Subject: AIDS Treatment News #134 Date: Sep 06 1991 (797 lines) &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& J O H N J A M E S writes on A I D S &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Copyright 1991 by John S. James; permission granted for non-commercial use. AIDS TREATMENT NEWS Issue #134, September 6, 1991 CONTENTS: [items are separated by "*****" for this display] Nutrition and AIDS: Some Information Sources Zinc and B Vitamins in HIV: Overview and Interview AIDS Travel Ban: 100,000+ Letters Against Mail Count: HIV Travel/Immigration Ban Clarification: Hydrogen Peroxide ***** Nutrition and AIDS: Some Information Sources by John S. James Nutrition, the most malnourished branch of Western medicine, is one of the hardest to address. The field is vast and amorphous, filled with science and speculation, and with wildly conflicting voices. Viewed from a distance, it seems to offer a choice between an establishment which can be credible to the point of being useless, or, on the other hand, one's personal pick of poorly supported theories and fads. A closer look shows a core of agreement -- perhaps enough to allow the AIDS community to develop some common framework for discussing the details, and for organizing community action when necessary. It is widely agreed that malnutrition is a very serious problem in AIDS, part of a vicious circle in which HIV disease contributes to malnutrition, which in turn contributes to disease progression. There is considerable agreement on the list of specific nutrients for which AIDS-related deficiencies have been documented. And some areas of disagreement have a fairly clear spectrum of opinion; for example, conservative physicians may use food supplements only sparingly if at all, or only late in disease progression, while more aggressive approaches can include vitamin, mineral, and other food supplements, almost as soon as persons know they are HIV-positive. There is less consensus on using nutrients to treat particular disease conditions (other than deficiency of the nutrient). Examples of this approach include: lysine, an amino acid used as an "underground" herpes treatment; and garlic, used as an antimicrobial. We suspect that more could be done with nutrients as therapy. Food components are usually inexpensive and available, and often safer than manufactured chemicals, since they have been in the human body for millions of years. It may be especially important now for the AIDS community to explore this area, and develop consensus on what are and are not reasonable approaches, because of increasing efforts by Federal authorities and others to restrict access to amino acids and other nutrients now widely available in health-food stores. Food components could be engulfed by monopoly medicine, to return years later as pharmaceuticals, at ten to a hundred times the price. The AIDS community must decide if it is interested, and if so, make sure that any restrictions imposed are based on legitimate safety concerns, not on commercial interests or the will to power. This article provides an overview of some information sources which may be useful. We have not surveyed the field or made any effort to be complete. We expect and welcome suggestions and criticisms. "Mainstream" Views * Surviving with AIDS: A Comprehensive Program of Nutritional Co-Therapy, by C. Wayne Callaway, M. D. with Catherine Whitney, 1991, 192 pages, $14.95, Little, Brown and Company, Boston. This short book appears to be an excellent first source for information about nutrition. Dr. Callaway is an internist and endocrinologist in private practice in Washington, D. C., and former director of the Mayo Clinic Nutrition Clinic and the Center for Clinical Nutrition at George Washington University Medical Center; he has worked with people with AIDS, focusing on nutrition, in private practice and with the Whitman- Walker Clinic in Washington, D. C. Surviving with AIDS is easy to read, and yet should be useful to physicians as well as persons with AIDS. The following section from the introduction explains its purpose and philosophy: "Surviving with AIDS was born out of the expressed need of both the PWAs and their caretakers. The nutritional program outlined in this book will provide a critical missing link in current AIDS therapies. It is designed as a co-therapy; that is, its effectiveness is demonstrated only when it is used hand in hand with established medical treatments. "This co-therapy addresses the threefold dietary problem experienced by PWAs: insufficient intake, poor nutrient absorption, and abnormal nutrient metabolism -- and it does so in a highly personalized way... "The co-therapy outlined in this book is not a 'Band- Aid' solution. Its implications are far more significant. As time goes on, we are seeing more lasting results from nutritional approaches in the treatment of AIDS. There is good reason to believe that we may substantially prolong quality-filled life by developing more rational nutritional support. With this co-therapy, the verdict may be changed from 'fatal disease' to A major focus of the book is control of diarrhea, often with a low-fat diet, which may be designed for the patient by Dr. Callaway's nutritionist. Treatment may also include "a resin to bind to the bile salts in the intestine and prevent them from being acted upon by bacteria"; examples are the prescription drugs cholestyramine (Questran or Cholybar) or colestipol (Colestid), which are usually used for reducing cholesterol level. Dr. Callaway recommends discontinuing these drugs if there is no improvement within one week. This treatment is not in widespread use; it should be considered by other physicians. Dr. Callaway uses drugs like Lomotil and Imodium only on a very short-term basis. The book also suggests other nutritional approaches to diarrhea, including checking for lactose intolerance. Non- nutritional approaches, such as treatment of gastrointestinal infections, are mentioned, but the details are beyond the scope of this book. Many other nutritional therapies are discussed, including treatment of conditions which cause pain when eating or otherwise restrict food intake, and blood tests for specific nutrient deficiencies which can then be corrected. Lists and tables include causes of pain or difficulty in swallowing, gastrointestinal infectious organisms, immune effects of specific nutrient deficiencies, complications from tube feeding, drug-nutrient interactions, organizations to contact, and books and articles for further information. There are sections on nutritional self-assessment, and special diet instructions for reducing diarrhea, for mouth or esophagus problems, for nausea and food intolerance, for drug-induced nausea, and for loss of appetite. A short food-safety section covers food preparation, restaurants, and traveling. There are over 50 pages of food plans and recipes. One notable list is five nutritional therapies which Dr. Callaway considers "particularly harmful": macrobiotic diet, vitamin/mineral megadoses, yeast-free diets, the "immune power" diet, and the "maximum immunity" diet. The book also has a chapter on suggestions for future research, and a reprint of an article by Donald Kotler, M. D., and colleagues on wasting and AIDS. It includes an extensive index and glossary. Surviving with AIDS is so new that we have not yet seen how it will be evaluated by patients or professionals. It is now appearing in bookstores, but no one we talked to by press time had yet seen a copy. * Nutrition and HIV Infection, prepared by FASEB (Federation of American Societies for Experimental Biology) under contract for the Center for Food Safety and Applied Nutrition, U. S. Food and Drug Administration, November 1990. This report of over 100 pages consists largely of an extensive literature review of what is known about HIV and nutrition. It is available for $15 (check or money order to FASEB) from: FASEB, Special Publications, Room #2310, 9650 Rockville Pike, Bethesda, MD 20814. This report is not organized as a practical guide, and will be more useful to physicians and researchers than to most patients. But some "alternative treatment" activists see its publication as important, despite the report's establishment origin, because it brings together the existing scientific justification for various nutritional approaches, and makes the science more accessible than before. We consider the report important for the AIDS treatment community because it will contribute to building the common framework within which nutritional issues can be addressed -- an advance over the previous situation in which many different ideas floated around without talking much to each other, and people often chose nutritional theories according to personal taste and did their own thing independently. A common framework will contribute to research progress, and also to community defense against access restrictions when such defense is necessary. And the only solid authority for anchoring this common framework is the scientific literature. [And yet it is remarkable how little good science is available in many areas of interest in nutrition and HIV. It is not surprising, perhaps, that a research system which can barely manage competent trials of pharmaceutical products would have trouble with nutrition, which can be scientifically more difficult to study than drugs, while offering less commercial incentive. A cynic might say that animal nutrition (for agriculture) would never be neglected as badly as human nutrition often has been, because animals are profitable when they are healthy, while humans are profitable when they are ill.] After an overview of HIV infection and of nutrition, the report goes into extensive technical material on the effects of HIV infection on nutritional state. Topics covered in detail include weight loss, body composition, circulating proteins and lipids, deficiencies in vitamins and minerals, and several causes of malnutrition: reduced food intake, drug-nutrient interactions, malabsorption, and altered metabolism. The next chapter, on the effects of nutritional state on HIV infection, begins with a look at the "striking similarity" in immune deficiency between AIDS, and protein-energy malnutrition caused by inadequate diet. A table shows the immune-system effects of deficiencies of a number of individual nutrients. Clinical effects of malnutrition are then examined; some of the studies discussed documented clinical improvements following treatments to correct particular deficiencies. Nutritional intervention trials, described in a separate subchapter, gave specific nutrients orally or by injection, or by enteral feeding (usually by a tube to the stomach), or by parenteral feeding (usually intravenously). A chapter on nutrition practices in the HIV community cites research showing that nutrition support is often neglected in hospitals, despite the physicians' intellectual belief that nutrition was important. Ninety three percent of AIDS healthcare providers responding to one survey said nutrition support was important -- but only 44 percent of the hospitalized patients received it. Only 20 percent of the hospitals had a nutritional management protocol for AIDS. Another survey found little use of enteral or parenteral feeding in hospitals, even though patients' weight loss during stays in those hospitals averaged 16 percent. The same chapter also includes a long list of "unproven nutritional therapies and unconventional diets," usually but not always emphasizing possible toxicity or other problems. An extensive literature review on nutrition for infants and children with AIDS includes practical advice on food choice, food safety, and enteral and parenteral nutrition. The report includes a nine-page appendix, "Practical Considerations in Nutritional Management of HIV-Infected Patients." About 400 published articles are cited. "Alternative" Approaches: Using Nutritional Supplements The following papers propose treatments which diverge from the mainstream represented above, yet have some scientific support. They tell how to use nutritional supplements, often in large doses -- which many physicians would discourage. Our own view is that much is still unknown about nutrition and AIDS, and no one has final answers. Our guess is that some of the therapies proposed below will prove to be useful, most will be useless, and some may be harmful; many if not most of them may have quite different effects in different people. During the five years that we have reported on experimental AIDS/HIV treatments, our consistent impression has been that the best strategy, in the absence of definitive science, has been to try rational treatment options, keeping the ones which seem to work for oneself and discarding those which seem not to. The result may be an individual plan which would not work for people in general, but that is OK. It may also contain useless treatments which were accepted because of placebo effect, but that also is no disaster. Naturally it makes sense to choose safer, more conservative treatments when possible. Earlier in this article we mentioned the need for developing a community-wide framework or overview, based on the medical and scientific literature, to support rational discussion of nutritional therapy options. Such community dialog would help evaluate treatments such as those mentioned below, to decide what is sensible now in view of existing knowledge. The same dialog would help us advocate for the research needed to support better decisions in the future. The papers described below contain much specific treatment information, such as doses. We chose not to include these specifics here, but instead to give an overview of what each paper covers, and tell how you can get it for yourself. It is important to discuss any nutritional supplements you plan to use with your physician, because there could be drug interactions or other health reasons for you to avoid certain ones, or to take other precautions. * Therapeutic Basics for People Living with HIV Infection (7 pages) and Choosing Supplements -- Quality vs. Cost (1 page), both by Lark Lands, Ph.D. Therapeutic Basics is now being revised; we have not yet seen the new version, which should be available by the time you receive this newsletter. The new list of supplements might be different from the one below. Therapeutic Basics was designed by Dr. Lands to answer the questions people asked her in her role of nutritional consultant. It includes information on a long list of specific nutrients, all but the first in alphabetical order: Multiple vitamin and mineral supplement; vitamin A; acidophilus; ascorbate therapy (vitamin C); vitamin B-6; vitamin B-12 and folic acid; beta carotene or carotene complex; bioflavonoids; blue- green algae; calcium; choline; co-enzyme Q10; copper sebacate; DMG (n-n- dimethylglycine or B-15); vitamin E; essential fatty acids (EFA); glandulars; inositol; iron; magnesium; molybdenum; monolaurin; N-acetylcysteine (NAC); pantothenic acid; quercetin; selenium; and zinc. Each item has a short rationale, often only two or three sentences, along with a suggested dose. But there is not much information on how to go about deciding which supplements to use. We suggest getting advice from various sources, including one's physician, about these treatment possibilities. To obtain a copy of Therapeutic Basics and of Choosing Supplements, send a self-addressed stamped envelope to: Carl Vogel Foundation, 1413 K Street NW, 14th floor, Washington, DC 20005-3405, 202/289-4898. * Joan C. Priestley, M. D., in Los Angeles has developed a protocol of nutritional supplements: vitamin C; vitamin A (beta carotene); vitamin E; NAC; multi vitamin/mineral (Jarrow Pack); quercetin; evening primrose oil; garlic; SSKI (potassium iodide); and B-complex injections. She reported recently on 83 patients who had used this protocol for an average of 13 months. The results appear to be good, with an average decline of T-helper cells of 9.4 during that time, and average weight loss of less than one pound. Eight of the 83 patients have died; six of the eight begin the treatment with an AIDS-defining illness. Dr. Priestley does not recommend AZT, although some of her patients use it. Her advice differs from the mainstream in other ways also. We are not able to evaluate her program, and do not have recommendations for or against. We sought out Dr. Priestley because she has followed the research on HIV and nutrition, a subject most physicians have overlooked. To obtain a copy of Dr. Priestley's protocol on nutrient therapy, send a self-addressed stamped envelope to: Joan C. Priestley, M. D., 7080 Hollywood Boulevard, Suite 603, Los Angeles, CA 90028. * Donald E. Knapp, a long-term AIDS survivor in San Francisco, has published HIV -- Nutritional Support, a six-page writeup on the nutritional program he has developed for himself and recommends for others. He discusses how to pick a good vitamin and mineral supplement, on both a moderate and low budget. He also strongly recommends additional use of six nutrients: beta carotene; vitamin C; vitamin E; iron; lysine; and zinc. Total cost of the program is about $150 to $250 per year. For a copy of HIV -- Nutritional Support, send $3.00 ($2.00 if limited income) to: Don Knapp, 3677-A 19th Street, San Francisco, CA 94110. In San Francisco, the paper is also available at A Different Light Bookstore, and at Rainbow Grocery. Comment The varied and often contradictory nutrition advice from different specialists shows the confusion prevalent in nutrition today, and the limited areas of widespread confidence and agreement. There are many different schools of thought even within the community which accepts the published scientific literature as its best available authority. More dialog between the different viewpoints -- as well as attention from mainstream physicians, and increased scientific research -- will help reduce the confusion and improve the advice available. ***** Zinc and B Vitamins In HIV: Overview and Interview by Denny Smith A number of medical journal reports in recent years have dealt with recurring questions of nutritional excesses and deficiencies in HIV infection. In particular, zinc, cobalamin (vitamin B12), and folic acid (folate) deficiencies, and excessive levels of copper have been connected to AIDS. The May, 1991 edition of AIDS Targeted Information Newsletter (ATIN) included a good review of such studies, authored by Neil M. H. Graham, M. B. B. S., M. D., M. P. H., of the School of Hygiene and Public Health at The Johns Hopkins University. Dr. Graham raises the possibility of using abnormal fluctuations of micronutrients as markers for charting HIV progression. He also briefly addresses AIDS-associated weight loss or wasting syndrome, which, like the deficiencies mentioned above, may not necessarily be caused by malabsorption or diarrhea, and which may in turn increase susceptibility to new opportunistic infections. We spoke to Dr. Graham by telephone and asked if he could elaborate on a few points in his review. Some of the studies to which he referred could create some confusion, since their results were often inconclusive or even contradictory. * * * DS: If HIV infection is associated with decreased serum [blood] zinc levels, would you describe this as both a symptom and a blood marker? NG: It is understandable that zinc deficiency could be looked at as a possible cofactor, because there is no doubt that a severe zinc deficiency can adversely affect immune functions. But it is difficult to say whether this is a cause, or an effect, of HIV progression. Inflammatory and neoplastic [cancer] processes are already known to decrease serum zinc, and increase serum copper. When we compared baseline zinc levels in seronegative and seropositive patients, we found that zinc intake had no relationship to disease progression in the seropositives. But levels of zinc in the blood did relate to progression, even after adjusting for CD4 [T-helper cell] count. This would imply that falling zinc levels represent a marker and not a contributor in HIV progression. So loading up with supplemental zinc may not help. In fact, one test-tube study suggested that HIV may actually require zinc in order to replicate. DS: What would that mean in clinical care -- would giving zinc to patients not be useful, or actually feed HIV? NG: No one has done clinical trials to compare supplementation with no supplementation, so we can't say for certain one way or the other. In most people with HIV, zinc deficiency is not so serious that it would dramatically impair immune function, and thus warrant therapeutic supplementation. At this point we are simply likening it to a marker, such as neopterin or beta 2 microglobulin. DS: How much of this is also true for vitamin B12 deficiency? NG: That situation is a bit less equivocal. There are data showing that B12 injections may benefit some individuals with HIV-related neurological conditions, particularly neuropathies, dementia and demyelinating conditions. But none of the relevant studies have used very big numbers, or controlled trials. I think that trials of B12 supplementation are well worth pursuing. DS: Several of our readers have told us that their neuropathy was improved by B12 injections. One person said that B6 also had this effect. I was interested in the connection you made in your review between neopterin and the metabolism of B vitamins. NG: Yes. Two studies reported in The Lancet that folate metabolism seems to be altered by rising neopterin levels, particularly in children with HIV who have developed dementia. DS: For years we have been hearing about possible connections between HIV progression and increased serum neopterin, but HIV clinicians haven't seemed to put much stock in it. Ostensibly this provides a fresh reason to look into neopterin as a marker or cofactor. NG: I think that's right. It certainly needs further study. I think both neopterin and beta 2 microglobulin should be considered as potential markers for HIV progression, or for measuring a response to therapy, particularly for neurologists treating HIV. DS: What would you say is useful for clinicians to look for in terms of nutritional deficiencies in HIV infection? NG: I think I'd definitely look for B12 and folate. They both tend to drop relatively early on in HIV, they are deficiencies that are known to cause problems, and they are potentially reversible. Zinc could be useful as a marker for progression. Body mass and weight loss should definitely be monitored. From our studies in the Multicenter AIDS Cohort Study we have noted a mild weight loss well before the progression to AIDS, and if you're going to intervene nutritionally, maybe it's worth starting before the appearance of major symptoms. DS: What are your thoughts on the value of beta carotene in immune function? NG: Beta carotene and vitamin A are of a lot of interest generally in developing countries, for benefiting eye problems as well as acute respiratory infections and diarrheal infections. They play an important role in immune function, especially in regard to surfaces lined with epithelial cells, which of course include the sites of respiratory and diarrheal infections. Vitamin A pretty clearly reduces morbidity and perhaps even mortality in children who suffer from deficiencies. DS: Is there a caution against people taking too much vitamin A, especially people who are having drug-induced liver problems, or histories of hepatitis? NG: Oh yes, that could be very dangerous. Nutrition as a discipline has gotten a bad name, because to some people it means doing what their mother told them to do, or what the local health food store is promoting. DS: Unfortunately, it's true. At least one vitamin store in San Francisco sells nutritional "consultations," during which some people have been told that they cannot be healthy as long as they take AZT. NG: That's very dangerous, and it happens a lot, not just to people with HIV, but everyone with chronic diseases -- cancer, asthma, etc. Nutrition is very hard to study scientifically, but we should be doing it. As more and more opportunistic infections come under control, nutritional changes and weight loss will become increasingly apparent, and we'll have to deal with it in a reasonable manner. DS: The increasing focus on nutrition is exciting, because it implies that people will be around long enough for it to matter. NG: That's a good point. Slowly but surely we're getting on to the next stage, treating AIDS as a chronic disease. ***** AIDS Travel Ban: 100,000+ Letters Opposed -- Interview with Ken McPherson, Mobilization Against AIDS by John S. James Last June 7 AIDS TREATMENT NEWS joined dozens of organizations urging people to write to the U. S. Centers for Disease Control (CDC) to oppose the travel and immigration ban prohibiting foreigners with HIV from entering the U. S., during the CDC's public-comment period which ended August 2. While the AIDS community could not save the Seventh International Conference on AIDS in Boston, which is now seeking another site because U. S. policies would impede attendance by HIV-positive delegates, the campaign was strikingly successful in generating letters and postcards to the CDC. Over 100,000 letters and postcards received by the CDC opposed having HIV on the list (of conditions excluding persons from entry into the United States), while fewer than 15,000 wanted HIV on the list (see "Mail Count," below). This outpouring of mail is especially notable since this is the first such campaign for the AIDS movement. Such grassroots political work, sadly underemphasized in AIDS until now, will be vitally important in the future. (A new postcard campaign supporting medically sound infection-control procedures instead of mandatory testing of healthcare workers is described below.) One organization, the San Francisco-based Mobilization Against AIDS (Mobilization), delivered 40,000 postcards opposing the travel/immigration ban. We interviewed Ken McPherson, special projects coordinator for Mobilization, who ran the postcard project and is now beginning the new campaign on healthcare workers. "Much of the success of this campaign was from its linkage with AB101 (a gay rights bill in California for equal employment and public accommodation). There was no additional cost to print the AB101 cards, since the postcards were printed as a set. Mobilization raised $10,000 from other AIDS organizations to cover costs, and the AB101 staff coordinated the volunteers. They trained them and did the phone banking. The combination of Gay Pride day, Pink Saturday (a street celebration in San Francisco's Castro district), and Mobilization's street table on weekends, brought us the 40,000 cards. The linkage worked because we both were doing a postcard campaign. "We photocopied all the postcards, so in the future, we can approach these people again. That's one of the reasons for doing a postcard campaign, to find your constituents. We will not need to re-invent the wheel each time; we are building a machine, an army, to take care of future AIDS needs. "We found it harder to get people to respond to AIDS; lesbian and gay issues are easier to sell on the street. One generation has been to so many funerals that there is a numbing effect. And that same generation is thinking, 'AIDS will go on for many years of my life; am I going to focus only on it, or on other things also? ' Meanwhile, the new generation has not been to the funerals yet. And since adolescence, they have grown up with AIDS, so the shock effect is gone. "Much of the press, when the Bush Administration gave its "No" on travel and immigration, only reported the 30,000 to 40,000 letters and postcards in the earlier comment period against the travel/immigration reform [proposed by the U. S. Department of Health and Human Services and effectively vetoed by the Justice Department and the White House -- ed.], without mentioning the 100,000 letters and postcards on our side in the comment period which ended August 2. That says we need to do a better job of public relations. The reason the PR didn't occur after the postcards were sent is that this whole campaign was done for $10,000, with two staff people working on it and the rest volunteer. You cannot do all that is necessary to nurture the media with such little funding and such a small staff. "Our community has never pushed letterwriting, at least on this coast. Yet it does a great deal of good. We need to start letting politicians know that not just once but every time they screw us over, they're going to hear from us. And not just from street demonstrations. ACT UP is an important component, and the AIDS service organizations are important components. But we cannot ignore the power of the constituency base (of voters writing to their political representatives), and that's something we are not yet up to speed on. The Senator Seymour Healthcare-Worker Campaign "Mobilization is now launching a new postcard campaign on amendments by Senator Jesse Helms, now going through Congress, which will in effect require mandatory HIV testing of healthcare workers and patients if they become law. These amendments are opposed by the American Medical Association, the American Dental Association, and the U. S. Centers for Disease Control. California Senator John Seymour twice supported Jesse Helms on these amendments. He will be voting on this issue again, so we want him to hear from the AIDS community. "The right way to address this issue is through enforcement of the OSHA (U. S. Occupational Safety and Health Administration) standard for universal precautions to prevent transmission of all bloodborne diseases. 'Universal precautions' means that all patients are treated as though they are potentially infectious. The OSHA standard will cover 4.5 million healthcare workers, and OSHA has teeth; for example, it can impose fines of $7,000 a day for violation, and it can enforce its standard in doctors' and dentists' offices as well as in hospitals. Legislation is being developed to expand OSHA's authority to impose criminal penalties for willful violations. "These precautions, including proper sterilization of equipment, repair of defective equipment, and proper gloves and gowns, have been in use at leading institutions since 1987; the problem is they have not always been applied. OSHA issued a proposed rule in May 1989; over two years later it has still not been made final. It should be applied and enforced immediately. Universal precautions are far more effective than mandatory HIV testing to protect both doctors and patients, because they prevent transmission of all bloodborne diseases, not only HIV, and they prevent patient-to-patient transmission [a far greater risk than doctor-to-patient transmission, as it's usually the patient's blood, not the doctor's blood, that gets on the instruments -- ed.]. Also, HIV tests are falsely negative for weeks or months after infection, so mandatory testing gives false assurance of safety. We want the public and the politicians to understand that there is a right way to prevent infection -- the universal precautions which need to be applied and enforced in all health-care settings." Ken explained that there were three ways to work with Mobilization Against AIDS: * Anyone can join by contributing $30 per year or more. * You can join Mobilization's "Lobby Team." You will be called several times a year to write letters to your representatives, and will receive an extensive information packet on each issue. Mobilization asks those who can afford it to contribute $10 a year to pay for the materials. You do not need to be a member of Mobilization to join the Lobby Team. Ken noted that "The lobby team is still the most effective means of changing peoples' minds. A handwritten letter is the most powerful tool for a Senator or Congressperson to receive in their mailbox. But if we can't get enough letters, then postcards are fine." * Anyone can request printed postcards from Mobilization, to circulate and return for the Senator Seymour campaign described above. There is no charge for the postcards. "We also want to contact agencies and others who can contribute financially. The whole budget for the Seymour campaign is $3400. If we could increase that to $10,000, then we could print banners and start advertising in the gay papers, to turn out tens of thousands instead of hundreds of cards. And advertising is what begins teaching the community that constituent pressure on political representatives is something we must make part of our lives. We must all become regular letter and card writers. We must consider this as normal and natural as the right-wing fundamentalists do." To contact Mobilization Against AIDS, call 415/863-4676, or write to 1540 Market Street, #160, San Francisco, CA 94102. Contributions are not tax deductible, because the organization is political. Comment The fact that the Bush Administration ignored over 100,000 pieces of mail (as well as the virtually unanimous consensus of the medical community) on the HIV travel/immigration issue, favoring instead a political hobbyhorse of right-wing bigots, does not mean that letterwriting does not work. No political means will work every time. We believe that there are four essential components of AIDS political action: * Consensus-building among AIDS organizations and the medical community; * Street demonstrations and other media work, e.g. by ACT UP; * Letterwriting and other forms of communication to politicians from the voters; and * Building coalitions, especially with groups working on other diseases. The first two have long been done well by the AIDS community. On the last two, we have only begun. All of us should support the activists who work year after year to defend our community, and defend medically rational AIDS policies developed by health experts. Without their continuing work, none of us is safe. ***** Mail Count: HIV Travel/Immigration Ban The following information was provided by the Division of Quarantine, U. S Centers for Disease control, Atlanta, Georgia. These counts are for the 60-day public comment period which ended August 2, 1991. Letters and postcards are counted together. Total letters received: 118,468. Of these, 117,902 were from individuals, 488 from U. S. organizations, and 78 from international organizations. Of the 117,902 from individuals, 103,573 (representing 108,065 signatures) were from persons opposed to having HIV on the list to exclude persons from the United States. On the other side, 14,329 letters (representing 17,833 signatures) wanted HIV on the list. Of the 488 U. S. organizations, 472 disagreed with having HIV on the list; 16 wanted HIV on the list. Of the 78 international organizations, all 78 disagreed with having HIV on the list. Percentages: 87.8 percent of the letters from individuals (85.8 percent of individual signers) opposed having HIV on the list of excludable conditions. Of the U. S. organizations, over 97 percent were opposed. Of the international organizations, 100 percent were opposed. ***** Clarification: Hydrogen Peroxide Two readers have called AIDS TREATMENT NEWS about our note on hydrogen peroxide ("Warning: Hydrogen Peroxide Might Stimulate HIV Growth," issue #132, August 9, 1991). * One scientist was concerned that our note might be misunderstood by laboratory personnel, who often use hydrogen peroxide to clean up laboratory spills of fluids containing HIV. Hydrogen peroxide is well- accepted for this use (inactivating the free virus on a surface). Our warning only applied to drinking dilute hydrogen peroxide, or bathing in it, as an HIV treatment. We referred to preliminary findings that hydrogen peroxide, in lower concentrations inside cells, could stimulate HIV growth. One historical note is that public-health experts considered hydrogen peroxide as an alternative to bleach for cleaning injection-drug needles (when the alternative was that contaminated needles would be re-used with no cleaning at all). Apparently both substances are about equally effective in killing the virus on surfaces. Bleach (aqueous sodium hypochlorite) was chosen because hydrogen peroxide can easily deteriorate if stored improperly, and users would not know that it had lost its potency. * Another reader was unable to find substantiation for our concern that hydrogen peroxide can act biochemically within infected cells to increase HIV growth. One recently-published article, which we did not have when we went to press, is "Reactive Oxygen Intermediates as Apparently Widely Used Messengers in the Activation of the NF-Kappa-B Transcription Factor and HIV-1," by Ralf Schreck and others, EMBO JOURNAL pages 2247-2258, August 1991. [Obsolete subscription information has been removed. See the latest issues for up-to-date information. -- sysop] &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& End of display