Because of difficulty in conclusively identifying the causative agents and
developing serologic tests, it remains a diagnosis of exclusion. Epidemiologic studies indicate
FIGURE 1. Cases and probable cases of postsurgical non-A. non-B hepatitis in factor IX
concentrate recipients. by month and factor IX usage patterns in cardiovascular surgery
patients - Arizona. January 1. 1984-June 3. 1985
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that percutaneous or blood borne transmission routes predominate, with 20% of affected persons acquiring infection by "'.)od transfusion, and 15%, by percutaneous drug abuse. Furthermore, non-A, non-B hepatitis now causes 80%-90% of the post-transfusion hepatitis observed in this country. Previously, outbreaks have been described in hemodialysis units (8)
ar-i t)lasmapheresis programs (9).
~,jon-A, non-B hepatitis associated with clotting factor preparations has been reported to
be variable in clinical presentation, usually clinically milder with less icterus than other types
of non-A, non-B hepatitis ( 10). The reasons for the severity of .illnesses reported in this outbreak are not known. However, it could be due to either a different viral agent contaminating
the clotting factor complex than that in previously reported outbreaks, to higher doses of the
infectious organism, or to host-factor differences. The reasons for significantly different risks
of illness associated with the products of different commercial manufacturers is also not
known but possibly relates to differences in manufacturing processes or to differences in the
donor pool that contributed to the respective products.
Because of the high risk of viral hepatitis, recommended use of clotting factor products
has been limited to persons with known clotting factor deficiencies. In other settings, singledonor products carry a lower risk and are preferable. At least two outbreaks of non-A, non-B
hepatitis have now been reported in surgery patients treated with clotting factor preparations
(4). Prevention of non-A, non-B hepatitis in this population clearly depends on physicians adhering to strict indications for the use of clotting factor preparations and avoiding these products when at all possible.
TABLE 1. Risk of non-A, non-B hepatitis in surgery patients, by receipt of factor IX and
other blood products - Arizona, January 1984-June 1985.
Factor IX Recipients
Exposure
No.
Brand A
Attack Rate
No.
Brand B
Attack Rate
No.
Nonrecipients
Attack Rate
All patients
55
5%
64
42%
59
0%
Packed red
blood cells
> 10 units
< 10 units
29
26
3',<,
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33
31
36');,
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4
55
0%
0%
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plasma
> 6 units
< 6 units
35
20
9%
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33
31
42[)'(J
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7
52
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Yes
No
43
12
52
12
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10
49
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TABLE 2. Lot-specific attack rates of postsurgical non-A, non-B hepatitis for single-lot
cardiovascular recipients of Brand B factor IX - Arizona, October 1984-June 1985.
Lot
1
2
3
4
5
Total
III
1
2
17
2
5
27
Not ill
6
3
25
1
0
35
Attack rate
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40°"
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100""
44%
References
1. Craske J, Spooner RJD, Vandervelde EM. Evidence for existence of at least two types of factorVIII-associated non-B transfusion hepatitis. Lancet 1978;11: 1 051-2.
2. Enck RE, Betts RF, Brown MR, Miller G. Viral serology (hepatitis B virus, cytomegalovirus, EpsteinBarr virus) and abnormal liver function tests in transfused patients with hereditary hemorrhagic diseases. Transfusion 1979; 19:32-8.
3. Fletcher ML, Trowell JM, Craske J, Pavier K, Rizza CR. Non-A non-B hepatitis after transfusion of
factor VIII in infrequently treated patients. Br Med J 1983;287: 1754-7.
4. Sugg U, Schnaidt M, Schneider W, Lissner R. Clotting factors and non-A, non-B hepati.tis. N Eng J
Med 1980;303:943.
5. Colombo M, Mannucci PM, Carnelli V. Savidge GF. Gazengel C, Schimpf K. Transmission of non-A,
non-B hepatitis by heat treated factor VIII concentrate. Lancet 1985;11: 1-4.
6. Preston FE, Hay CRM, Dewar MS, Greaves M, Triger DR. Non-A, non-B hepatitis and heat-treated
factor VIII concentrates [Letter]. Lancet 1985;11:213.
7. Bradley OW, Maynard JE, Popper H, et al. Posttransfusion non-A, non-B hepatitis: phYSicochemical
properties of two distinct agents. J Infect Dis 1983; 148:254-65.
8. Galbraith RM. Dienstag JL. Purcell RH, Gower PH •. Zuckerman AJ, Williams R. Non-A, non-B hepatitis associated with chronic liver disease in a haemodialysis unit. Lancet 1979;1:951-3.
9. Guyer B, Bradley OW, Bryan JA, Maynard JE. Non-A, non-B hepatitis among participants in a plasmapheresis stimulation program. J Infect Dis 1979; 139:634-40.
10. Craske J, Dilling N, Stern D. An outbreak of hepatitis associated with intravenous injection of factor
VIII concentrate. Lancet 1975;11:221-3.
Genital Herpes Infection -
United States, 1966-1984
Genital herpes infection remains a major public health problem in the United States. Data
collected by the National Disease and Therapeutic Index (NOT!) from 1966 to 1981 showed
marked increases in the numbers of patient consultations for genital herpes (1,2 Current
analysis shows continued upward trends in symptomatic genital herpes infections among private patients in the United States.
r
The NDTI survey is a national stratified random sample of data from private practitioners'
office-based practices in the contiguous United States (3). This survey is a continuing compilation of statistical information about patterns and treatments of various diseases and represents a sample of patient-physician interactions. Included in the data coded are: (1) "consultations" about genital herpes between patients and physicians, including office visits, house
calls, telephone calls, and hospital visits; (2) "office visits," referring to initial or repeat visits
for genital herpes; and (3) "first office visits," coded if the patient presents to a physician participating in the survey for the first time with genital herpes. No laboratory confirmation of the
physicians' diagnoses is included in the survey.
The estimated number of physician-patient consultations for genital herpes increased
15-fold between 1966 and 1984, from 29,560 to 450,570 (Figure 2). Office visits accounted for 790,;.. of these consultations. Also, first office visits- a more likely indicator of newly acquired infection-increased nearly ninefold, from 17,810 in 1966 to 156,720 in 1984. Although a decline in consultations, office visits, and first office visits was evident from 1978 to
1980: the upward trends remain statistically significant for all three types of physician-patient
interaction (p < 0.004).
The number of first office visits for genital herpes was approximately the same for both
men and women. However, over the 19-year span, women made more total office visits for
genital herpes than did men. In each of three time periods-1966-1972, 1973-1978, and
1979-1984-the number of consultations increased for men and women in each age group,
except for men 40-44 years of age (Figure 3). Adults 20-29 years of age continued to account for the largest proportion of consultations in all age groups in each period.
Genital herpes infections increased uniformly in all regions of the country. The specialists
most likely to see patients with genital herpes over the 19-year span were obstetricians-
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FIGURE 2. Consultations, otfice visits, and first visits to office for genital herpes
United States, 1966-1984
FIGURE 3. Consultations for genital herpes, by age group and sex -
500
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gynecologists (36'10 of total), general practitioners (19%), dermatologists (13%)' internists
(12%), and urologists (5%1. Office visits to all other types of specialists accounted for the remaining 15%,
Reported by Div of Sexually Transmitted Diseases, Center for Prevention Svcs, CDC,
Editorial Note: The trends in symptomatic genital herpes infection reported here are comparable to data reported from a population-based study in Rochester, Minnesota, where investigators found a consistent annual increase in the incidence of genital herpes from 1965 to
1979 (4 I. The Rochester study also showed a similar age distribution for patients with symptomatic genital herpes infections, as in this report.
These data do not show the actual number of genital herpes cases in the United States, Patients with genital herpes may seek care in public health-care facilities and from other private
ambulatory-care providers, Therefore, the total number of visits are minimum estimates, However, the data are useful in describing trends in health-care seeking for genital herpes by private patients over the 19-year period.
At least five other factors may have affected the trends in genital herpes measured by the
NDT/:
1. Recent media attention-especially since 1982-may have increased both physicians'
and patients' awareness of the signs and symptoms of genital herpes, thus increasing
the numbers of patients seen in recent years,
2. A patient seen by a surveyed physician for the first time for genital herpes may not actually represent a newly diagnosed case.
3. Asymptomatic infections are increasingly recognized to be common and would not be
represented in the survey (5,6 I.
4. Many of those with symptomatic genital herpes may not seek medical attention at all.
5. The licensing of topical acyclovir by the U.S. Food and Drug Administratj.'n in 1982 for
treatment of genital herpes may account for some increase in numbers of patients seen
in the most recent years of this survey.
Despite these caveats, upward trends of genital herpes among private patients probably
reflect a true increase in the numbers of cases of this sexually transmitted disease nationwide.
References
1. CDC, Genital herpes infection - United States, 1966-1979. MMWR 1982;31: 137 -9.
2, Becker TM, Blount JH. Guinan ME. Genital herpes infections in private practice in the United States,
1966 to 1981. JAMA 1985;253: 1601-3.
3, Coding manual and descriptive information for the national disease and therapeutic index diagnosis
volume. Rockville, Maryland: IMS America Ltd .. 1984.
4, Chuang TY, Su WPD, Perry HO. IIstrup OM, Kurland LT. Incidence and trend of herpes progenitalis: a
15-year population study. Mayo Clin Proc 1983;58:436-41.
5, Mertz GJ, Schmidt 0, Jourden JL, et al. Frequency of acquisition of first-episode' genital infection
with herpes simplex virus from symptomatic and asymptomatic source contacts. Sex Transm Dis
1985; 12:33-9.
6. Rooney JF, Felser JM, Ostrove JM, Straus SE. Acquisition of genital herpes from an asymptomatic
sexual partner. N Engl J Med 1986:314: 1561-4.
July 4,1986/ Vol. 35/ No. 26
CENTERS FOR DISEASE CONTROl
MtlWR
421
HTLV-III/LAV Antibodv Prevalence in U.S.
Military Recruit Applicants
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Current Trends
Human T-Lynphotropic Virus Type III/Lymphadenopathy-Associated
Virus Antibody Prevalence in U.S. Military Recruit Applicants
From October 1, 1985, through March 31, 1986, as part of medical evaluation of individuals volunteering for military service, the U.S. Department of Defense tested 308,076 recruit
applicants for serologic evidence of infection with human T -Iymphotropic virus type 1111
lymphadenopathy-associated virus (HTLV-III/LAV), the etiologic retrovirus of acquired immunodeficiency syndrome (AIDS): Blood samples were obtained at 71 Military Entrance Processing Stations. The screened population consisted predominately of young adults in their
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late teens (54%) and early twenties (33% were 20-25 years oldl. Eighty-five percent were
male, and 77% were white. Sera were tested by a single contracting laboratory using a commercial human T -Iymphotropic virus type III (HTLV -ilil enzyme-linked immunosorbent assay
(ELISA) test (Electronucleonics, Inc.l. All samples repeatably reactive by ELISA were also subjected to confirmation testi II.' by the Western blot. Blots were considered positive if antibod
ies to gp 41 andlor p24+p55 were detected. Recruit applicants with confirmed HTLV-IIII
LAV antibody are excluded from military service.
, The mean prevalence of confirmed positive tests was 1 .5 per 1,000 recruit applicants. Antib(lr:y prevalence increased progressively with age (Table 1). a pattern consistent throughout
the country (Table 2l. The seroprevalence was higher among the 265,361 men of all ages,
1,6/1 ,000, than among the 42,715 women, 0.6/1,000. The ratio of male-to-female prevalence rates was 3: 1, Prevalence also varied by race: for the 237,586 whites, the rate was
0,9/1,000; for the 55,185 blacks, 3.9/1,000; and for the 15,305 applicants of other racial
groups, 2.6/1,000, The relationships of seroprevalence rates by sex and race remain when
the data are adjusted by age.
Seroprevalence rates (Table 2) were highest in the coastal regions of the country other
than New England. Rates were lowest in New England and in the inland regions. Based on preliminary analysis by county, the highest HTLV-III antibody rates were found in recruit applicants from major urban centers arid lowest in those from rural areas,
Reported by the Health Studies Task Force, Office of the Assistant Secretary of Defense (Health Affairs);
Dept of Virus Disease, Div of Preventive Medicine, Walter Reed Army Institute of Research; Survel1/ance
and Evaluation Bf. AIDS Program, Center for Infectious Disease, CDC.
differences by Hispanic ethnicity, (4) ThE! geographic distribution of seroprevalence among recruits is generally consistent with the incidence of cases, both by region and by urban versus
rural residence. More detailed geographic analysis will be possible when cumulative data are
available from screening additional recruits.
As in the case with serologically positive blood donors ( 141. recruit applicants with confirmed positive antibody are informed of their status and its implication regarding infection
with HTLV-III/LAV; they are counseled on reducing the risk of transmission to others through
sexual contact, sharing IV needles, or other exchanges of blood or body fluids.
Counselling and testing for HTLV-III/LAV antibody should be offered to persons who may
have already been infected as a result of intimate contact with the seropositive recruit applicant (i.e., sexual partners, persons with whom needles have been shared, infants born 'to seropositive mothers). In addition, seropositive individuals should be interviewed by 8f1 experienced investigator to determine their risk factors for infection. This, coupled with observation on suitable controls, would facilitate determining modes of acquisition and evaluating current trends in risk of exposure to the virus in these populations.
The continued analysis of data emerging from the HTLV-III/LAV serologic screening of
military recruit applicants will permit the examination of the extent and the trends over time of
infection with the causative agent of AIDS in this sentinel population.
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age - United States, October 1985-March 1986
Editorial Note: Although there is considerable knowledge regarding the distribution of
'The AIDS virus has been variously termed human T-Iymphotropic virus type III (HTLV-III),
lymphadenopathy-associated virus (LAV), AIDS-associated retrovirus (ARV), or human immunodeficiency virus (HIVI. The designation human immunodeficiency virus (HIV) has recently been proposed by a
subcommittee of the International Committee for the Taxonomy of Viruses as the appropriate name for
the retrovirus that has been implicated as the causative agent of AIDS) (Science 1986;232:697).
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17
18
19
20
21-25
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All ages
59,113
61.452
43.978
29,835
73,998
39,700
308,076
Positives/l,ooot
0.2
0.4
0.8
1.1
2.5
4,4
1.49
reported cases of AIDS in the United States ( 1). there has been much less information about
the prevalence of infection with HTLV-III/LAV. Studies of HTLV-IlI/LAV antibody prevalence
have primarily involved selected high-risk groups, including homosexual men (24%-68% posi- 'Western blot confirmed.
tive) (2-5). intravenous (IV) drug abusers (2%-72% positive) (6-8). and hemophilia patients tRates/l.000 tested.
(40%-88% p"ositive) (9-11l. The limited published data from blood-bank screening programs,
where persons in high-risk groups are specifically discouraged from donating, indicate a confirmed antibody prevalence nationally of less than 0,4/1,000 ( 12).
TABLE 2. Prevalence of HTLV/III antibody' per 1,000 military recruit applicants tested,
The Department of Defense medical evaluation program provides additional information by region and age group - United States, October 1985-March 1986
on the geographic and demographic factors associated with HTLV-III/LAV infection in the
Age group (yrs)
United States, The population of individuals volunteering for military service may not be repre;;!: 26
All ages
21-25
17-20
Region t
No. tested
sentative of the U,S. population at large due to the spontaneous, if partial, self-exclusion of
hemophilia patients, actively homosexual men, and current IV drug abusers. However, the
1.9§
1.0§
0.3§
0.6
14.131
data suggest the following: (1) While the highest seroprevalence occurs among those over New England
4,4
10,1
2.8
0,9
Mid-Atlantic
43.196
25 years old, the age of acquisition of confirmed antibody (and by implication, infection) can EN Central
0.8
2.2
55.943
2.0§
0,2§
often be in "the late teens and early twenties. Age at diagnosis of reported AIDS is older, with a W,N, Central
1.1
1.4
0.6
0.2
26.850
3.3
'1.9
S, Atlantic
50.854
5.7 §
0.7 §
median of 32-35 years, depending on risk group, race, and sex. Only 0.7% of reported cases
1,1
2,2
0.9
0.4
E,S, Central
21.027
among adults/adolescents occur between 13 and 20 years of age; 6.5% develop between 21
1.4
2.6
2.5
W.S, Central
34.782
07 §
and 25 yea~s; the r,emaining 92,8% are diagnosed at or after 26 years of age, (2) The ratio of
2,6
1.1
1,8
0,3
19.015
Mountain
1.5
4.7
1.5
seroprevalence between male and female recruit applicants is 3: 1, This is much lower than
0.7
Pacific
39.260
4.4
1.5
2.5
0.5
All 11
308.076
the ratio of 1 3: 1 observed among all AIDS cases, but like the 3: 1 ratio among other AIDS patients if homosexual and hemophilia-associated cases are excluded. (3) The ratio of sero'Western blot confirmed.
prevalence rates of black to white recruit applicants (4: 1) is intermediate between the 2,6
tDefined in notifiable diseases table (Table III),
relative risk for blacks among all AIDS patients (25,2% of cases are among non-Hispanic
§Rate based on five or fewer positives.
blacks, who comprise 11,5% of the population [13]) and the 8,3 relative risk for blacks
11 Includes data from Puerto Rico. Virgin Islands. Guam. American Samoa, Northern Marianas, and the
Trust Territories.
among AIDS patients not associated with either homosexuality or hemophilia (blacks comprise 52.0% of these casesl. The data do not yet permit a detailed analysis of seroprevalence
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References
1.
Peterman TA, Drotman DP, Curran JW. Epidemiology of the acquired immunodeficiency syndrome
(AIDS). Epidemiol Rev 1985;7: 1 -21.
2. Phair J. Prevalence and correlates of HTLV-III antibodies among 5000 gay men in 4 cities. Multicenter AIDS Cohort Study (MACS) [Abstract]. 25th Interscience Conference on Antimicrobial Agents
and Chemotherapy. Minneapolis: America Society for Microbiology, 1985:229.
3. Collier AC, Barnes RC, Handsfield HH. Prevalence of antibody to LAV/HTLV-III among homosexual
men in Seattle. Am J Public Health 1986;76:564-5.
4. Schwartz K, Visscher BR, Detels R. Taylor J, Nishanian P, Fahey JL. Immunological changes in lymphadenopathy virus positive and negative symptomless male homosexuals: two years of observation [Letter]. Lancet 1 985;11:831 -2.
5. Darrow WW, Jaffe HW, O'Malley PM, et al. Sexual practices and HTLV-III/LAV infections in a
cohort of homosexual male clinic patients, San Francisco [Abstract]. 6th International Meeting of
the International Society for STD Research. Brighton: International Society for STD Research,
past 32 years has been 5%. The failure of tuberculosis morbidity to decline as expected in
1985 is probably related to the occurrence of tuberculosis among persons with acquired immunodeficiency syndrome (AIDS) or human T -Iymphotropic virus type II\/Iymphadenopathyassociated virus (HTLV ILAV)· infection. Several reports have indicated that mycobacterial
disease is common among AIDS patients and among persons at risk for AIDS (2-9). The
most common mycobacterial species isolated from patients with diagnosed AIDS is Mycobacterium avium complex (MAC). although in some groups in which tuberculous infection is
highly prevalent, disease caused by M. tuberculosis is more common (10-12). Even among
1985:31.
6. Levy N, Carlson JR, Hinrichs S, Lerche N, Schenker M, Gardner MB. The prevalence of HTLV -Iil/LAV
,antibodies among intravenous drug users attending treatment programs in California: a preliminary
report [Letter]. N Engl J Med 1986;314:446.
7. Weiss SH, Ginzburg HM, Goedert JJ, et al. Risk for HTLV-III exposure and AIDS among parenteral
drug abusers in New Jersey [Abstract]. Atlanta: International Conference on Acquired Immunodeficiency Syndrome (AIDS). 1985:44.
Spira T J, DesJarlais DC, Bokos D, et al. HTLV-III/LAV antibodies in intravenous drug (IV)
abusers-comparison of high and low risk areas for AIDS [Abstract]. Atlanta: International Conference on Acquired Immunodeficiency Syndrome (AIDS), 1985 :84.
8.
MagO! IVIV.
:;1.
leguTU:=ler \.le, nanUWerK.-L.60er \,.,. L.t:WI:>. oJn, IVldytll VVL • .:l'fJt:IU
oJ""'.
"'1t:Vcll~(ICt:
allu sero·
conversion of human T -Iymphotropic retrovirus (HTLV-III) antibody in patients with hemophilia [Abstract]. Atlanta: International Conference on Acquired Immunodeficiency Syndrome (AIDS).
10.
11.
12.
13.
14.
1985:74.
Jason J. McDougal JS, Holman RC, et al. Human T-Iymphotropic retrovirus type 1111
lymphadenopathy-associated virus antibody. Association with hemophiliacs' immune status and
blood component usage. JAMA 1985;253:3409- 15.
Goedert JJ, Sarngadharan MG, Eyster ME, et al. Antibodies reactive with human T cell leukemia
viruses in the serum of hemophiliacs receiving factor VIII concentrate. Blood 1985;65:492-5.
Schorr JB, Berkowitz A, Cumming PO, Katz AJ, Sandler SG. Prevalence of HTLV-III antibody in
American blood donors [Letter]. N Engl J Med 1985;313:384-5.
U.S. Bureau of the Census. Table 49: general characteristics of persons by Spanish origin and race:
1980. In: 1980 Census of Population. Volume 1: Characteristics of the Population. Washington,
D.C.: U. S. Department of Commerce, 1980: 1-52 (General population characteristics, [PC
80- 1 -B 1] United States summary).
CDC. Provisional Public Health Service inter-agency recommmendations for screening donated
blood and plasma for antibody to the virus causing acquired immunodeficiency syndrome. MMWR
1985;35:1-5.
July 18, 1986/ Vol. 35/ No. 28
MtlWR
'The Human Retrovirus Subcommittee of the International Committee on the Taxonomy of Viruses has
proposed the name human immunodeficiency virus (HIV) for this virus (Science 1986;232:6971.
groups in which MAC is the most common mycobacterial pathogen, M. tuberculosis accounts
for a substantial proportion of the mycobacterial isolates, The association between mycobacterial disease and AIDS raises several important clinical and public health issues that are
addressed below.
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DIAGNOSIS OF TUBERCULOSIS IN PATIENTS LIKELY TO HAVE HTLV-III/LAV
. INFECTION
Clinicians should consider the diagnosis of tuberculosis in patients with, or at risk of,
HTLV-II\/LAV infection, even if the clinical presentation is unusual (4,13,141. Available data
indicate that extrapulmonary forms of tuberculosis, particularly lymphatic and disseminated
(miliary), are seen much more frequently among patients with HTLV-III/LAV infection than
among those without such infection. Pulmonary tuberculosis in patients with HTLV-III/LAV infection cannot readily be distinguished from other pulmonary infections, such as Pneumocystis carinii pneumonia, on the basis of clinical and radiographic findings. Patients with tuberculosis may have infiltrates in any lung zone, often associated with mediastinal and/or hilar
lymphadenopathy. Cavitation is uncommon, Appropriate specimens to establish a cultureconfirmed diagnosis of tuberculosis include respiratory secretions, urine, blood, lymph node,
bone marrow, liver, or other tissue or body fluid that is indicated clinically. All tissue specimens
should be stained for acid-fast bacilli and cultured for myc·obacteria. In the presence of undiagnosed pulmonary infiltrates, bronchoscopy with lavage and transbronchial biopsy (if not
contraindicated) may be needed to obtain material for both culture and histologic examination.
A tuberculin skin test should be administered, but the absence of a reaction does not rule out
the diagnosis of tuberculosis because immunosuppression associated with HTLV-III/LAV infection may cause false-negative results.
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448 Diagnosis and Management of
Mycobacterial Infection and Disease in
Persons with HTLV-III/LAV Infection
Current Trends
Diagnosis and Management of Mycobacterial Infection and Disease
in Persons with Human T-Lymphotropic Virus Type 1111
Lymphadenopathy-Associated Virus Infection
In 1985, the number of new tuberculosis cases reported to CDC was essentially the same
as that reported in 1984 (11. In contrast, the average annual decline in morbidity during the
TREATMENT OF MYCOBACTERIAL DISEASE IN A PATIENT WITH HTLV-III/LAV
INFECTION
Chemotherapy should be started whenever acid-fast bacilli are found In a specimen
from a patient with HTLV-III/LAV Infection and clinical evidence of mycobacterial dis8aS8, Because it is difficult to distinguish tuberculosis from MAC disease by any criterion
other than culture, and because of the individual and public health implications of tuberculosis,
it is important to treat patients with a regimen effective against tuberculosis. With some exceptions, patients with tuberculosis and HTLV-III/LAV infection respond relatively well to
standard antituberculosis drugs (15); however, their treatment should include at least three
drugs initially, and treatment may need to be longer than the standard duration of 9 months
(16), The recommended regimen is isoniazid IINH), 10-15 mg/kg/day up to 300 mg/day;
rifampin (RIFI. 10-15 mg/kg/day up to 600 mg/day; and either ethambutol (EM B), 25 mg/
kg/day, or pyrazinamide (PZAI. 20-30 mg/kg/day. The last two drugs are usually given only
during the first 2 months of therapy. The addition of a fourth drug may be indicated in certain
situations, such as central nervous system or disseminated disease or when INH resistance is
:
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suspected. An initial drug-susceptibility test should always be performed, and the treatment
regimen, revised if resistance is found to any of the drugs being used. The appropriate duration of treatment for patients with tuberculosis and HTLV-III/LAV infection is unknown; however, it is recommended that treatment continue for a minimum of 9 months and for at least 6
months after documented culture conversion. If INH or RIF is not included in the treatment
'regimen, therapy should continue for a minimum of 18 months and for at least 12 months following culture conversion. After therapy is completed, patients should be followed closely,
and mycobacteriologic examinations should be repeated if clinically indicated.
Some clinicians would take a different approach to treatment than that outlined above, to
cover the possibility of MAC disease. Although the clinical significance and optimal therapy
of MAC disease in these patients is not well defined, and there are no definitive data on the efficacy of treatment, one regimen. commonly used to treat MAC disease substitutes rifabutin
(ansamycin LM 427) for rifampin, combined with INH, EMS, and clofazimine. Rifabutin and
clofazimine are experimental drugs available to qualified investigators only under investigational new drug protocols. Rifabutin is distributed by the CDC Drug Service (telephone: [4041
329-3670)' and clofazimine, by Ciba-Geigy: (telephone: [2011277-5787). If M. tuberculosis
is isolated from a patient receiving this four-drug regimen, treatment should be switched to
one of the three-drug regimens outline'd above (iNH, RIF, and EMS or PZA). If MAC is isolated
from a patient who has been started on a three-drug regimen, the clinician may continue the
three-drug regimen or switch to the four-drug regimen of INH, EMS, rifabutin, and clofazimine.
Although experience is very limited, patients with disease due to M. kansasii should respond to INH, RIF, and EMB. Some clinicians advocate the addition of streptomycin (SM).
1 gram twice weekly, for the first 3 months. Therapy should continue for a minimum of 15
months following culture conversion.
. Monitoring for toxicity of antimycobacterial drugs may be difficult for patients who may·
be receiving a variety of other drugs and may have other concomitant conditions. Because
hepatic and hematologic abnormalities may be caused by the mycobacterial disease, AIDS, or
other drugs and conditions, the presence of such abnormalities is not an absolute contraindication to the use of the treatment regimens outlined above.
INFECTIO,,! CONTROL
Recommendations for preventing transmission of HTLV-III/LAV infection to health-care
workers have been published (1 7). In addition, infection-control procedures applied to patients
with HTLV-III/LAV infection who have undiagnosed pulmonary disease should always take the
possibility of tuberculosis into account. This is especially true when diagnostic procedures,
such as sputum induction or bronchoscopy, are being performed. Previously published guidelines for preventing tuberculosis transmission in hospitals should be followed ( 18).
CONTACT INVESTIGATION FOR TUBERCULOSIS
Patients with pulmonary tuberculosis and HTLV-III/LAV infection should be considered
potentially infectious for tuberculosis, and standard procedures for tuberculosis contact investigation. should be followed ( 19). Specific data on the infectiousness of tuberculosis in patients with HTLV -III/LAV infection are not yet available.
EXAMINING HTLV-III/LAV-INFECTED PERSONS FOR TUBERCULOSIS AND TUBERCULOUS INFE~TlON
Individuals who_are known to be HTLV-III/LAV seropositive should be given a Mantoux
skin test with 5 tuberculin units of purified protein derivative as part of their clinical evaluation.
Although some f~lse-negative skin test results may be encountered in this setting as a result
of immunosuppression induced by HTLV-Ill/LAV infection, significant reactions are still meaningful (20). If the skin test reaction is significant, a chest radiograph should be obtained, and
if abnormalities are detected, additional diagnostic procedures for tuberculosis should be undertaken. Patients with clinical AIDS or other Class IV HTLV -III/LAV infections (21 ) should receive both a tuberculin skin test and a chest radiograph because of the higher probability of
false-negative tuberculin reactions in immunosuppressed patients.
EXAMINING PATIENTS WITH CLINICALLY ACTIVE TUBERCULOSIS OR LATENT
TUBERCULOUS INFECTION FOR HTLV-III/LAV INFECTION
•
As part of the evaluation of patients with tuberculosis and tuberculous infection, risk factors for HTLV-III/LAV should be identified. Voluntary testing of all persons with these risk factors is recommended (22). In addition, testing for HTLV-III/LAV antibody should btl considered for patients of all ages who have severe or unusual manifestations of tuberculosis. The
presence of HTLV-III/LAV infection has implications regarding treatment (see above), alerts
the physician to the possibility of other opportunistic infections, and allows for counselling
about transmission of HTLV-III/LAV infection (23). Testing for HTLV-III/LAV antibody is e~pe
cially important for persons over age 35 with asymptomatic tuberculous infection, because
INH would not usually be indicated for persons in this age group unless they 'are also HTLV-1II1
LAV seropositive.
PREVENTIVE THERAPY
HTLV-Ill/LAV seropositivity in a person of any age with a significant tuberculin reaction is
an indication for INH preventive therapy (16). Although it is not known whether INH therapy
is as efficacious in preventing tuberculosis in HTLV -III/LAV -infected persons as in other
groups, the usually good response of HTLV-Ill/LAV-infected persons with tuberculosis to
standard therapy suggests that INH preventive therapy would also be effective. Before instituting preventive therapy, clinically active tuberculosis should be excluded.
Developed by Center for Prevention Svcs, Center for Infectious Diseases, CDC, with consultation from:
RS Holzman, MD, New York University Medical Center. New York City; PC Hopewell, MD, San Francisco
General Hospital Medical Centllr. California; AE Pitchllnik. MD. University of Miami Medical Centllr. Florida; LS Reichman, MD, University of Mtldicine and Dentistry of New Jersey, New Jersey Medical School,
University Hospital, Newark, New Jersey; RL Stoneburner. MD, New York City Dept of Health.
References
1. CDC. Tuberculosis-United States, 1985-and the possible impact of human T-Iymphotropic
virus type IIIl1ymphadenopathy-associated virus infection. MMWR 1986; 35: 74-6.
2. Cohen RJ, Samoszuk MK, Busch 0, Lagios M. ILetterl. Occult infections with M. intracellulare in
bone-marrow biopsy specimens from patients with AIDS. N Engl J Med 1983;308: 1475-6.
3. Wong B, Edwards FF, Kiehn TE, et al. Continuous high-grade Mycobacterium avium-intracellulare
bacteremia in patients with the acquired immunodeficiency syndrome. Am J Med 1985;78:35-40.
4. Pitchenik AE, Cole C, Russell BW. Fischl MA. Spira TJ. Snider DE. Jr. Tuberculosis. atypical mycobacterioSis. and the acquired immunodeficiency syndrome among Haitian and non-Haitian patients
in south Florida. Ann Intern Med 1984; 101 :641-5.
5. Macher AM, Kovacs JA. Gill V. et al. Bacteremia due to Mycobacterium avium-intracellulare in the
acquired immunodeficiency syndrome. Ann Intern Med 19B3;99:782-5.
6. Zakowski P. Fligiel S. Berlin GW. Johnson L. Jr. Disseminated Mycobacterium'avium-intracellulare
infection in homosexual men dying of acquired immunodeficiency. JAM A 1982; 248: 2980-2
7. Greene JB, Sidhu GS. Lewis S. et al. Mycobacterium avium-intracellulare: a cause of disseminated
life-threatening infection in homosexuals and drug abusers. Ann Intern Med 1982;97:539-46.
8. Chan J. McKitrick JC. Klein RS. MycolNlcterium gordonae in the acquired immunodeficiency syndrome (Letter). Ann Intern Med 1984; 101 :400.
9. Eng RH. Forrester C. Smith SM. Sobel H. Mycobacterium xenopi infection in a patient with acquired
immunodeficiency syndrome Chest 1984;86: 145-7.
10. Pape JW. Liautaud B, Thomas F. et al. Characteristics of the acquired immunodeficiency syndrome
(AIDS! in Haiti. N Eng J Med 1983;309:945-50.
11. Maayan S. Wormser GP. Hewlett D. et al. Acquired immunodeficiency syndrome (AIDS! in an economically disadvantaged population. Arch Intern Med 1985; 145: 1607-12.
12. Goedert JJ. Weiss SH. Biggar RJ. et al. Lesser AIDS and tuberculosis (Letter!. Lancet 1985;ii:52.
13. Sunderam G. Maniatis T. Kapila R. et al. Mycobacterium tuberculosis disease with unusual manifestations is relatively common in acquired immuno-deficiency syndrome (AIDS! (Abstractl. Am Rev
RespDis 1984;129 (part2t:A191.
14. Pitchenik AE. Rubinson HA. The radiographic appearance of tuberculosis in patients with the acquired immune deficiency syndrome (AIDS! and pre-AIDS. Am Rev Resp Dis 1985; 131 :393-6.
15. Sunderam G. McDonald RJ. Maniatis T. Oleske J. Kapilii R. Reichman L8. Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS), JAM A 1986; 256: 35 7 ·61
16. American Thoracic Society. Treatment of tuberculosis and other mycobacterial diseases. Am Rev
RespDis 1983;127:790-6.
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***** THE OFFICIAL NEWSLETTER OF THE NCGSTOS * VOLUME 7:5 * JUNEI JULY, 1986 * PAGE 41 *****
************************************************************************************************************************
17. CDC. Recommendations for preventing transmission of infection with human T -Iymphotropic virus
type III/lymphadenopathy-associated virus in the workplace. MMWR 1985;34:681-95.
18. CDC. Guidelines for prevention of T8 transmission in hospitals. Atlanta. Georgia: U.S. Department
of Health and Human Services. 1982: HHS publication no. (CDC) 82-8371.
19. American Thoracic Society/CDC. Control of tuberculosis. Am Rev Resp Dis 1983; 128:336-42.
20. American Thoracic Society. The tuberculin skin test. Am Rev Resp Dis 1981; 124:356-63. 21. CDC. Classification system for human T -Iymphotropic virus type III/lymphadenopathy-associated
virus infections. MMWR 1986;35:334-9.
T -Iymphotropic virus type III/lympadenopathy-associated virus. MMWR 1986;35: 152-5.
23. CDC. Human T-Iymphotropic virus type III/lymphadenopathy-associated virus antibody testing at'
alternate sites. MMWR 1986;35:284-7.
***************************************
with thanks to
Ih~ ~~!iQ~:~ ~~~l!h,
the American Public Health Association, July, 1986
Chilling Predictions of Future of A.IDS
Editor's Note: The fol/owing are ex·
cerpt. from the predictions and rteom·
mendations on acquired immune defi('i~ncy syndrome from the recent conference spon.,ored by the Public Health
Service In &rkeky Springs. West Virgi·
nia (see page one), They a~ presented
here because of their importance to the
public health community.
Five yeanJ have elapsed since the initial
report of PIlf'lImncyslilr carinii pneumonia
from Los Angele!t marked the recognition
of whal has become known 8S AIDS. By
1984. a human retrovirus, HTLVIIIILAV, had been determined to be the
etiologic agent of AIDS and, by early
1985, serologic lesls for antibody to the
virus were licen8ed and widely available.
In retrospect. when AIDS was initially
reported. in June 1981, some five years already had elapsed since the introduction
of IITLV·JlI/LAV into the United State.,
and three years had elapsed. since the
first clinical cases had occurred.. AIDS
cases have been reported from all 50
states, the District of Columbia, and four
territories. Casea have been reported
from more than 100 count.ries.
Studies of the molecular biology of
HTLV·JlIILAV have revealed that a copy
of the viral genetic material becomes an
integral and permanent component of the
DNA of an infected individual. As a
result, such an individual is likely a carrier of the virus for the rest of his life
and, for purposes of public health control.
is assumed. to be capable of transmitting
the viru!' lo olh(~r~.
The HTLV·III/LAV genome has been
completely sequf>nced and the function of
!!Ieveral of it!!! genes are known. Considerable differences in some genes have been
found among variou!! isolates. In addition,
related viruse!l have been identified in
man and nonhuman primates. These
related viruses cause a range of different
di.!lea!'e!'. Studies in animall'll indicate the
feasibility of vaccination again~t retroviruses, and one veterinary vaccine ie
availahle ror the prevention or feline
leukemia virus.
54,000 Deaths
Predicted in 1991
The rollowing projections are based on
the Cente" ror Disease Control (CDC)
surveillance data and epidemiologic studiel'll of populations at high risk to infection
with the virus.
• Twenty to 30 percent of the estimated
1 to 1.5 million Americans infected with
IITLV·IIIILAV a. of June 1986 are pro·
jected to develop AIDS by the end of
1991. The latency period between infection and overt AIDS average. four or
more years in adults. Therefore, mORt persons who will develop AIDS between
1986 and 1991 will be those who are al·
ready infected with HTLV ·III/LA V.
• Based on an empirical model that
use" reported cases of AIDS, by the end oC
1991, the cumulative tases of AIDS in
the US meeting the CDC survemance
definition will total more than 270,000.
During 1991 alone, more than 145,000
CR.!IeS of AIDS will require medical care
and over 54.000 AIDS patienbl are predicted to die, bringing the cumulative
numher of deaths due to AIDS to over
179.000.
• In 1985. 9.000 cases of AIDS were di·
agnosed in the United States and reported
to the Centers ror DiseaBe Control. The
empirical model predicts that caeel will
continue to increase through 1991, that
there will be nearly 16,000 CaReR reported
in 1986, and more than 74,000 C81H pro·
jected (or 1991. The estimatee ror 1991
range from 46,000 to 90,000.
• More than 70 percent of the caBe8
will be diagnosed among homosexual or
bisexual men. and 25 percent of the cases
will occur among IV drug ahuser. with
ROme overlap to continue between the
groups.
• Additional cases in heterosexual men
and women are projected.; the 1,100 (7
percent of the total) ror 198$ will increaBe
to nearly 7.000 (more than 9 percent) by
1991.
• Through 1985. rewer than 60 percent
of caBe8 were diagnosed in persons outside
New York City and San Francisco, but by
1991 more than 80 percent or cases are
predicted to be reported rrom other Ita tel
and localitiel_
• Current information 18 inlurficient
to predict the future incidence or HTLV·
IIIILAV infection in heterosexual popula·
tions, but incfealea in hetel'08exual traneminion are likely.
Antiviral Unlikely
ForSeveral Years
A sare and effective antiviral agent is
not likely to be in general use for the next
several yeare. Experimental pror:lucts are
also under study for treatment or oppor·
t.unistic infections and neoplaams aaeociated with HTLV·IIIILAVinfection.
Con~lu8ionfil
• Further expansion of the multiinstitutional. multidisciplinary approach
to identiry and develop agents for the
treatment and prevention of HTLV·
III/LAV infection and associated diseases,
including central nervous sy!tem diseaee.
is nece8B8ry. Part of this erfort must be
the establishment of a large capacity
screening program to measure the antiviral, immunomodulators and toxic effects
of newly identined natural and synthetic
compounds.
.
• A system for classifying HTLV·
IJI/LAV aS8OCiated. diseue manifestations which is useful in the design, implementation and analyses or therapeutic
trials must be developed.
• The most erncient design of dinical
trials of candidate antiviral agents will
require the use of placebo controls.
• Since antiviral drugs currently
under development are likely to repreRS
rather t.han eliminate the AIDS virus in·
fection. long·term therapy is expetted
and with it the emergence of drugresistant strains.
infection depends largely upon efrective
approaches to decreaH sexual tran8mis.
lion, tran,miuion among IV drug usen:
and perinatal transmiNion from inrected
mothen.
Public heallh activities directed toward
the control and prevention of AIDS have
required ,igniricant funding and ataffing
at national. slate. and local levels. The
projected increates in AIDS and HTLVIIJILAV inrection over the next five
years will pose ,ubstantial continuing
demands for resourceR ror theae efforts.
Inrormation Base
• Information is needed to better determine the size of the population at greatest
ri8k in the United. Statea.
• Better information is needed on the
number of persons infected with HTLV.
IIIILAV. Exten.ive and repeated .eroepidemiologic surveys are needed to deter~
mIRe the incidence and prevalence or infection by age, race. ethnicity, ,ex,
geographic area and sexual prererence.·
States should be encouraged to obtain
and report data on incidence and preval.
ence to CDC ror publication.
• The United State. should continue to
play 8 role in undentanding and aaisting
efforts to control the diaeaH worldwide.
particul.,ly in are.. with seemingly dieferent epidemiologic patternl.
Information and Education
• PHS should explore the advantagee
using paid radio. TV and printed medii
adverti.ing a. well a. public ...rvice an.
nouncemento to inform ihe public on
!1~~a~~;.L~~!I/:':a~ i~!:~~~on.iepart.
ments. state and local boards of educa.
tion, colleges, universities, and other or.
ganizationsshould support and encourage
comprehensive education about A]DS
and HTLV-IIIILAV infection.
• Health care providers need current in.
formation and training on the diagnoais,
psychoeocial counseling and management
or HTLV-IIIILAV infected personl.
IV Drug A bUlle
MUllt Be Target
• IV ~rug abu,ers .se~ve al. the !"ajor.
reservOir for traneml!lslOn o~ l-:alectlon to
heterosexual adults and thetr Infanll, 8S
well a8 among themsel.ves. As a grou~,
they are not well orgaOlzed, ofte~ poorly
~ucat~. and tend to have .Iess mteractlon with the health care dehv~~ IYlte!"
than other groups who partiCipate In
high risk behaviora. Efforts to change
drug abuse behavior must proceed with
the understanding that addictive heha·
vior is not often changed without specific
drug treatment.
• A systematically increa!led. capacity
for treating IV drug abuaen i!l needed.
Until adequate capacity ill available; perVaccine Likely to
sons in need of treatment ,hould be
Take Several Years
prioritized.
A number of vaccine candidates for • Until treatment capacity ill adequate
human beings are currently under devel- ror pel'BOns who continue to abu8e IV
opment and limited clinical testing for drup, studies are needed to evaluate the
BOrne could begin within two years. Field efficacy and. reaflibility of promoting
trials to demonstrate erficacy may reo ufer use of drug paraphernalia (for
quire additional yean. A vaccine for example, increased availability or sterile
general use is not anticipated before the ~pedle8 or "wo~k'· and education n:gordnext decade and its use would not afrect 109 use or stenle needles and !Iharmg of'
the number of persons infected by that needles.
time.
Control Depends on
Cutting Transmission
.. In the absence of a vaccine and therapy,
prevention and control of HTLV-Ill/LAV
*************************~************************
in the proportion of heteroeexual trans.
mission over the next five yeau.
A central goal of local disease control
programs ,hould be to reach the greateRt
number of HTLV·IIIILAV infected per·
lIOn, with tellting and counseling. At pre·
Bent. only a small proportion of the aiready infected popUlation has been
reathed.
• Serologital testing of penons whose
behavior places them at risk should be en·
couraged and made widely available.
• Setr·referral or an infected penon',
sexual and needle·sharing contacts
should be encouraged. In BOme areas or
JlOPulations, additional contact notifica'
tion activities may be offered to infected
.penons by the health agency.
• For penon. who know that they are
infected with HTLV·III/LAV yet con·
tinue to practice high risk eexual or
needle-sharing activities, temporary involuntary isolation should be con'idered an
option only in rare instances and after
due prOCeB8. Enforced ieolation i. not a
practical way to minimize .pread or the
.infection, since infected penone remain
infectiou! for life. EdUcation. counaeling.
and extenlion or aocial lervices - induding drug treatment - are the main inter·
vention. for dealing with thirpi-oblem
and are appropriately applied to recalcitrant inrected penons and their potential
coneentin. partnen.
tl I
d B de
as Y ncrease
ur n
To Health Care System
Vi
Over the period or J988 to J99J. AIDS
and aasocisted condltio"?'tII place an 'ncreasing burden on the health care delivery Iystem through an increaaed number
of patients and incr-eased coats of care.
The burden will be .hared by a .argor
number of communitiee, including some
which will have a lea complete capacity
for reeponee. There will be increaRinll
fragmentation and lees health care con·
trol of eervicel provided ir more non·
medical,less tradition.land eome unethi·
cal provider. become involved.
PHS Htimateo that the direct health
~::~~o~~7:nbiii:~:~~Di";~I;;:;~
sums represent 1.2 to 2.4 percent ol the
expected lotal US personal health care ex.pendituree in 1991 of about $650 billion.
BecauBe people with AIDS are concentra ted in certain urban centere, however. these costs will be disproportionate'
Iy bome
.
Conelullione:
• Develop a coordinated lederal, .tate.
and local fesponH to manage the health
serviCt."8 and henlth rinancing erisi" posed
by the escalating AIDS epidemic. This re·
l!lponse mUllt renect the plur81i,tic charatter of the American health care ,yste-m.
and must involve the coordinated partidpation of the public, private and volun·
tary settof1l. as wen as ambulatory, in·
hOllpital and long term care providers;
• Emphasize the needs of in,titulional
and community-based providen for train·
ing, continuing edutation. and plychOlo~
cial8upport;
a Upon requut, lulst Illte, local
governments. and community·ba!led organizations to assess. develop and implement comprehensive servite delivery sys·
terns of core for AIDS patient. in a costPrevention
erfective manner;
Sexual Transmission
• Utilize ~ludiefl of the special health
Sexual contact will remain the primary "ervices need!' and harriers to prevention
mode of HTLV·III/LA V infection for the or HLTV·III/LAV infection in Blacks and
for~eeable future, with greater increase . Hispanics.
of
f
************************************************************************************************************************
THE HUMAN TRIALS IN TESTING THE CURRENT HOPES FOR ACURE
by Ro~ F. Wood with thanks to the Washington Blade L ~L~~L~§
-- -- ---- ---- ------ -- ---
Roy F. Wood, aUlhor oj ResOcss
Rednecks: Gay Tales of a Chansing Sourh, •
(/lin. 10 lYashiJ'glon. D.C. /ast December
Ij 10 participate in drug lrittis Dl Ihe
National l,.,titUles oj Health. Till! jollowing
is Itis /irsi-penon accounI-- wrinen in
February-oj Whol il was like 10 IOke pim in
tlws.drugtrittisojIlPA-13. Mr. lYooddied
in a hospilOl neGr his hom. in Alhe"",
GeorgiD, April II jrom complicalions
lWOCiateJ wilh AIDS. H.
in his txJr/y
forties.
""s
by Roy F. Wood
My doctor worked very hard IflCr I was
diaSROsed in July or last year as having
AIDS. None of Ihis silling around wlilins
10 die; we had 10 do something, find •
program, examine possibilities! Frankly, I
would have preferred 10 have remained at
bome, wbere I have conslructed a peaceful
life, and simply IClithe virus 10 gel ",",. AI
rhe same lime, I was finaOy led 10 the
conclusion rhal I OUShl 10 Iry I remedy or
Iwo if lltey were ...ilable-and affordable.
Whal I gOl myselr inlO was an
perim.nlal drug program allbe Nalional
Inslilules or Health (NIH) in Washinglon,
.C.
GdO", involved in such programs strikes
me much rhe same way as whall bear aboul
gelling involved wirh lite Social Securily
Adminisullion: come prepared 10 wail
awhile-a 10", while. Obviously anyone
applying couJd weD be dead before Iny
decision is made.
I came 10 D.C. AuJUS! 20, 198', (al my
own expense, lhe only part or lhe business I
had 10 pay for). and they drew I vial or IWO
or blood and conducted a brief inlCn'iew.
Two \0 six weeks, and rd hearsomclbi",,1
was \DIlL II was aaually laIC NIWemher
before an)'lhiDc more was said. Then il was
back \0 WashioIlOn, £or drawinclols more
blood; an eateosiv.. detailed e..minalion;
and an interview With a doctor who would
he workinS on lhe program. This lrip was
made 10 D.C. Ihe finl week in Deo:mher,
and a couple 10 days laler, I was accepled
inlO the program. December 16 "und me al
NIH 10 begin an eillhl-week prngram with
rhe drug HPA-23.
Anyone undergoing treatmenl wirh an
experimenlal drug has, I suppose, • riahllO
fed nervous. I can'l say I did. The firsl day
on rhe program w.s spenl like so many II
NIH: lIivi", blood. I'm surprised anyone has
any blood left by rhe lime they Bel 01[ the
prosram. rm nollalki", aboullwo or Ib...
small lUbes-no, when one is sent 10
"Phlebolomy," (a word I was alwlYS
~
uncomfortable wilb), one genenOy had 10
sunonder six 10 eighl small lubes of blood
plus Ibree or four very large ones.
After the bIoodIcl\ins. il was on for xrays and EKGs. Dy the lime I was Jinished
wirh aU thai and ready 10 receive the first
. dose or the medicine (or druc-don'lknow
as I'd classify il as a wteJiclne, wbich I reel
indicates il is heneIiciaI), il had aU lost
somcIhin& in termS orboth fear and maaic-I
simply wanled \0 Bel back \0 my hotel and
take a breakl
HPA-23 is I clear, WllCr-Iooki",COIlCOI>. lion. II was \0 be liven 10 me five days a
w..... ror eighl weeks, intravenously. My
fil1l dose was anti-dimlClic- Nodling
happened. and I was free \0 leave ror the
day. AU or us on the propam were "oulpalien.." and, if IlOl £rom the D.C......
stayed in hotels lround the Medical CenlCr.
NIH paid a stipend for the """' of the hotel
and livi", while on the program.
I did not last the entire program. (I wenl
inlO my levenrh week and was Iaken oft' on
a Wednesday-actuaOy I received 32 days
of the drug as opposed 10 the complete 40).
Dull was in illOll8 enousb 10 hear a 101 and
walCb other people's reactionsAs lime wenl along, I golthe impression
thai many of the BUys on the program (or
"prorocol" as il is ""lied .1 NIH) really had
bigh hopes of r=ivi", some henefil.
I did noI. Thing. like ·miracle" cures
don't happen 10 me, probably because I
don'l believe in miracles. Besides, as we
were loid hefore signins lbe luthorizations,
lite ptupOSeof the program we were on, was .
nollO find • cure in the finl place-il was 10 .
measure side-e1Tecls and lesl various desrees
or dooages. The only encouragemenl we
were oIfered w.. lha~ in \eslluhes,the drug
bad eirher inhibilcd or hailed the growtb of
the AIDS virus. The assumplion was thai
the druc miabl do the.me ror us. if il dido'l
kill us IirsI. We were, as far as NIH was
coaccmed, II¥' fil1l people II> be &iVeD the
drug. HPA-23 was used on some people in
France (includins Rock Hudson), bUI
menlioning lhe French cxperimenlS al NIH
was like waving that proverbial red nag, so I
have no idea if anyrbing was learned in
France.
On Ihe Monday I hegan Ihe program, I
became Numher 12, oul of 12. Since Ihen
lhe lotal numher of people involved has
gone up 10 16 and is supposed 10 10 higher;
my memory seems 10 recall 64 bUI lhal is
conjeclure. However. even if the drug does
5OO1e good for some people, we aren't
talkinS .boUI doing much for very many
palienlSl
CompIIcatlona
Four people bad srarted the drug Iwo
weeks before mysd~ rout the week before
(and the last foor aboul a week and I half .
before I was removed rrom rhe drug.) Of
Ihesc 16, five have already been taken 01[
the prOlOCOI. (One died, bul of complications. ~ I helieve. directly relaled 10 the
dru&-)
So when I started my lilSt day, some guys
bad already been on the stuff IWO weeks.
and compJications were devdopi",_ I've
never been sure just how much we were
aauaIIy IOId about lite side-eft'ccts. other
than whal we miBbl have IOId each other.
Also, there _med 10 me 10 be an overabundance of manied people in the
program-6ve.1 believe oulofthesi....n.1
couJd never he sure if Ihesc people bad
AIDS because of ..xURI conlaCl or from
ollter reasons (blood, drup, elC.)
The group was odd, I feJ~ in aoollter way.
Otbe, IhaII myself, 00 one ever menlioned
being Gay (with rhe exceplinn or one guy
who would brinB bis lover out 10 the clinic
rrom time 10 lime). My impression was thai
mosl people were ashamed of wby rhey
were there and of their G.y""". Thank
goodness I've never had thai dilflCllllY and
never will.
Most or lhe complicalions I heard aboul
were severe headaches .nd lemble slOmach
pains. Many of us developed skin problems,
myself included, alrhough a large ponion of
mine slCmmed, Ilhink, from going off olher
medication-I was one. (No OIher medicine is
allowed wbileon HPA-23,exceptTylonol.)
I slill have some large acne-like sores on my
cbest and back.
Bul oolbing happened thai first day. I
didn'l £ain~ go inlO convulsions. or anylhing
so dramatic. Nor was the rest of the first
w.... out of Ibe ordinary. Various people
wlnled me 10 keep a journal during lite
procram. I did nul There simply was nOi
enousb malCrial 10 wrilC about Even wirh
(Ol1lpIiL';.Itions. 11/0.\1 of thc -'~ Ja,'" I
fI.:l· •..'i,l·J thc Jrug \\crc fllUlillC: glllhl·liinil.
gl·t thl· IIP:\·~3. kit'C. II.JlJI\" ;lIl' ,lull lit
dramatll.:!oo.
.
\,"'hat did harr"!O. w mc. hll!llD III 111\
\\lock. On Tu~~lal and \\·t·lll1l'~d .. \.
I cxpcri~nl:\."d a great affillUnt Ilf an;&!
hl\."cJin~. "fhey a~kcJ nle if I \\ ()uld unJcrgll
~'\:ond
~mlclhmg i.:<lllcu a ··bone: Illaml\\" iI'IpllalIOI1." FranUy, I didn't OI:'1pin.: Iu II OIL all. I
~hould mcmion herc thai .. II sort\ of extra
prucl.xiurl."S such as thc tkmc marn )\'
blbinL"SS ,·a/l be rdusc::d. It i~lft like hcin~
undc:r a doctor's care 31 home and ha\ lug lei
do what he suggests. Under this PHlh>l.:t11.
unc is free to say yes or nl); one mighl abtl
lea\"c the program at any puinl, \..·ilh nu
repercussions.
They explained the aspiration lechnique
carefully and I agrffil. It diun', ,ound like
much fun-and wasn'l-my auitude was
,hal I was here 10 he helpful. Whallhey did
was take a large nffille, deaden a Spol above
my hip, insert the needle, and withdraw a
tiny bil of" marrow. They wanted the
marrow 10 see why my blood plalelel counl
dropped.
Dlood platelelS! Those linle rascals were
my bane throushoul lhe whole program.
I'm nol sure whal their full purpose is, bUI
they play. major role in lhe cloning faclor. I
believe one is supposed 10 ha ve II leasr I SO
of them. (Everylhing is rounded 01T: 150
equals ISO,OOO.) AI the beginning of my
second week, lI)ine had dropped down 10
46. At 40 one is removed from the program.
1be bone marrow business was to see
whether or not my marrow was still
produci", pI.teI.... If il was, then lbey
could logically assume the druc was the
problem. Happily (I suppose) il did lum oul
10 be the drug.
The nexl couple of weeks were spen~ by
me al any rate, in bopiogthe plaleJelS would
remain high enough thaI I mighl.remain on
lhe prosram. They wenl up and down, then
levelled 01[ for a lime around 60. NOI very
high, but su1Iic:ienl.
The plaleleb drop
Then,the reading OIl my 32Dd day of the
drua was 24, and as il remained 01 24 the
followi", d.y as weD, 01[ the program I
came.
Frankly, al linll was cxrremdy pleased.
The las! few days before wming off the
pnogram I spenl simply counling the lime
unlil I wuld leave for borne. I .nlicipaled
thai being removed from lhe prOlocol
would soon have me wi",ing my way back
10 the sunny soulh, in this case, Goorsia.
Bu~.1as, four days Ifter I wasoffthedrus I
was su11 sitting in a D.C. holCl room. Th~y
needed to IlU1 a "saUium scan" on me to see
if I bad wntracled pneumonia.
Should you pal1klpa"?
The queslion logically arises: would I do
il apin? If you come down with AIDS
ouShl you consider gelli", inlO some sort or
program with a (relalively) untried drug?
In my e",.. bavi", made an effort 10 do
somdhi", posilive aboul my alness. I will
not again venture into an unknown
program unless the odds seem much heller
than lbey did rhis lime. I came 10 D.C.
expecli", nOlhing, so I'm nOl unduly
disappoinled. However, I am a homebody. I
have my own house.nd Iwo calS (and, no, I
wouldn'l gel rid of my anim.1s in spile of the
faa we are advised 10 do so). Bei", II home
and sumvi", only Ihree Or four monrhs
would be belter ror me Iban livinS two or
rh... yean here and there chasi", ·cu.... •
****************.**********************************
AMFAR AWARDS GRANTS
by Peg Byron and Lisa M. Keen, with thanks to
!h! ~~!h!~g!~
~l~~!,
5/30/86
The American Foundation for AIDS Research (AmFAR) awarded more than $1.1 million to 20 research projects, its first
since consolidating the AIDS Medical Foundation of New York with the National AIDS Research Foundation of Los Angeles.
The grants, which averaged $58,000 each, ranged from a study to develop 'noninvasive diagnosis of pneumocystis carinii
in AIDS' to 'Regulation of HTLV-IlI gen~ expression' to 'AIDS Public and Civil Liberties: the ethical issues.'
**************************************************
CITY APPROVES CLINIC MALPRACTICE INSURANCE FOR 2 YEARS
with thanks to !h! ~!!b!~g!~ ~l!~!, 6/6/86
The Washington, D.C. City Council Committee on Human Services unanimously approved a bill to provide medical liability
insurance to the city's 'free clinics'--including the Whitman-Walker Clinic, The bill would,cover liability for
negligence in providing health care and related services to the clinics which can not obtain private' policies at a
r.easonable cost, The coverage, which under the bill would last for two years, has been provided on a temporary basis to
the clinic since their private policies were canceled in January'. Whitman-Walker Clinic Administrator Jim Graham said
the bill is 'absolutely essential' for the Clinic to be able to continue its services.
Graham blamed the national
liability insurance crisis for causing malpractice coverage to skyrocket_ He said the lowest price policy the Clinic
has been able to find is for $38,000 per year., compared with a policy it had last year for $2300_
********l*****************************************
************************************************************************************************************************
DONORS BLOOD TO BE TRACED
~~y!!!,
6/11/86
Blood collection agencies in the United States will search for people who received transfused blood from donors later
found to have been exposed to the AIDS virus. The American National Red Cross, the American Association of Blood Banks
and the Council of Community Blood Centers will look for people who received blood before March, 1985, when all blood
collection agencies began using a new test to screen blood for the presence of the AIDS virus. Although the AIDS
epidemic began in 1979, officials are not yet decided on how far back they need to investigate. Health officials and
doctors will tell people who .received blood before that date that they may have been exposed, according to a Red Cross
official. Those people could be tested for exposure.
**************************************************
MARIPOSA FOUNDATION PRESENTS AWARD TO BRAD TRUAX
with thanks to Detroit's ~~y!!!, 5/21/86
The Mariposa Education and Research Foundation announced that it has selected prominent San Diego physician [and NCGSTDS
member!] Brad Truax, MD, to receive the 19B6 Mariposa Foundation Award for outstanding contributions to moving society
closer to recognizing the dignity of every human being. The award, which includes a check for $1000, was presented by
the Mariposa Foundation' at the annual awards dinner of the Fund for Human Dignity,
May 12 in New York. Last year's recipient of the Award, former director of the National Gay Task Force Ginny Apuzzo,
presented the 1986 award to Dr. Truax. In Southern California, Truax is widely known as the 'gay mayor of San Diego.'
One of that city's leading physicians and humanitarians, he serves as clinical professor in the Dept. of Family Medicine
at the University of California in San Diego and on the San Diego Human Rights Commission.
He co-founded San Diego
Physicians for Human Rights, as well as the United San Diego Elections Committee, was a delegate to the Democratic
National Convention, and served several terms as President of the San Diego Democratic Club ..
**************************************************
PWA SWITCHBOARD OFFERS SERVICES IN SAN FRANCISCO
People with AIDS Switchboard is an organized group of people with AIDS (PWAs) and people with AIDS related complex
(PWARC) concerned with helping other PWAs and PWARCs deal with the emotional and practical p~o~;cms of the disease. A
call-in hotline was established in order to provide telephone counseling, information, calendar events, and referrals
for all PWAs, PWARCs, and their friends, families, and loved ones. Although not professional counselors Switchboard
volunteers are willing to share their experiences and providing information can be very helpful to others.
PWA
Switchboard is a joint project co-sponsored by the San Francisco AIDS Foundation and People With AIDS, San Francisco,
with offices located at the San Francisco AIDS Foundation. The Switchboard operates Monday-Friday, 1-4pm, and receives
referrals from anywhere in the country, or from AIDS service providers by dialing 415/861-7309.
**************************************************
MOBILIZATION MEMORIALS IN 70 CITIES WORLDWIDE
by Marcos Bisticas-Cocoves (& Loie Hayes in Boston), with thanks to Boston's
§!~ ~~1;~ ~!!!,
6/7/86
People gathered in nearly 70 cities on Memorial Day to COmmemorate those who have died from AIDS and support those who
are living through the present health crisis. Organizers call the third annual candlelight memorials the largest action
around AIDS to date.
The memorials were coordinated by Mobilization Against AIDS, a San Francisco-based national
political action group. The 'candlelight actions' initiated by Mobilization ranged from religious services, to silent
vigils, to marches followed by rallies. The theme of this year's memorial was 'Still Fighting for Our Lives.' Frank
Richter, one of the national coordinators of the event, said, 'We chose Memorial Day for this because people with AIDS
are at war, they are fighting for their lives. People with AIDS have displayed a lot of courage in the face of
adversity, they've been in the forefront of battles for services and funding.' Richter said that the goal of the
memorials 'is to show that people allover the country, not just people in big cities, are concerned about AIDS, that
they are supportive of people with AIDS. We want to show that the appropriate response to disease is caring and
support, and to put a lie to the doctrine that people are to be blamed for being sick, or that they're morally culpable
for what's happened to them.' Nearly 90 cities planned to hold some kind of memorial on May 26, however only about 70
cities were able to follow through with their plans. One notable exception was Tokyo, which canceled its plans due to
fear of harassment. In San Francisco, crowd estimates ranged from 5000-15,000 for a march and rally. In Oklahoma City,
the first memorial included an all-night vigil attracting nearly 75 vigilers. In New York, about 500 people gathered in
Greenwich Village's Sheridan Square. In Lynchburg, Virginia, home of the Reverend Jerry Falwell, about 25 people turned
out for a vigil and church service. According to local organizer Doug Deaton, the Lynchburg service proceeded without
incident. 'The people in Lynchburg are so conservative,' said Deaton, 'that they didn't even show up to protest." In
Boston, about 800 walked from the Boston Common to Old South Church for an ecumenical religious service.
Local
organizers were unanimous in their support for future actions. However, Paul Boneberg, of Mobilization, said the
memorials cost his group between $5-10,000. 'We have to recover our seed money if we're going to do this again,' said
Boneberg, 'and the community has to ask itself, do they want this to happen next year?"
****************************************.**.++++++
***** PAGE 4' * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 *****
************************************************************************************************************************
KAN SUES OVER ANTfBODY TEST RESULT DISCRIMINATION
with thanks to £~!~, (Computerized AIDS Information Network), 5/1/86
A 30-year-old man from Brick Township, New Jersey, who lost his job after mentioning he had tested positive for AIDS
antibodies has sued his employer, Dumar, Inc., a Branchburg Township roofing company, alleging he was the victim of
unlawful discrimination. 'The employer said, 'I've had enough of your personal problems on the job,' and fired him,'
after he had mentioned that an earlier blood test was positive for antibody to the AIDS virus, said Jeffrey Fogel of the
New Jersey chapter of the American Civil Liberties Union. The state's Civil Rights Division has filed an application to
intervene in the case, said Deputy Attorney General Susan Reisner, believing AIDS is a handicap under New Jersey's antidiscrimination law.
'Unless the employer can demonstrate that the handicap actually interferes with the ability to
perform work or causes a hazardous condition to other workers, then you may not discriminate against those workers,'
said Fogel.
.
**************************************************
KNOWING IS BETTER?!
£~~i!!,
7/23/86
Some gay men dread getting AIDS so much that they're relieved finally to learn they have the deadly disease.
Researchers found that for some gay men, not knowing whether suspicious symptoms will turn into AIDS is worse
psychologically than knowing they have the disease. The study surveyed AIDS patients, men with AIDS-related complexsometimes known as pre-AIDS, in which victims show some symptoms but don't have the disease--and a control group of
healthy homosexual men. Depression and anxiety showed up in 76% of the AIDS-related complex group, compared with 59%
for people with AIDS and 41% for the' control group.
**************************************************
AIDS BLOOD SCREENS--CHAPTERS 2 AND 3
by Joanne Silberner, with thanks to
§~i!~~! ~!!!,
7/26/86
[EO NOTE--Science News and specifically medical reporter Joanne Silberner have consistently provided outstanding
quality, d~pth:- ~nd- readability of issues dealing with AIDS and health. We once again encourage our readers to
subscribe to this excellent weekly publication: call 1/800/247-2160 for new subscriptions; rates: $29.50 for one year;
$50 for 2 years. You will be satisfied!!] In March 1985, the US Food and Drug Administration approved the marketing of
several blood screens that detect antibodies to the AIDS virus. The nation's blood banks immediately began screening
L_ ...3tad blood and pulling positive units from their shelves. The screens have been credited with halting new infections
from blood or blood products. But while the tests are very sensitive--they identify just about all contaminated blood-they also have their problems: *They give positive results for some blood that would not transmit AIDS. In fact, says
Max Essex, an AIDS researcher at Harvard University, 'Ninety to 95% of the people who test positive don't really have
the virus.'
Included in this group are people who test positive because they have other cross-reactive antibodies,
unrelated to the AIDS virus. *Of the apparently healthy 'true positives' it does identify, the type of screen used
today does not pinpoint which people will go on to develop AIDS within 5 years--a fate that will befall an estimated 2030% of them, according to CDC officials. *A small number of people whose tests come up negative actually have AIDS
virus in their blood, and at least one person has contracted the virus from an 'antibody-negative' donor. In the wake
of such difficulties, researchers and industry have been searching for a second generation blood screen, and several are
expected to be approved by the FDA in the next few months. While the 2nd generation tests, like the first generation,
detect antibodies rather than the virus itself, they are more specific and less prone to false positives.
Unfortunately, they won't be any better than the 1st generation tests at picking out people who harbor the virus but
have not raised antibodies against it. To detect these antibody-negative, virus positive people will take 3rd
generation tests that hunts for the virus itself. Such tests are already being developed by several companies. The
blood screens are the first practical application of AIDS laboratory research. Since there is a s yet no cure for AIDS,
screening blood, sticking to safe sexual practices and avoiding intravenous drug abuse are the only steps that can be
taken against [infection].
The American Red Cross, while following the development of the 2nd and 3rd.generation
screens, is expressing confidence in the sensitivity of the current antibody screen despite its problems.' 'Since the
initiation of the screen there has not been a report of any transfusion-associated AIDS,' says Jos~ph O'Malley, a
medical specialist at the American Red Cross in Washington, DC., 'although .recently there has been, one case of
seroconversion [development of antibodies]."
The seroconversion, detailed in the June 20 ~~~B [see else~here in
Newsletterj, occurred in a 60 year old man who had received blood during surgery in August 1985. The blood, which had
(Continued)
***** THE' OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 1:5 * JUNE/JULY, 1986 * PAGE 45 *****
************************************************************************************************************************
~!Q~ ~~QQQ ~~~~~M~~ ~2n~!n~!g
tested negative, came from a
after the donation that caused
fact that the donor was in a
the individual should not have
itself.'
donor who was homosexually active 'with one partner; a blood sample taken several months
the seroconversion retested positive. 'The blood was [initially] nonr~active due to the
'window' period between infection and seroconversion,' says O'Malley. 'As a homosexual,
donated blood. The only way around a case like this.is to develop a test for the virus
Both the 1st and 2nd generation screens are ELISAs (enzyme-linked immunosorbent assays). They are augmenting the crude
screening-simply requesting that members of high-risk groups not donate b100d--on which blood banks have been depending.
In an ELISA, blood serum is added to small wells containing bits of the AIDS virus, which has been recently renamed HIV
(human immunodeficiency virus) by an international committee of virologists. If there are HIV antibodies in the blood,
they'll stick to the virus. To detect such antibodies, a second, enzyme-linked antibody is added. which will attach to
the antibody-virus complex, if present.
When a chemical with which the enzyme reacts is added, the.enzyme itself
changes color, signaling the presence of antibody. The problem with the 1st generation ELISA, which costs about $4 per
sample, is that nonspecific cellular debris from the initial cell culture in which the virus was grown can be present in
the well with the virus, Some people test positive not because they have antibodies to the virus but because they have
antibodies to the cell in which it was grown. Included in this group are monogamous women who, in the course of bearing
several children, were exposed to foreign white blood cells and developed antibodies to them.
The American Red Cross, which collects and distributes half the blood donation in the nation, rechecks initial positives
with two more ELISAs. If either is positive, the blood is considered a repeat reactive. About 1% of Red Cross donors
are initially reactive; about 0.3 to 0.35%--30 to 35% of initial reactives--are repeaters. Repeat reactive blood is
tested with what is called a Western Blot, or immunoblot assay. In this procedure, which costs about $65, suspect blood
is added to blotting paper that contains AIDS virus proteins of different sizes. Antibodies specific to the particular
proteins will stick. As with ELISA, an enzyme-linked antibody is added; in this case, when a chemical with which the
enzyme reacts is added, the complex turns color and can be detected visually. About 0.025% of the Red Cross donors-roughly 8% of· the repeat reactives on the ELISA test--wind up with positive Western Blots. The CDC estimates that 1-1.5
million apparently healthy individuals in the US are antibody positive and thus presumably Western Blot positive.
Red
Cross notifies donors· who are Western Blot positive but not those who are Western Blot negative, even if they are
repeatedly reactive.
To safeguard the blood supply however, the Red Cross discards any blood testing repeatedly
reactive on ELISA irregardless of their Western Blot results. A variation on the current ELISAs received FDA approval
in February. Made by Genetic Systems Corp. of Seattle, the test is more a cousin than a 2nd generation descendant: it
is an ELISA that uses a viral isolate provided by the Paris based Pasteur Institute and grown in a different cell line
that reduces the number of false positives caused by reactivity against non-AIDS proteins. The antibody screens
produced by other US companies are based on a virus and cell line developed at the National Institutes of Health (NIH)
in Bethesda, and patented by the US government. That patent is currently being contested by the Pasteur Institute of
Paris, which claims that NIH researchers depended on viral isolates the French group had shared with them, and that
Pasteur's earlier patent application should be the valid one. The US patent office put the onus on NIH to prove that
its antibody detection method predates Pasteur's.
The primacy question could become moot when screens that use proteins produced by genetic engineering rather than by HIV
itself are approved. The benefit, notes Hubert Schoemaker, president of Centocor, a biotechnology company, is that
these screens don't use the cell-grown virus. This eliminates the cellular debris that causes nonspecific reactions, so
that· a positive reading will reflect true HIV antibodies. In addition, he notes, genetically engineered proteins
eliminate the hazard of working with live virus. Centocor, based in Malvern, Pennsylvania, has a recombinant protein
product Schoemaker believes is near FDA approval. But the 2nd generation antibody tests won't take care of everything.
False negatives, says Harvard's Essex, are 'still a limitation in the 1st and 2nd generation test. Some percentage of
people infected with the virus--the best figure used is 5%, but nobody knows exactly--don't have detectable antibody.'
Included in the antibody negative, virus positive group are people who picked up the virus only recently and haven't yet
produced antibodies. It can take weeks or months following infection for antibodies to appear int he blood. Jay Levy
of the University of California at San Francisco has used immunofluorescence to find antibody negative, virus positive
blood. In the procedure, he treats potentially infected cells with a chemical that opens them up, allowing viral
antibodies to enter. These antibodies, in turn, can be identified by fluorescent tags. 'We have seen [in the same
blood sample] a positive by immunofluorescence and negative by ELISA and immunoblot,' says Levy. '1 think its rare, but
it does occur.'
The only way to find antibody ~egative, virus positive samples is by checking for the virus directly instead of the
antibody footprints, This is the goal of the 3rd generation tests. Detecting virus is difficult because HIV generally
(Continued)
***** PAGE .6 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 *****
************************************************************************************************************************
~!q§ ~bQQQ ~RE~3L ~QI.!ti!!~
is present in only low concentrations. At the moment, such testing is impractical. 'The only sure way of showing [the
virus] is there is to grow it out,' says O'Malley. 'But that's extremely difficult and expensive.', The virus has to be
grown in'cell cultpres kept alive while it replicates.' 'Even some of the largest medical research groups in the country
have been tripped up trying to isolate the virus,' says O'Malley. In one type of 3rd generation test, DNA probes use
one side of the virus's double helix to seek out its complementary half.
L.R. Overby of Chiron Research Labs in
Emeryville, California, says 'There's no evidence even with [easy to use] probe technology that there's sufficient virus
to be detected that way.' The company has been working on a probe, but it is being designed as a research and clinical
tool, not as a simple screen. It may prove useful for determining whether a person with symptoms of AIDS actually has
HIV, says Overby. Centocor is also working on a method to detect AIDS virus. Theirs is not a DNA probe but will depend
on antibodies that bind to the virus's genetic material. Such direct testing, however, won't necessarily be more
practical than antibody tests for screening blood, he believes. Cetus Corp. of Emeryville, CA is going for a DNA probe
in a novel manner. Because the virus's concentration in the blood is so low, they have developed a series of chemical
steps that will reproduce any HIV present in a blood sample. Asubsequent DNA probe will have a greater amount of HIV
to survey and, therefore, a much greater chance of determining whether the blood is infected. Researchers from UCSF are
working on another way to test for the virus. At the International Conference on AIDS in Paris earlier this summer,
Jacque Homsy described a test for an AIDS virus protein that involves pitting suspect blood against known levels of
recombinantly produced protein and measuring its ability to bind to antibody that is specific to the protein. If the
blood being tested contains that particular virus-bound protein,the protein will compete with its recombinant twin, and
less of the recombinant protein will bind to the antibody. Conversely, if all the recombinant protein is bound, it
means no virus is present. The test, Homsy claims, yields few false positives and can detect as few as 100 infected
cells in a blood sample. Tests for virus are expected to eliminate the handful of exceptions that slip through the
current screening process. 'If you include screening for risk groups and pick out antibody positives, you get the
majority of the dangerous [blood] out,' says Thomas Merigan, a specialist in infectious diseases at Stanford University.
'It would be nice to have them all out.'
**************************************************
AIDS VIGIL SEPT. 5-7
.
with thanks to ~~!~ {~Q!2Yi!~!!!~ ~!P§ !!!fQ~!!!!Qn M!!!Q~~l, 7/25/86
More than 200 congregations that make up the Universal Fellowship of Metropolitan Community Churches will be
participating in a 50 hour International AIDS Vigil of Prayer to be held during the weekend of September 5-7, 1986.
Vigil coordinator, Rev. David Farrell, pastor of Metropolitan Community Church in San Diego, says that the Vigil will
accomplish three things.
Farrell sees the Vigil as a spiritual statement of support for all persons who have been
affected by AIDS, as a forum to provide education on AIDS and related issues and as a vehicle to stimulate volunteers
and community financial support on behalf of persons living with AIDS through love offerings received for local AIDS
Projects and AIDS Charities. During the Vigil, Metropolitan Community Churches will be offering special worship services
which address the spiritual concerns of those living with AIDS as well as those of their families and friends.
Sanctuaries of many churches will be open continuously during the 50 hours of the Vigil so that persons of any faith or
spiritual belief can reflect or pray silently. Local AIDS service organizations will be providing information booths and
assisting the congregation in organizing lectures, educational panels and discussion groups on the various issues
surrounding AIDS. For many, this will be the first time that they will have access to accurate medical information on
AIDS and to viewpoints concerning the social and personal issues created by the health crisis. Farrell and his San Diego
congregation held a highly successful local vigil during the first weekend of January, 1986.
That vigil received
favorable media 'attention and support from San Diego's religious and secular community. All churches and religious
organizations throughout the United States and Canada are being invited to participate. These organizations are being
asked to send a representative to the MCC Vigil so that they can then familiarize their congregations with the
Metropolitan Community Churches' concerns. In addition, each organization is being asked to devote some time, either in
prayer, reflection or by sermon, to the spiritual and emotional needs of those affected by AIDS during the Vigil
weekend. 'This Vigil is NOT about lifestyles,' emphasizes Farrell. It is an outreach to the entire community, giving
pastors and their congregations an opportunity to lend spiritual support. 'We need to get the disease talked about and
address 'the issue of what a truly Christian response should be.' Farrell believes that an International AIDS Vigil of
Prayer will provide all churches with a forum in which to minister to the concerns of persons living with AIDS and their
families and friends. 'Many churches haven't perceived AIDS as their issue. We are attempting to change that perception
by increasing their knowledge of the issues involved, pointing out that persons with AIDS, and especially their friends
and families are often members of THEIR congregations.' Since his congregation's local Vigil in January, Farrell has
been traveling throughout the United States and Canada, organizing the International Vigil. The Board of Elders of the
Universal Fellowship of Metropolitan Community Churches has endorsed plans for the Vigil. Farrell has also approached
other religious groups, such as the National Council of Churches, offering information and resource packets about the
Vigil. 'I think the church has an obligation to be a teacher in a time of international crises,' says Farrell;
'You
don't have to be religious OR gay to be involved in this weekend. You just have to be concerned for the welfare of
those affected by the disease. This weekend will emphasize both the ~piritual support of the community and be
informative at the same time.' Farrell recently celebrated ten years as pastor of the MCC San Diego and has been an
active member of the church for over 15 years. During his service to the MCC, David has become a respected leader of
the gay, lesbian and religious communities. For more information, contact the Rev. David Farrell, Coordinator,
International AIDS Vigil of Prayer, 619/280-7744.
"'.++,.,.............. , ........................................................
.l. ..................................... .
,************************************************************************************************************************
'DYNASTY' ACTOR HAS AIDS
with thanks to Chicago's
~!~~~ ~!~~
Ii!!!, 7/17/86
TV actor Paul Keenan confirmed he has AIDS. Keenan, 30, who is gay, appeared on the TV show Qy~~!~~ in 1982 and ,1984,
and has appeared in several other television programs. He is the second actor on that show who has announced he has
AIDS; last year, before his death, Rock Hudson publicly announced he had AIDS.
**************************************************
INTERNATIONAL HEALTH RESEARCH FOUNDATION FORMS
with thanks to the ~!~ YQ~~ ~~~!Y!' 6/2/86
"Receptive anal intercourse might not be the only thing on the minds of AIDS researchers at the CDC; But then again, it
might be.'
So reads an advertisement for the newly formed International Health Research Foundation (IHRF) in North
Miami Beach. The Foundation hopes to support independent research into areas the government is ignoring, such as
African Swine Fever Virus, other arboviruses (carried by insects), mosquitoes, and the environment. The Foundation was
established by AIDS researchers Drs. Jane Teas, James Hebert, John Beldekas, and Mark Whiteside. One of the greatest
impetuses of investigation is why there are no satisfactory explanations for the high rate of AIDS in the rural Florida
community, Belle'Glade. The town has a population of 16,500 but has the disproportionately high caseload of 250. Teas
and Hebert found a farm with 146 pigs in Belle Glade, many of them very ill; preliminary blood tests found the presence
of HTLV-III antibody. You can imagine how pork producers feel about any inferred relationship between pigs and AIDS,
let alone research into such a connection. Despite roadblocks by private lobbying groups as well as the Public Health
Service and the Department of Agriculture, among other agencies, the strength of conviction may be the source of
inspiration for the new Foundation. For more information, or for sending a tax-exempt donation:
The International
Health Research Foundation, 1780 Northeast 168th Street, North Miami Beach, Florida 33162.
**************************************************
CUBA OKAYS MOTHER'S VISIT TO DYING SON WITH AIDS
by Kim Westheimer, with thanks to Boston's
§!~ ~Q~!Y~i~~ ~!!!,
6/29-7/5/86
After a year-long battle with Cuban authorities, Estrella Hechaverria was allowed to travel to Boston to see her son,
just days before he .died of AIDS. Cuban authorities had earlier denied her a visa, claiming they feared she would
'return to Cuba with the virus.' Following the visa denial in May of this year, Hechaverria's son, Luis Valdes, his
lover, Steven Yost, and longtime family friend, Jose Rey, sent letters to the Massachusetts Congressional delegation and
to Senators Kennedy and Kerry. Finding no success, they met with black activist and candidate in the Eighth District
Congressional race, Mel King. According to John Demeter, media coordinator for the King campaign, King immediately
called the Cuban Interests Section and began negotiations that led to Hechaverria's receiving a visa. King spoke with
officials about transmission of AIDS, insisting that Hechaverria would not receive AIDS from visiting Valdes. David
Aronstein of the Boston AIDS Action Committee said they had also been working to obtain a visa for Hechaverria during
the last year. The situation was looking hopeless, he said, until King's contact with Cuban,officials. Upon securing
the visa, King, the AIDS Action Committee and Valdes' co-workers from Oficina Hispana worked to raise funds for a
special charter flight for Hechaverria. Hechaverria had not seen her son since his 1980 departure from Cuba.
**************************************************
SOCIAL PRESSURES BLAMED FOR BLOOD SCREENING FAILURES
by Rick Harding, with thanks to !b! ~!!hi~g~~
@l!~!,
7/11/86
Although the safety of the nation's blood supply has greatly improved since HTLV-III (hereafter referred to as HIV]
antibody blood screening began 16 months ago, a National Institutes of Health panel reported that the most effective
method of controlling AIDS infection through blood transfusions is still for gays and others at high ~~sx for the
syndrome to refrain from giving blood. Released in the wake of reports of a recent case in which blood from a newly
infected person slipped through screening tests without detection, the report recommends that there be 'continuing
vigorous efforts to educate the public and facilitate anonymous self-deferral at the time of blood donation.' The panel
noted that '(b]ecause of real or perceived social pressures,' some people at high risk of transmitting AIDS may 'feel
compelled to donate blood.' The panel report recommended that blood banks institute a system which would allow donors
to check off a confidential form to ensure that their blood is discarded after donation. The panel's 19-page report was
released at the close of a three-day public conference to assess 'the impact of routine [HIV] antibody testing of blood
and plasma donors on public health.' The report notes that although the primary focus of blood collection centers
should be to protect the blood supply, an important secondary focus should be to notify and counsel people who test
positive for the HIV antibody. Although several invited speakers, including an attorney representing the Lambda Legal
Defense and Education Fund reported on how antibody testing is having an impact on the gay community in particular, the
panel opted to keep the scope 9f its report narrow and to consider only how the tests are having an impact on blood
donors. The report does note, however, that '[q]uestions can be raised' about using the test for 'purposes other than
protection of the blood supp'ly." When the report was read, several audience members, including a representative of the
American Red Cross, urged the panel to reconvene at a later date.
************************************************************************************************************************
NON-DEADLY AIDS VIRUS CREATES HOPE FOR VACCINE
with th4nks to ~~!~, 8/1/86
WASHINGTON (AP) Cancer researchers have created a non-deadly version of the AIDS virus, raising hopes the mutant
can be used to develop a treatment or vaccine for the always-fatal disease, according to a recent report. The
laboratory-altered version wouldn't destroy the genuine AIDS virus that has killed more than 12,000 Americans but
could compete with it in a victim's body, suggests the report by National Cancer Institute researchers in the
August 8 edition of the journal Science. Thus, if an AIDS victim were given the altered version, it would go after
the same immune-system cells the AIDS virus attacks, but with one crucial difference: It wouldn't kill them. And after
those crucial cells were infected with the altered virus, the killing AIDS couldn't get in. Most of that, however,
is still theory, and no human tests are even scheduled at the moment. Researchers still need to learn much more about
other,
possibly negative effects the altered virus might have on people, said one of the researchers, Flossie WongStaal. Some researchers, including some at the National Cancer Institute, oppose even the general idea of putting the
virus into people, she said. However, she added, "logistical problems" with such a tactic might seem less in
light of the fact that infected people who might eventually be treated seem otherwise headed for sure death from
AIDS. Animal tests could begin soon, she said in a telephone interview. At the very least, creation of the altered AIDS
virus provides a heartening first indication the disease's deadliness and ability to spread "are not intrinsically
coupled," the report said. Experimental treatments up to now have occasionally succeeded in slowing the spread of the
virus or even stopping it for a time, but there has been little apparent progress toward reversing its effects and
restoring the damaged immune system. Researchers also are continuing work aimed at developing a vaccine, which
likely would contain some form of the AIDS virus. The advantage of basing it instead on the non-deadly mutant, if that
could be done, would be in putting a layer of safety between the original virus and the person who would be getting
the vaccine, she said. The altered version of the AIDS virs was created by removing pieces of a key gene during
laboratory experiments, the Scie~ce report says. In addition to opening up a possible treatment avenue, the
finding that virus replication and deadliness aren't necessarily linked also sheds new light on the overall base of
AIDS knowledge.
**************************************************
UGANDA SEXUALITY, AIDS STUDIED
by Paul Raeburn, AP Science Editor, with thanks to
~~!~,
7/29/86
KAMPALA, Uganda (AP) Dr. Fred Kigozi may be the man who "writes the Kinsey report for Uganda." as one of his
colleagues puts it. Kigozi, a psychiatrist and a member of Uganda's fledgling AIDS research team, has begun the
first comprehensive study of the sexual habits of Ugandans, to try to understand how AIDS
is spread. Almost
nothing
is known about the sexual behavior of Africans living in the AIDS belt that spans the continent.
Because heterosexual activity is believed to be the primary means of AIDS transmission there. an understanding of
sexual behavior is essential to any attempt to control the disease's spread. "Ugandans are sexually active," said
Wilson Carswell, a surgeon at Mulago Hospital and a member of the AIDS research group. "Whether they are more
sexually acti~e than Amerians and Europeans. I don't know. I would guess. not necessarily." Kigozi has so far
conducted interviews with about 30 AIDS victims and 30 people without AIDS. He agreed
to share
preliminary
findings if it was clear he was speaking on his behalf. not in any official capacity. Among the earliest findings, he
said, is that "homosexuality; or anal or oral sex, does not exist," he said. Heterosexual promiscuity does seem to be
a factor, however. "If you look at the number of partners, the victims have had more than twice as many as the
controls," he said. Most AIDS patients are 20 to 30 years old, and most have families, he said. "People
tend to pair up quite early on," he said. "They drop out of school at 17 or 18. In fact,
it's interesting;
there were more married couples in the AIDS group than in the controls." Prostitution has so far not emerged as an
important means of transmission, Kigozi said. But, he added, "It's too early to conclude anything with great
confidence. 'We're going on.' Carswell is expanding the testing for AIDS antibodies he originally began to map
the extent of Uganda's epidemic. Carswell was part of a group that mounted a 36-hour field
trip last summer to
Masaka,
about 80 miles southwest of Kampala near the Tanzanian border. Uganda's epidemic of AIDS or slim, as it's
often called began there in 1982. "There were three physicians, two surgeons and a virologist, which isn'.t a
great epidemiology task force,"
Carswell said. "It's very amateur .... Basically, I'm only a bush surgeon."
Nevertheless, the amateurs accomplished a lot. They examined 71 patients aged 17 to 60 and found that in all slim
had been transmitted heterosexually. They confirmed it was caused by the AIDS virus, as had been suspected·. . They
also recorded a number of patients who had all the symptoms of slim but did not test positive to AIDS. These patients
could be
victims
of a different strain of AIDS virus, or of anot~er virus altogether. This was particularly
interesting in light of the discovery this year of a new AIDS virus by researchers at the Pasteur Institute in Paris.
The virus, called LAV-II, was found in two residents· of· Guinea-Bissau, a small West African nation. The two patients,
like some cf the Ugandans, had AIDS but no evidence of exposure to the original AIDS virus, designated LAV or HTLVIII. **************************************************
************************************************************************************************************************
DAILY INTERFAITH WORLD-WIDE MOMENT OF MEDITATION
with thanks to ~~!~< 7/31/86
A world-wide moment of prayer and meditation is being held for people with AIDS and AIDS related conditions for five
minutes every day at 7pm (local time for your area). Allover the world, people are joining together in one spirit and
one mind to end the AIDS crisi, each in their own way. We ask people of faith to pray; those who pra~tice meditation or
visualization to meditate or visualize; for those who do metaphysical work to know the truth. We ask all people to take
this moment to be of one spirit and of one humanity. The daily AIDS meditation &prayer is sponsored by the AIDS
Interfaith
Network
and
the
Healing
Project
of
San
Francisco
(415/552-3038).
**************************************************
GENETICALLY ENGINEERED HEP B VACCINE EXPECTED IN JANUARY
with thanks to !h~ ~!~h!Qg~~ ~l!~~, 7/25/86
The makers of Heptavax B, the currently available hepatitis B vaccine, announced that a new genetically engineered
version of the vaccine will be available by January, 1987. Recombivax HB was developed by Merck, Sharp, &Dohme after
the Pennsylvania-based company realized that many high-risk groups for hepatitis--sexually active gay men and hospital
employees with frequent exposure to blood and blood products--were not taking the vaccine because they were afraid they
could contract AIDS from the blood products used to make Heptavax. Many studies have demonstrated that the three
purification steps used in producing Heptavax kills the AIDS virus. Recombivax is produced using yeast rather than
blood plasma, and still require 3 vaccination injections at a cost of about $100. The vaccine represents the first
genetically engineered vaccine approved by the Food &Drug Administration. [ED NOTE--Those of us working in health care
settings know that the main reason for patients at high risk to not seek the hepatitis B vaccine is not fear of AIDS-but rather the relatively high cost that frequently is not reimburseable by insurance companies, the hassle of not only
3 separate visits over a 6 month time for the actual injections, but also the initial screening and post vaccine
antibody tests, and the general feeling that 'hepatitis won't infect me--it's not a problem.' Let's remember this when
we read reports in a year or two about Merck's disappointment that the new vaccine's sales are just as sluggish as the
old. We told 'em so! See back issues of the Newsletter.]
**************************************************
HEPATITIS &AIDS VACCINE DEVELOPMENT NEAR?
with thanks to
~~!~,
8/1/86
PASADENA, Calif. (AP)
Scientists have pinpointed the part of the hepatitis B virus that infects the liver, saying
their discovery raises hope for possibly developing an AIDS vaccine. They
say
it also bolsters the chance of
developing a cheaper, better hepatitis vaccine. A segment of a protein called "preS" on the surface coating of the
hepatitis B virus was identified as the "binding site" that attaches the virus to the cells it attacks, much like a
plug fits into a socket, the researchers reported in Friday's issue of the journal Cell. If the scientists also can
locate the binding sites used by AIDS and other viruses to infect cells, it might
be
possible
to develop
vaccines against such diseases, said the New York Blood Center and the California Institute of Technology scientists.
That's because the binding site remains almost constat among various strains of the same virus, providing an
unchanging target for a vaccine. Other parts of the.virus' surface proteins can change, which is why some vaccines
fail against new strains of a virus such as influenza. The researchers hope to create inexpensive proteins that mimic
the binding sites of various viruses, including the one believed to cause acquired immune deficiency syndrome, said
Blood Center virologist-biochemist A. Robert Neurath. The same team previously created a version of the preS protein,
and showed it provoked the human body to produce antibodies against the real hepatitis virus. In February, they
reported such antibodies actually destroyed the virus when tested in rabbits. They don't know yet if they can create a
protein that mimics the binding site on the AIDS virus and could be used in an AIDS vaccine, Neurath said during
a telephone interview. "It's a possibility that needs to be investigated," said Dr. James Maynard, chief of the
hepatitis branch at the Centers for Disease Control. Even if a man-made protein could be created to mimic the plug on
the AIDS virus, it isn't known if the protein would provoke creation of antibodies that really would prevent AIDS,
he said in an interview from Atlanta. Maynard said a new hepatitis B vaccine based on the Blood Center-Caltech research
probably would be cheaper, but not necessarily more effective than either the conventional vaccine
or
a
genetically engineered version approved last week by the Food and Drug Administration. Those vaccines use a protein
called "S" to induce immunity to hepatitis. Neurath contends a vaccine that also contains preS would be more
effective. Maynard said that may prove correct, but remains controversial. The conventional, three-dose hepatitis
vaccine is derived from infected human blood and costs more than $100. The version approved last week is made
by altered yeast that produce part of the hepatitis virus to provoke tibodies. The vaccine's maker has said its price
will be comparable to the existing vaccine. Neurath said a cheaper vaccine is needed because most of the world's
200 million hepatitis B carriers live in poor Asian and African nations. Hepatitis B, the most serious form of
hepatitis, infects the liver ,and causes nausea, jaundice and abdominal pain. About 1 million of the carriers are
in the United States, where the about 4,000 people die annually from hepatitis-related cirrhosis of the liver, 600
from hepatitis-related live~ cancer and 250 from severe infection.
**************************************************
***** PAGE 50·* THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 *****
************************************************************************************************************************
TB SKIN TEST ADVISED WHEN ANTIBODY TEST IS POSITIVE
with thanks to !n!!~n~l ~~!g!n! ~!!!, 5/1-1./86
Individuals with positive HTLV-III antibody tests should receive a tuberculin skin test, according to Dr. Arthur E.
Pitchenik, of the University of Miami Medical School. Seropositive persons may be at high risk of developing T-cell
immunosuppression, so those with positive tuberculin skin tests also may be likely to have and transmit tuberculosis.
Isoniazid prophylaxis is indicated for those with positive TB skin tests.
Tuberculosis is the only AIDS-related
infection that spreads to healthy people by the aerosol route. Chmoprophylaxis is likely to be effective since the
disease responds well to antibiotic treatment, even among people with AIDS, Pitchenik said.
**************************************************
WASHINGTON ARCHBISHOP NAMES PRIEST AS LIAISON TO GAY COMMUNITY
by Lou Chibbaro Jr., with thanks to !h! ~~~h!ng!Qn ~l~~!, 6/27/86
Washington, DC Archbishop James A. Hickey named Father John P. Gigrich, a local priest who frequently celebrates mass
for gay Catholics, as the archdiocesan coordinator of ministry to persons with AIDS. Hickey, who heads the Catholic
Archdiocese of Washington, DC, also named Gigrich as his special assistant for ministry to gay and lesbian Catholics.
Gigrich is associate pastor of the District's St. Matthew's Cathedral, and will remain in that post while taking on his
additional positions, according to the ~~!hQlig §!~n~~~~, the official publication of the Washington Archdiocese.
Members of the Washington chapter of the gay Catholic group Dignity, said they were pleased with Gigrich's appointments,
noting that he had been working unofficially as II minister to persons with AIDS and to gay Catholics for many years.
Gigrich told the ~l~~! he has celebrated mass for the Washington Dignity periodically since the chapter formed in the
early 1970s, and has counseled PWAs for the past three years as well as officiating at funerals for PWAs. Gigrich said
he has also served as a 'pastoral volunteer' for the Whitman-Walker Clinic and is a member of the board of directors of
the Clinic's Schwartz Housing Services, which provides housing to persons with AIDS in need of shelter. In addition, he
has headed a support group for PWAs.
**************************************************
CHRONIC HEPATITIS B CARRIERS NEEDED FOR PLASMAPHERESIS
with thanks to Chicago's ~in~~ ~!!~ !i~!~, 5/15/86
As part of its ongoing program to help stop the spread of hepatitis B, Chicago's Howard Brown Memorial Clinic announced
it is seeking plasma donors to aid in production of the hepatitis B vaccine. The process, known as plasmapheresis, is
similar to donating blood and takes about two hours. Suitable donors will be paid $50 for each donation. Anyone who
has chronic hepatitis B, or is currently recovering from the infection, may qualify as a donor. 'Not only will the
donor be paid for his time, he will also be helping HBMC, which receives medical supplies each time he donates. These
materials help the clinic in testing and prevention o.f hepatitis,' said Norman Altman, HBMC research director.
'With
all the current publicity about AIDS, many people have forgotten about the dangers of hepatitis B,' Altman said. 'But
hepatitis B, which can be prevented, is still a major health concern in the gay community.
Although hepatitiS B
infection appears mild at times and is often undetected, the health consequences can be devastating.' The clinic offers
screening during regular hours for hepatitis B, as well as low-cost vaccination which provides immunity to the hepatitis
For more information about the plasma donation program or hepatitis B screening and vaccination contact the
B virus.
Clinic: 312/871-5777.
**************************************************
COSMETICS TO COVER KAPOSI'S LESIONS
with thanks to e!Q~l! ~i!h ~!Q§ ~~~~!! from Shanti Project and the San Francisco AIDS Foundation, July, 1986
Debra Povanzano, professional cosmetologist, is introducing cosmetics which she claims can cover up Kaposi's sarcoma
lesions! Povanzano has done make-up and hair for television artists appearing on 'As The World Turns' and 'The Guiding
Light.' She has been nominated for an Emmy Award in the 1986 Daytime Emmy Awards competition. Povanzano would like to
contact anyone interested in exploring her products. Although her studio is in New York, you may direct inquiries to
her associate in San Francisco, Morgan Manning (415/864-0709).
**************************************************
PERSONAL SAFE SEX SAMPLER KIT DEVELOPED BY EXODUS TRUST
The Personal Safe Sex Sampler Kit was developed to help in the prevention of AIDS and other sexually transmitted
diseases. The kit can be used by health educators to explain safe sex practices in a positive and non-threatening
manner. It contains a generous sample which has a laboratory-proven safety record of effectiveness in killing the AIDS
virus. The kit is accompanied by a sex education brochure of risk reduction guidelines and ways to enjoy t'hesafe sex
products. The kit contains: several brands of lubricant and rubber sheaths (several brands of condoms, iatex gloves,
etc.) and other materials. All products in the kit were tested by the AIDS Research Department Clf The ,Institute for
Advanced Study of Human Sexuality in San Francisco, and all items bear the Institute's Safe Sex Seal of Recommendation.
The kit is packaged and distributed by Trimensa Corporation. For more information, contact: The Exodus Trust, 1523
Frankli, St., San Francisco, CA 94109 (415/928-1133).
**************************************************
************************************************************************************************************************
, KAPOSI'S (ONCE AGAIN) LINKED TO POPPERS
with thanks to Chicago's ~in~Y
~i!Y
Ii!!!,
7/17/86
The incidence of Kaposi's sarcoma (KS) in cases of AIDS has dropped from 34% in 1981 to 14% today, and CDC researchers
are beginning to speculate that the reason why is a decline in the use of amyl and butyl nitrites, or 'poppers,' reports
~~ ~~~~~Q!~ The incidence of KS in non-gays with AIDS is less than,S'.
**************************************************
TOURING AIDS EXHIBITION
Response to the AIDS crisis inside gay/lesbian communities has been swift and largely positive: support groups, fundraising efforts, safe-sex campaigns, public education programs, hospices and more, have' been founded and funded. All of
these organized responses have employed the visual and media arts as part of their educational and funding campaigns.
The AIDS Show exhibition, is' testimony to these community and individual responses to the crisis as reflected in
p~;ter;:-pa;phiets, video, film, etc. The exhibition will be organized to reflect the two directions from which AIDS
image-making primarily comes: community organizations and individual artists. The exhibition will be sponsored by and
open at The Ohio State University Gallery of fine Art in Columbus. The show will open during National Gay Pride Week in
June, 1987, and will afterward tour in two different versions--one for gallery and museum exhibition spaces; a second
in simplified format for exhibition by community organizations. The proposed catalogue will include an introduction by
curator Jan Z. Grover, an essay by British critic Simon Watney, and statements from representatives of gay rights-AIDS
care organizations.' The Ohio State University Gallery exhibition will be accompanied by a number of COMMunity-generated
panels, workshops, and events on AIDS-related graphics/publishing and AIDS health issues.
Graphics, film, video,
photographs, fliers, posters, brochures, illustrations, PSAs by community organizations an individual artists responding
to the AIDS crisis are needed for this touring exhibition and catalogue. Contact: J.Z. Grover, c/o The Ohio State
University Gallery of Fine Art, 128 North Oval Mall, Columbus, OH 43210, 614/422-0330. Send slides or VHS tapes with
background information/resume before November 3D, 1986.
For more information about THE AIDS SHOW, contact Nancy
Robinson, Public Programs Coordinator, at the above address and phone.
**************************************************
TEXAS APPROVES NATION'S FIRST AIDS CENTER
by Craig C. McDaniel, with thanks to the
~~ !Q~~ ~!!j~!,
6/30/86
AHouston hospital will be converted into the nation's first AIDS research and treatment facility. under a plan approved
June 6 in Austin by the University of Texas System Board of Regents. The board agreed to allow state college medical
faculty to work with American Medical International, Inc. (AMI), to establish the Institute for Imauno1ogical Disorders
in one of AMI's 11 Houston-area hospitals. Some health officials and Houston gay leaders have attacked or expressed
reservations about the idea, saying such a facility could become a 'leper colony' or make it harder for indigent AIDS
patients to get care. AMI describes the lSD-bed facility as a 'free-standing in-patient hospital dedicated to research
to research and treatment of immunological and infectious diseases, with initial focus on AIDS>' The agreement permits
staff members at the University of Texas (UT) Health Science Center and UT System Cancer Center (M.D. Anderson Hp~pital
and Tumor Institute) to direct medical and research activities for the new center. AMI agreed to convert Citizens
General Hospital to the AIDS Institute. Conversion is expected to be finished in 'several weeks.' 'The UT System is
pleased needed, not only in Houston but in the entire state of Texas,' said Dr. Charles B. Mullins, a university vice
chancellor. 'Our faculty physicians are excited about using their expertise in conjunction with AMI and putting a halt
to this medical dilemma.
We hope the research that evolves out of this project will have worldwide importance.'
Critics of the plan include Dr. James Haughton, director of Houston's Health and Human Services Department. He had said
that providing a place in which AIDS patients can be segregated will make it appear the patients should be segregated.
'I don't see the need for it,' he said. Gay leaders agree, but say privately that Haughton's warning is ironic,
especially after he supported an unsuccessful attempt by state health officials to add AIDS to the quarantine list.
Houston AIDS patients, mostly homosexuals, who have cancer (such as Kaposi's sarcoma) have been treated without charge
at wofld-reknowned M.D. Anderson, a state-run hospital that must, by law, treat any Texas resident who has cancer. AIDS
patients unable to pay for other medical care had relied on M.D. Anderson hospital for their treatment. Leaders of the
AIDS Foundation of Houston worry that these patients may be barred from the University of Texas hospital and forced to
the for-profit AMI Institute. 'We do have some ongoing concerns,'said Curtis Dickenson, executive director of the AIDS
Foundation. 'There is the appearance that Texas and M.D. Anderson are beginning to withdraw from AIDS activities. If
they are going to continue treating AIDS patients with cancer, that's great.' Houston lawyer Donald L. Skipworth,
chairman of the foundation's board, said, 'I don't like the idea of an AIDS-only hospital.
AMls a for-profit
organization.
They're not going to be interested in providing for the indigent.' University hospital officials deny
those charges, saying AMI would provide care for those who cannot afford the huge costs of treating AIDS 'to the extent
of their ability.' Another concern about the AMI facility is its distance from the inner city, where most AIDS victims
live, The AIDS hospital will be about ten miles north of downtown Houston. Skipworth said in a telephone interview
that his organization and the gay community are giving the plan the benefit of the doubt. 'We have to look at the
alternatives,' he said, citing recent rejections of funding for AIDS counseling programs in Houston and the state Health
Department's efforts to have AIDS added to a list of quarantinable diseases. 'We are in the state of Texas and Texas is
not a good place to be sick.'
---
**************************************************
k*** PAGE 52 * THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5 * JUNE/JULY. 1986 *****
<**********************************************************************************************************************
LESBIANS SUFFER FROM AIDS BIAS
with thanks to !h! ~~!~!~g~~
§l~~!.
6/6/86
Even though lesbians are considered perhaps the group at lowest risk of contracting AIDS. they are in a high risk group
for suffering from the increased discrimination that has emerged from the epidemic. according to speakers at a recent
forum in the District. Nancy Polikoff. staff attorney for the Women's Legal Defense Fund and one of the speakers at the
forum. 'AIDS: Its Impact on Us as Women.' said that some lesbian mothers. in court battles over custody or visitation
rights. have found judges prepared to consider all homosexuals--male and female--at risk of transmitting and contacting
the disease. In one case. she said. a Judge of the West Virginia Supreme Court was asked whether a lesbian should be
considered as 'unfit' to parent her child. 'We don't have much of that around here.' Polikoff said the judge replied.
But. said Polikoff. the Judge added that if a lesbian were before him in a custody case. he would have to give closer
scrutiny to the matter because of the AIDS epidemic. 'We are becoming homophobic within our own community.' said
Colevia Carter. community relations specialist with the DC Dept. of Corrections and the DC Human Rights Commission. She
believes that lesbians tend to discriminate against our gay brothers.
**************************************************
PRISONERS WITH AIDS IN NEW JERSEY MOVED INTO SEPARATE UNIT
with thanks to the ~!! yg~~ ~~!!Y!. 5/19/86
Prisoners with AIDS have been placed in a separate unit of the Trenton State Prison as of April 15. There are 23 known
cases of AIDS in the prison. The 14 PWAs moved into the unit were chosen because they do not require acute medical
attention. James Stabile. a spokesperson for the New Jersey Department of Corrections. said the prisoners were moved
mainly due to security. rather than for medical reasons. because. 'The other inmates don't want to be near them.' The
PWAs are allowed to cook for themselves and have greater mobility than the other prisoners. When their conditions
worsen. they will be moved into a hospital unit in the prison. reports James Roberts in Au Courant.
**************************************************
-- -------
SANITATION WORKERS IN NYC DUMP ON CO-WORKER WITH AIDS
with thanks to !~ ~~!~!~g~~ §l!~!. 6/27/86
Forty New York City sanitation workers protested the return of a co-worker with AIDS by locking the entrance of their
Harlem district garage with garbage trucks and refusing to work. The city responded to the walk-out by suspending them
for the day. docking each about $115 in pay. according to a sanitation department spokesperson. When sanitation worker
Levy Wallace. 34. of Brooklyn. who was out sick since December and on light duty since mid-March. had his first day back
at his old job. 18 garbage truck workers called in sick. Wallace. described by department spokesperson Al O'Leary as '
hard worker' and 'pleasant.' voluntarily transferred to an office job. 'He was very concerned about causing problems
for his co-workers.' O'Leary told the ~l!~!. 'He wanted things to go well.'
Mayor Ed Koch emphasized after the
incident that city workers with AIDS would be protected from discrimination. Sanitation Commissioner Brendan Sexton
said the department would have stood by Wallace if he wanted to keep his truck job. which pays about $20 more per shift.
The walk-out left about 150 tons of garbage on East Harlem's streets.
**************************************************
BITTEN DEPUTY CHARGES ATTEMPTED MURDER
by Stephanie Poggi'. with thanks to Boston's ,§!~
2~!:!i!~ ~!!!.
6/7/86
A Fort Lauderdale. Florida prisoner with AIDS has been charged with attempted murder after officials said he bit a
sheriff's deputy on the finger. according to the Boston ~lQ~!. Deputies at the Broward County Jail said Kelly Dobbins.
26 threatened and then bit deputy Harold Bennett. May 23. There are no known cases of persons contracting AIDS by being
bitten.
**************************************************
DOCTOR WITH AIDS FIRED IN DISTRICT
with thanks to e~11!~!1~h!~ §~~ ~!!!. and
!h!
§~1~1!g~! §!~ e~~!~. July. 1986
A suburban Washington. DC physician was fired from the clinic where he had worked for two and a half years because he
has AIDS. even though public health authorities say medical personnel with the disease pose no threat to their patients.
The doctor. who requested that his name not be revealed. was diagnosed with AIDS early this year while undergoing
treatment in the Fairfax. Virginia hospital. After his release, he notified Primary Care Associates, operators of two
clinics int he area, that he would be able to return to work in February. but they told him he was not welcome.
The
hospital had told his employers the nature of his illness. The doctor has filed suit in US District Court in Alexandria
against Primary Care Associates. Jim Graham, director of the area's Whitman-Walker Clinic, expressed surprise at the
firing. 'You would like to believe that of all people doctors would understand that AIDS is not casually tran~mitted.'
**************************************************
****************************************************************************************************f*******************
SCHOOLS SHOULD INCLUDE AIDS EDUCATION
with thanks to Detroit's g~Yi!!, 7/2/86
Schools shouldn't fire teachers with AIDS or dismiss students with the virus, a report released advises. What they
should do ~s include AIDS education in the curriculum 'to educate and stop the spread of this horrendous disease,' says
Roberta Welner, executive editor of A!Q§~ !m~~£~ Q~ ~h! §£hQQ1!~ Weiner, who interviewed 100 people knowledgeable about
AIDS, hopes the report will serve as a guide for school districts faced with an AIDS dilemma. The book sells for $65
and can be ordered from Capitol Publications, Circulation Dept., 1300 N. 17th St., PO Box 9672, Arlington, VA 22209.
**************************************************
CHICAGO CITYWIDE COMPREHENSIVE AIDS PREVENTION EDUCATION PROGRAM (CAPEP)
The Chicago Citywide Comprehensive AIDS Prevention Education Program (CAPEP) is a new program designed to help eliminate
not only the spread but also the fear of AIDS, and is designed to begin operations September 1, 1986. Avariety of
positions in health education and management will be posted shortly, requiring experience or backgrounds in public
health, AIDS education, program administration and related areas, should send a curriculum vitae to: David Ostrow, MD,
PhD, CAPEP Office, Chicago Department of Health, Room 233, Daley Center, Chicago, IL 60602. CAPEP will be sponsoring a
logo contest for the 'agency. Inquiries may be addressed to the above address.
**************************************************
GUIDE TO ILLNESS AND HEALTH: STEVEN JAMES' TOTALLY SUBJECTIVE, NON-SCIENTIFIC TEN STEP GUIDE
by Steven JaMS, with thanks to the ~~ gQ!l!H~ ~!!!l!~!, June/July, 1986
!Q @!~ §!£~~ 1) Don't pay attention to your body. Eat plenty of junk food, drink too much, take drugs, have lots
of unsafe sex with lots of different partners--and, above all, f!!l g~!l~~ ~~QY~ !~. If you are over-stressed and
tired, ignore it and keep pushing yourself. 2) Cultivate the experience of your life as meaningless and of little
value.
3) Do the things you don't like, and avoid doing what you really want. Follow everyone else's opinion and
advice, while seeing yourself as miserable and 'stuck.'
4) Be resentful and hyper-critical, especially towards
yourself. 5) Fill your mind with dreadful pictures, and then obsess over them. Worry most, if not all, of the time.
6) Avoid deep, lasting, intimate relationships. 7) Blame other people for all your problems. 8) Do not express your
feelings and views openly and honestly. Other people wouldn't appreciate it. If at all possible, do not even know what
your feelings are. 9) Shun anything that resembles a sense of humor. Life is no laughing matter! 10) Avoid making any
changes which would bring you greater satisfaction and joy.
tlQ~
tlQ~ !Q @!~ §i£t!~ iIf YQ~:~! ~l~!~g~ §i£~l~ 1) Think about all the awful things that could happen to you.
Dwell upon
negative, fearful images. 2) Be depressed, self-pitying, envious, and angry. Blame everyone and everything for your
illness. 3) Read articles, books, and newspapers, watch TV programs, and listen to people who reinforce the viewr~int
that there is ~Q tlQ~~. You are powerless to influence your fate. 4) Cut yourself off from other people.
Regard
yourself as a parish. Lock yourself up in your room and contemplate death. 5) Hate yourself for having destroyed your
life. Blame yourself mercilessly and incessantly. 6) Go to see lots of different doctors. Run from one to another,
spend half your time in waiting rooms, get lots of conflicting opinion and lots of experimental drugs, starting one
program after another without sticking to any. 7) Quit your' job, stop work on any projects, give up all activities that
bring you a sense of purpose and fun. See your life as essentially pointless, and at an end. 8) Complain about your
symptoms, and if you associate with anyone, do so exclusively with other people who are unhappy and embittered.
Reinforce each other's feelings of hopelessness. 9) Don't take care of yourself. What's the use? Try to get other
people to do it for you, and then resent them for not ding a good job. 10) Think how awful life is, and how you might
as well be dead. But make sure you are absolutely terrified of death, just to increase the pain.
tlQ~ !Q §~~~ ~!ll iQ~ @!~ ~!~~!~L If YQ~:~! ~Q~ §Q ~!ll 1Q ~!gi~ ~i~hl~ 1) Do things that bring you a sense of
fulfillment, joy, and purpose, that validate your worth. See your life as your own creation, and strive to make it a
position one. 2) Pay close and loving attention to yourself, tuning in to your needs on all levels.
Take care of
yourself, nourishing, supporting, and encouraging yourself. 3) Release all negative emotions--resentment, envy, fear,
sadness, anger. Express your feelings appropriately; don't hold onto them. Forgive yourself. 4) Hold positive images
and goals in your mind, pictures of what you truly want in your life. When fearful images arise, re-focus on images
that evoke feelings of peace and joy. 5) Love yourself, and love everyone else. Make loving the purpose and primary
expression in your life. 6) Create fun, lOVing, honest relationships, allowing for the expression and fulfillment of
needs for intimacy and security. Try to heal any wounds in past relationships, as with old lovers, and mother and
father. 7) Make a positiVe contribution to your community, through some form of work or service that you value and
enjoy. 8) Make a commitment to health and well-being, and develop a belief in the possibility of total health. Develop
your own healing program, drawing on the support and advice of experts without becoming enslaved to them. 9) Accepting
yourself and everything in your life as an opportunity for growth and learning. Be grateful. When you fuck up, forgive
yourself, learn what you can from the experience, and then move on. 10) Keep a sense of humor.
**************************************************
***** PAGE 54 * THE OFFICIAL NEWSLETTER OF THE'NCGSTDS * VOLUME 7:5 * JUNE/JULY, 1986 *****
************************************************************************************************************************
CALIFORlUA 8OVERIOR CUTS 40' FROM AIDS ASSISTANCE
with thinks to Chicago', !i~~ ~i!~ Ii!!!, 7/17/86
California Governor George Deukmejian slashed the 1986-87 state AIDS budget by 40\, reducing expenditures towards the
worst health crisis to face the state in history to $28.8 million. The governor's action repeated a similar slashing
veto of the past year. Most severely cut were programs in support of persons with AIDS and ARC, closely followed by
education and prevention programs, reports the ~!~ ~r!! B!P9r~!r.
**************************************************
LAW STUDENT SUES NBC-TV FOR ERROR IN AIDS STORY
with thanks to Miaai's !h! !!!~l~ ~!!!, and !h!
§!l!i!Q~! §!~ e!2!~'
July, 1986
AYale law school student who claims NBC television incorrectly minimized the danger AIDS presented to heterosexuals has
filed a federal lawsuit against the network. Arvind Shankar is seeking a retraction of the story, or equal time to
present his side, and unspecified punitive damages to be donated to AIDS research. The suit involved ,a January 21
newscast anchored by Tom Brokaw, that said a woman with a steady sexual partner, who was not in any high-risk group, was
.ore likely to die in a car accident or be murdered than to get AIDS. Not so, says Shankar. He said a non-promiscuous
heterosexual woman's chances of getting AIDS in New York City or San Francisco are 'pretty similar to a soldier's chance
of dying in World War I.' Shankar, a California doctor studying at Yale, said a woman's actual chances of contracting
AIDS are close to one in 400, rather than one in a million as NBC allegedly reported.
**************************************************
POLICE IN SAN DIEGO FORCE GAY MAN TO BE ANTIBODY TESTED
by Jim Fauntleroy, with thanks to Boston's §!~
~~~!!~ ~!!!,
7/20/26/86
In an apparent violation of California state law, a gay man was forced to submit to an HTLV-III blood test after being
arrested at the Gay Pride Parade, according to the ~~~2£!~!. ~rian Barlow was arrested during a confrontation between
parade participants and a group of fundamentalists. Police allege that Barlow bit two of the officers during the
scuffle. Barlow refused to submit to a test at a nearby hospital, but claims that he was later forced to do so at the
San Diego jail. Barlow has sued the department for violating California state law which forbids any such test being
made mandatory and which requires that the results from the test be kept confidential.
**************************************************
KENNEDY CENTER SHUNS 'NORMAL HEART'
by Barry Adkins, with thanks to the ~!! !2~~ ~!!!~!, 7/21/86
Adeal between the producers of Larry Kramer's blockbuster play about AIDS, Ib! ~2~m!1 tl!!~~, and the Kennedy Center in
Washington, DC fell through as a result of the recent Supreme Court ruling upholding sodomy laws in Georgia. Kramer
told the ~!1!~! that Roger Stevens, head of the Kennedy Center, had made a 'verba1 agreement' with producers Michael
Frazier and Randy Johnson to produce the show at the center this fall. On June 30, the day of the high court's ruling,
however, Kramer said Frazier received a call from Stevens calling the show off. Kramer stated that Stevens did not feel
the Board of Trustees of the center would approve the play's production in light of the ruling. Concurring with Kramer,
Johnson, the man who produced the play in Los Angeles starring actor Richard Dreyfus, said the decision was 'a
combination of the Supreme Court ruling, ReaganomiCS, and homophobia.' Johnson said that conservatism in the nation's
capital colored the decision. '1 think they're scared of the subject. They're afraid to let people see what the
government is doing to suppress gay rights and th~ issue of AIDS,' he said. Alan Wasser, general manager of theater at
the Kennedy, said that it was 'very unlikely' the Supreme Court ruling had any affect on the decision. Wasser explained
that Stevens makes all of the decisions regarding artistic productions at the center, and to his knowledge, Stevens does
not normally consult with the Board of Trustees on such matters. Wasser said he met with Stevens on June 14 where a
list of potential productions was presented. Half of the plays were cut, including The Normal Heart. 'It was my sense
that it wasn't a very good script,' he said. Kramer reported that his play has 'brok;~ -;;;;y -b~;- office record in
London's Royal Court' where Martin Sheen is starring in the play. Sheen had agreed to do the Kennedy Center production,
Johnson said. '1 want the show to play in Washington,' Johnson said. 'It's played in every major city, except there.'
Ib! ~2~!!1 tl!!~1 was the longest running show at New York City's Public Theater.
**************************************************
LAS VEGAS AIDS PHOTO 10 CARD REJECTED
with thanks to the ~!! !gr~
~!1!Y!,
5/19/86
The Clark County Health Department has proposed that photo identification cards be issued on a voluntary basis to anyone
who has submitted to the ELISA test for antibodies to HTLV-III, the so-called 'AIDS virus,' and tested negative.
The
plan was proposed by Dr. Otto Ravenho1t, chief of the health department. The cards would be issued at a cost of $20
each and expire after 30 days. Wes Davis, president of the Las Vegas ~id for AIDS of Nevada, attacked.the proposal,
citing the fact that the ELISA test is not diagnostic. Davis called the idea 'counterproductive,' and ~aid the only
benefits would come to the health deDartment, 'because they will get $20 every 30 days,' reports the §gb!ID1!D §ygl!. The
~!11Y! was told by the Clark County Health Dept. that the proposal was rejected April 24th by the Clark County Board of
Health.
•
**************************************************
************************************************************************************************************************
CALIFORNIA TO VOTE ON LAROUCHE AIDS QUARANTINE
by Jim Kiely, with thanks to Boston's
§~~ ~~n!~~ ~!!!,
7/6-12/86
California state .officials confirmed that followers of Lyndon LaRouche have gathered enough signatures to place an
initiative on the November ballot that could lead to the quarantine of people with AIDS. Earlier, the office of the
Secretary of State had announced the signatures did not pass an initial verification An initiative requires .393,000
signatures to become a ballot item. Gay and lesbian activists in the state, who began organizing three months ago when
it became clear the LaRouche camp was making progress, are geared up for battle. 'We have a major educational campaign
ahead of us,' said Paul Boneberg, of the San Francisco-based Mobilization Against AIDS. Boneberg added, 'If the vote
were held today, [the initiative] would probably pass.' The initiative calls .on the state department of health to
consider AIDS a communicable, infectious disease and to enforce the state health and safety code that applies to such
diseases. According to Doug Warren, a lawyer with the California American Civil Liberties Union, that translates the
initiative into a call for quarantine. 'Already people with typhoid and other communicable diseases can legally be
placed under house arrest by the board of health. With the passing of this initiative, it could also happen to people
with AIDS.' While most lesbian and gay activists here appear to agree with Warren, some activists and lawyers do not
believe quarantine would result if the initiative passed. Anne Jenning, a lesbian activist and a lawyer with the
California State Attorney General's office, said the initiative would change nothing. She said AIDS is already
considered an infectious disease by the state board of health, but that health officials have not chosen to quarantine
individuals.
'AIDS is not typhoid. The means of transmitting HTLV-III are extremely limited,' said Jenning. In
addition to advocating quarantine, the initiative could pave the way for mandatory testing of people suspected of having
AIDS and for dismissal of any 'carrier of the disease' from public health Jobs and employment in the food industry. The
wording of the initiative fails to explain the term, 'carrier,' drawing no distinction between a person with AIDS and a
person who has tested positive for the AIDS virus. The meaning of 'carrier' 'can only be left to the imagination,' said
Warren.
However the initiative would be used, gay and lesbian activists are wasting no time organizing a statewide
campaign to defeat it. According to Boneberg, Mobilization Against AIDS has already conducted numerous meetings across
the state, out of which the California AIDS Network (CAN) has emerged. CAN is a political and health committee which
hopes to attract thousands of people in the fight against the initiative. The official title of the LaRouche group
promoting the quarantine measure is PANIC (Prevent AIDS Now Initiative Committee) .. With offices in San Francisco and
Los Angeles, PANIC serves as clearinghouse for initiative materials and volunteers.
No officials of PANIC were
available for comment to §~~.
**************************************************
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************************************************************************************************************************
PRICE TRIPLED ON RIBAVIRIN
with thanks to Detroit',
~~~!!!,
June 18, 1986
Project Inform, a San Francisco based AIDS Issues and Research Foundation, has confirmed that the price of the antiviral 'drug Ribavirin has been tripled by the manufacturer, ICN Pharmaceuticals in Costa Mesa, California. The price
went from $6.95 'to 20.50 for a box of 12 capsules of ribavirin, which is thought to be helpful against AIDS and ARC and
is beCOMing MOre acceptable both among medical workers and among patients, and is thought to be legally used by between
3-10,000 Americans under the supervision of their doctors. Ribavirin is presently one of the few available treatments
for AIDS and ARC patients which has substantial credibility among medical researchers, and although not yet licensed in
the US, the FDA permits importation of the drug from Mexico and other countries for use by individual patients.
This
extreme price increase appears to be the first instance in the public forum of profiteering in the AIDS epidemic. Since
the drug is not licensed by the FDA, its cost is not covered by insurance plans. The cost for treatment with the drug
is now about $300 per month, which most patients must use indefinitely in combination with at least one other drug. ICN
is currently beginning eight clinical trials of ribavirin in a $10 million joint venture with Eastman Kodak of
Rochester, New York,
**************************************************
SALIVA TEST MAY PROVE RELIABLE FOR SCREENING
with thanks to !n~!~n!l ~!~!n! ~~, 5/1-1(/86
Testing saliva for the presence of antibodies to the AIDS virus may provide a reliable way to screen for exposure to the
virus, according to David W. Archibald, DMD. of Harvard's School of Public Health. The possibility of developing such a
test after Archibald and associates showed that antibodies to the AIDS virus were present in the saliva of people
exposed to the virus. The finding helps explain why saliva does not appear to be very infectious in the transmission of
AIDS. Despite earlier studies that detected the virus in saliva. there are no reported cases of AIDS being passed on
through the saliva. This may be due to saliva containing a low goncentration of virus, or that antibodies in saliva bind
to the virus and inactivate it. In a recent study, except for/people with AIDS, everyone who was seropositive for HTLVIII antibody .also had detectable salivary antibodies to the virus. The low antibody concentrations usually found in
saliva may be reduced in PWAs as a result of their immunodeficient state. It now is 'theoretically possible' that the
saliva could be used generally as a test for infection to the AIDS virus.
**************************************************
WASHINGTON, DC OPENS UH FACILITY FOR PWAs
with thanks to !h!~!!n !!l~!~ ~l!n!~
A!Q§
f~gg~!~,
June 1986
The J. Charles Gilbertson House as the fourth facility of the Schwartz Housing Services of Washington, DC's WhitmanWalker Clinic, and is the first apartment building for PWAs. The facility has five one bedroom and efficiency
apartments. The addition of the facility will enable' the housing service to respond to a variety of persons with
special needs. Current residents of the Gilbertson House include couples, families, and infants. The four houses,
which can accommodate up to 24 places, are now filled to capacity. A fifth house is planned for opening in the summer.
**************************************************
BILLBOARD FUNDRAISING PROJECT SUCCESSFUL IN LOS ANGELES
with thanks to the ~!! yg~~ ~!~!Y!' 6/2/86
AIDS Project/Los Angeles (APLA) unveiled a 15 x 48 foot billboard listing the names of the 20 people who helped raise
$10,000 for APLA. The unveiling is part of Projec~ Billboard, started by Dean Doser of Gannett Outdoor Co., along with
Richard Gross and Bill Rampelt in September, 1985. Doser and Gross encouraged donors by telling them their names would
appear in the advertisement. Gannett Inc., donated the billboard. The money was presented to APLA executive director
Paula Van Ness. For more information about the project, call 213/271-2627.
**************************************************
UNITED WAY SHORT CHANGES SAN FRANCISCO AIDS • GAY SERVICE AGENCIES
with thanks to !h! !!!h!ng~2n @l!~!, 6/13/86
The United Way chapter in the Bay Area collected $41 million during 1985, but distributed less than 2% of those funds to
gay or AIDS-service related organizations. That's not fair, say some activists, and they're meeting with United ~ay
officials to press for an increase. The ~!~ ~~!! 8!~g~~!~ quoted one activist, businessman Arthur la~ere: as sugge~t~ng
that 'at least 10%' of the $41 million raised 'are gay dollars,' and criticized United Way for havlng no recognltl0n
that there is a health crisis in our community.' Currently, only two gay organizations are 'member agencies' of the Bay
area United Way and, thus, eligible to receive an annual allocation from the money raised. Ten other gay organizat~ons
have been designated as 'special needs' groups, and receive funding even though they are not official member ~gencles.
Those 12 groups received $338,991 from United Way this year. Another $279,689 went to gay groups through Unl:ed Way
from donors who earmarked their contributions to those specific groups,. Tim Dayonot, a spokesman for . the Unlted Way
chapter, said the charity cannot dispense funds according to the percentage of. population each needy group comprises,
but said 'ongoing meetings' are taking place with gay leaders to work on a solution.
**************************************************
************************************************************************************************************************
, BATHHOUSES SUED BY LOS ANGELES COUNTY HEALTH DEPARTMENT
by John A. Fall, with thanks to the !!! YQ~~ !!~i!!, 7/21/86
The Los Angeles County Department of Health Services took its alleged war against AIDS one step further May 28 by filing
suit against four local bathhouses, claiming the establishments have not observed the county's siX-MOnth-old bathhouse
regulations, which among other things, requires bathhouses to hire "monitors· for every 20 patrons to detect the
occurrence of any proscribed sexual activities. The owners of the Meatrack, the Compound, the Midtowne Spa, and the
Melrose Baths are accused in the suit of maintaining or permitting to be maintained ·conditions which facilitate and
encourage high risk sexual activities by patrons. Said activities contribute to the spread of the AIDS virus and
constitute a pubic health menace.· High risk sex includes anal intercourse or fel"atio with or without a condom, and
oral-anal contact. Bathhouses must ensure that monitors remove patrons observed to engage in high risk activities, and
a daily log of the names of those patrons removed must be maintained. Lighting and structures, such as walls and doors,
must not impede the observations of monitors. Melrose Bath owner Marty Benson said ·the nUMber one thing that has
brought respect to the gay community is the right to have adult consensual sex, [and] that right is being taken away by
the health department. I don't see them asking the Sheraton Hotel to do what they are asking me to do.·
**************************************************
NAVY COURTMARTIALS AND EXPELS SAILOR
by Lou Chibbaro Jr •• with thanks to !b!
!!!b!ng~~ @!!~!.
6/27/86
Asailor who was court-martialed at a Virginia Beach naval base for refusing to take the HTLV-III antibody test told a
military judge he began receiving telephone death threats shortly after he informed his commanding officer of his
decision not to take the test. Petty Officer Second Class Phillip J. Nolan, 25, was sentenced at the June 23 courtmartial proceeding to 45 days in the brig at the Navy's Atlantic fleet headquarters in Norfolk, Virginia. In addition,
Capt. Daniel J. Zemniak, serving as military judge, lowered Nolan's rank to that of E-1, the lowest rank for an enlisted
person, and gave Nolan a bad conduct discharge. Nolan had been charged with one count of disobeying an order, for
refusing to have his blood tested for HTLV-III (HIV) antibody, and one count of failing to deploy with his ship. Nolan
told the court-martial that he did not board his ship, the aircraft carrier John F. Kennedy on May 6 because he received
several anonymous telephone calls indicating his life would be endangered if he sailed with the ship.
Nolan also
testified that he received ·threats· from the ship's captain, Commander Alan M. Gemmill, who denied making such threats.
Gemmill testified that he was ·stern· with Nolan concerning Nolan's refusal to be tested, but that he never threatened
Nolan. Gemmill also testified that he reassured Nolan that he would be safe onboard the ship. Nolan's court-appointed
military attorney told the court-martial proceeding that the test violated his client's constitutional right to privacy
and amounted to an illegal ·search and seizure.· But Navy prosecutors said the test was ·medically necessary· to
protect the health of all military personnel. Navy officials said Nolan is the first known member of the military to
refuse to be tested since the test was made mandatory for all 2.2 million members of the US armed services.
Navy
spokesperson Mickie Jakubec said no questions were raised at the court-martial about Nolan's sexual orientation. The
decision is expected to be appealed.
**************************************************
CONGRESSIONAL RIGHT-WING FANATICS NOVE TO STOP DC INSURANCE MEASURE
by Lou Chibbaro Jr. with thanks to !h! !!!b!ng~~ @!!~!, 6/20/86
Republican Representative William Dannemeyer (California) and Republican Senator Jesse Helms (North Carolina) announced
that they plan to introduce resolutions in the House and· Senate to veto a D.C. City Council approved bill that prohibits
insurance companies from denying coverage to persons who test positive for the AIDS antibody. At a press conference on
Capitol Hill, Dannemeyer, leaders of the New Right Christian groups, and the Rev. Cleveland Sparrow, the head of the DC
Chapter of the Moral Majority, said the City Council insurance bill sets a dangerous precedent by providing ·special
privileges· to gay men and others at risk of contracting AIDS. ·Drug addicts, prostitutes of all kinds, and homosexuals
will flock to DC to get health insurance they can't get elsewhere,· Sparrow told the press conference. ·Our children
will be at risk,· Sparrow continued, adding. ·the resident and the tourist will risk concentrated exposure to this
hideous disease.· Under the District's home rule charter, Congress may veto bills passed by the City Council if both
the House and Senate approve a ·resolution of disapproval· by simple majority votes, and if the President signs the
resolution. The insurance bill forbids health, life, or disability insurers from denying, canceling, or refusing to
renew insurance coverage because a person has tested positive for the [HIV] antibody or because the individual tests
positive on any other test for the 'probable causative agent' for AIDS. Aspokeswoman for the industry's two leading
trade groups--the American Council of Life Insurance and the Health Insurance Association of America--said the groups
declined invitations by Dannemeyer to join in the effort to seek a Congressional veto of the Ray bill. 'We have always
supported home rule,' said Amy Biderman. media information manager for the health insurance groups. Two Congressional
committees will consider the disapproval resolution, however they tend to favor autonomy for the District and are
expected to bottle the resolutions up until the 3D-day Congressional review period ends. New Right leaders are expected
to call for a discharge petition, which can override the committee and send the resolution to the floor of the House for
a vote. But. a discharge petition requires signatures from 218 House members, and officials said the possibility of this
occurring is remote. Chances of favorable consideration by the Senate subcommittee are also remote.
**************************************************
************************************************************************************************************************
Ne. IIIIINE BOOSTER??
by Ann Giudici Fettner, with thanks to the
~~ YQ~~ ~!~!Y!'
6/23/86
Dinitrochlorobenzene (ONCB) is one of those quirky substances that seem to turn up now and then when a doctor uses his
or her head to make connections. When he was at Stanford University, dermatologist Bruce Mills participated in a study
of children who were covered with warts. These kids, who had a specific, tiny immune defect, were at the least, in
social agony.
Nothing seemed to help this strange, unattractive expression of viral infection, until Mills tried
painting of a few warts here and there with DNCB. Within months, !ll the warts were in remission. When Mils began
practicing in San Francisco, at about the same time AIDS made its appearances, he saw numerous patients--gay and
straight--with what he describes as 'purple spots.' Remembering his experience with the children's warts, he decided to
try ONCB. 'In the non-gay patients, the spots resolved spontaneously,' Mills said in a telephone interview. He began
treating patients with AIDS and ARC, and has Just published a letter in the Journal of the American Academy of
Dermatology. His results, if they stand up, are amazing. Between 40 and 50 of Mill's private-practice patients have
been treated, many since December 1984.
According to Mills, his results include 600-800 total white-cell counts
improving to 2000-3000; anemia and low platelet counts normalizing, as have IgG, IgA, and IgE immunoglobulin measures;
restored mitogen responses; and 'patients report they feel better.' In those with rheumatic manifestation, many were
able to stop taking anti-inflammatory medications. The mechanism by which this 'active organic molecule' works is
Thought to be unable to respond to any contact-sensitizing agent (because of the anergy
largely still mysterious.
created by destruction of T-cells), all of Mills's patients eventually were able to react to the DNCB-painted skin
areas.
Mills spoke to the Kaposi's sarcoma study group at the University of California at San Francisco in May, at a
meeting attended by Dr. William Epstein, President of the Americap Academy of Dermatology, who described Mills's results
as 'fascinating.' Epstein will be using DNCB in his own studies' at the School of Medicine. Here are the particulars
you may want to .know about {or to pass on to your own doctor]: Mills uses a coin-sized 2% solution in acetone, which is
applied to the upper arm, covered with gauze and paper tape. This is left on overnight and washed off the following
day. He does this weekly, until the immune parameters begin to improve. The solution is then cut to less than 1% over
subsequent weeks. Mills says it 'takes a while to see improvement,' but reports that virtually all patients--including
those on chemotherapy, interleuken-2, etc.--appear to realize some benefit. DNCB costs little and is available from
chemical supply houses, where it is sold for photographic purposes. When I was working for the Arthritis Foundation,
they fought a constant battle to prevent patients from using DSMO (dimethyl sulfoxide), a cheap industrial solvent. The
only trouble was, it worked. Doctors were using it on themselves for muscle pains and winking at patients' use, and all
the big-time athletes swear by it for torn ligaments, etc. The problem is that no one stands to make any money from a
substance like this, despite its medicinal efficacy.. So no one bothers to explore its possibilities.
If you're
interested, get your physician to contact L. Bruce Mills, MD, 450 Sutter Street, 12304, San Francisco, CA 94108.
**************************************************
DOCTORS REFUSING TO REPORT AIDS CASES DUE TO STIGMA
by Wayne King, with thanks to the ~!! YQ~~ I!!!!, ca. 5/26/86
The man who died was 32 years old, a nurse, never married, a resident of a section of San Francisco that is
predominantly homosexual. His death occurred within weeks after serious respiratory problems developed, and his body
was cremated. . It seemed to be a classic case of AIDS. But the death certificate listed 'respiratory failure' as the
immediate cause of death and 'adult ,respiratory distress syndrome' as the underlying cause. It made no mention of AIDS
or of any of the illnesses that Federal health officials have established as defining AIDS. This case illustrates a
dilemma facing physicians who treat people with AIDS: There is the need to provide accurate data, both for public
health policy and for continuing research, but doctors also want to protect victims and their families. The case of the
San Francisco nurse is being cited by a California organization as an example of the problem. The physician who treated
the nurse, while declining to discuss the cause of death, said: 'I have a tendency not to put AIDS on the death
certificate. That is public information, and if the wrong person sees it, it could be a problem for the family.' A New
York internist said: 'We're more concerned about the patient's happiness. The patient may say, 'I don't want to tell my
mother I'm homosexual, have AIDS and am dying." Indeed, more than a score of doctors around the country, most of whom
spoke anonymously, said they declined to report all the AIDS' cases they treated. They cited the stigma associated with
AIDS, the refusal of some insurance companies to honor claims of victims, and the reluctance of some funeral homes to
embalm the victims.
Public health officials say that although some doctors may not be fully disclosing AIDS cases,
checks on the reporting system assure a count of cases that is 90 to 95 percent accurate. [ED NOTE: If some doctors
are not reporting, than how can public health officials assure a 90-95% reporting accuracy?!] A Houston physician,
whose practice is almost exclusively people with AIDS, said PWAs or their families often requested that· they not be
identified. 'They become outcasts,' he said. 'Even when they die, the insurance companies try to wea~el out of paying
the death claim, saying it was a pre-existing disease. And a lot of ' funeral homes won't accept the boqy, and if they
do, it's usually cremated without embalming.' In general, insurance companies seek to screen out people who are at risk
of expensive and fatal diseases. Once a policy is granted, most companies deny benefits if a policyholder ~ho has a
(Continued)
***** THE OFFICIAL NEWSLETTER OF THE NCGSTOS * VOLUME 1:5 * JUNE/JULY, 1986 * PAGE 59 *****
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DOCTORS REFUSING TO REPORT AIDS CASESL Continued
--serTous-dTseise~- does-nofTilfTtii ln-s-uran-ci-colllpany when applying and dies of it within two years. Disputes between
insurance companies and AIDS victims are often complicated by the years-long incubation period for the disease. Several
doctors noted that some apparent cases of AIDS do not Deet the strict criteria adopted by the CDC for defining and
reporting the disease. Health officials in fact say there is underreporting for all diseases that should be reported to
authorities, sexually transmitted diseases in particular. Health officials say a relatively accurate count of cases is
assured by the fact that most AIDS victims eventually end up in a hospital that makes a report to local health officials
and ultimately to the CDC. However, health officials in Houston said at least one large hospital that treats PWAs does
not report its cases, and PWAs and their doctors in several other cities also said SOlI hospitals do not report all
cases. Dr. Bernard Ackerman, a pathologist heading the testing laboratory at New York University Medical Center, said
that in the last five years. his lab had diagnosed 2500 cases of Kaposi'& sarcoma, 95' of them for private physicians
treating AIDS victims outside the hospital. 'I think it's unlikely 1'. seeing lOre than half the cases in the country,'
said Ackerman. When he made that observation, Just under .000 cases of Kaposi's had been reported nationwide.
His
experience suggests that some doctors who are getting positive lab tests are not reporting the cases, or at least are
not promptly reporting them. Laboratories do not report results of AIDS tests to the health authorities. only to the
physician requesting the test. A35 year old administrator of a Houston organi~tion for gay rights said that in
October he was diagnosed with Kaposi's. He has since seen three doctors in the Houston area and said all agreed to his
request that his case not be reported. 'It was like I really didn't need to ·ask,' he said, adding that although he had
no fear ~f losing his Job, he did worry about his insurance. Astudy of AIDS cases in California suggests that a
reluctance by doctors to report AIDS cases may be greater when the disease strikes married lin. Dr. Gary F. McHolland
and Wes Weller, in an academic actuarial study, compared the number of AIDS cases reported to the State of California
through June. 1985. with the number of death certificates listing AIDS-related diseases. The researchers found that at
least 17% of those listed as having died of AIDS related diseases had never been reported as having the disease. For
married men. the figure was 35%. 'The estimated 17% understatement,' their report said, could result frOi a nuaber of
factors. including incomplete reporting. But, it went on, a lore likely cause 'relates to the rigid CDC classification
of cases. 'It has become increasingly recognized that not all AIDS cases meet the strict CDC criteria for defining an
AIDS cases,' the report said.
'For example. a person could be infected with the AIDS virus and have AIDS-related
diseases, and in the opinion of the treating phYSician have AIDS, yet not meet the strict CDC case definition because
certain laboratory tests were not performed (e.g., patient refuses). Also, a person could die from pneu.ocystis carinii
pneumonia (PCP), with AIDS indicated as an underlying cause on the death certificate, but still not I88t the strict CDC
case definition.' As for the 35% figure on married men, McHolland said, 'They don't want the world to know, even thOugh
the reporting is very confidential.' The possibility of significant under reporting of AIDS among married .en has
'serious public health implications,' in hi~ view. 'Wives may be more exposed than they think.' In California, the
American Association of Women Voters, the group that cited the case of the San Francisco nurse, says it has other
evidence Lr underreporting. But Dr. Dean Echenbert, director of disease control for that city's Dept. of Public Health,
said he did not think underreporting posed a serious problem. He said San Francisco and other cities with a Significant
number of people with AIDS maintained 'a system of active surveillance' that includes scrutiny ~f palhology and
infectious disease reports. death certificates. and autopsy and coroner's reports. The reluctance of SOlI doctors to
list AIDS as a cause of death emphasizes the unusual emotional context surrounding the reporting of the disease. An
AIDS researcher associated with Harvard Medical School, discussing whether the disease was ever left off death
certificates, said. 'We do it all the time. We routinely honor the request of the family and don't put it on.' 'I feel
a moral obligation to protect the patient and his or her family,' he added. He cited a recent case in which AIDS was
put on the death certificate of a young man from a religious family. The funeral home, upon seeing the certificate,
refused to allow a wake with an open casket. 'Backlash from the diagnosis is tremendous,' he added. But the doctor
emphasized that the cases in which AIDS is not specifically mentioned on the death certificate do not get lost.
They
are still reported. as required. to the Boston Dept. of Health through a coded system that allows for confidentiality.
Doctors often ascribe the cause of death to the specific disease that caused it, rather than to AIDS.
This is
acceptable practice, although California requires that AIDS be listed as a cause of death. The Boston doctor cited the
case of a young gay man who died of AIDS in Boston. His mother, who was taking the body back to a small town in Indiana
for burial. was concerned that the funeral home would get a copy of the death certificate and the information would
become known in town. Physicians are ambivalent about the need to inform funeral homes about the cause of death of an
person with AIDS. Sume places will not accept the bodies of AIDS victims for embalming because of fear that lortuary
aides will be infected. John E. Rudolph Jr., general manager of a Houston funeral home, said embalmers wore double
gloves. double gowns and masks when embalming the body of a person with AIDS. Special care is given to sterilizing
instruments after embalming. 'It's very easy to cut the skin through a glove,' he said.
**************************************************
NEXT NEWSLETTER
Article submissions for the next issue of the ~~§§IQ§ Qffi~i~l M!~21!~~!C, volume 8:1. August/October, are due by
September 5.. 1986. Anticipated publication and mailing will be in late September. early October. Address articles to:
NCGSTDS. PO Box 239. Milwaukee. WI 53201. Thanks!!
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***** PAGE 60 * THE OFFICIAL NEWSLETTER OF THE NCaSTDS * VOLUME 7:5 * JUNE/JULY, 1986 *****
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HEALTHY TRABISSICII Of EnTAL HERPES
with thinks to ~!~! ~!!!. 6/28/86
People with genital herpes can evidently transmit the infection even if they show no signs of it., In the June 12 ~!!
~~gl!~~ ~2ytn!1 21 ~1~1~!, Jales F. Rooney, Stephen E. Straus and their colleagues at the National Institute of
Allergy and Infectious Diseases in Bethesda, document the transmission of herpes by an asymptomatic man. The man was
taking part in a trial of weekend-only use of acyclovir, a drug that controls the replication of herpesvirus, and
keeping careful records of his symptoas. He had sexual relations with a woman during a symptom-free period; the woman
developed genital blisters five days later. Characterization of her virus indicated it was structurally identical to
his. The study, say the researchers, provides biochemical proof of asymptomatic transmission, which has been shown with
epid8liologic data. Last year Gregory Mertz, then at the University of Washington in Seattle and now at the University
of New Mexico in Albuquerque, reported on 66 people with new cases of genital herpes. Of the sources, 62% had had no
evidence of oral or genital herpes in the three weeks prior to transmitting the disease; many of them did not even know
they had herpes. Mary Guinan of the Centers for Disease Control in Atlanta, a coauthor of that study, estimates that
only about a quarter of all people with genital herpes have symptoms.
**************************************************
EFFECTS OF LEARNING HTLV-III/LAV ANTIBODY STATUS ON SUBSEQUENT SEXUAL ACTIVITY
abstract frOi the !n~!t~!~12n!1 ~!~ ~2nt!~~~!, Paris, June, 1986
Author: Robin Fox, N. Odaka, B.F. Polk, Johns Hopkins University, Baltimore. One thousand one hundred fifty-three
gay/bisexual men enrolled in a longitudinal study of the natural history of HTLV-III infection are evaluated every 6
months at which tile they are interviewed and examined, and have specimens taken for laboratory studies. One year after
enrollment, participants had the opportunity to learn their HTLV-III antibody status. 68% asked for the test results.
Wanting to know was not associated with Ab status, race, education, number of sexual partners, a history of having sex
with someone who developed AIDS, perception of swollen lymph nodes, or feelings of depression. Men wanting to know
their Ab status were more likely to have generalized lymphadenopathy. All participants were counseled concerning HTLVIII Ab test results; all were advised to practice 'safe sex.' Of 541 men thus far evaluated at the visit following
voluntary disclosure, behavior. change was measured by a change in the number of male sexual partners. 80th seropositive
and seronegative men not wanting to know their Ab status reported significant decrease in number of partners.
Seropositives who were informed of their Ab status reported 50% decrease in number of partners, while seronegatives who
were informed of their Ab status reported no change. Disclosure of a positive Ab test result to participants appeared
to decrease further their sexual activity and hence chances of transmitting infection. Disclosure of a negative Ab test
on the other hand, did not result in a comparable reduction in sexual activity. Despite the overall national trend of
decreasing sexual activity among gay men, the effect of informing gay men of their Ab status may be contrary to the goal
of public health programs, which is to decrease the spread of HTLV-III/LAV through sexual activity.
**************************************************
ALTERNATE TEST SITES REPORT OVERALL POSITIVITY AT 17%
by Peg Byron and Lisa M. Keen, with thanks to !b!
!!!h1~g~2n @l!~!,
5/30/86
The Centers for. Disease Control released figures showing that of the 79,083 persons who took the HTLV-Ill antibody test
at alternate test sites in 1985, 11.3% repeatedly tested positive and was reported in the May 2 ~2~~i~i!~ ~ ~2~!~11!~
~!~~l~ 8!22t!·
While 21,200 tests were taken during the first 6 months the test was available, more than twice that
number of tests were administered in the last four months of the year, a phenomenon which some observers have attributed
to the news of actor Rock Hudson's illness and death due to AIDS. The ~~B report said that the antibody test has shown
itself 'to be remarkably sensitive and specific and to be useful, not only for preventive purposes [???!!!--ED), but
also for the diagnosis and differential diagnOSis of clinical illness.'
**************************************************
RATE OF AIDS TRANSMISSION DIVES IN SAN FWlCISCO
by Ji. Fauntleroy, with thanks to Boston's §!~ ~2!!Y~!~~ ~!!!, 7/13-19/86
According to the @~~ ~~!! 8!22~!!~, a gay men's health study shows the rate of AIDS transmission in San Francisco has
dropped sharply since 1984. Epidemiologist Warren Winkelstein, of the University of California at Berkeley School of
~ublic Health, ~hic~ conducted the study, said 'this drop in the rate of AIDS transmission is directly linked to changes
ln sexual behavl0r. In particular, Winkel stein noted a decline in the number of men having anal sex without a condom.
The study found that in 1985 the rate of gay men testing positively for the HTLV-III (HIV) virus for the first time was
3-5%. In 1984, the new infection rate was 18\. The study, begun in 1984, is following 800 gay and 20b heterosexually
men r~ruited randomly from nei~h~orhoods with the highest gay population. The study also found that 51% of gay men in
the Clty are HTLV-III (HIV) posltlve, much less than the two-thirds figure quoted in San Francisco's daily papers The
higher figure was based on a smaller study that only included men who had had hepatitis.
.
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***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7:5' * JUNE/JULY, 1986 * PAGE 61 *****
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IMMUNITY AND STRESS ONCE AGAIN LINKED
by J. A. Miller, with thanks to ~!!ng! M!!!, 5/31/86 and
by Judy Foreaan, with thanks to !h! ~~Qn §lg~
Women whose marriages have recently broken up show poorer immune system function than do married women, according to
reports linking distressing events in a person's life to depressed immune function. Recent research by behavioral
scientist Janice Kiecolt-Glaser and immunologist Ronald Glaser of Ohio State University in Columbus has explored the
relationship between marital status and immunity.
Earlier epidemiologic studies had indicated that separated and
divorced women have increased mortality rates for some diseases. The Ohio scientists have examined illUne function in
two groups of 38 women each. The women in one group were married; those in the other group had separated from their
spouses during the last six years. The groups were matched for a variety of socioeconomic factors.
On, several
different measures of how - well immune system cells are functioning, the separated and divorced women showed lower
responses than the married women, Kiecolt-Glaser reported at the annual meeting of the American Association for the
Advancement of Science in Philadelphia.
Within the group of separated and divorced women, those with a continued
feeling of attachment to the husband or ex-husband--whether it was persistent anger or longer--reported greater feelings
of depression and showed poorer immune system function. Among the married women, those who reported dissatisfaction
with their marriages showed a poorer response on three out of sex measures of immune function than did women who rated
their marriages more favorably. The less happily married women also reported .ore feelings of depression.
Life's
stresses do not' have to be as great as the breakup of a relationship to affect the immune system. Kiecolt-G1aser also
reports immune system changes occurring among medical students during the school year.
In five different studies,
employing 20 different assays, she and her colleagues have shown a decrease in immune system activity during medical
school final examinations. Among the immune functions suppressed during exams is natural killer cell activity.
This
activity is thought to be important as a defense against viruses and cancer. In addition, production of interferon,
which stimulates natural killer cells, plummeted during final exams. Kiecolt-Glaser reports that she and her colleagues
have also found that these periods of stress-related immunosuppression among medical students are associated with
episodes of infectious disease.
"The heightened distress regularly found in our medical student samples during
examinations is probably quite comparable to that elicited by everyday events that are frequently experienced [by the
general population]--for example, the several days of frenzied activity that frequently precede vacations," she says.
"If emotional distress in these situations is comparable to that of medical students during examinations, then similar
immunologic changes may be expected." Among both the separated and divorced women and the anxious medical students,
changes in eating and sleeping habits do not explain the observed changes in immune function, Kiecolt-Glaser says. If
distress interferes with immune function, reductions in distress might enhance immune, the Ohio scientists reasoned. In
both medical students and an elderly population, they have observed that relaxation exercises increase measurable
aspects of immune function. "Transient immunosuppression can be produced by heightened and sustained distress,"
Kiecolt-Glaser concludes.
But whether this condition leads to disease depends on factors including psycho1gocia1
resources, prior health and exposure to infectious diseases. She suggests that distress-related immunosuppression has
its most important consequences in elderly individuals and others who have preexisting deficiencies in immune function.
In the area of AIDS, another researcher, Andrew A. Monjan, chief of the immunology section of the National Institute of
Aging in Bethesda, said that the fear of getting sick with AIDS seems to lead to poorer immune function than denying to
oneself the possibility of getting sick. In a study of 5000 homosexually active men, Monjan said, those who did not
appear to be infected with the AIDS virus but who were depressed and worried about getting swollen lymph glands had less
favorable scores on a test to measure ratios of critical immune cells than those who were not depressed and were not
worried. This held true whether or not a person actually had lymphadenopathy, he said. "People without lymphadenopathy
who think they have it are as badly off as if they really did have it," Monjan said. In a continuation of experiments
that surprised immunologists a decade ago, researchers at the University of Rochester School of Medicine reported that
mice and rats can be taught to enhance their immune systems and to suppress them. Like Pavlov's dogs, which became
conditioned to salivate when they heard a bell that they came to associate with feeding, rodents can learn to suppress
their immune systems in response to a substance that has no intrinsic effect on the immune system, such as saccharin, if
this substance is first paired with a genuine immunosuppressant drug. Immunologist Nicholas Cohen said there is also
some evidence that animals can also be trained to enhance their immune systems, and preliminary data show that some
animals will modify their behavior as if they were trying to correct immune deficiencies, he said.
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KIDNEY PROBLEJIIS MY DEVELOP IN 50' OF PWAs
with thanks to !~~!~~!l ~!£!~! ~!!!, 5/1-1./86
As ma·ny as o~e-half of all people with AIDS may develop renal abnormalities, and some present with a progressive
nephrotic syndrome that may be fatal in a matter of months, according to Dr. Thomas L. Curry at the Virginia regional
meeting of the American College of Physicians. A review of renal failure in PWAs was prompted when in July 1985 a
patient presented with symptoms of AIDS and acute renal failure. The person's renal function progressively det~riorated
to end stage renal disease over a 6 week period, in spite of beginning maintenance hemodialysis in the fall. Only three
studies could be found in the English-language literature dealing with AIDS and renal failure. These studies indicated
that the frequency of renal abnormalities may be as high as 50%, with severity ranging from asymptomatic proteinuria to
acute renal failure. The high incidence of sepsis, hypotension, and exposure to nephrotoxic agents in this population
may predispose patients to renal failure.
**************************************************
AIDS VIRUS MUTATES UP TO AMILLION TIMES FASTER
with thanks to ~!~£! ~!!!, 6/28/86
Analysis of the molecular structure of AIDS virus DNA shows it mutates up to a million times faster than the standard
mutation rate for DNA from other organisms. The high rate of mutation, the researchers suggest, could be what allows
the AIDS virus to escape attack by the immune system. Beatrice H. Hahn of the university of Alabama in Birmingham and
colleagues report int he June 20 §£1!~£! on a comparison of AIDS DNA taken over the course of one or two years from
three people. Each person had been infected with only one AIDS virus, although one man had had sexual encounters with
about 1000 men between 1980 and 1985. The exclusivity of infection, the researchers suggest, implies that infection by
one AIDS virus may protect against infection by another. Figuring out how that happens, they note, ·could be important
in developing methods for the treatment and prevention of AID~.·
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CIRID MEDICAL UPDATES
[Prepared as a public service to the medical community by the Division of Clinical Immunology/allergy, ·Dept. of
Medicine, UCLA School of Medicine. These updates represent editorial opinion and should not be construed as otherwise.
Published by the Center for Interdisciplinary Research in Immunology and Disease (CIRID) at UCLA and by the UCLA AIDS
Center, Andrew Saxon, MD, Editor in Chief. For additional inforaation, or subscriptions, call 213/825-1510.]
~!§~!~§~Q§!§ QE ~ ~~~!~~~ ~~~~~~ !~ ~~!!~~!§ 8~E~88~~ !Q ~ ~!Q§ ~~!~!~::~~~~:~!~§~~ (H. Hollander and D.O.
Coutland, ~!2~!r~ ~9~r~!1 9! ~!~1£1~!, 144:373, 1986.) The authors report 5 cases of individuals referred to an AIDS
clinic who turned out to have ·pseudo-AIDS;· they had another medical problem but because of real or presumed risk
factors for AIDS, they were diagnosed as having AID~ and sent to an AIDS referral center.
Two presented with
lymphadenopathy, one of which turned out to have tuberculosis, and another had nothing more than a muscle strain. Two
cases were referred for pulmonary complications of ·AIDS· and one of these turned out to have a lymphoma while the other
had ischemic heart disease. One patient presented with hematologic abnormalities which turned out to be a combination
of iron and vitamin B12 deficiency. *****CIRID EO COMMENT: This article makes a simple but meaningful point. Just
because individuals have real or presumed risk factors for AIDS, they should not be diagnosed as having HTLV-III/LAVrelated illness without firm evidence in this regard. While HTLV-III related illness is common in high risk individuals
in metropolitan centers such as Los Angeles, San Francisco, and New York, other illnesses are just a s likely to occur
in these persons. Not only is there potential .for grave medical harm by the over-eager diagnosis of HTLV-IlI-related
illness but the prospect for social and emotional harm is enormous.
~~!!~Q~!~§ !Q ~!~Y:!!!l~~Y !~ Y~~~~~A~~~ ~~!!~~!§ ~!!~ ~~~!~ ~~~AB!A~ !~E~~!!Q~§, (D.J. Volsky, et al., ~!~ ~~gl~ ~9~~~
9! ~!~~, 314:647, 1986.) The authors evaluated serum from patients with Plasmodium vivax or Plasmodium falciparum
infection for the concurrence of seropositivity to HTLV-III/LAV. None of these individuals were in a known risk group
for AIDS or had any AIDS associated disorders.
HTLV-III seropositivity was assayed by ELISA, indirect
immunoflourescence, Western Blot and radioimmunoprecipitation. Three of the persons with falciparum and 5 with vivax
infection were HTLV-III/LAV antibody ppsitive. Though the titers were low (1:320 or less), they were positive on the
battery of the HTLV-III tests mentioned, in addition the antigens that were recognized on Western Blot were those
normally seen from patients with AIDS. At the same time there was less than 1% frequency of antibodies to HTLV-III/LAV
in healthy blood donors in the area of the study. *****CIRID ED COMMENT: This report is part of an increasing body of
evidence that there is some relationship between HTLV-III/LAV seropositivity and malaria infection.
Previous reports
from Africa as well as South America suggested this. This report shows definitive evidence for an antibody response in
8 or the 24 patients with acute malaria. Since none of the patients in these studies have had any manifestations
suggestive of AIDS, the alternate possibility is that there is some other retrovirus(es) that travels with malaria in
these areas. The recent report of an HTLV-III/LAV-like agent in Africa (HTLV-IV) that is not associated with evidence
of immune deficiency is intriguing in this regard. (NCGSTDS EO NOTE:, Readers are reminded that malar~a is a protozoan
infection transmitted through the bite of an infected mosquito (anopheles), transfusion of contaminated blood, or use of
a common syringe by drug addicts. This supports the hypothesis of an insect vector, as proposed by researchers studying
the unusually high incidence of AIDS in Belle Glade, Florida, and maybe other places??]
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***** THE OFFICIAL NEWSLETTER OF THE NCGSTDS * VOLUME 7~5 * JUNE/JULY, 1986 * PAGE 63 *****
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ORAL SEX MAY BE SAFER?
~~Y1!!,
6/25/86
Aletter in the April 4, 1986 issue of the JQy~~~l Qf !h! !m!~1£~~ ~~1£!1 ~!!Q£1!!!Q~ by Drs. David Lyman, Michel
Ascher, and Jay Levy, suggests that oral sex might be considered safer than previously thought. The doctors began the
San Francisco Men's Health Study in June 1984 and continued it though January 1985. Recruited for the study were 1035
gay and straight men. The 214 heterosexual men who were found to be seronegative for antibodies to the AIDS virus were
dropped from the study. The remaining 821 bisexual and homosexual men were divided into three groups; no sexual
partners (15 men); oral-genital contact only (56 men); and continued rectal intercourse (750 men). In the first two
groups, only 20\ of the men tested positive for ARV, as opposed to 51\ of the men having continued rectal intercourse
who tested positive. The study results do not completely exclude the chance for oral sex leading to infection with the
AIDS virus. "They do, however, show no excess risk of infection by this route and support the theory that anal-genital
sex exposure is the major risk of infection," says the letter.
**************************************************
KILLING VIRUSES
with thanks to §£1!'l£!
~~,
7/12/86
Viruses are a hardy bunch. They survive exposure to many potent chemicals unscathed, and most compounds that can kill
them wipe out the· host cell as well. In Vancouver, researchers at the University of British Columbia are working with a
class of phototoxic plant compounds that, they say, show promising though preliminary signs of antiviral activity.
Phototoxic compounds can cause allergic reactions, and sometimes illness or death, when they are eaten or touched by an
animal that is then exposed to the ultraviolet A radiation in sunlight. But at last month's annual meeting of the
American Society for Photobiology in Los Angeles, Neil Towers reported that five such compounds, found in plants of the
marigold and sunflower families, appear to be even more toxic to viruses than to animal cells. Towers and James Hudson
grew Sindbis virus and mouse-cytomegalovirus in mouse cells, then exposed the cultures to the phototoxins in varying
concentrations.
According to Hudson, "relatively low" concentrations of the compounds destroyed the viral membranes
while leaving the membranes of the mouse cells undamaged. The compounds appear to act on unsaturated fatty acids in the
viral membranes, Towers says. Though the viruses were still able to penetrate the host cells, they were "essentially
killed," since they were no longer able to replicate. There are other photoxins that appear to have antiviral activity,
the researchers say, many of them derived from plants traditionally considered to have medicinal value. Some of these
compounds disrupt the virus's genetic material and are more likely to have harmful side effects on the host cells. The
researchers have not yet tried the membrane-specific compounds in animals, but if in vitro results are borne out, Hudson
says, there is the potential for a new class of drugs, potent against many viruses-b~t-;ithout sOle of the serious side
effects that occur with other antiviral drugs.
**************************************************
TREATMENT OF AIDS-INDUCED ADRENAL INSUFFICIENCY WITH CORTISOL MAY HELP PROLONG LIFE
with thanks to g!!!!~£h g!!~~£!! B!eg~!!~, May, 1986 (HHS/PHS/NIH)
Daily administration of cortisol, a steroid hormone normally produced by the cortex of the adrenal gland, can relieve or
reduce the severity of some symptoms associated with AIDS. Scientists at the University of California General Clinical
Research Center (GCRC) in San Francisco emphasize that the treatment is not a cure for AIDS, which is almost invariably
fatal.
Instead, the cortisol injections make up for the adrenal gland's failure to provide enough of the natural
hormone, cortisol. Replacement therapy could improve management of even prevent some of the severely debilitating
symptoms that result from adrenal insufficiency in people with AIDS, namely weight loss, nausea, vomiting, and
debilitation. The treatment is likely to be most beneficial to PWAs with severe adrenal insufficiency, who apparently
comprise about 10% of the affected population, according to GCRC researchers. Of the 100 people participating in the
study so far (as of submission of report for publication), about 10% exhibit primary adrenal failure (Addison's
disease).
According to Dr. Edward Big1ieri, cytomegalovirus (CMV) infection could have caused adrenocortical
dysfunction in three of the PWAs from the initial study. CMV infection, as indicated by the presence of CMV antibodies,
is extremely prevalent among homosexuals. About 95% of otherwise healthy homosexual males have CMV antibody, suggesting
previous or current infection. "CMV infiltration may destroy certain adrenal pathways, resulting in absent or severely
impaired adrenal reserves," Biglieri says. Others problems, however, could contribute to the adrenal insufficiency.
Infection with cryptococcus or ~~£Q~~£!!~i~~ ~Yi~~:i~!~~£!ll~l~~!, Kaposi's sarcoma, hypotension from septic shock, or
bleeding may predispose the adrenal gland to necrosis and hemorrhage.
Bleeding may be caused by disseminated
intravascular coagulation, which is characterized in the late stages by profuse hemorrhaging, or from thrombocytopenia,
which is characterized in the late stages by a decreased number of blood platelets. "Of course, we are also
investigating the possibility of a direct effect of the [AIDS virus] on the adrenals," Biglieri says.
He and his
colleagues are now planning to study adrenal function in patients with ARC, which is characterized by the early symptoms
of AIDS, including fatigue, fever, night sweats, and gradual loss of weight.
(Research described in this article was supported in part by the National Institute of Arthritis, Diabetes, and
Digestive and .kidney Diseases an~ the General Clinical Research Centers Program of the NIH Division of Research
Resources.]
**************************************************
************************************************************************************************************************
AIDS EPIDEMIOLOGY/SURVEILLANCE UPDATE
abstracted from ~!~ ~!~1~ §y~Y!111!n~! B!~Q~~, CDC AIDS Activity
As of July 21, 1986, the Centers for Disease Control AIDS Activity reports a total of 22,815 adult and pediatric cases
of AIDS in the U.S. (CDC strict case definition). [The present estimate of all those infected with antibody to the AIDS
virus in the United States is 2,281,500, based on those currently diagnosed multiplied by 100; those with AIDS-related
conditions but without a specific diagnosis of AIDS is conservatively estimated to be 228,150, based on those currently
diagnosed multiplied by 10. --NCGSTDS Editor] ~AI!~~I B!~~ §BQ~~l Homosexually active men account for 73% of all cases;
17% from IV drug users; 1% from hemophiliacs; 2% from heterosexual contacts with PWAs or at risk for AIDS; 2% from
blood/blood product recipients; and 5% from those in no apparent risk or unknown risk group. [Note that Haitians are no
longer considered a 'high risk' group, yet they had accounted for 3% of all cases. The CDC continues to receive
criticism for their atypical 'hierarchical' listing, whereby if homosexually active men are also IV drug users or
hemophiliacs, they are only counted in the top, i.e., homosexual, category, therefore confusing and misrepresenting the
data. CDC officials admit this situation. --ED] A§~l 22% of the cases are aged 29 or less; 47% from ages 30-39; 21%
from ages 40-49; and 10% from ages over 49. BA£!AblgI~~!£ ~A£~§BQ~~Ql 60% of the cases are white; 25% are black; 14%
are hispanic/latino; 2% are other or unknown. Note that 60% of the pediatric cases are black, 21% hispanic, 19% white,
and 1% are unknwon. §~Q§BA~~!£Ab Q!§IB!~~I!Q~l 55 states and territories, including the District of Columbia &Puerto
Rico have reported cases to the CDC; New York &California have the most cases, with 33% &23%. respectively; Florida,
New Jersey. &Texas report 6%, 6% &5%, respectively; Illinois, Pennsylvania, Massachusetts, the District of Columbia,
and Georgia, each report 2% of the cases; all other areas each report 1% or less. OVERALL MORTALITY: 54%. CASES PER
~!bb!Q~ QE eQe~bAI!Q~l 100.2 overall for the entire U.S.; it ranges from 759~5-pM-in-N~;-Y~~k~ 734.0 pM-i~ Sa~
Francisco, 261.0 pM in Los Angeles. 392.4 pM in Miami, 295.0 pM in Newark, and 50.6 pM elsewhere in the U.S.,
irrespective of standard metropolitan statistical area.
**************************************************
VIRUS TRANSMITTED FROM 'FALSELY NEGATIVE' BLOOD
with thanks to Detroit's £~~1!!, 7/2/86
Health researchers reported the first case of a patient becoming infected with the AIDS virus from a blood transfusion
that had been tested and showed no signs of the deadly disease. The case, which occurred in 1985 in Colorado, involved
a donor who gave blood so soon after a homosexual encounter that he had not yet developed the antibodies that trigger
the AIDS blood tests, said officials with the CDC. The chance of a blood recipient getting the virus that causes AIDS
remains less than one in 100.000, said Dr. Harold Jaffe, an AIDS specialist with the CDC. But the CDC noted that AIDS
antibodies take months to appear in blood tests. For that reason, Jaffe said, 'men who have had sexual contact with
another man since 1977 must not donate blood.'
**************************************************
HORMONAL LOOK-ALIKE
by J. Silberner, with thanks to
~~1!n~! ~!~,
5/31/86
Antibodies against a human hormone that stimulates the immune system also inhibit test-tube replication of the virus
associated with AIDS, report researchers from the National Cancer Institute in Bethesda. and George Washington
University in Washington, DC. Why antibodies to the hormone would. work against the AIDS virus remains to be discovered,
but the results suggest a new path to an AIDS vaccine, the researchers write in the May 30 §£i~n~~. The hormone target
The
is thymosin alpha-I. which promotes the activity of helper T cells, the prime victims of the AIDS virus.
researchers suspected a thymosin-AIDS connection because children with a genetic inability to produce thymosin develop
an AIDS-like disease. In a computer match-up of the viral and hormone proteins, they found that about half the
components along a short stretch of thymosin are identical to an inner-core AIDS protein. They injected thymosin alpha1 into rabbits and added the resultant antibodies to a human cell line infected with the AIDS virus. 'We found we could
protect cells [in culture] by adding the antibody,' says Prem S. Sarin of the National Cancer Institute. The
researchers are now searching for a vaccine that will stimulate humans to produce their own antibodies against the AIDS
core protein.
AIDS vaccine work has focused predominantly on the proteins that surround the viral core, on the
presumption that the 'envelope' proteins are more exposed to the immune system. But these outer proteins vary from
strain to strain of the AIDS virus, complicating the search for a single vaccine. In contrast, the core protein--which
GW's Allan L. Goldstein calls 'the Achilles' heel of the virus'-- apparently remains stable. 'We feel we have solved
one of the major obstacles to vaccine development--namely, genetic drift,' says Goldstein. For an immune reaction to
occur, the core protein must be exposed to antibodies at some point. This may happen, Goldstein suggests, when the
virus injects itself into the cell, or if the antibody enters infected cells, or if the core protein is in the envelope
as well. Whether the structural similarity between the virus and the hormone is simply coincidental or has a functional
explanation. Sarin says, remains an open question.
**************************************************

I GAY AND L:: :E~S~:SSOCIATION

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