Subject: AIDS Activists in San Francisco Shout Down Health and Human Services Secretary's Speech Date: Published: 6/25/90 (238 lines) Source: Wall Street Journal. Copyright Dow Jones & Co. Inc. Technology & Health: AIDS Activists in San Francisco Shout Down Health and Human Services Secretary's Speech ---- By Marilyn Chase Staff Reporter of The Wall Street Journal SAN FRANCISCO -- A deafening chorus of activists howling "shame, shame," all but completely drowned out a speech by Louis Sullivan, secretary of Health and Human Services, to close the Sixth International Conference on AIDS. Showered by paper missiles, Dr. Sullivan plowed stolidly through a speech that was intended to defend the administration's research efforts to fight the disease. But this week those efforts have been completely overshadowed here by the administration's curbs on the travel and immigration of people who carry the AIDS virus. The policy was condemned by speakers including Hiroshi Nakajima, director general of the World Health Organization, minutes before Dr. Sullivan's introduction unleashed the 20-minute-long protest. His speech went almost completely unheard. Amid the shrieking of whistles and air horns, most people missed the secretary's criticism of an unpopular amendment to the Americans with Disabilities Act, which permits employers to reassign AIDS-infected food handlers. The impromptu addition to his text was timed to coincide with a key vote scheduled on that amendment today. Scientists agree the virus isn't passed by casual contact, or through food. But the hundreds of activists in the audience taking part in the protest were unmoved by any note of conciliation. They were joined in some cases by scientists who stood holding leaflets aloft in silent solidarity against the U. S. travel curbs. But many were also dismayed by the display. "I feel like crying. He should be allowed to speak," said Pierre Ludington, a San Francisco AIDS activist. A grim-faced spokesman for the San Francisco AIDS Foundation said he feared the hostile show would exhaust any remaining sympathy for activists within the administration. "It doesn't leave us a lot of maneuvering room," Rene Durazzo, the foundation spokesman, said. As the flag bearer for President Bush, who declined to attend, Dr. Sullivan was dispatched to San Francisco to represent the administration without anything new to offer the assembled thousands of delegates. But aides said yesterday that he knew what he was getting into. "It was his idea" to try to speak through the clamor, said Robert Schmermund, deputy assistant secretary for public affairs. "He wanted to come here and present what the administration is doing." Dr. Sullivan's speech brought to noisy closure a meeting best described in the words of one activist as "not an academic workshop, but a fight for people's lives." As AIDS enters its second decade in the 1990s, many unresolved questions remain to be answered in AIDS clinics and laboratories around the world. Even as drugs and behavior change slow its spread in parts of the United States, new waves of AIDS are growing around the world. "The AIDS pandemic remains volatile and dynamic. Its major impact has yet to be felt," said Jonathan Mann, former AIDS chief at the World Health Organization. Rapid spread continues in Africa, Latin America, Asia and the Caribbean, he said. "Heterosexual transmission in India is fueling a rapidly expanding epidemic," he said. Up to 20% of prostitutes sampled in the city of Bombay test positive, one report noted. In Africa and the Third World, a huge resource gap yawns between rich and poor countries. And giving has been strikingly low. "The industrialized world's total contribution to AIDS {in the developing world} is about $200 million-or one-fifth the AIDS budget of New York State," Dr. Mann said. In Malawi, a country of 8 million people, Chief of Health Services H. M. Ntaba said his annual AIDS budget totals $2 million, or 25 cents per person. It is vastly more than he has to fight malaria, but still "a drop in the bucket," he says. AIDS also is expected to leave Africa with a legacy of between 250,000 and one million orphans, experts said during the meeting. In the Soviet Union, where the country's admitted 490 cases were spread by unsterile medical practices, journalist Elena Pankova says: "We are afraid to go to the dentist. We are afraid to take our children to the hospital." Speaking in an effort to drum up charitable contributions for her country, she said, "We have no disposable needles or syringes, and no condoms. Just imagine!" She said the true size of the epidemic is many times larger than official figures. On the domestic research agenda, a major unresolved dilemma touches the need to balance early treatment of HIV infection against the risk of encouraging the rise of viruses that are resistant to drugs like Wellcome PLC's AZT. Margaret Fischl, a researcher at the University of Miami, said that earlier treatment is clearly linked with longer-term survival benefits for people with HIV disease. Still, the virus can begin mutating to evade the drug within months of starting treatment. Douglas Richman, a researcher at the University of California at San Diego, previewed a new study showing that viral resistance appears as early as six months in late-stage patients, and 12 months in early-stage patients. As the time between infection and the appearance of AIDS stretches out to 10 years and beyond, scientists worry about mass initiation of long-term AZT therapy. "Will widespread use of AZT come to resemble the use of penicillin for now-resistant staph infection? " asked Hiroshi Mohri, a researcher at the University of California, Los Angeles. "With passage of time, will AZT become less useful? " For this reason, more and more studies now are aimed at testing a vast array of combination treatments, alternating AZT with other drugs such as DDC by Hoffman La Roche Inc. or DDI by Bristol-Myers Squibb Co., or with immune-boosting agents, which try to reconstitute a failing immune system. Immune-boosting agents will be a major focus for the 1990s, as will treatment for opportunistic infections, caused by an array of microbes that attack weakened patients. So far, immune-boosting treatments have been "marginal at best, and transient," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Refining the treatment of opportunistic infections deserves attention as much as the virus itself, he said. "We already know more about HIV than those other microbes we've been studying for decades," Dr. Fauci added yesterday. Outreach to minority populations at risk, especially intravenous drug users, is a major point of contention between the scientific community and certain black social activists. Deborah Fraser-Howe, executive director of the Black Leadership Coalition on AIDS, spoke as a woman in Harlem, "raising another generation as the shadow of death falls across our community." Her speech was picketed by activists who want free needle exchange and bleach programs to halt spread of AIDS -- an approach rejected by many middle-class blacks as encouraging addiction. Yet white American and European academics like Don Des Jarlais of New York and Raymond Brettle of Edinburgh, Scotland, argue it is imperative to make needle use less perilous for those who can't quit drugs. Moreover, needle exchange doesn't create new addicts, Dr. Brettle says. "We have to persuade people that {reducing the harm of I-V drug use} and primary reduction of drug use are compatible." Adolescents -- especially runaway teens who are sexually active and using drugs -- are potential tinder for the AIDS epidemic. Researchers here said up to 40% of selected samples of urban runaway youth may carry the HIV virus. In the arena of vaccine research, where researchers have shown they can shield test animals from infection and alter the human immune response, many issues remain. Dr. Fauci said that the convention of waiting for clear evidence of safety and effectiveness in animals before human trials, may be tempered by the increased willingness of affected populations to take risks. Major unresolved questions between the activist and scientific communities still revolve around the validity of various drugs in community trials, and the adequacy of expanded distribution programs channeling experimental drugs to patients. A trial of the drug Compound Q or tricosanthin, an extract of Chinese cucumber, by Martin Delaney and Project Inform purported to show a trend toward rising counts of infection-fighting T-cells among an uncontrolled group of 46 patients. However, data on all patients were mixed together, averaged, and extrapolated in a way scientists immediately attacked. Arnold Relman, editor of the New England Journal of Medicine, publicly chastised the activist. "Mr. Delaney, you are irresponsible. Publish your data and let the chips fall where they may. Your claims are undocumented, untested and uncontrolled." Mr. Delaney, still insisting the drug is promising, said he plans to publish his data in a medical journal soon. So far, six of 51 early patients suffered dementia while on the drug, two progressing to coma, with one coma patient dying of pneumonia after regaining consciousness. Meanwhile, the jury is still out on academic center trials of the pure synthetic form of the drug by Genelabs Inc. of Redwood City, Calif. In a study at San Francisco General Hospital, 18 patients with AIDS and AIDS-related complex (ARC) tolerated the drug well except for one patient who suffered "a severe neurologic catastrophe" and died of uncertain causes 118 days after treatment. Overall, the patients' immune status was unchanged after the treatment, researchers reported. "Parallel track" programs to distribute experimental drugs even while tests proceed to check effectiveness, promise to be the subject of continuing wrangling between scientists, companies and activists. The activist group ACT UP has attacked Roche's plan to give away the drug DDC as too narrow, an attack a company spokesman described as "an affront" to all who worked to bring it about. But there were moments of unexpected rapprochement too. Ellen Cooper, a scientist and the Food and Drug Administration's main liaison with activists on drug development, has often been reviled by ACT UP as a villain. But when ACT UP member Jay Lipner on Saturday commended her role in broadening access to drugs, activists applauded. "I knew then that hell had frozen over," said an astonished federal scientist. The AIDS conference has become the scene of a major trade show over the years, with major drug companies mounting slick presentations, next to unconventional products such as a female condom, and whimsical items such as a Bart Simpson T-shirt depicting the TV urchin sporting an earring and purple cape, and saying "AIDS is a global crisis, dude." Unusual research alliances also were spawned this year, such as a study of venereal disease in prostitutes, sponsored by UCLA at the Chicken Ranch Brothel of Pahrump, Nev. A raucous demonstration last week highlighted the need to bring more women into experimental drug trials. "Women with AIDS can't wait till later, we are not your incubator," protesters chanted. Dr. Daniel Hoth, of the National Institute of Allergy and Infectious Diseases, replied that he was promoting plans to bring more women into studies as "a matter of access, not science" since he said there's little evidence that women -- except during pregnancy -- react differently to drugs from men. While conceding that activists have important contributions to make to the research dialogue, Dr. Fauci gently warned them not to overdo it. "It is particularly devastating when scientists of good faith and enormous talent have been singled out and denounced as scoundrels," he said. Giovanni Rossi, chairman of the 1991 AIDS conference planned for Florence, Italy, unveiled as his conference logo an image of Michelangelo's David, and won applause for an optimistic prediction. "David was fighting a giant that was threatening his culture," he said. "He won his battle against Goliath. So will we." 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