Subject: CDC AIDS Daily Summary for Date: Mon Oct 29 13:31:01 PST 2001 (394 lines) From: National AIDS Info Clearinghouse Copyright 2001, Information, Inc., Bethesda, MD The CDC National Center for HIV, STD and TB Prevention provides the following information as a public service only. Providing synopses of key scientific articles and lay media reports on HIV/AIDS, other sexually transmitted diseases and tuberculosis does not constitute CDC endorsement. This daily update also includes information from CDC and other government agencies, such as background on Morbidity and Mortality Weekly Report (MMWR) articles, fact sheets, press releases and announcements. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC HIV/STD/TB Prevention News Update should be cited as the source of the information. Contact the sources of the articles abstracted below for full texts of the articles. HEADLINES NATIONAL NEWS "State Plans Attempt to Limit Brand-name Drugs for Medicaid Clients" "Manager with HIV Wins $5 Million in Lawsuit Against McDonald's" "Older HIV Patients Given a Voice" INTERNATIONAL NEWS "World Conference Focuses on Improving Lives for People with HIV/AIDS" "Zambia Ex-President Seeks Funds to Fight AIDS Crisis in Africa" MEDICAL NEWS "The Effect of Insurance Coverage Changes on Drug Utilization in HIV Disease" LOCAL AND COMMUNITY NEWS "Gift of Hope" NEWS BRIEFS "Staff of West Hollywood Medical Marijuana Clinic Protest DEA Raid" "AIDS Cases Rise in China" "FDA Approved AIDS Drug" ************************************************************ NATIONAL NEWS ************************************************************ "State Plans Attempt to Limit Brand-name Drugs for Medicaid Clients" Associated Press (10.27.01)::Rebecca Cook A Washington state plan to reduce Medicaid costs is receiving a worried reaction from doctors, patient advocates and some in the drug industry. Modeled on a Florida program that limits brand name drug prescriptions to four per Medicaid patient, the Washington plan was introduced on Friday and is set to take effect in January. The program employs an out-of-state pharmacy consultant to review with doctors any patient's drug history that calls for prescription of more than four brand-name medications. If possible, the consultant would suggest cheaper alternatives. The doctor would have the final say. "The proposed rule has the potential of causing harm and confusion among patients and exhaustive bureaucracy for pharmacists and providers," Joel Hastings, Lifelong AIDS Alliance government affairs director, wrote to Gov. Gary Locke in a letter also signed by advocates for people with asthma, Parkinson's disease, mental illness, arthritis, epilepsy and heart disease. Several categories of drugs would be exempt from the count, however, including medications for HIV/AIDS and cancer, antidepressants and antipsychotics, and contraceptives. But this has prompted some groups to cry foul and indicate that the new rule will set up a "divide and conquer" move, since it does not make drug limits for all diseases. "We are definitely going to file a complaint with the Attorney General's office under the Americans with Disabilities Act," said Skip Dreps of the Northwest Chapter of the Paralyzed Veterans of America. "We are on a collision course," said Thomas Bedell, acting assistant secretary of the state's Medical Assistance Administration. "There are going to be some harsh realities." Drugs cost the state Medicaid program more than $400 million a year. Health-related expenses account for 55 percent of the state's budget growth. With the downturn in the economy, the Department of Social and Health Services (DSHS) is looking at major budget cuts. Prescription drugs are an obvious target. The "Therapeutic Consultation Service" will apply to about 437,000 Medicaid fee-for-service patients in Washington. Of those patients, between 15,000 and 17,000 take more than five prescription drugs per month. "Manager with HIV Wins $5 Million in Lawsuit Against McDonald's" Associated Press (10.28.01) A jury in Cleveland has awarded a former McDonald's restaurant manager $5 million based on his claims that the company discriminated against him because he has HIV. The jury in Cuyahoga County Common Pleas Court deliberated less than three hours Friday before ruling in favor of Russell Rich at the end of the nine-day trial. Rich sued McDonald's Corp. claiming discrimination on the basis of the illness after he was forced to resign his job in October 1997. "This case is about prejudice. Prejudice in the workplace is unacceptable as a condition of employment," said Paige A. Martin, the Columbus attorney who represented Rich. Lisa Howard, spokesperson for McDonald's, said Sunday the company is considering appealing the decision. Rich, 37, of the Akron suburb Fairlawn, worked for 20 years at McDonald's franchise restaurants. The company hired him in July 1997 to manage a corporate-owned store. Two weeks later, Rich was hospitalized for an AIDS-related illness. McDonald's said he could continue to work only if the company could review his medical records. He agreed. After that, Rich said his supervisors refused to let him do his management duties, improperly disciplined him for job abandonment and scheduled him to work unreasonably long hours. He said that when he tried to complain about the hostile work environment to a McDonald's operations manager, he was told to take a two-week, unpaid leave of absence because the manager did not have time to listen to his complaints. Rich became ill, but when he notified McDonald's he wanted to return to work, he was told he was being transferred to another restaurant. There he could co-manage the store at a manager's salary but his duties would be limited "for the rest of his career" to selling hamburgers at the front counter, Martin said. Rich, who filed his discrimination case in October 1998, has "suffered greatly over the years," Martin said. "Older HIV Patients Given a Voice" Detroit Free Press (10.29.01)::Julie Edgar It has been ten years since Jane Fowler found out she was part of a growing number of older people who had contracted HIV. Now Fowler, 66, runs the National Association on HIV Over 50 and speaks around the country about being older and infected with a virus that is stigmatized as a disease of intravenous drug users and promiscuous homosexuals. Fowler, a former newspaper journalist for 18 years, was married for 23 years before she began dating after her divorce. Five years after a New Year's Eve date with a friend she had known for years, Fowler was diagnosed with HIV. She discovered she was infected when a health insurance company rejected her application for coverage. "We're fighting the stigma of ageism as well as having a sexually transmitted disease," said Fowler. The rate of AIDS infection in the 50-plus population has climbed. People over 50 now represent 10 percent of all cases, according to the CDC. As of July, there were 471 cases of AIDS in people over 50 in Michigan, or about 10 percent of the total, and 299 people over 50 with HIV, or slightly more than 5 percent of all cases, according to the Michigan Department of Community Health's HIV/AIDS Prevention and Intervention Section. Fowler, a resident of Kansas City, Mo., will speak on "Age Isn't a Vaccine Against HIV" at 7 p.m. at Congregation Shaarey Zedek, 27375 Bell Road in Southfield, Mich. The event, sponsored by the synagogue and the Michigan Jewish AIDS Coalition, is open to the public. For information, telephone 248-594-6522. ************************************************************ INTERNATIONAL NEWS ************************************************************ "World Conference Focuses on Improving Lives for People with HIV/AIDS" Associated Press (10.27.01)::Tony Fraser Improving the lives of those with HIV/AIDS is the central focus of the 10th Annual International Conference for People Living with HIV/AIDS, which began Saturday in Trinidad and Tobago. Participants at the conference are discussing vaccines, access to medication, patient rights, prevention and discrimination. Another topic is the need for governments to commit more money to HIV/AIDS prevention and treatment, even as they attempt to ward off terrorist or technological crises. Yolanda Simon, chair of the conference, questioned why "it's taking so long to experience mobilization for HIV in the same manner as that for terror-inspired anthrax." Peter Piot, director of the Joint UN Program on HIV/AIDS, said governments need "political will" to fund prevention and treatment campaigns for the estimated 36 million people infected. "Hundreds of billions of dollars were spent on the non-virus of the Y2K millennium," he said, referring to the campaign to update computers for the year 2000. Piot said HIV/AIDS should be made a major human rights issue. The UN's global fund for HIV/AIDS and other infectious diseases has only reached $1.5 billion -far below the targeted $7 billion to $10 billion, Piot said. About 700 people are attending the five-day conference, including 600 people from around the world who are infected with the virus, and health workers and observers. This year's conference was planned in the Caribbean because the region has a large proportion of people infected with HIV, said Stuart Flavell of the Netherlands-based Global Network of People Living with HIV/AIDS. In the Caribbean, about 500,000 people are living with the virus, according to the Caribbean Task Force on HIV/AIDS. An estimated 2 percent of people in the Caribbean, excluding Cuba, have HIV/AIDS -the world's highest regional infection rate after sub-Saharan Africa, where 25.3 million are living with the virus. The conference continues through Wednesday. "Zambia Ex-President Seeks Funds to Fight AIDS Crisis in Africa" Plain Dealer (Cleveland) (10.29.01)::Regina McEnery "You see HIV/AIDS here in America, you see it in Europe, but people are not dying in the millions as they are in Africa. Our main problem is poverty. Poverty must be fought," Zambian ex-president Kenneth Kaunda said last Wednesday in Cleveland. Speaking at a luncheon meeting of the AIDS Taskforce of Greater Cleveland, Kaunda said Zambia lacks the basics needed to fight AIDS. There are not enough doctors or hospitals; most people cannot afford AIDS drugs; and education is inadequate, he said. Kaunda played a leading role in his nation's efforts to gain independence from Great Britain in the 1960s before becoming president of Zambia. But after his son died of AIDS in 1986, Kaunda began talking about the disease at a time when other African leaders downplayed it or refused to recognize it. Since leaving office in 1991, he has devoted much of his time to the Kenneth Kaunda Children of Africa Foundation, which helps care for AIDS orphans and sponsors radio broadcasts about AIDS. The messages are delivered by Kaunda's son Waza, a physician who operates a medical clinic in Lusaka, Zambia. Kaunda was in Cleveland to drum up support for the Children of Africa Project, whose goal is to link African-Americans with Africans to try and break the cycle of poverty and educate youths on both continents about HIV/AIDS. Project organizers are trying to persuade local churches to establish Children of Africa Clubs. Millions of African children are "at the bottom of a well" waiting for the world to rescue them, said Earl Pike, executive director of the AIDS Taskforce of Greater Cleveland. But Kaunda trod delicately over some issues in the fight against AIDS. African culture doesn't promote condom use, and Kaunda said he isn't "sure that we should be insisting on condoms as the answer to the problem." ************************************************************ MEDICAL NEWS ************************************************************ "The Effect of Insurance Coverage Changes on Drug Utilization in HIV Disease" Journal of Acquired Immune Deficiency Syndromes (10.23.01) Vol 28; No 2: P 140-149::Scott R Smith; Duane M Kirking Changes in insurance coverage can produce a significant change in access to health care. Given the chronic and often debilitating nature of HIV disease, affected individuals in the United States, where health insurance is largely dependent on either employment or participation in an indigent insurance program, may lose or change health insurance with changes in employment. Previous studies have shown that as HIV disease progresses, individuals have a greater likelihood of losing employment. Increasing the financial loss is the increased need for prescription drugs to manage the disease and treat associated complications. Hence, changes in insurance coverage may be important in explaining patient access and adherence to medications in the treatment of HIV disease. The investigators hypothesized that patients with HIV disease who have a change in health insurance coverage will have lower drug use rates over time as compared with those whose benefits remain unchanged. They examined the use rate data of antiretroviral (ARV), antipneumocystic (drugs for prophylaxis of Pneumocystis carinii pneumonia, PCP) and antidepressant (ADP) drugs in a heterogeneous cohort of people living with HIV disease by adults participating in the AIDS Cost and Services Utilization Survey (ACSUS). ACSUS was an 18-month panel survey (March 1991 through August 1992) of patients in care for HIV/AIDS at 26 sites in the United States. Poisson regression analyses with estimating equations were conducted to determine the effects of demographic and socioeconomic variables on the acquisition rate of the three medicines. The sample included 1,566 respondents who provided 6,518 interviews to ACSUS. Changes in insurance coverage were common in the population. Yet, complete loss of insurance was reported in only 1.5 percent of the interviews, whereas gaining insurance was reported in 3.3 percent of interviews. Having no insurance was associated with significantly lower rates of antiretroviral use (rate ratio, 0.73), antipneumocystic use (rate ratio, 0.58) and antidepressant use (rate ratio, 0.58). Gaining insurance coverage was associated with lower antiretroviral use (rate ratio, 0.75) and antipneumocystic use (rate ratio, 0.70), whereas losing insurance was associated with lower antiretroviral use (rate ratio, 0.58). In multivariate analyses, these associations remained. Even after adjusting for socioeconomic factors, according to the authors, "individuals who gained, lost, or had no coverage still acquired ARVs at a significantly lower rate than those with stable overall insurance coverage. Loss of overall coverage was associated with an even greater reduction in ARV use than that observed among the uninsured." Notably, the transition in Medicaid coverage was similar to the transition in overall insurance coverage, emphasizing the importance of Medicaid coverage for access to medication in HIV disease. The investigators concluded the study indicating that the hypothesized relationship between change in health insurance coverage and lower prescription drug use for ARVs was upheld but not the relationship between insurance coverage and PCP and ADP. The difference in drug category, coupled with the facts that uninsured patients with HIV disease report worse access to medical care, and "the uninsured are less likely to receive or be offered ARV treatment," signify the broad need for an insurance safety net for patients with HIV disease. ************************************************************ LOCAL & COMMUNITY NEWS ************************************************************ "Gift of Hope" People (10.29.01):: William Plummer; Vickie Bane; Simon Perry After more than three decades of working in Africa, Hugh and Marty Downey are no strangers to suffering. They have treated famine victims in Sudan and massacre survivors in Eritrea. But despite all the misery that the American couple has seen, they can't get used to one sound they hear with growing frequency in Kenya. "Off in a corner of the village, people are wailing," said Hugh. "You know someone has died." More often than not, the cause of death is AIDS. This East African nation is a hot spot of an epidemic that has swept the continent during the past 20 years, killing some 20 million men, women and children and leaving more than 12 million orphans. An estimated one out of seven adult Kenyans is infected with HIV. As a result, Hugh and Marty are motivated to leave their modest brick home in Arvada, Colo., twice a year to spend a few weeks at Lake Victoria. They run the Lalmba Association, a relief agency whose small size -fewer than 200 volunteer doctors and project directors and a handful of low-wage local employees -belies its grand mission. "Lalmba means 'place of hope'" said Hugh. "That's what we're about. We create hope." Despite Lalmba's efforts, "people are dying in the prime of life," lamented Wanda McLure, who, with husband Dave, oversees Lalmba's Kenyan branch. The organization concentrates increasingly on rescuing HIV/AIDS orphans. In March, the Downeys launched a program that sends social workers to care for more than 300 AIDS orphans in bush villages, where they might otherwise be forced to fend for themselves. Since 1997 they have operated a home for the neediest of those children in the lakeside town of Ongoro. When one of its 24 young residents left to enter boarding school recently, 67 applied for his place at the orphanage. Around here, said Dave, the Ongoro orphans are seen as the "elite kids." ************************************************************ NEWS BRIEFS ************************************************************ "Staff of West Hollywood Medical Marijuana Clinic Protest DEA Raid" Associated Press (10.26.01)::Christina Almeida Operators of a medical marijuana clinic raided by federal agents blasted the action on Friday as a "death sentence" for people who use the facility. The center, which has been open since 1996, provides marijuana to patients suffering from AIDS, epilepsy, glaucoma, cancer and other serious illnesses. Drug Enforcement Administration (DEA) agents searched the Los Angeles Cannabis Resource Center Thursday afternoon, seizing computers, financial documents, 400 marijuana plants and medical records of some 3,000 current and former patients, said Scott Imler, president of the resource center. "This action is effectively a death sentence for patients all across Los Angeles County," Imler said. "Our immediate concerns are our 960 patients who have no place to go for marijuana." At a press conference on Friday, Imler was joined by members of the West Hollywood City Council and a representative of the Los Angeles County Sheriff's Department, both of whom expressed support for the resource center. "Our city is going to stand with our residents and this club," said councilmember John Duran, who also provides legal representation for the center. "These people will be forced once again into the streets to deal with drug dealers." "AIDS Cases Rise in China" Associated Press (10.28.01) China recorded 5,616 new cases of AIDS infection in the first nine months of this year, more than in all of last year, a state newspaper said Saturday. That raised the known number of people in China with HIV virus to 28,133, the China Youth Daily said. Last year, some 5,201 new cases were reported, the newspaper said. The report added to growing official candor about the AIDS epidemic in China, where experts believe that at least 600,000 people carry the HIV virus. Needle-sharing among intravenous drug users and the thriving sex trade were blamed for most new cases, the newspaper said. In another break from previous official reticence, the newspaper said 0.2 percent of new cases were traced to homosexual intercourse. Officials usually are reluctant to acknowledge homosexuality in Chinese society. As a result, health experts worry that many homosexuals lack the information needed to avoid being exposed through sex. "FDA Approved AIDS Drug" Associated Press (10.28.01) The U.S. Food and Drug Administration (FDA) on Friday approved Viread, a new once-daily pill to treat HIV. San Francisco AIDS specialist Dr. Stephan Becker, who treated more than two dozen patients with Viread in clinical trials prior to federal approval, said the drug reduced HIV levels without the side effects that are common with other drugs. "This is exactly what we had hoped for," said AIDS activist Martin Delaney. "This is going to be an important drug for AIDS treatment at every stage of the disease." The FDA approved Viread for all patients, including those being treated for the first time. Delaney and others had feared the drug would be limited to those patients resistant to other treatments. Gilead will begin shipping Viread to pharmacies this week. A year's supply will cost $4,135.