Subject: CDC AIDS Daily Summary Date: Thu Mar 6 08:36:02 PST 1997 (207 lines) From: National AIDS Info Clearinghouse Copyright 1997, Information, Inc., Bethesda, MD AIDS Daily Summary March 6, 1997 The CDC National Center for HIV, STD, and TB Prevention makes available the following information as a public service only. Providing this information does not constitute endorsement by the CDC. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC National AIDS Clearinghouse should be cited as the source of this information. Copyright 1996, Information, Inc., Bethesda, MD ****************************************************** "Casting Off the 'Unreliable' AIDS Patient" "Gift to a Dying Daughter: Orders to Spare Her Pain" "Doctors and Medical Marijuana" "Judge Imposes June Deadline on Settling an HIV Suit by Hemophiliacs" "Across the USA: Indiana" "A Brave Spirit Survives, Helping AIDS Victims" "Obituary: Wayne Fischer, 39, Teacher; Chronicled His AIDS on TV" "HIV Infection Rates Remain Steady" "An Opportunity Lost: HIV Infections Associated With Lack of a National Needle-Exchange Program in the USA" "Community-Based HIV Prevention in Presumably Underserved Populations--Colorado Springs, Colorado, July-September 1995" ****************************************************** "Casting Off the 'Unreliable' AIDS Patient" New York Times (03/06/97) P. A35; Baxter, Daniel By withholding powerful new AIDS treatments from patients who may not be relied on to stick to the strict regimen required, doctors could be helping the disease spread further, contends Daniel Baxter of Casa Promesa, a housing facility for AIDS patients in the South Bronx, in the New York Times. Some doctors are reluctant to prescribe the drugs to people who are homeless or substance abusers for fear that if they do not take the drugs properly, drug-resistant HIV strains will develop. However, Baxter argues that patients on the margins of society are aware of the potential of the new drugs and that a black market will develop if doctors refuse to provide the drugs to some patients. Patients who acquire their treatment via the black market, he notes, would be treating themselves without any supervision, increasing the threat of poor compliance and drug resistance. "Gift to a Dying Daughter: Orders to Spare Her Pain" New York Times (03/06/97) P. A1; Fein, Esther B. When Francisca Rodriguez learned in 1992 that she and her 5-year-old daughter Gabriella were infected with HIV, she decided to take the proper precautions regarding her own illness and her daughter's. She named a health proxy to make decisions when she no longer could, and signed a living will to detail her end-of-life care. She also said she wanted no experimental drugs, no unnecessary tests, and no machines for her child when her health declined. Rodriguez died at home on July 8, 1993, and was followed by her daughter two years later. Unlike most dying patients in the United States, Gabby's care was outlined and discussed by her family well before she died. Moreover, because Gabby's mother did not want her to be in pain, she asked that her child not be enrolled in clinical trials testing experimental drugs. According to her mother's wishes, Gabby was not put on AZT or other antiretrovirals, which doctors believed could have delayed the child's death but not prevented it. "Doctors and Medical Marijuana" New York Times (03/06/97) P. A34 The Clinton administration's threat to sanction doctors who recommend marijuana to their patients interferes with free speech and patient rights, claim the editors of the New York Times. The authors note that as it attempts to enforce federal anti-drug laws, the administration also needs to clarify that it will not prevent doctors from providing the best care for their patients. Leading AIDS and cancer doctors in California recently brought a lawsuit against the government for threatening to violate their First Amendment rights and interfering with doctor-patient communication. The White House has responded by saying that doctors may discuss the medical use of marijuana but not recommend the drug in an oral or written statement. The editorialists argue that this serves to limit improperly doctors and that they should be able to advise the use of marijuana freely as long as they do not aid patients in obtaining the drug. "Judge Imposes June Deadline on Settling an HIV Suit by Hemophiliacs" Philadelphia Inquirer (03/06/97) P. A5; Shaw, Donna Four pharmaceutical companies have until June to finalize a proposed settlement with some 4,600 HIV-positive persons with hemophilia, a federal judge in Chicago ruled Wednesday. About 6,200 hemophiliacs who contracted HIV from tainted blood products are involved in the settlement, which calls for each person to receive $100,000. Lawyers for the hemophiliacs and the pharmaceutical companies have been negotiating for months over state and federal regulations that impact about 1,600 of the plaintiffs. The HIV-positive persons with hemophilia have already received Medicaid or other publicly funded medical benefits and could be forced to pay most of their settlement money to the government. The lawyers are trying to secure waivers for these persons or their survivors. "Across the USA: Indiana" USA Today (03/06/97) P. 11A A computer glitch delayed a request to Medicaid to cover drug therapy for a 6-year-old Evansville, IN, boy who pricked his finger on a hypodermic needle he found. After the six-day delay, the therapy, designed to prevent HIV or hepatitis infection, could be useless. "A Brave Spirit Survives, Helping AIDS Victims" Washington Times (03/06/97) P. A2; Clinton, Hillary Rodham Elizabeth Glaser, an AIDS activist who died of the disease in December 1994, is remembered in the Washington Times by First Lady Hillary Rodham Clinton and applauded for her contributions to the AIDS movement. Glaser contracted HIV through a blood transfusion in 1981 and unknowingly transmitted the virus to her then-unborn daughter and son. After losing her 7-year-old daughter to AIDS, Glaser started the Pediatric AIDS Foundation to support research into the prevention and treatment of AIDS in children. The Centers for Disease Control and Prevention reported last year that the rate of HIV transmission from mothers to children decreased 27 percent between 1992 and 1995. Reasons for the decline include new drug treatments and aggressive therapies. In conclusion, Clinton notes that while Glaser would be encouraged by recent advances in the fight against AIDS, efforts against the disease must continue. "Obituary: Wayne Fischer, 39, Teacher; Chronicled His AIDS on TV" New York Times (03/06/97) P. B23; Dunlap, David W. Wayne David Fischer, a New York City high school teacher who reported on his life with HIV in a weekly cable television show, died of AIDS on Sunday. Fischer's show, "AIDS: A Journal of Hope," showed his day-to-day life, including drug injections and infusions, candlelight vigils, trips to Brazil, hospitalizations, family gatherings, and baseball games. Fischer retired from Martin L. King Jr. High School in 1993 because of his illness. He had disclosed that he was gay and HIV-positive at a Board of Education meeting in 1990. His influence helped spur the development of both an HIV prevention program and a gay and lesbian counseling group at the school. "HIV Infection Rates Remain Steady" USA Today (03/06/97) P. 12A; Bryan, Dawn Despite a reported decline in AIDS-related deaths, the number of people becoming infected with HIV has remained stable, pointing to the need for continued support for HIV patients, notes Dawn Bryan of the Momentum AIDS Project in a letter to the editor in USA Today. Bryan cites the increased demand for meals and groceries at Momentum's New York City center, adding that HIV rates are especially high among women and minorities--the same populations that make up most of the group's clients. "An Opportunity Lost: HIV Infections Associated With Lack of a National Needle-Exchange Program in the USA" Lancet (03/01/97) Vol. 349, No. 9052, P. 604; Lurie, Peter; Drucker, Ernest The Centers for Disease Control and Prevention reports that most new HIV infections are linked to injection drug use, which indicates that HIV prevention strategies for this population are especially important. Despite the success of needle-exchange programs in foreign countries, opposition to the programs in the United States has limited their number and scope. A U.S. law enacted in 1988 bans the use of federal funds for needle exchanges until the programs are shown to reduce HIV transmission without leading to increased drug use. Six government-sponsored studies have shown that needle exchanges meet these criteria, and four reviews have called for the ban to be lifted. Researchers Peter Lurie of the University of California, San Francisco, and Ernest Drucker of Montefiore Medical Center estimate that between 4,394 and 9,666 HIV infections could have been prevented between 1987 and 1995 had needle exchange programs been established during this period. They calculate these preventable infections could cost the U.S. health care system some $244 million to $538 million as a result. Moreover, the researchers claim, if current policies are not changed, between 5,150 and 11,329 new HIV infections could occur by the year 2000. In conclusion, Lurie and Drucker note the urgency of lifting the ban on federal funding for such programs. "Community-Based HIV Prevention in Presumably Underserved Populations--Colorado Springs, Colorado, July-September 1995" Morbidity and Mortality Weekly Report (02/21/97) Vol. 46, No. 7, P. 152; Brace, N.E.; Zimmerman, H.P.; Potterat, J.J.; et al. People who are homeless, chemically dependent and not in treatment, or mentally ill may be at increased risk of HIV infection but are suspected of being underserved by HIV prevention and testing programs. Health officials in Colorado Springs, CO, conducted a study from July to September 1995 to evaluate the prevalence of high-risk behaviors, the acceptance of HIV counseling and testing, and rates of HIV infection among these groups. Researchers at the El Paso County Department of Health and Environment report that such individuals are accessible, commonly report high-risk behaviors, and have been previously tested for HIV. The findings also led researchers to conclude that social isolation is partly responsible for low HIV seroprevalence in this population. Of the 224 study participants, 51 percent were classified as having engaged in some type of high-risk behavior--either injection-drug use, receptive anal sex, or sex with more than two partners--in the previous six months. Among the participants who consented to HIV testing, 1 percent were newly tested and identified as seropositive, 69 percent reported having been tested at some point since 1985, and 29 percent had never been tested. Individuals who reported high-risk behavior were more likely to have been tested before. An editorial note accompanying the study adds that high-risk behavior and HIV testing were reported by a high proportion of participants and that they were willing to use HIV outreach services. The prevalence of HIV infection was low, moreover, despite the presence of high-risk behaviors.