Archive-Name: aids-faq1 Last-Modified: 10 Nov 1993 Welcome to the sci.med.aids, the international newsgroup on the Acquired Immune Deficiency Syndrome (see Q1.1 `What is sci.med.aids?' for more details). This article, called the sci.med.aids "FAQ", answers frequently asked questions about AIDS and the sci.med.aids newsgroup. The FAQ is posted monthly to sci.med.aids and related newsgroups. If you are new to sci.med.aids, please read it before posting articles or responses. If you are a sci.med.aids veteran, please skim the FAQ occasionally. You may find something new here. Please contribute to the sci.med.aids FAQ. Currently there are some gaping holes. Send suggested changes to aids-request@cs.ucla.edu. You don't have to format it: just send it. You can skip to a particular question by searching for `Question n.n'. See Q9.2 `Formats in which this FAQ is available' for details of where to get the PostScript and Emacs Info versions of this document. =============================================================================== Contents Section 1. Introduction and General Information Q1.1 What is sci.med.aids? Q1.2 Discussion topics. Q1.3 Sci.med.aids distribution. Q1.4 Subscribing and unsubscribe to sci.med.aids. Q1.5 What is a moderated newsgroup? Q1.6 Editorial guidelines. Q1.7 How do I submit a posting? Q1.8 The moderators. Q1.9 Cooperative moderation. Q1.10 Discussing sci.med.aids moderation policies. Section 2. How to prevent infection. Q2.1 How is AIDS transmitted? Q2.2 How effective are condoms? Q2.3 How do you minimize your odds of getting infected? Q2.4 How risky is a blood transfusion? Q2.5 Can mosquitoes transmit AIDS? Q2.6 What about other insect bites? Q2.7 Is there even a remote chance of insect transmission? Section 3. Confidentiality. Q3.1 How is blood tested in the United States? Q3.2 What if a blood-bank finds out you are HIV positive? Section 4. Treatment options. Q4.1 General treatment information. Q4.2 AIDS and Opportunistic Infections. Q4.3 Guide to Social Security Benefits. Q4.4 What if you can't afford AZT? Q4.5 What about DNCB? (please contribute) Section 5. The common debates. Q5.1 What are Strecker and Segal's theories that HIV is manmade? Q5.2 Other conspiracy theories. Q5.3 Duesberg's Risk-Group Theory Q5.4 Contaminated polio vaccine? (please contribute) Q5.5 Who is Lorraine Day? (please contribute) Section 6. Internet resources. Q6.1 Ben Gardiner's Gopher AIDS Database Q6.2 CDC AIDS Public Information Dataset. Q6.3 HIVNET/AEGIS Gateway (BETA VERSION) Q6.4 Other USENET newsgroups. Section 7. Other Electronic Information Sources. Q7.1 Ben Gardiner's list of AIDS BBSes. Q7.2 National AIDS Clearinghouse Guide to AIDS BBSes. Q7.3 National Library of Medicine AIDSLINE (please contribute) Q7.4 Commercial Bulletin Boards Q7.5 Reappraisal of the HIV-AIDS Hypothesis. Q7.6 Lesbian/Gay Scholars Directory. Section 8. Non-Electronic Information Sources. Q8.1 Phone Information about AIDS. Q8.2 Phone Information about AIDS drug trials. Q8.3 US Social Security: Information for Organizations Section 9. Administrative information and acknowledgements Q9.1 Feedback is invited Q9.2 Formats in which this FAQ is available Q9.3 Authorship and acknowledgements =============================================================================== Section 1. Introduction and General Information Q1.1 What is sci.med.aids? Q1.2 Discussion topics. Q1.3 Sci.med.aids distribution. Q1.4 Subscribing and unsubscribe to sci.med.aids. Q1.5 What is a moderated newsgroup? Q1.6 Editorial guidelines. Q1.7 How do I submit a posting? Q1.8 The moderators. Q1.9 Cooperative moderation. Q1.10 Discussing sci.med.aids moderation policies. ------------------------------------------------------------------------------- Question 1.1. What is sci.med.aids? "sci.med.aids" is a USENET newsgroup which discusses AIDS and HIV. A gateway forwards articles posted to sci.med.aids to a BITNET listserv mailing list called AIDS. Thousands read sci.med.aids, including people with HIV infections, published authors, researchers, public health officials, and interested individuals. It is carried in several countries, particularly in the Americas and Europe. Sci.med.aids is moderated by a team. When you submit an article to sci.med.aids, it must be approved by a member of the moderation team. ------------------------------------------------------------------------------- Question 1.2. Discussion topics. Sci.med.aids covers topics of interest to people with AIDS (Acquired Immune Deficiency Syndrome), their friends, relatives, and loved ones, AIDS service providers, educators and researchers, and the general public. Some common topics are Causes of AIDS and opportunistic infections. Vaccines for AIDS. Treatments or cures for AIDS and opportunistic infections. AIDS prevention and education. Sci.med.aids carries some regular magazines. Here's a current list: CDC AIDS Daily Summary AIDS Treatment News The Veterans Administration AIDS Info Newsletter If you have the time to add to this list, we invite you to contribute (if you obtain copyright permission, of course). ------------------------------------------------------------------------------- Question 1.3. Sci.med.aids distribution. Sci.med.aids is distributed as a USENET newsgroup, where it has approximately 40,000 readers. At one time USENET was carried primarily at research and educational institutions, but that is changing; a number of commercial services now carry USENET. Here is a breakdown of comparable newsgroups, for the month of September 1993. You can obtain a full list of network traffic by anonymous ftp from ftp.uu.net:/usenet/news.lists/USENET_Readership_report_for_Sep_93.Z +-- Estimated total number of people who read the group, worldwide. | +-- Actual number of readers in sampled population | | +-- Propagation: how many sites receive this group at all | | | +-- Recent traffic (messages per month) | | | | +-- Recent traffic (kilobytes per month) | | | | | +-- Crossposting percentage | | | | | | +-- Cost ratio: $US/month/rdr | | | | | | | +-- Share: % of newsrders | | | | | | | | who read this group. V V V V V V V V 39 110000 1700 76% 3845 6418.0 6% 0.07 3.6% soc.motss 77 96000 1420 67% 1885 3541.1 11% 0.04 3.0% alt.drugs 131 81000 1203 80% 1571 4064.6 13% 0.06 2.6% sci.med 231 65000 961 61% 1269 2863.5 6% 0.04 2.0% alt.politics.homosexuality 558 44000 647 66% 282 760.5 38% 0.02 1.4% talk.politics.drugs --------------------------------------------------------- 605 41000 615 78% 383 1556.0 2% 0.05 1.3% sci.med.aids --------------------------------------------------------- 724 37000 545 68% 512 1053.6 12% 0.03 1.2% sci.med.nutrition 729 37000 542 77% 53 96.0 12% 0.00 1.2% sci.med.physics 880 32000 481 43% 436 1033.5 8% 0.02 1.0% alt.homosexual 1202 25000 370 41% 326 529.6 9% 0.01 0.8% alt.drugs.caffeine 1320 22000 332 21% 27 62.4 4% 0.00 0.7% alt.sex.homosexual 1343 22000 326 66% 48 89.1 7% 0.00 0.7% sci.med.occupational 1398 21000 314 35% 182 2557.2 0% 0.07 0.7% bit.listserv.gaynet 1412 21000 310 56% 145 510.1 0% 0.02 0.7% sci.med.telemedicine 1425 21000 307 59% 97 353.2 0% 0.02 0.7% sci.med.dentistry 1559 19000 276 48% 99 138.4 8% 0.01 0.6% sci.med.pharmacy 1685 17000 254 42% 235 378.1 0% 0.02 0.5% alt.med.cfs 1888 14000 213 13% 12 29.3 100% 0.00 0.5% clari.news.law.drugs 1916 14000 207 38% 5 19.7 20% 0.00 0.4% bionet.molbio.hiv 2449 3500 52 11% 55 97.5 6% 0.01 0.1% de.sci.medizin Sci.med.aids is also distributed as electronic mail by the AIDS listserv. Mail is not as convenient a way to read sci.med.aids as is a newgroup, but mail is available at more sites (including Compuserve, America Online, MCImail, ATTmail and many institutions which have Internet gateways). In additional to these primary distributions, sci.med.aids is redistributed by various bulletin boards and mail gateways. ------------------------------------------------------------------------------- Question 1.4. Subscribing and unsubscribe to sci.med.aids. The answer to this question depends on your system. You may have to ask your local system administrator. Here are some guidelines valid on many systems: * You may have USENET on your system, especially if you run UNIX or VMS. Here are some commands to try: "rn", "trn", "xrn", "nn", "tin". If they work, try joining the newsgroup "sci.med.aids". That might not work, since some sites limit the newsgroups they receive. All is not lost: you can get sci.med.aids by e-mail. * If USENET is not available you can get sci.med.aids by e-mail. Send a mail message to listserv@rutvm1.rutgers.edu. The message body should contain just the following command: subscribe aids Type in your real name (not your e-mail address) instead of . A complete message might look like this: To: listserv@rutvm1.rutgers.edu Subject: subscribe aids Joe Smith To unsubscribe, send a message to listserv@rutvm1.rutgers.edu containing the text unsubscribe aids Please unsubscribe before your account expires. The moderators get all sorts of junk mail if you don't. ------------------------------------------------------------------------------- Question 1.5. What is a moderated newsgroup? A moderated newsgroup is one in which all postings must be approved by a moderator before being distributed. The purpose of moderation is to restrict what can appear. Postings which do not adhere to the guidelines for the group will be rejected. ------------------------------------------------------------------------------- Question 1.6. Editorial guidelines. As with any newsgroup, read sci.med.aids for a few days before posting, to see if your question has been answered already, and to get a feel for the tone of the group. Postings to sci.med.aids should: * Write on topics directly relevant to AIDS, HIV, or related topics. * Unconventional medical/research claims must be accompanied by references to the popular press (i.e., major newspaper, magazine, etc.) or scientific press (i.e., Science, Nature, Lancet, Scientific American, Cell, Brain Research, etc.). We require references for unconventional medical/research claims, because some therapies carry with them potential danger. Some unconventional medical/research claims are fallacious. Without this policy, sci.med.aids would have printed several dangerous and undocumented therapies by now. * Political, sociological opinion/analysis articles are acceptable. The interpretation, and even the existence, of this particular policy continues to be the subject of internal debate among the moderators. However, in the past we have printed articles holding both popular and unpopular opinions on topics like "Quarantining HIV Positives" or "who did Clinton appoint to the AIDS Task Force." * Refrain from personally attacking other participants. For example, do not call someone an 'idiot' or say they are 'biased'. Instead, point out the flaws in their argument. If you find yourself getting angry at a poster, and construct a reply, please try to remember this rule. It is often useful to wait a day to see what other reactions have been posted before sending something off in anger. * Send one line "quips" as personal mail to the original submitter, rather than posting. * When posing a question to a previous poster, reconsider whether the question needs to be posted. Perhaps you could ask the question by e-mail and request a posted response. * Do not invoke religion. * Do not break copyright laws. Reprints of articles from other sources must include a statement of permission to reprint. An exception is made for abstracts of articles from scientific journals, which are not usually restricted. If you can't get reprint permission, excerpt or summarize the article. * Do not construct an article with more than 20% text from a previous article, unless it is very old (i.e., months old). The best approach when constructing a response is to tersely summarize the article to which you respond, in square brackets. For example, In article <11233@sci.med.aids>, Dan Greening wrote: > [reasons to not include too much of a prior article] Also, don't forget that many people get this stuff by mail, so huge inclusions clog hundreds of mailboxes, including mine. Thanks. * Do not duplicate something which has recently appeared. The moderators don't always agree on what's acceptable and what's not. If an article is rejected, you should receive a note from the moderator saying why. These notes, and other discussions about the running of sci.med.aids will be distributed on the aids-d mailing list (see Q1.10 `Discussing sci.med.aids moderation policies.'). ------------------------------------------------------------------------------- Question 1.7. How do I submit a posting? This depends on the software you are using. On many USENET systems, you can use the command postnews You can also post by sending your article as e-mail to aids@cs.ucla.edu. Because sci.med.aids is moderated, your submission will not appear immediately. Sometimes the delay is very short; often it may be 24 hours. It depends on network delays and how busy the moderators are. A tickler program reminds us of postings older than 48 hours. IMPORTANT: Whether you use postnews or e-mail, please format your article exactly the way you want it to appear in the newsgroup. Because our moderation software is somewhat unpolished, editing out notes to the moderators in a posting is quite tedious. If you must communicate directly with the moderators, send a note to aids-request@cs.ucla.edu. ------------------------------------------------------------------------------- Question 1.8. The moderators. Three people currently moderate sci.med.aids. They are Phil Miller Professor, Biostatistics, Washington University Jack Hamilton Interested layperson Dan Greening Founder sci.med.aids, Director AppWare C++, Novell Michelle Murrain Health issues researcher, Professor, Hampshire College Phil and Jack do most of the moderation. Dan repairs the moderation software. Phil is probably the most liberal moderator, Dan the most restrictive, Jack in-between. Michelle is new, so it's too early to tell. Various individuals have been moderators in the past, including David Dodell Founder, Grand Rounds fidonet echo, Dentist Steve Dyer Writer, Gay Community News, Software Consultant Alan Wexelblat Freelance writer, ethicist Tom Lincoln Informatics Director, USC Medical Center Craig Werner MD/PhD Student, Albert Einstein School of Medicine Will Doherty Gay Activist, technical writer Sun Microsystems ------------------------------------------------------------------------------- Question 1.9. Cooperative moderation. Cooperative moderation seeks to limit the burn-out associated with newsgroup moderation, by sharing the workload among several moderators. In addition, it provides a more balanced treatment of contentious issues. An early paper on the sci.med.aids cooperative moderation scheme is D.R. Greening and A.D. Wexelblat, Experiences with Cooperative Moderation of a USENET Newsgroup, Proceedings of the 1989 ACM/IEEE Workshop on Applied Computing. available by FTP from cs.ucla.edu:pub/aids.paper.ps.Z This paper is also available from the UCLA Computer Science Department as a technical report. ------------------------------------------------------------------------------- Question 1.10. Discussing sci.med.aids moderation policies. A separate mailing list, aids-d, has been set up for the moderators and for people who interested in how sci.med.aids is run. Most readers will not be interested in aids-d; its purpose is internal discussion rather than information dissemination, and most articles on aids-d are examples of what moderation has filtered out. If you want to subscribe, send email to aids-d-request@sti.com. =============================================================================== Section 2. How to prevent infection. Q2.1 How is AIDS transmitted? Q2.2 How effective are condoms? Q2.3 How do you minimize your odds of getting infected? Q2.4 How risky is a blood transfusion? Q2.5 Can mosquitoes transmit AIDS? Q2.6 What about other insect bites? Q2.7 Is there even a remote chance of insect transmission? ------------------------------------------------------------------------------- Question 2.1. How is AIDS transmitted? The Human Immunodeficiency Virus and Its Transmission CDC National AIDS Clearinghouse Research has revealed a great deal of valuable medical, scientific, and public health information about the human immunodeficiency virus (HIV) and acquired immmunodeficiency syndrome (AIDS). The ways in which HIV can be transmitted have been clearly identified. Unfortunately, some widely dispersed information does not reflect the conclusions of scientific findings. The Centers for Disease Control and Prevention (CDC) provides the following information to help correct a few commonly held misperceptions about HIV. Transmission HIV is spread by sexual contact with an infected person, by needle-sharing among injecting drug users, or, less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth, or through breast-feeding after birth. In the health-care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into the worker's bloodstream through an open cut or splashes into a mucous membrane (e.g., eyes or inside of the nose). There has been only one demonstrated instance of patients being infected by a health-care worker; this involved HIV transmission from an infected dentist to five patients. Investigations have been completed involving more than 15,000 patients of 32 HIV-infected doctors and dentists, and no other cases of this type of transmission have been identified. Some people fear that HIV might be transmitted in other ways; however, no scientific evidence to support any of these fears has been found. If HIV were being transmitted through other routes (for example, through air or insects), the pattern of reported AIDS cases would be much different from what has been observed, and cases would be occurring much more frequently in persons who report no identified risk for infection. All reported cases suggesting new or potentially unknown routes of transmission are promptly and thoroughly investigated by state and local health departments with the assistance, guidance, and laboratory support from CDC; no additional routes of transmission have been recorded, despite a national sentinel system designed to detect just such an occurrence. The following paragraphs specifically address some of the more common misperceptions about HIV transmission. HIV in the Environment Scientists and medical authorities agree that HIV does not survive well in the environment, making the possibility of environmental transmission remote. HIV is found in varying concentrations or amounts in blood, semen, vaginal fluid, breast milk, saliva, and tears. (See below, Saliva, Tears, and Sweat.) In order to obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Although these unnatural concentrations of HIV can be kept alive under precisely controlled and limited laboratory conditions, CDC studies have showned that drying of even these high concentrations of HIV reduces the number of infectious viruses by 90 to 99 percent within several hours. Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, drying of HIV- infected human blood or other body fluids reduces the theoretical risk of environmental transmission to that which has been observed- -essentially zero. Incorrect interpretation of conclusions drawn from laboratory studies have alarmed people unnecessarily. Results from laboratory studies should not be used to determine specific personal risk of infection because 1) the amount of virus studied is not found in human specimens or anyplace else in nature, and 2) no one has been identified with HIV due to contact with an environmental surface; Additionally, since HIV is unable to reproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions), except under laboratory conditions, it does not spread or maintain infectiousness outside its host. Households, Offices, and Workplaces Studies of thousands of households where families have lived with and cared for AIDS patients have found no instances of nonsexual transmission, despite the sharing of kitchen, laundry, and bathroom facilities, meals, eating utensils, and drinking cups and glasses. If HIV is not transmitted in these settings, where repeated and prolonged contact occurs, transmission is even less likely in other settings, such as schools and offices. Similarly, there is no known risk of HIV transmission to co- workers, clients, or consumers from contact in industries such as food service establishments (see information on survival of HIV in the environment). Food service workers known to be infected with HIV need not be restricted from work unless they have other infections or illinesses (such as diarrhea or hepatitis A) for which any food service worker, regardless of HIV infection status, should be restricted; The Public Health Service recommends that all food service workers follow recommended standards and practices of good personal hygiene and food sanitation. Kissing Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Because of the theoretical potential for contact with blood during "French" or open-mouthed kissing, CDC recommends against engaging in this activity with an infected person. However, no case of AIDS reported to CDC can be attributed to transmission through any kind of kissing. Saliva, Tears, and Sweat HIV has been found in saliva and tears in only minute quantities from some AIDS patients. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV. Insects From the onset of the HIV epidemic, there has been concern about transmission of the virus by biting and blood-sucking insects. However, studies conducted by researchers at CDC and elsewhere have shown no evidence of HIV transmission through insects--even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. Lack of such outbreaks, despite intense efforts to detect them, supports the conclusion that HIV is not transmitted by insects. The results of experiments and observations of insect biting behavior indiciate that when an insect bites a person, it does not inject its own or a previous victim's blood into the new victim. Rather, it injects saliva. Such diseases as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and, therefore, cannot survive) in insects. Thus, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on or bites. There is also no reason to fear that a biting or blood-sucking insect, such as a mosquito, could transmit HIV from one person to another through HIV-infected blood left on its mouth parts. Two factors combine to make infection by this route extremely unlikely-- first, infected people do not have constant, high levels of HIV in their bloodstreams and, second, insect mouth parts do not retain large amounts of blood on their surfaces. Further, scientists who study insects have determined that biting insects normally do not travel from one person to the next immediately after ingesting blood. Effectiveness of Condoms The proper and consistent use of latex condoms when engaging in sexual intercourse--vaginal, anal, or oral--can greatly reduce a person's risk of acquiring or transmitting sexually transmitted diseases, including HIV infection. Under laboratory conditions, viruses occasionally have been shown to pass through natural membrane ("skin" or lambskin) condoms, which contain natural pores and are therefore not recommended for disease prevention. On the other hand, laboratory studies have consistently demonstrated that latex condoms provide a highly effective mechanical barrier to HIV. In order for condoms to provide maximum protection, they must be used consistently (every time) and correctly. Incorrect use contributes to the possibility that the condom could leak or break. Proper use should include the following: * Put on the condom as soon as erection occurs and before any sexual contact (vaginal, anal, or oral). * Leave space at the tip of the condom. * Use only water-based lubricants. (Oil-based lubricants can weaken the condom.) * Hold the condom firmly to keep it from slipping off and withdraw from the partner immediately after ejaculation. When condoms are used reliably, they have been shown to prevent pregnancy up to 98 percent of the time among couples using them as their only method of contraception. Similarly, numerous studies among sexually active people have demonstrated that a properly used latex condom provides a high degree of protection against a variety of sexually transmitted diseases, including HIV infection. Condoms are classified as medical devices and are regulated by the Food and Drug Administration. Each latex condom manufactured in the United States is tested for defects, including holes, before it is packaged, and several studies clearly show that condom breakage rates in this country are less than 2 percent. Even when condoms do break, one study showed that more than half of such breaks occurred prior to ejaculation. Latex condoms can provide up to 98-99 percent protection against pregnancy and most sexually transmitted diseases, including HIV infection, but only if they are used consistently and correctly. For more detailed information about condoms, see CDC's fact sheet, "The Role of Condoms in Preventing HIV Infection and Other Sexually Transmitted Diseases." The Public Health Service Response The U.S. Public Health Service is committed to providing the scientific community and the public with accurate and objective information about HIV infection and AIDS. It is vital that clear information on HIV infection and AIDS be readily available to help prevent further transmission of the virus and to allay fears and prejudices caused by misinformation. In addition to research on the virus and its transmission, the PHS program to prevent the spread of HIV/AIDS includes counseling, testing, and education. Through these programs, individuals who have engaged in high-risk behaviors can receive voluntary HIV-antibody testing for themselves and their partners, and those found to be infected can be counseled regarding preventive services and treatment options, as well as how to prevent transmission to others. For more information: CDC National AIDS Hotline: 1-800-342-AIDS Spanish: 1-800-344-7432 Deaf: 1-800-243-7889 CDC National AIDS Clearinghouse P.O. Box 6003 Rockville, MD 20849-6003 ------------------------------------------------------------------------------- Question 2.2. How effective are condoms? Update: Barrier Protection against Sexual Diseases CDC National AIDS Clearinghouse Although refraining from intercourse with infected partners remains the most effective strategy for preventing human immunodeficiency virus (HIV) infection and other sexually transmitted diseases (STDs), the Public Health Service also has recommended condom use as part of its strategy. Since CDC summarized the effectiveness of condom use in preventing HIV infection and other STDs in 1988 (1), additional information has become available, and the Food and Drug Administration has approved a polyurethane "female condom." This report updates laboratory and epidemiologic information regarding the effectiveness of condoms in preventing HIV infection and other STDs and the role of spermicides used adjunctively with condoms. * Two reviews summarizing the use of latex condoms among serodiscordant heterosexual couples (i.e., in which one partner is HIV positive and the other HIV negative) indicated that using latex condoms substantially reduces the risk for HIV transmission (2,3). In addition, two subsequent studies of serodiscordant couples confirmed this finding and emphasized the importance of consistent (i.e., use of a condom with each act of intercourse) and correct condom use (4,5). In one study of serodiscordant couples, none of 123 partners who used condoms consistently seroconverted; in comparison, 12 (10%) of 122 seronegative partners who used condoms inconsistently became infected (4). In another study of serodiscordant couples (with seronegative female partners of HIV-infected men), three (2%) of 171 consistent condom users seroconverted, compared with eight (15%) of 55 inconsistent condom users. When person-years at risk were considered, the rate for HIV transmission among couples reporting consistent condom use was 1.1 per 100 person-years of observation, compared with 9.7 among inconsistent users (5). Condom use reduces the risk for gonorrhea, herpes simplex virus (HSV) infection, genital ulcers, and pelvic inflammatory disease (2). In addition, intact latex condoms provide a continuous mechanical barrier to HIV, HSV, hepatitis B virus (HBV), Chlamydia trachomatis, and Neisseria gonorrhoeae (2). A recent laboratory study (6) indicated that latex condoms are an effective mechanical barrier to fluid containing HIV-sized particles. Three prospective studies in developed countries indicated that condoms are unlikely to break or slip during proper use. Reported breakage rates in the studies were 2% or less for vaginal or anal intercourse (2). One study reported complete slippage off the penis during intercourse for one (0.4%) of 237 condoms and complete slippage off the penis during withdrawal for one (0.4%) of 237 condoms (7). Laboratory studies indicate that the female condom (Reality (trademark) **) -- a lubricated polyurethane sheath with a ring on each end that is inserted into the vagina -- is an effective mechanical barrier to viruses, including HIV. No clinical studies have been completed to define protection from HIV infection or other STDs. However, an evaluation of the female condom's effectiveness in pregnancy prevention was conducted during a 6-month period for 147 women in the United States. The estimated 12-month failure rate for pregnancy prevention among the 147 women was 26%. Of the 86 women who used this condom consistently and correctly, the estimated 12-month failure rate was 11%. Laboratory studies indicate that nonoxynol-9, a nonionic surfactant used as a spermicide, inactivates HIV and other sexually transmitted pathogens. In a cohort study among women, vaginal use of nonoxynol-9 without condoms reduced risk for gonorrhea by 89%; in another cohort study among women, vaginal use of nonoxynol-9 without condoms reduced risk for gonorrhea by 24% and chlamydial infection by 22% (2). No reports indicate that nonoxynol-9 used alone without condoms is effective for preventing sexual transmission of HIV. Furthermore, one randomized controlled trial among prostitutes in Kenya found no protection against HIV infection with use of a vaginal sponge containing a high dose of nonoxynol-9 (2). No studies have shown that nonoxynol-9 used with a condom increases the protection provided by condom use alone against HIV infection. Reported by: Food and Drug Administration. Center for Population Research, National Institute of Child Health and Human Development, National Institutes of Health. Office of the Associate Director for HIV/AIDS; Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Div of Sexually Transmitted Diseases and HIV Prevention, National Center for Prevention Svcs; Div of HIV/AIDS, National Center for Infectious Diseases, CDC. Editorial Note: This report indicates that latex condoms are highly effective for preventing HIV infection and other STDs when used consistently and correctly. Condom availability is essential in assuring consistent use. Men and women relying on condoms for prevention of HIV infection or other STDs should carry condoms or have them readily available. Correct use of a latex condom requires 1) using a new condom with each act of intercourse; 2) carefully handling the condom to avoid damaging it with fingernails, teeth, or other sharp objects; 3) putting on the condom after the penis is erect and before any genital contact with the partner; 4) ensuring no air is trapped in the tip of the condom; 5) ensuring adequate lubrication during intercourse, possibly requiring use of exogenous lubricants; 6) using only water-based lubricants (e.g., K-Y jelly (trademark) or glycerine) with latex condoms (oil-based lubricants (e.g., petroleum jelly, shortening, mineral oil, massage oils, body lotions, or cooking oil) that can weaken latex should never be used); and 7) holding the condom firmly against the base of the penis during withdrawal and withdrawing while the penis is still erect to prevent slippage. Condoms should be stored in a cool, dry place out of direct sunlight and should not be used after the expiration date. Condoms in damaged packages or condoms that show obvious signs of deterioration (e.g., brittleness, stickiness, or discoloration) should not be used regardless of their expiration date. Natural-membrane condoms may not offer the same level of protection against sexually transmitted viruses as latex condoms. Unlike latex, natural- membrane condoms have naturally occurring pores that are small enough to prevent passage of sperm but large enough to allow passage of viruses in laboratory studies (2). The effectiveness of spermicides in preventing HIV transmission is unknown. Spermicides used in the vagina may offer some protection against cervical gonorrhea and chlamydia. No data exist to indicate that condoms lubricated with spermicides are more effective than other lubricated condoms in protecting against the transmission of HIV infection and other STDs. Therefore, latex condoms with or without spermicides are recommended. The most effective way to prevent sexual transmission of HIV infection and other STDs is to avoid sexual intercourse with an infected partner. If a person chooses to have sexual intercourse with a partner whose infection status is unknown or who is infected with HIV or other STDs, men should use a new latex condom with each act of intercourse. When a male condom cannot be used, couples should consider using a female condom. Data from the 1988 National Survey of Family Growth underscore the importance of consistent and correct use of contraceptive methods in pregnancy prevention (8). For example, the typical failure rate during the first year of use was 8% for oral contraceptives, 15% for male condoms, and 26% for periodic abstinence. In comparison, persons who always abstain will have a zero failure rate, women who always use oral contraceptives will have a near-zero (0.1%) failure rate, and consistent male condom users will have a 2% failure rate (9). For prevention of HIV infection and STDs, as with pregnancy prevention, consistent and correct use is crucial. The determinants of proper condom use are complex and incompletely understood. Better understanding of both individual and societal factors will contribute to prevention efforts that support persons in reducing their risks for infection. Prevention messages must highlight the importance of consistent and correct condom use (10). References 1. CDC. Condoms for prevention of sexually transmitted diseases. MMWR 1988;37:133-7. 2. Cates W, Stone KM. Family planning, sexually transmitted diseases, and contraceptive choice: a literature update. Fam Plann Perspect 1992;24:75-84. 3. Weller SC. A meta-analysis of condom effectiveness in reducing sexually transmitted HIV. Soc Sci Med 1993;1635-44. 4. DeVincenzi I, European Study Group on Heterosexual Transmission of HIV. Heterosexual transmission of HIV in a European cohort of couples (Abstract no. WS-CO2-1). Vol 1. IXth International Conference on AIDS/IVth STD World Congress. Berlin, June 9, 1993:83. 5. Saracco A, Musicco M, Nicolosi A, et al. Man-to-woman sexual transmission of HIV: longitudinal study of 343 steady partners of infected men. J Acquir Immune Defic Syndr 1993;6:497-502. 6. Carey RF, Herman WA, Retta SM, Rinaldi JE, Herman BA, Athey TW. Effectiveness of latex condoms as a barrier to human immunodeficiency virus- sized particles under conditions of simulated use. Sex Transm Dis 1992;19:230- 4. 7. Trussell JE, Warner DL, Hatcher R. Condom performance during vaginal intercourse: comparison of Trojan-Enz (trademark) and Tactylon (trademark) condoms. Contraception 1992;45:11-9. 8. Jones EF, Forrest JD. Contraceptive failure rates based on the 1988 NSFG. Fam Plann Perspect 1992;24:12-9. 9. Trussell J, Hatcher RA, Cates W, Stewart FH, Kost K. Contraceptive failure in the United States: an update. Stud Fam Plann 1990;21:51-4. 10. Roper WL, Peterson HB, Curran JW. Commentary: condoms and HIV/STD prevention -- clarifying the message. Am J Public Health 1993;83:501-3. * Single copies of this report will be available free until August 6, 1994, from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849- 6003; telephone (800) 458-5231. ** Use of trade names is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services. ------------------------------------------------------------------------------- Question 2.3. How do you minimize your odds of getting infected? "Playing the AIDS Odds" (21 Oct 93) Robert S. Walker, Ph.D. Phone: (210)224-9172 Emeritus professor Internet: rwalker@trinity.edu Trinity University, Pol.Sci. 715 Stadium Drive office: 128 Main Plaza, No.310 San Antonio, TX 78212 San Antonio, TX, 78205 Everyone worries about the degree of transmission-risk involved in various activities. Can you get infected from mutual masturbation? From fisting? From using poppers? From this and from that? The real question is, "Is it possible to provide answers with sufficient precision to allow an individual confidently to assess risk and modify behavior in specific situations?" The answer is "No." No one knows enough about either sexual or drug behaviors, and their relation to HIV sero- conversion, to speak with assurance. But this doesn't mean that meaningful recommendations are out of the question. Those interested in risk assessment might read two articles representing different approaches. First: Michael Shernoff, "Integrat- ing Safer Sex Counseling into Social Work Practice, Social Casework: The Journal of Contemporary Social Work, vol. 69 (1988), pp. 334-339. The author offers a scaled list of 30 sexual behaviors from abstinence through fisting to condomless, receptive anal intercourse. The list is graded from "least likely" to transmit virus to "most likely." Some of the relative rankings are arguable, but the biggest problem is that the intervals of the "risk" scale are not equal. For example, #29 is "vaginal intercourse to orgasm without condoms," #30 is "anal inter- course to orgasm without condoms;" these two are separated by the same scaler distance as abstinence (no.1) and solitary masturbation (no.2). But everyone agrees that, anal intercourse is many times more dangerous than vaginal for the receptive partner, not just "one interval" more dangerous. Such lists are not too useful; I doubt that any subscriber to this list needs to be told that solitary masturbation is safer than receptive anal intercourse. Further, until a lot more is known about the relationships between specific behaviors and sero-conversion, the intervals cannot be meaningfully quantified. The second article is Norman Hearst and Stephen B. Hulley, "Heterosexual AIDS," Journal of the American Medical Association, April 22, 1988. The authors calculate probabilities for HIV transmission for different parameters (such as: the area's seroprevalence rate, the infectiousness of a partner, the condom/spermicide failure rate, and the number of sexual encounters). The "odds" of transmission with different parameters (such as: 500 encounters, .01 condoms failure rate, area seroprevalence of .0001, and so forth) are then projected. The resulting odds range from a "low" of 1 chance in 5 billion to a "high" of 1 transmission in 500 encounters. In the lowest risk example, there is 1 in 5 billion chance that HIV will be transmitted when: (1) your partner tests negative; (2) he/she has no history of high-risk behavior; (3) condoms are used in intercourse, and the condom failure rate is .01; (4) the area seroprevalence rate is 0.000001, (5) the infectivity value is 0.002; and (6) there is only one sexual encounter. As behavioral guides, neither approach is very helpful. When the possible sex or drug scenarios become as disparate as they are in real-life situations, and when the odds resemble your chances of winning a major lottery, then stating intervals or odds does not provide much more than a illusion of knowledge and resulting security. I suggest a different approach to thinking about risk. First, do not worry about practices for which there is no documentation of transmission (as distinct from speculation about it). If there is any risk in kissing, masturbation, skinny-dipping or whatever, it is probably much less than the chance of being hit by lightning - and few people worry about that. Focus on those activities, like intercourse and/or injecting drugs, which common sense tells you are risky, if for no other reason than that they have a long history of transmitting other diseases (like syphilis or hepatitis). Such behaviors would clearly include injecting drug use within a group, condomless anal and/or vaginal intercourse, and less clearly oral sex, fisting, or any S&M practice that involved a possible blood exchange. Second, take into account the overall setting within sexual or drug activity is taking place. While it seems that we are all biologically at equal risk, we do not face equal environmental risks. While HIV theoretically can spread uniformly from the North to the South pole, it has not in fact done so. It is one thing to pick up someone at a bar in Brahma, Oklahoma and another in San Francisco, California. The risk involved in employing a prostitute in Des Moines is much less than in Newark, NJ or Washington D.C. where the seroprevalence rate among prostitutes is very high. Similarly, patronizing a Newark shooting gallery or crack house is like asking for AIDS, but the risk of transmission within the West Coast drug scene is much less. For area comparisons see the Centers for Disease Control's quarterly HIV/AIDS Surveillance Report, and/or Jonathan Mann et al, AIDS in the World, Harvard U. Press, 1993. What I am suggesting is that some information plus common sense is a better guide than current statistical or quasi-statistical statements about relative risk. This will remain the case until a great deal more empiric data is amassed about some of our most private behaviors. If you are a person who does not feel comfortable without precise, reliable, quantified guidelines, then your only course is to abstain from activities wherein there is a possibility of transmission. There are many mood-altering substances that do not require injection, and a lot of sexual behavior that does not involve penetration and fluid exchange. With respect to non-sex or drug modes of transmission, all one can say is that there have been no documented cases of transmission through insect bites, shared utensils, shared occupational space or equipment, food handling, and so on. Theoretical risks for an infinite number of imagined scenarios can be computed, but in the actual world there are no data supporting transmission in these scenarios. An excellent survey of 14 principal articles searching for data on other routes of transmission can be found in: Robyn R.N Gershon et al, "The Risk of Transmission of HIV-1 Through Non-Percutaneous, Non-Sexual Modes: A Review," Department of Environmental Health Sciences and Department of Epidemiology, The Johns Hopkins University School of Hygiene and Public Health, distribut- ed by New York City's Gay Men's Health Crisis, AIDS Clinical Update, October 1, 1990. There have been cases of transmission through transfusions /transplants of contaminated whole blood, blood products, donor organs, and dental work. The only thing one can do is to be aware of the possibility, and make sure that those who treat you take all precautions. Currently, the only way to load the dice in your favor is to use common sense in any situation wherein someone else's body fluids might be introduced into yours through sexual or drug behaviors. If one can foresee that there would be opportunity for fluid exchange - blood, semen, vaginal secretions - then a large measure of safety can be had from the use of condoms (see: Condom Faq) and/or your own works for injecting drugs. The only safer course - and it is an honorable and intelligent one - would be to abstain from such activities altogether. What must be kept in mind is that the risk of HIV transmission is totally unlike the risk of losing at the races. Because you cannot recoup the loss represented by infection, you ought not think of the "odds" in the same way. In fact, it is better not to focus on the so- called "odds" at all. Given that (1) infection almost always leads to AIDS (estimates=95%), and (2) that AIDS almost always leads to death (estimates=99%), people must now think of sex or injecting drug use as an all-or-nothing game, . Each time you play, there are only two possible outcomes. If you win you have, perhaps, enjoyed a pleasant encounter; if you lose, you die. And each time you play without regard to common sense evaluation and personal protection, you enhance the possibility that you will lose. Its as simple as that. ------------------------------------------------------------------------------- Question 2.4. How risky is a blood transfusion? The following October 15, 1993 United Press International article, was summarized in the CDC AIDS Daily News Summary. "CDC Study Finds Five Transfusion-Related AIDS Cases Per Year" United Press International (10/25/93) Miami Beach, Fla.--Since screening for HIV began in 1985, very few people have become infected with the virus via blood transfusions, according to experts at the Centers for Disease Control and Prevention. The rate of transfusion-related AIDS cases rose steadily from 1978 to 1984, then fell dramatically when testing began in 1985, said the CDC. Officials report that between 1986 and 1991, the number of such cases may have been as low as five per year. "While the risk of getting AIDS from a transfusion is not zero, this study corroborates other CDC research and published data indicating that the risk is extremely low," said Dr. Arthur J. Silvergleid, president of the American Association of Blood Banks. A total of 4,619 individuals are believed to have been infected through the blood supply. Each year in the United States, about 4 million people receive blood transfusions. ------------------------------------------------------------------------------- Question 2.5. Can mosquitoes transmit AIDS? Please see Q2.1 `How is AIDS transmitted?' for general information about insects and AIDS transmission. Malaria is transmitted to humans through mosquito bites. Why can't AIDS be transmitted this way? Plasmodium, the protozoan that causes malaria, is highly specialized to infect through a mosquito vector. The gametocytes ingested by the mosquito from an infected host undergo a further stage of development and give rise to sporozoites. These migrate through the insects body until they reach the salivary glands . They are then injected into a new host by the mosquito along with its saliva which is an anti-coagulant and needed to stop clotting. ------------------------------------------------------------------------------- Question 2.6. What about other insect bites? From: "Natural History", July 1991, p. 54: Acquired Immune Deficiency Syndrome (AIDS), the deadly epidemic caused by the HIV virus, is most often transmitted by contaminated hypodermic needles or sexual contact. Since mosquitos feed on human blood and may attack a series of individuals, the question arises: can you get AIDS from a mosquito bite? According to Jonathan F. Day, of the University of Florida's Medical Entomology Laboratory, insects can transmit viruses in two ways, mechanically and biologically. With mechanical transmission, infected blood on the insect's mouthparts might be carried to another host while the blood is still fresh and the virus still alive. Infection by this means is possible but highly unlikely, because mosquitos seldom have fresh blood on the outside of their mouthparts. Mechanical transmission does occur in horses, however, with equine infectious anemia, a virus closely related to AIDS and transmitted by horseflies. These flies are "pool feeders"; their bite causes a small puddle of blood to form, and they immerse their mouthparts, head, and front legs while lapping it up. If disturbed, however, they quickly move on to another horse, where the fresh blood of the two hosts may mingle. Blood-feeding mosquitos are much neater and more surgical; they insert a tube for drawing blood, and by the time they are ready for their next meal, even on a second host following an interrupted meal, any viruses from their first meal are safely stored away in their midgut. With biological transmission, the pathogen must complete a portion of its life cycle within the carrier, or vector species. Protozoans that cause malaria, for instance, go through an extremely complex cycle within the mosquito, eventually congregating in the salivary glands, from which they may infect avian, primate, rodent, or reptilian hosts, depending on the malaria species. The HIV virus, however, does not replicate or develop in the mosquito; once in the insect's gut, the virus quickly dies. Repeated studies since 1986 show that AIDS-infected blood fed to mosquitos and other arthopods does not live to be passed on and that, fortunately, there is no biological-transmission cycle of AIDS in blood-feeding arthopods, which frequently ingest the virus as part of their blood meal. ------------------------------------------------------------------------------- Question 2.7. Is there even a remote chance of insect transmission? An interesting paper is: Do Insects Transmit Aids? by Lawrence Miike Health Program; Office of Technology Assessment United States Congress; Washington D.C. 20510-8025 September 1987 -- A Staff Paper in OTA's Series on AIDS-Related Issues For sale by the Superintendent of Documents U.S. Government Printing Office Washington, D.C. 20402 This paper indicates that "The conditions necessary for successful transmission of HIV through insect bites, and the probabilities of their occurring, rule out the possiblility of insect transmission of HIV infection as a significant factor in the way AIDS is spread. If insect transmission is occurring at all, each case would be a rare and unusual event." Miike suggests that there are two theoretical mechanisms by which biting insects might transmit HIV infections: 1). biological (insect's saliva to person's blood) and 2). mechanical (HIV-infected person's fresh blood to another's blood). Based on experimental results, they were able to rule out biological transmission. This leaves mechanical transmission during interrupted feeding as a viable mechanism. So it COULD happen; HOWEVER... "The probability of HIV transmission from an insect bite would be calculated by multiplying (not adding, because each event's probability is independent of each other) the following factors: 1) how frequently interrupted feeding occurs, 2) the probability the the insect had bitten an HIV-infected person prior to biting an uninfected person, and 3) the probability that the insect bite contained enough HIV to transmit infection." "The frequency of interrupted feeding depends on the type of insect; in general, the larger the insect and the more painful the bite -- such as horse flies -- the greater the probability that interrupted feeding will occur. Other bites, such as from mosquitoes and bedbugs, are usually unnoticed and therefore usually uninterrupted. With others, such as ticks, if their feeding is interrupted, the probability of quickly transferring to another person is extremely low." "In mechanical transmission, the maximum amount of HIV that insects would be able to transfer would be the amount of virus in the blood they had ingested prior to biting an uninfected person. Experience with viruses actually transferred in this manner has shown that the amount of blood that might be transferred is limited to the amount of blood on the insect's mouthparts (on the order of 1/100,000 of a milliliter of blood). An uninfected person would also have to be bitten within an hour of the insect's biting an infected person; and both infected and uninfected persons would have to be in close proximity to each other (a few hundred feet for mosquitoes and biting flies, in the same household for bedbugs), or else the insect will not have an opportunity to transfer to another person if its feeding was interrupted." "Most HIV-infected persons (70-80 percent) do not have detectable levels of infectious virus in their blood. Those that do have measurable HIV have very low levels, much below the levels that are needed for insect transmission of other viral diseases. Only rarely does an HIV-infected person have a blood virus level that might contain enough infectious HIV for insect transmission." There you go... it seems that you CAN become HIV-infected via a mosquito bite. Then again, you CAN also win the multi-million dollar lotto game five times consecutively! 8-) I wouldn't lose any sleep worrying about either of those. Archive-Name: aids-faq2 Last-Modified: 10 Nov 1993 =============================================================================== Section 3. Confidentiality. Q3.1 How is blood tested in the United States? Q3.2 What if a blood-bank finds out you are HIV positive? ------------------------------------------------------------------------------- Question 3.1. How is blood tested in the United States? All blood products in the U.S. are screened by ELISA assays for several infectious agents, including: HIV 1/2, HTLV I/II, HBV, HCV, Syphillis, Hepatitis B core, and a liver enzyme ALT, indicative of hepatic infections. Some blood donations are also tested for CMV, a more common virus that has devestating effects in immunocompromised individuals, such as cancer patients and transplant recipients. In addition to these laboratories, all donors are screened through questionaires that meet or exceed FDA requirements. ------------------------------------------------------------------------------- Question 3.2. What if a blood-bank finds out you are HIV positive? The Red Cross and other blood banks routinely test blood donations for HIV antibodies. The Red Cross has specifically asked that people not use blood donation as a way of finding out if they are HIV+. If you think you might be infected, go get a blood test. Many cities offer free anonymous HIV testing. Contact your local public health service office for details. This is particularly important if you think you might have been infected within the last six months, since there's the risk that you are indeed infected, but do not yet have antibodies to HIV. Blood donation is a fine thing to do--but how will you feel if you donate, then a month later you find out through some other means that you're HIV+? We're supposed to be making a gift of life, not death. The following article discusses how blood banks use the information, if you have tested positive for HIV antibodies. In addition to your possible role in killing another person, donating blood to obtain a free HIV test also risks your anonymity. From: McCullough J. The nation's changing blood supply system. JAMA. 1993 May;269(17):2239-45. "The coded identity of potential or actual blood donors who are found to be unsuitable on the basis of medical history or laboratory testing is entered into a donor referral registry (DDR). Before each donated unit of blood is made available for use, the coded identity of the donor is checked against the DDR to ensure that the donor has not been found to be unsuitable during a previous donation. Although potentially infectious donors are so informed and asked not to give blood in the future, this DDR check is thought to improve the safety of the blood supply by serving as an additional way of identifying potentially infectious blood should these donors return. The American Red Cross operates a single DDR with information from all of its 47 reginal centers. However, other blood banks' DDRs act only locally since there is no requirement that different blood banks in the same or neighboring communities exchange this DDR information. The operation of these DDRs costs money, consumes experts' time, and has the potential for many abuses such as failure to obtain informed consent and breeches of confidentiality. The value of a DDR in improving the safety of the blood supply has not been established. An analysis of the value of thse DDRs should be conducted, and based on the results, DDRs should be either eliminated or refined into an appropriate system." See also: Grossman BJ. Springer KM. Blood donor deferral registries: highlights of a conference. Transfusion. 1992;32:868-72. =============================================================================== Section 4. Treatment options. Q4.1 General treatment information. Q4.2 AIDS and Opportunistic Infections. Q4.3 Guide to Social Security Benefits. Q4.4 What if you can't afford AZT? Q4.5 What about DNCB? (please contribute) ------------------------------------------------------------------------------- Question 4.1. General treatment information. [This article was published in AIDSFILE, 1993 Sept, Vol. 7, No. 3, p. 1-3. (Copyright 1993 The Regents of the University of California). The Regents grant permission for material in AIDSFILE to be reprinted for use by nonprofit educational institutions for scholarly or instructional purposes only, provided that (1) the author and AIDSFILE are identified; (2) proper notice of the copyright appears on each copy; (3) copies are distributed at or below cost.] Review of Clinical Guidelines - Antiretroviral Therapy Paul A. Volberding, MD Introduction A number of new observations have been made recently concerning antiretroviral therapy for HIV infection. Although new data is always welcome, lately it seems to cause as much confusion as clarification. Caregivers for patients with HIV disease continue to recognize the established benefits of antiretroviral therapy, but new uncertainties have been introduced. These uncertainties mean that we must consider the new information in order to make the best use of available treatments at the same time that we appreciate their limitations. Those who care for patients with HIV disease also anticipate the introduction of new classes of drugs, and we are beginning to determine how we might use these additional agents in our patient care. Review of Clinical Guidelines Antiretroviral therapy clearly has shown activity in delaying the progression and death of patients with HIV infection, especially when therapy has been tested in patients with more advanced disease. But even in asymptomatic HIV infection there is a general agreement of at least a transient clinical benefit from the use of nucleoside analog therapy. It is clear also that antiretroviral therapy improves various laboratory markers of the disease, including immunologic and virologic disease markers, such as CD4 cell counts and HIV p24 antigen levels. Further evidence of the clinical activity of these drugs comes from trials showing a second period of benefit when therapy is changed to a non-cross-resistant agent, for example, switching from zidovudine to ddI. In addition, we are encouraged by symptomatic improvement in patients with advanced disease who are started on antiretroviral drugs. Also, many retrospective epidemiology studies continue to show a survival advantage in patients taking these drugs. Despite continuing agreement on some of the benefits of antiretroviral therapy, we also face growing uncertainties. Recent studies have shown no survival advantage when antiretroviral drugs are used in asymptomatic HIV infection, and any benefit in slowing clinical progression seems to disappear when zidovudine monotherapy, at least, is given for a prolonged period. Questions continue as well about the degree of benefit of antiretroviral therapy for patients with advanced HIV disease. Early clinical trials of zidovudine, for example, were done before the routine used of PCP prophylaxis, which, by itself, delays progression to that common indicator of AIDS. Questions about the current status of antiretroviral therapy include: Which drug or combination is superior as initial therapy? When should this initial therapy begin? What is the duration of the benefit from initial therapy? How long should it be continued before other drugs or combinations are initiated? Finally it is important to consider: Which drugs should be used following initial therapy? What might we anticipate in the future from drugs in current clinical development? Beginning Therapy -- What and When Probably the easiest question at the moment in the field of HIV therapy is which drug to use to begin treatment. Data from ACTG 116A make it clear that zidovudine is superior to ddI as a monotherapy in previously untreated patients, and data from other studies show the superiority of zidovudine over ddC. An independent "State of the Art Panel" recently convened by the National Institute of Allergy and Infectious Diseases (NIAID) and chaired by Merle Sande, MD, UCSF chief of the medical service at San Francisco General Hospital, found an easy consensus that zidovudine monotherapy is the initial therapy of choice. Even here, however, other opinions may be heard, especially concerning the potential for initial use of combinations of nucleoside analogs. For example, the recent ACTG 155 trial in much more advanced disease tended to show a superiority of the combination of zidovudine and ddC, which was limited to patients with the highest CD4 cells (between 150 and 300). A large study, ACTG 175, is comparing initial combination with monotherapy, but the results from this trial are not anticipated before the end of 1995. In the meantime, combinations including zidovudine with ddI or zidovudine with ddC as initial therapy remain of interest. When best to initiate antiretroviral therapy is probably the most controversial question in the field of HIV management. Extended data from ACTG 019 demonstrate durable clinical progression benefit with the use of 500 mg of zidovudine daily in patients with asymptomatic HIV infection and with CD4 cell counts between 300 and 500, but these data are in apparent conflict with those from the recently completed Concorde Study. Concorde, enrolling more than 1700 patients with any level of CD4 count, compared the initial use of one gram of zidovudine daily with the same therapy deferred until after the person developed AIDS or ARC. After a median treatment duration of three years, and despite a clear and sustained CD4 improvement with the immediate use of zidovudine, there was no apparent benefit in the immediate treatment group either in clinical progression or survival. When the investigators analyzed a subset of the overall group with CD4 counts below 500 cells and after one year of therapy, a benefit similar to that seen in ACTG 019 was observed. Although Concorde was a powerful study, given the size and duration of follow-up, concerns have been raised that the dosage at one gram was excessively high and that the large number of patients allowed to begin therapy before they became symptomatic complicates the analysis. Also adding to the confusion are the recently published results of the European-Australian cooperative Group trial, which tended to find a clinical benefit with the use of zidovudine in patients with CD4 counts up to 750 cells. The State of the Art Panel recommended two broad options after considering the available data--initiating therapy in asymptomatic individuals with CD4 counts under 500 cells, or delaying this therapy until symptomatic HIV disease intervened. Another option favored by many clinicians is to follow patients, delaying therapy until evidence of more rapid disease progression becomes apparent as manifested by rapid declines in CD4 count or by a rise in p24 antigen or, especially, a rise in beta-2 microglobulin. At any rate, the clinician must discuss the various options with each patient, individualizing this decision according to the clinical and laboratory status of the patient and according to the patient's own desires. Duration of Therapy A second difficult question in the field of HIV management is how long to continue initial zidovudine. Again, the ACTG 019 experience would suggest that zidovudine monotherapy has a prolonged period of benefit, especially in patients with higher CD4 cell counts (300-500) when therapy is begun. On the other hand, ACTG 116A seemed to indicate that the initial superiority of zidovudine was lost after as little as two to four months of treatment with this drug prior to treatment with didanosine. Here again, the State of the Art panel could find little room for consensus. When therapy is begun in individuals with CD4 counts above 300, the panel suggested that it should be continued until the CD4 cell count fell below 300. When zidovudine monotherapy is begun in patients with CD4 counts under 300, the additional option of switching to ddI monotherapy after a fixed interval was raised, but again this interval was not defined. Once zidovudine monotherapy has been used, and when it is no longer felt to be effective for an individual, secondary therapy must be initiated. The choice of this therapy, however, is also uncertain. In moderate disease, with CD4 cell counts below 300, switching to ddI was superior to continuing with zidovudine in ACTG trials 116a and 116b/117, while switching to ddC was not of benefit in ACTG 155. On the other hand, from data gathered in CPCRA Trial 002, in patients with more advanced disease, ddI and ddC were equivalent in secondary treatment of patients previously treated with zidovudine who had progressed despite taking that drug or who were intolerant of zidovudine toxicity. In fact, ddC had a slight but significant superiority compared to ddI in terms of survival in this trial. It was hoped that combination therapy following zidovudine would be beneficial but questions have been raised following the results of ACTG 155. In this study, patients previously treated with zidovudine with CD4 cells below 300 were randomized to stay on zidovudine, start ddC monotherapy, or begin zidovudine and ddC combination therapy. Overall, there was no difference in clinical progression or survival among the three study arms. When the baseline CD4 counts are examined, however, it was found that combination therapy was superior in patients with higher CD4 cell counts, especially between 150 and 300. Therefore, it might seem advisable not to delay the introduction of combination therapy until patients have very advanced disease but rather to use such therapy earlier in the disease course. Whether zidovudine and ddI would be as good as zidovudine and ddC has not been investigated. Newer Classes of Drugs Along with new data on existing therapies, more information is available now on newer classes of drugs. These include nucleoside analogs, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and the tat inhibitor. Nucleoside Analogs. New nucleoside analogs in clinical investigation include d4T (stavudine) and 3TC. d4T has been much more extensively studied and appears effective in raising CD4 count and lowering HIV p24 antigen in a number of Phase 1 trials. It appears safe. Although cases of pancreatitis have been reported, they seem to be extremely rare. Neuropathy is the main toxicity but, again, it appears to be somewhat less than with ddI or ddC. d4T may not be suitable for combination with zidovudine as the two drugs have a negative interaction limiting their activation within the cell. On the other hand, d4T is a well-tolerated drug and may prove to be an alternative to one or more of the existing nucleosides. 3TC also appear safe and may be able to help restore sensitivity to zidovudine when the patient's HIV has become resistant. Reverse Transcriptase Inhibitors. The non-nucleoside reverse transcriptase inhibitors, including nevirapine and the Merck "L" drug, were recently thought to have limited value because they induce high-level drug resistance so rapidly. At the Berlin conference, however, one report showed that by increasing the dosage of nevirapine to 400 mg daily, a dose well above the level of resistance, prolonged benefit might be achieved. Also, it was shown that combining zidovudine with nevirapine delays the onset of nevirapine resistance. Thus, these drugs may still find a place in clinical medicine. At the same time, convergent therapy, using three drugs together, was disappointing because of simultaneous resistance to zidovudine, ddI and non-nucleoside reverse transcriptase inhibitors. Protease Inhibitors. Protease inhibitors seem to be gaining some ground. In Phase 1 trials, several of these compounds have evident antiretroviral activity, which was reflected in decreasing HIV p24 and increasing CD4 cell counts. Clinical benefits have not been established nor has the activity of these drugs used in combination with zidovudine been described. Because several structurally different protease inhibitors are being developed by different drug companies, it is hoped that at least one of these compounds will become more widely available soon for clinical use. Tat. While the protease inhibitors appear encouraging, tat inhibitors appear to be clinically inactive. In Phase 1 trials of the Hoffman LaRoche tat inhibitor, little or no antiretroviral activity was seen and it is probably that this class of drugs will not be developed further. Summary Given this complex and seemingly confusing information, what recommendations can be given to the clinician? Most important is to individualize the decision-making and to consider the desires of the patient even more than previously. Some patients gravitate easily to more aggressive therapy, while others prefer a more conservative therapeutic approach. With the former, initiating therapy at or even above 500 CD4 counts, perhaps even with a combination of zidovudine and ddI, may be considered. For more conservative patients, however, following the recommendations of the Concorde study may in order. In other words, defer the initiation of zidovudine monotherapy until the onset of clinical symptoms. Once the choice of initial therapy has been made, all other recommendations must also be individualized. No firm data are available to guide the decision about how long to continue a therapy or even about what to use next. Most of these options have not been compared directly in clinical trials. It would seem advisable to continue therapy longer in patients with relatively earlier disease when therapy is initiated. On the other hand, if patients have more advanced disease, for example, are symptomatic or have CD4 cell counts below 300 when therapy is begun, then a more rapid alteration of therapy to a non-cross-resistant drug or combination should be considered. The goal in each patient is to continue effective antiretroviral therapy for as long as possible, discontinuing the therapy if further benefits appear impossible. Although the results of recent clinical trials are disappointing in some respects, it nevertheless is important to have these data. Only then can we adjust our expectations and our patients' expectations of antiretroviral treatment and learn how to make the best use of the drugs that we have available. Recognizing the increasing need for the development of new classes of more effective drugs in combinations, we must still seek to maintain the optimism that enables progress in our patients' care. Dr. Volberding is a UC San Francisco professor of medicine and Director, UCSF AIDS Program at San Francisco General Hospital. References: ZDV and The AIDS Clinical Trials Group (1989-93): Aweeka FT. Gambertoglio JG. et al. Pharmacokinetics of concomitantly administered foscarnet and zidovudine for treatment of human immunodeficiency virus infection (AIDS Clinical Trials Group protocol 053). Antimicrobial Agents & Chemotherapy. 36(8):1773-8, 1992 Aug. Fischl MA. Richman DD. et al. The safety and efficacy of zidovudine (AZT) in the treatment of subjects with mildly symptomatic human immunodeficiency virus type 1 (HIV) infection. A double-blind, placebo-controlled trial. The AIDS Clinical Trials Group [see comments]. Annals of Internal Medicine. 112(10):727-37, 1990 May 15. [Editor's Note: This article reports the results of ACTG 106.] Fischl MA. Parker CB. et al. A randomized controlled trial of a reduced daily dose of zidovudine in patients with the acquired immunodeficiency syndrome. The AIDS Clinical Trials Group. New England Journal of Medicine. 323(15): 1009-14, 1990 Oct 11. Gelber RD. Lenderking WR. et al. Quality-of-life evaluation in a clinical trial of zidovudine therapy in patients with mildly symptomatic HIV infection. The AIDS Clinical Trials Group. Annals of Internal Medicine. 116(12 Pt 1):961-6, 1992 Jun 15. Hochster H. Dieterich D. et al. Toxicity of combined ganciclovir and zidovudine for cytomegalovirus disease associated with AIDS. An AIDS Clinical Trials Group Study. Annals of Internal Medicine. 113(2):111-7, 1990 Jul 15. Kahn JO. Lagakos SW. et al. A controlled trial comparing continued zidovudine with didanosine in human immunodeficiency virus infection. The NIAID AIDS Clinical Trials Group [see comments]. New England Journal of Medicine. 327(9):581-7, 1992 Aug 27. Koch MA. Volberding PA. et al. Toxic effects of zidovudine in asymptomatic human immunodeficiency virus-infected individuals with CD4+ cell counts of 0.50 x 10(9)/L or less. Detailed and updated results from protocol 019 of the AIDS Clinical Trials Group. Archives of Internal Medicine. 152(11):2286-92, 1992 Nov. Krogstad DJ. Eveland MR. et al. Drug level monitoring in a double-blind multicenter trial: false-positive zidovudine measurements in AIDS clinical trials group protocol 019. Antimicrobial Agents & Chemotherapy. 35(6): 1160-4, 1991 Jun. Meng TC. Fischl MA. Richman DD. AIDS Clinical Trials Group: phase I/II study of combination 2',3'-dideoxycytidine and zidovudine in patients with acquired immunodeficiency syndrome (AIDS) and advanced AIDS-related complex. American Journal of Medicine. 88(5B):27S-30S, 1990 May 21. Sidtis JJ. Gatsonis C. et al. Zidovudine treatment of the AIDS dementia complex: results of a placebo-controlled trial. AIDS Clinical Trials Group. Annals of Neurology. 33(4):343-9, 1993 Apr. Sperling RS. Stratton P. Treatment options for human immunodeficiency virus-infected pregnant women. Obstetric- Gynecologic Working Group of the AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases. Obstetrics & Gynecology. 79(3):443-8, 1992 Mar. Volberding PA. Lagakos SW. et al. Zidovudine in asymptomatic human immunodeficiency virus infection. A controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. The AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases [see comments]. New England Journal of Medicine. 322(14):941-9, 1990 Apr 5. [Editor's Note: This article reports the results of ACTG 109.] See also: Aboulker JP. Swart AM. Preliminary analysis of the Concorde trial. Concorde Coordinating Committee [letter]. Lancet. 1993 Apr 3;341(8849):889-90. Comment in: Lancet 1993 Apr 17;341(8851): 1022-3; Lancet 1993 Apr 17;341(8851):1023; Lancet 1993 May 15; 341(8855):1276; Lancet 1993 May 15;341 (8855):1276-7; and Lancet 1993 May 15;341(8855):1277. Cooper DA. Gatell M. et al. Zidovudine in persons with asymptomatic HIV infection and CD4+ cell counts greater than 400 per cubic millimeter. New England Journal of Medicine. 329(5): 297-303, 1993 Jul 29. Hamilton JD. Hartigan PM. et al. A controlled trial of early versus late treatment with zidovudine in symptomatic human immunodeficiency virus infection. Results of the Veterans Affairs Cooperative Study. New England Journal of Medicine. 326(7):437- 43, 1992 Feb 13. ------------------------------------------------------------------------------- Question 4.2. AIDS and Opportunistic Infections. AIDS and Opportunistic Infections NIAID BACKGROUNDER: Office of Communications, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892 - September 1993 Opportunistic infections (OIs) cause most of the illnesses and deaths among people infected with HIV, the virus that causes AIDS. The National Institute of Allergy and Infectious Diseases (NIAID) leads the way in U.S. research on these life-threatening infections. As part of the NIAID effort, investigators are defining the optimal therapies, alone and in combination, to prevent and treat OIs. They seek ways to identify infections earlier and recognize resistance to therapies more quickly. What are OIs? The immune systems of most people with HIV gradually deteriorate, leaving them vulnerable to numerous viruses, fungi, bacteria and protozoa that are held in check in people with healthy immune systems. These microbes can become active in HIV-infected individuals, causing frequent and severe disease. NIAID uses a two-pronged approach to the prevention and treatment of OIs: basic laboratory research to learn how these microbes cause disease and clinical research to develop and evaluate promising therapies. Prevention and treatment of one such disease, Pneumocystis carinii pneumonia or PCP, has been a major thrust of the NIAID program. Other NIAID investigations include cytomegalovirus (CMV) infection, Mycobacterium avium complex (MAC) and tuberculosis (TB). Institute research focuses on these infections because, although they occur repeatedly among HIV-infected people, they are rare in the general population and few drugs are available now to prevent and treat them. PCP: The Most Common OI PCP remains the most common, life-threatening opportunistic infection in people with HIV, occurring in up to 80 percent of individuals who do not take preventive therapy. The PCP organism, a microscopic parasite, appears to infect most people during childhood. In people with healthy immune systems, the parasite normally remains dormant, but it may cause disease in those with damaged immune systems. PCP infection is characterized by a dry cough and shortness of breath. Individuals may experience other, less specific symptoms such as fever, fatigue and weight loss for weeks or even months before respiratory problems appear. As PCP infection progresses, the functioning lung tissue becomes clogged, which decreases the transport of oxygen from the inhaled air into the blood. At this point, the oxygen in the blood may be lowered to dangerous or even fatal levels. Without treatment, close to 100 percent of HIV-infected patients with PCP die. During the 1980s, the development of effective therapies led to better management of PCP. Drugs for preventing and treating PCP include aerosolized pentamidine and oral trimethoprim-sulfamethoxazole (TMP/SMX), but both can result in serious side effects that prevent some patients from taking the drugs. TMP/SMX is recommended more often than aerosolized pentamidine for treating and preventing PCP because the combination is effective, tolerated by about half of the patients who take it and may work against other disease-causing organisms as well. In 1992, an NIAID-supported trial proved that TMP/SMX is better than aerosolized pentamidine at preventing a second episode of PCP in people with AIDS who can tolerate either therapy. Although definitive research data are lacking, other agents may be considered in situations in which neither TMP/SMX nor aerosolized pentamidine can be given. The drug atovaquone is approved for patients with mild to moderate PCP who cannot tolerate TMP/SMX. One NIAID study showed that primaquine, an antimalaria drug, with clindamycin is an effective oral therapy for PCP. TMP with dapsone is an alternative treatment. The search for new, more effective, less toxic drugs and combinations of drugs to fight PCP continues. NIAID studies play an important role in this effort. One trial compares three drug regimens--TMP/dapsone, primaquine/clindamycin and TMP/SMX--for oral treatment of mild to moderate PCP. Another protocol looks at an 8-aminoquinoline, an antimalaria drug, while a third trial considers two regimens of TMP/SMX to prevent PCP. CMV: A Herpesvirus Infection with CMV, a virus in the herpes family, may occur throughout life. By age 50, about half of the general population has been exposed to this virus, yet most people do not become ill. After the original infection, the virus may lie dormant and reactivate itself if the immune system becomes suppressed. For people with HIV infection, CMV is one of the most frequent and serious OIs they face. CMV retinitis, an inflammation of the light-sensitive inner layer of the eye, is the most common CMV infection and leads to blindness if left untreated. Infections also may occur in the gastrointestinal tract, lungs, brain, heart and other organs. Both intravenous ganciclovir and foscarnet are approved to treat CMV retinitis. Lifelong maintenance on either treatment is required because the drugs do not kill CMV, they merely slow down its ability to grow. Even with therapy, the rate of relapse is high. NIAID studies of CMV and other herpesviruses have shown that intravenous foscarnet and ganciclovir are equally effective for CMV retinitis, although foscarnet was associated with increased survival for patients in the study. An ongoing trial is testing an oral form of ganciclovir to prevent CMV disease. The oral form of the drug would be much easier and safer for patients to take. MAC: A Bacterial OI Infection with MAC is diagnosed in up to 40 percent of people with AIDS in the United States, making it the most common bacterial OI. Usually, it affects people in advanced stages of HIV disease when the immune system is severely suppressed. The MAC organism is found widely in the environment and is thought to be acquired most commonly through the mouth or gastrointestinal tract. It can spread to the lungs, liver, spleen, lymph nodes, bone marrow, intestines and blood. MAC causes chronic debilitating symptoms--fever, night sweats, weight loss, fatigue, chronic diarrhea, abdominal pain, liver dysfunction and severe anemia. Rifabutin is the first drug to be approved for preventing MAC disease in people with advanced HIV infection. The Food and Drug administration based this approval on clinical studies showing that patients who received rifabutin were one-third to one-half as likely to develop MAC as were patients who received placebo. To prevent MAC disease, a U.S. Public Health Service Task Force on Prophylaxis and Therapy for MAC suggests that patients with HIV infection and fewer than 100 CD4 + T cells receive oral rifabutin for the rest of their lives unless disease develops. In the latter case, multiple drug treatment is needed. CD4+ T cells are immune system cells targeted and killed by HIV. No other drug regimen is recommended currently to prevent MAC. Azithromycin and clarithromycin are promising agents for prophylaxis, but studies of these agents have not been completed. Increasing evidence suggests that treatment can benefit patients with disseminated MAC, especially multiple-drug regimens including either clarithromycin or azithromycin. Therefore, the PHS task force suggests that all regimens, outside of a clinical trial, should consist of at least two drugs, including clarithromycin or azithromycin plus one other agent such as clofazimine, rifabutin, rifampin, ciprofloxacin and, in certain situations, amikacin. They recommend continued therapy for the patient's lifetime, as long as clinical benefit and reduction of mycobacteria are observed. NIAID has several studies under way looking at the roles of clarithromycin and azithromycin, and other drugs such as sparfloxacin, alone and in combination, to prevent and treat this serious disease. TB: An Airborne Disease TB, a chronic bacterial infection, causes more deaths worldwide than any other infectious disease. About one-third of the world's population harbors the predominant TB organism, Mycobacterium tuberculosis, and is at risk for developing the disease. The World Health Organization (WHO) estimates that 4.4 million people worldwide are coinfected with TB and HIV. WHO predicts that by the year 2000, TB will take one million lives annually among the HIV-infected. Because of their weakened immune systems, people with HIV are vulnerable to reactivation of latent TB infections, as well as to new TB infections. Transmission of this disease occurs most commonly in crowded environments such as hospitals, prisons and shelters--where HIV-infected individuals make up a growing proportion of the population. Active TB may occur early in the course of HIV infection, often months or years before other OIs. TB most often affects the lungs, but it also can cause disease in other parts of the body, particularly in people with advanced HIV disease. Of particular concern for people with AIDS is multi-drug-resistant TB (MDR-TB). MDR-TB can occur when patients fail to take their TB medicine for the prolonged periods necessary to destroy all TB organisms, which then become resistant to the drugs. These resistant organisms can be spread to other people. Even with treatment, for individuals coinfected with HIV and MDR-TB, the death rate may be as high as 80 percent, as opposed to 40 to 60 percent for people with MDR-TB alone. The time from diagnosis to death may be only months for some patients with HIV and MDR-TB, as they are sometimes left without adequate treatment options. The initial site of TB infection is in the balloon-like sacs at the ends of the small air passages in the lungs. In these sacs, white blood cells called macrophages ingest the inhaled TB organism. Some of the organisms are killed immediately, while others remain and multiply within the macrophages. If the organism breaks out of the sacs, TB can become active disease. This spreading sometimes results in life-threatening meningitis and other problems. NIAID launched the first large U.S. study to assess TB treatment strategies for people coinfected with HIV and TB. The study is aimed at finding state-of-the-art treatment. NIAID is the lead institute for TB research at the National Institutes of Health, supporting more than 50 research projects related to TB. Other OIs NIAID-supported scientists also study other OIs including fungal infections, herpes simplex virus infections, toxoplasmosis and cryptosporidium infections. ------------------------------------------------------------------------------- Question 4.3. Guide to Social Security Benefits. U.S. Department of Health and Human Services Social Security Administration SSA Publication No. 05-10020 September 1993 A Guide to Social Security and SSI Disability Benefits For People With HIV Infection About This Booklet Social Security can provide a lifeline of support to people with HIV infection. That lifeline comes in the form of monthly Social Security disability benefits and Supplemental Security Income payments, Medicare and Medicaid coverage, and a variety of other services available to people who receive disability benefits from Social Security. If you are disabled because of HIV infection, this booklet will help you understand the kinds of disability or Supplemental Security Income programs. What's Inside Part 1 -- Background Information The first section provides some brief background information about HIV infection and Social Security. Part 2 -- What Benefits Are You Eligible For? This section explains the nonmedical rules and eligibility factors for Social Security Disability Insurance benefits and Supplemental Security Income Disability payments. Part 3 -- How Does Social Security Define "Disability?" This section explains Social Security's definition of "disability" and how it relates to claimants with HIV infection. Part 4 -- How Does Social Security Evaluate Your Disability This section explains how Social Security evaluates disability claims involving HIV diseases in general. And it includes up-to- date information about the way we process claims, especially those involving women and children with HIV infection. Part 5 -- How Do You File For Disability Benefits? This section includes information about when and how to apply for disability, what steps we take to ensure that your claim is processed quickly and accurately, and most important, what things you can do to help the process along. Also included is information about situations when we can presume a person is disabled and make immediate payments. Part 6 -- Helping You Return To Work This section provides an overview of special rules designed to help you return to work. Part 7 -- What you Need To Know About Medicaid And Medicare This section includes a brief overview of the kinds of benefits available from the Medicaid and Medicare programs. For More Information ***************************************************************** PART 1 -- BACKGROUND INFORMATION Acquired immunodeficiency syndrome (AIDS) is characterized by the inability of the body's natural immunity to fight infection. It is caused by a retrovirus known as human immunodeficiency virus, or HIV. Generally speaking, people with HIV infection fall into two broad categories: 1) those with symptomatic HIV infection, including AIDS; and 2) those with HIV infection but no symptoms. Although thousands of people with HIV infection are receiving Social Security or Supplemental Security Income disability benefits, we believe there may be others who might be eligible for these benefits. Social Security is committed to helping all men, women, and children with HIV infection learn more about the disability programs we administer. And if you qualify for benefits, we are just as committed to ensuring that you receive them as soon as possible. You should also be aware that the Social Security Administrations's criteria for evaluating HIV infection are not linked to the Centers for Disease Control's (CDC) definition of AIDS. This is because the goals of the two agencies are different. CDC defines AIDS primarily for surveillance purposes, not for the evaluation of disability. PART 2 -- WHAT BENEFITS ARE YOU ELIGIBLE FOR? We pay disability benefits under two programs: Social Security Disability Insurance, sometimes referred to as SSDI, and Supplemental Security Income, often called SSI. The medical requirements are the same for both programs, and your disability is determined by the same process. However, there are major differences in the nonmedical factors, which are explained in the next two sections. Social Security Disability Insurance Benefits: The Nonmedical Rules Of Eligibility Here are examples of how people qualify for SSDI: o Most people qualify for Social Security disability by working, paying Social Security taxes, and in turn, earning "credits" toward eventual benefits. The maximum number of credits you can earn each year is 4. The number of credits you need to qualify for disability depends on your age when you become disabled. Nobody needs more than 40 credits and young people can qualify with as few as 6 credits. o Disabled widows and widowers age 50 or older could be eligible for a disability benefit on the Social Security record of a deceased spouse. o Disabled children age 18 or older could be eligible for dependent's benefits on the Social Security record of a parent who is getting retirement or disability benefits, or on the record of a parent who has died. (The disability must have started before age 22.) o Children under the age of 18 qualify for dependents benefits on the record of a parent who is getting retirement or disability benefits, or on the record of a parent who has died, merely because they are under age 18. For more information about Social Security disability benefits in general, ask Social Security for a copy of the booklet, Disability (Publication No. 05-10029). How Much Will Your Benefits Be? How much your Social Security benefit will be depends on your earnings history. Generally, higher earnings translate into higher Social Security benefits. You can find out how much you will get by contacting Social Security and asking for an estimate of your benefits. We'll give you a form you can use to send for a free statement that contains a record of your earnings and an estimate of your benefits. In addition to checking your benefit, we encourage you to use this statement to verify that your earnings have been properly recorded in our files. It's important that you do this because any missing or unreported wages could lower your Social Security benefit or even prevent you from qualifying for disability benefits. If you find a problem, contact your local Social Security office right away, show them proof of your actual wages, and the record will be corrected. This can be particularly important for people who have tested positive for HIV but have not developed symptoms, so that any potential benefits will not be delayed by wage correction efforts. Disabled widows, widowers, and children eligible for benefits as a dependent on a spouse's or parent's Social Security record receive an amount that is a percentage of the worker's Social Security benefit. Supplemental Security Income: The Nonmedical Rules Of Eligibility SSI is a program that pays monthly benefits to people with low incomes and limited assets who are 65 or older, or blind, or disabled. As its name implies, "Supplemental" Security Income "supplements" a person's income up to a certain level that can go up every year based on cost-of-living adjustments. The level varies from one state to another, so check with your local Social Security office to find out more about SSI benefit levels in your state. We don't count all the income you have when we figure out if you qualify for SSI. And if you work, there are special rules we use for counting your wages. Again, check with Social Security to find out if you can get SSI. In addition to rules about income, people on SSI must have limited assets. Generally, individuals with assets under $2000, or couples with assets under $3000, can qualify for SSI. However, when we figure your assets, we don't count such items as your home, your car (unless it's an expensive one), and most of your personal belongings. Your Social Security office can tell you more about the income and asset limits. For more general information, ask for a copy of the booklet, SSI (Publication No. 05-11000). PART 3 -- HOW DOES SOCIAL SECURITY DEFINE DISABILITY? In this section, we'll explain the criteria you must meet in order to be considered "disabled." First, we'll explain in general terms how Social Security defines and determines disability. Then we'll discuss how it applies to people with HIV infection. The General Definition Of Disability Disability under Social Security is based on your inability to work because of a medical condition. You will be considered disabled if you are unable to do any kind of "substantial" work for which you are suited. (Usually, monthly earnings of $500 or more are considered substantial.) Your ability to work must be expected to last at least a year. Or, the condition that keeps you from working must be so severe that you are not expected to live. For children, we decide how the condition affects their ability to function--to do the things and behave in the ways that other children of the same age normally would. How This Definition Of Disability Applies To People With HIV Infection A person with symptomatic HIV infection is often severely limited in his or her ability to work. In other words, if the evidence shows that you have symptomatic HIV infection that severely limits your ability to work, and if you meet the other eligibility factors, the chances are very good that you will be able to receive Social Security or SSI Benefits. On the other hand, some people with HIV infection may be less impaired and able to work, so they may not be eligible for disability. PART 4 -- HOW DOES SOCIAL SECURITY EVALUATE YOUR DISABILITY? Social Security works with an agency in each state, usually called a Disability Determination Service (DDS), to evaluate disability claims. At the DDS, a disability evaluation specialist and a doctor follow a step-by-step process that applies to all disability claims, thus assuring a consistent approach to evaluating disability. First, the DDS specialists decide whether your impairment is "severe." This simply means the evidence must show that your disability interferes with your ability to work. The next step in the process is deciding whether the disability is included in a list of impairments. This list describes, for each of the major body systems, impairments that are considered severe enough to prevent an adult from doing any substantial work or in the case of children under the age of 18, impairments that are severe enough to prevent a child from functioning in a manner similar to other children of the same age. Recently we published a list of impairments for HIV infections. In this list, we have included many conditions associated with symptomatic HIV infection, including some that specifically apply to women and children with HIV infection (See next two sections). Some of the HIV-related conditions included in the HIV list of impairments are shown below. The level of severity that an impairment must meet to be found disabling are also specified in the regulations. o Pulmonary tuberculosis resistant to treatment o Kaposi's sarcoma o Pneumocystis carinii pneumonia (PCP) o Carcinoma of the cervix o Herpes Simplex o Hodgkin's disease and all lymphomas o HIV Wasting Syndrome o Syphilis and Neurosyphilis o Candidiasis o Histoplasmosis Remember: these are just a few examples. You can see a complete list of HIV-related impairments at any Social Security office. The complete list will also include the findings necessary for listed impairments to be considered disabling by Social Security. If you have symptoms of HIV infection that are not specifically included in (or equal in severity to) the impairments on our list, then DDS disability specialists will look at how frequently these conditions occur and how they affect your ability to function. The DDS team will evaluate how well you function in three general areas: daily activities; social functioning; and the ability to complete tasks in a timely manner, which requires the ability to maintain concentration, persistence, and pace. If you have "marked limitations" in any one of these functional areas and repeated manifestations of HIV meeting the criteria in the listings, you may be found disabled. A marked limitation is one that seriously interferes with your ability to function independently, appropriately, and effectively. It does not mean that you must be confined to bed, hospitalized, or in a nursing home. If the specialists decide that you are not disabled at this point because you do not have a condition that exactly matches or is equal in severity to one on our list, then they will look to see if your condition prevents you from doing the work you normally do. If it does not, then we look to see if it prevents you from doing any other type of work you're suited for, based on your age, education, and experience. If it does, you may still be found disabled. Remember, at all steps in the process, your impairment must be documented. Documentation includes medical records from your doctors, as well as laboratory test results, X-ray reports, etc. The HIV infection itself--that is, the presence of the virus--must be documented as well as any HIV-related manifestations. At all steps in the process it is important that we have evidence of signs, symptoms, and laboratory findings associated with HIV infection, as well as information on how well you are able to function day-to-day. The signs and symptoms may include: repeated infections; fevers/night sweats; enlarged lymph nodes, liver or spleen; lower energy or generalized weakness; dyspnea on exertion; persistent cough; depression/anxiety; headache; anorexia; nausea and vomiting; and side effects of medication and/or treatment, as well as how your treatment affects your daily activities. Evaluation Of HIV Infection In Women Statistics show that there is an increasing number of women with HIV diseases. Social Security's guidelines for the immune system recognize that HIV infection can show up differently in women than in men. In addition to following the criteria outlined in the previous section, DDS disability evaluators consider specific criteria for diseases common in women. These include: vulvovaginal candidiasis (yeast infection); genital herpes; pelvic inflammatory disease (PDI); invasive cervical cancer; genital ulcerative disease; and condyloma (genital warts caused by the human papillomavirus). Again, the level of severity necessary for these impairments to be considered disabling is included in the list of impairments. Evaluation Of HIV Infection In Children We also have separate listings for children with HIV infection. These guidelines recognize the fact that the course of the disease in children can differ from adults. As with adults, some children may not appear to have the conditions specified in the guidelines, or may have listed conditions that are not as severe as the guidelines require. When this happens, a functional assessment is made using criteria contained in the lists. A child may be disabled if the HIV-related impairments substantially reduce his/her ability to grow, develop, or engage in activities similar to children of the same age. For more information about disability benefits for children, ask Social Security for a copy of the booklet, Social Security And SSI Benefits For Children With Disabilities (Publication No. 05- 10026). PART 5 -- HOW DO YOU FILE FOR DISABILITY BENEFITS You apply for Social Security and SSI disability benefits by calling or visiting any Social Security office. All Social Security files are kept strictly confidential. It would help if you have certain documents with you when you apply. But don't delay filing because you don't have all the information you need. We'll help you get the rest of it after you sign up. The information you'll need may include: o your Social Security number and birth certificate; o the Social Security numbers and birth certificates for family members signing up on your record; and o a copy of your most recent W-2 form (or your tax return if you're self-employed). If you're signing up for SSI, you will need to provide records that show that your income and assets are below the SSI limits. This might include such things as bank statements, rent receipts, care registration, etc. You'll also need to give us information about how your condition affects your daily activities, the names and addresses of your doctors and clinics where you've received treatment, and a summary of the kind of work you've done in the last 15 years. If you have medical evidence such as reports of blood tests, laboratory work, or a physical, it would be helpful if you brought them with you. In the section below (What You Can Do to Expedite the Processing of Your Claim), we give you some guidelines for providing us with medical and vocational information that will help speed up your claim. But first, we want you to know what Social Security does to make the process work as smoothly as possible. What Steps Has Social Security Taken To Ensure Prompt Processing And Payment Of Disability Benefits? All HIV infection claims are given prompt attention and priority handling. For many people applying for SSI with a medical diagnosis of symptomatic HIV infection, the law allows us to PRESUME they are disabled. This permits us to pay up to 6 months of benefits pending a final decision on the claim. You will qualify for this immediate payment if: o a medical source confirms that the HIV infection is severe enough to meet SSA's criteria; o you meet the other SSI nonmedical eligibility requirements; and o you are not doing "substantial" work (See section, "The General Definition of Disability" in Part 3). If you have symptomatic HIV infection but the local Social Security office cannot provide immediate payment, a disability evaluation specialist at the DDS may still make a "presumptive" disability decision at any point in the process where the evidence suggests a high likelihood that your claim will be approved. (If we later decide you are not disabled, you will NOT have to pay back the money you received.) Special arrangements have been made with a number of AIDS service organizations, advocacy groups, and medical facilities to help us get the evidence we need to streamline the claims process. And many DDS's have Medical/Professional Relations Officers who work directly with these organizations to make this process work smoothly. What You Can Do To Expedite The Processing Of Your Claim You can play an active and important role in ensuring that your claim is processed accurately and quickly. The best advice we can give you is to keep thorough records that document the symptoms of your illness and how it affects your daily activities, and then to provide all of this information to Social Security when you file your claim. Below are some guidelines you can follow: o Document the symptoms of your illness early and often Use a calendar to jot down brief notes about how you feel on each day. Record any of your usual activities you could not do on any given day. Be specific. And don't forget to include any psychological or mental problems. o Help your doctor help you Not all doctors may be aware of all the kinds of information we need to document your disability. Ask your doctor or other health care professional to track the course of your symptoms in detail over time and to keep a thorough record of any evidence of fatigue, depression, forgetfulness, dizziness, and other hard-to-document symptoms. o Keep records of how your illness affected you on the job If you were working, but lost your job because of your illness, make notes that describe what it is about your condition that forced you to stop working. o Give us copies of all these records when you file In addition to these records, be sure to list the names, addresses, and phone numbers of all the doctors, clinics, and hospitals you have been to since your illness began. Include your patient or treatment identification number if you know it. Also include the names, addresses, and phone numbers of any other people who have information about your illness. PART 6 -- HELPING YOU RETURN TO WORK If you return to work, Social Security has a number of special rules, called "work incentives," that provide cash benefits and continued Medicare or Medicaid coverage while you work. They are particularly important to people with HIV disease who, because of the recurrent nature of HIV-related illnesses, may be able to return to work following periods o disability. The rules are different for Social Security and SSI beneficiaries. For people getting Social Security disability benefits, they include a 9-month "trial work period" during which earnings, no matter how much, will not affect benefit payments; and a 3-year guarantee that, if benefits have stopped because a person remains employed after the trial work period, a Social Security check will be paid for any month earnings are below the "substantial" level (generally $500). In addition, Medicare coverage extends through the 3-year timeframe after the trial work period, even if your earnings are substantial. SSI work incentives include continuation of Medicaid coverage even if earnings are too high for SSI payments to be made, help with setting up a "plan to achieve self-support" (PASS), and special consideration for pay received in a sheltered workshop so that SSI benefits may continue even though the earnings might normally prevent payments. These and other work incentives are explained in detail in the publication, Working While Disabled...How Social Security Can Help (Publication No. 05-10095). For a free copy, just call or visit your nearest Social Security office. PART 7 -- WHAT YOU NEED TO KNOW ABOUT MEDICAID AND MEDICARE Medicaid and Medicare are our country's two major government-run health insurance programs. Generally, people on SSI and other people with low incomes qualify for Medicaid, while Medicare coverage is earned by working in jobs covered by Social Security, for a railroad, or for the federal government. Many people qualify for both Medicare and Medicaid. Medicaid Coverage In most states, Social Security's decision that you are eligible for SSI also makes you eligible for Medicaid coverage. (Check with your local Social Security or Medicaid office to verify the requirements in your state.) State Medicaid programs are required to cover certain services, including inpatient and outpatient hospital care and physician services. States have the option to include other services, such as intermediate care, hospice care, private duty nursing, and prescribed drugs. For more information about Medicaid, contact your local Medicaid agency. Medicare Coverage If you get Social Security disability, you will qualify for Medicare coverage 24 months after the month you became entitled to those benefits. Medicare helps pay for: o inpatient and outpatient hospital care; o doctor's services; o diagnostic tests; o skilled nursing care; o home health visits; o hospice care; and o other medical services. For more information about Medicare, call or visit your local Social Security office to ask for the booklet Medicare (Publication No. 05-10043). FOR MORE INFORMATION For more information or to apply for benefits, call or visit Social Security. It's easiest to call Social Security's toll-free telephone number. The number is 1-800-772-1213. You can speak to a representative 7 a.m. to 7 p.m. each business day. The best times to call are early in the morning, early in the evening, late in the week, and toward the end of the month. The Social Security Administration treats all calls confidentially--whether they're made to our toll-free numbers or to one of our local offices. We also want to ensure that you receive accurate and courteous service. That's why we have a second Social Security representative monitor some incoming and outgoing telephone calls. Note from the AIDS Information Center: This document reflects changes in Social Security rules that took effect on July 2, 1993 and, also, how SSA evaluates claims based on HIV/AIDS. Copies of this publication, available in English and Spanish, can be ordered through Social Security's toll-free number, 1-800-772-1213. The publication numbers are 05-10020 (English) and 05-10920 (Spanish). For bulk quantities call the Public Information Distribution Center at (410) 965-0945. The fax number for ordering publications is (410) 965-0696. ------------------------------------------------------------------------------- Question 4.4. What if you can't afford AZT? PATIENT ASSISTANCE PROGRAM AT BURROUGHS WELLCOME The Burroughs Wellcome Company has announced changes in its Patient Assistance Program (PAP) to make access to its drugs easier for disadvantaged patients. Physicians can now call a toll-free number, once they have determined that a patient is in need, to receive authorization to enroll the patient in the program. Upon authorization, the physician will give the patient a prescription benefit card from PCS Health Systems that can be used at any pharmacy. To qualify, patients must meet the following guidelines: o be a resident of the United States or its territories; o be financially disadvantaged; o have applied for and be awaiting reply from other prescription funding sources; or o not qualify for private or government assistance. The primary patient groups expected to participate are those using Burroughs Wellcome products for HIV and related infections, those with herpesvirus infections, transplant recipients, and those with cancer or congestive heart failure. Enrollment in the PAP must be initiated by a physician. To find out if an individual is eligible, patients should have their physicians call (800) 722-9294. ------------------------------------------------------------------------------- Question 4.5. What about DNCB? (please contribute) (please contribute to this FAQ) Archive-Name: aids-faq3 Last-Modified: 10 Nov 1993 =============================================================================== Section 5. The common debates. Q5.1 What are Strecker and Segal's theories that HIV is manmade? Q5.2 Other conspiracy theories. Q5.3 Duesberg's Risk-Group Theory Q5.4 Contaminated polio vaccine? (please contribute) Q5.5 Who is Lorraine Day? (please contribute) ------------------------------------------------------------------------------- Question 5.1. What are Strecker and Segal's theories that HIV is manmade? Jakob Segal's theory is that HIV was formed from visna (a sheep virus) and HTLV-I (Human T-cell Leukemia Virus) by US army biological research labs in 1977 or 1978. The virus supposedly escaped accidentally after being tested on prisoners. Robert Strecker's theory is that HIV was formed from visna and BLV (Bovine Leukemia Virus) by the US in the 1970's after 30-40 years of work. The virus was supposedly tested on populations in Africa and was deliberately introduced into the US homosexual community through the hepatitis B vaccination program. The alleged evidence to support this theory: * Visna is very similar to HIV. HIV can be formed by combining the genes of visna and BLV or HTLV. HIV is not similar to primate viruses. The government was interested in biological warfare and was planning to make an immune-system destroying virus. In particular, the DOD Appropriations for 1970 Hearings, 91st Congress, Part 6, p 129 states: There are two things about the biological agent field I would like to mention. One is the possibility of technological surprise. Molecular biology is a field that is advancing very rapidly, and eminent biologists believe that within a period of 5 to 10 years it would be possible to produce a synthetic biological agent, an agent that does not naturally exist and for which no natural immunity could have been acquired. Mr. Sikes. Are we doing any work in that field? Dr. MacArthur. We are not. Mr. Sikes. Why not? Lack of money or lack of interest? Dr. MacArthur. Certainly not lack of interest. [MacArthur provides the following information:] The dramatic progress being made in the field of molecular biology led us to investigate the relevance of this field of science to biological warfare. A small group of experts considered this matter and provided the following observations: * All biological agents up to the present time are representatives of naturally occurring disease, and are thus known by scientists throughout the world. They are easily available to qualified scientists for research, either for offensive or defensive purposes. * Within the next 5 to 10 years, it would probably be possible to make a new infective microorganism which could differ in certain important aspects from any known disease-causing organisms. Most important of these is that it might be refractory to the immunological and therapeutic processes upon which we depend to maintain our relative freedom from infectious disease. * A research program to explore the feasibility of this could be completed in approximately 5 years at a total cost of $10 million.'' * HIV is a new disease that appeared suddenly in the late 1970's without a natural source. * HIV could have been easily synthesized in a laboratory in the 1970's. The evidence is overwhelmingly against these theories. The key problem with these theories is they arose in the early 1980's, before SIV (simian immunodeficiency virus) was discovered and before the relevant viruses were sequenced. The genetic sequences clearly show: * HIV is much closer to SIV (simian immunodeficiency virus) than HIV is to visna, BLV, HTLV or any other known virus. * HIV can't be formed from splicing together parts of other known viruses. Viral genetic sequences can be ftp'd from ncbi.nlm.nih.gov in repository/aids-db. To summarize the other arguments against Strecker and Segal's theories: * The military testimony described a future study to see if making a new agents was feasible, not to actually produce it. More importantly, they are looking for an agent refractory to immunological processes; this means something resisting immunological processes. The quoted testimony and other parts of the testimony state they are looking for a new agent for which people do not have natural immunity; this is entirely different from an agent that destroys the immune system. It is also much easier than producing something like HIV. * Most scientists believe HIV evolved from SIV or a close relative. HIV did not suddenly appear in the late 1970's, but has been found in preserved blood samples from the 1950's. * Biotechnology was not sufficently advanced in the 1970's to produce something like HIV, and it is debatable that it would be possible even now. Since the details of HIV are not understood even now, it is inconceivable that someone could have deliberately designed HIV in the 1970's. Strecker's claim that HIV was introduced via hepatitis B vaccinations is extremely doubtful. McDonald et al, Lancet, 1983 Oct 15, 2(8355):882-4 state the incidence of AIDS in unvaccinated sexually active homosexual men was _higher_ than in vaccinated men, although the rates were too low for statistical significance. Stevens et al, JAMA, 1986 April 25, 255(16):2167-2172 tested blood samples from the beginning of the vaccination program and found that 6.6% were already HIV-positive. Therefore, HIV couldn't have been introduced via the vaccinations. While evaluating these theories, I recommend treating Segal's and Strecker's literature citations with extreme skepticism, as they are both rather casual about the connection between their claims and the contents of the papers. In particular, Strecker provides quotes that do not appear in the cited papers. Finally, since both theories allege a coverup of the connection between visna and HIV, a clear explanation of their relationships may be helpful. The viruses described above are all retroviruses. Retroviruses have three subfamilies: Oncoviruses, Lentiviruses, and Spumaviruses. HTLV is a oncovirus, while the remainder are lentiviruses. The analysis of genetic sequences gives strong evidence for the evolution of lentiviruses. They apparently branched into the primate lentiviruses (HIV-1, HIV-2, and SIV), and the nonprimate lentiviruses (visna, BLV, EIAV, FIV, CAEV, etc.) Thus, HIV and visna have many similarities since they are both lentiviruses, but HIV and SIV are much more similar. (See Fields Virology for more information on retrovirus classification and "The Emergence of Simian Human Immunodeficiency Viruses", Myers et al, AIDS Research and Human Retroviruses, 8(3), 1992 373-386 for more information on lentivirus evolution.) ------------------------------------------------------------------------------- Question 5.2. Other conspiracy theories. One school of thought holds that the "AIDS was a U.S. biological warfare experiment" myth was extensively spread as part of a dezinformatsiya campaign by Department V of the Soviet KGB (their `active measures' group). They may not have invented the premise (Soviet disinformation doctrine favored legends originated by third parties), but they added a number of signature details such as the name of the supposed development site (usually Fort Meade in Maryland) which still show up in most retellings. According to a defector who was once the KGB chief rezident in Great Britain, the KGB promulgated this legend through controlled sources in Europe and the Third World. The Third World version (only) included the claim that HIV was the result of an attempt to build a "race bomb", a plague that would kill only non-whites. From the CDC AIDS Clearinghouse: "Soviets Secretly Tried to Blame U.S. for AIDS--CIA" Reuters (09/30/93) Langley, Va.--For more than five years, the former Soviet Union attempted to blame the AIDS virus on a plot by U.S. military scientists, according to newly declassified CIA documents. The papers reported that the Soviets launched a campaign in 1983 aiming to tie the emergence of AIDS to American biological weapons research. The disinformation was circulated in 25 different languages in over 200 publications, as well as in posters, leaflets, and radio broadcasts, in more than 80 countries before the campaign was finally abandoned by the Soviets, according to a study cited by the CIA in the documents. The Soviets dropped the campaign in 1988 when the United States refused to cooperate with them on a research program on AIDS, which was by then spreading in the U.S.S.R., said the CIA article. The Soviet campaign was apparently retaliation for the Reagan administration's claims of Soviet-produced "yellow rain," or yellow traces found on vegetation due to a Soviet biological weapon. Reproduction of the above excerpt is encouraged; however, copies may not be sold, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1993, Information, Inc., Bethesda, MD ------------------------------------------------------------------------------- Question 5.3. Duesberg's Risk-Group Theory The following discussion is excerpted from the sci.skeptic ``Frequently Questioned Answers'' posting. The generally accepted theory is that AIDS is caused by the Human Immunodeficiency Virus (HIV). There are two different versions of HIV: HIV-1 and HIV-2. These viruses are believed, on the basis of their genetic sequences, to have evolved from the Simian Immunodeficiency Virus (SIV), with HIV-2 being much more similar to SIV. Several years after the initial HIV infection, the immune system is weakened to the point where opportunistic infections occur, resulting in the syndrome of AIDS. A good reference for more information on the "mainstream" view of AIDS is: The Science of AIDS: readings from Scientific American magazine. New York: W.H. Freeman, c1989. Peter Duesberg has promulgated this theory: HIV is a harmless retrovirus that may serve as a marker for people in AIDS high-risk groups. AIDS is not a contagious syndrome caused by one conventional virus or microbe. AIDS is probably caused by conventional pathogenic factors: administration of blood transfusions or drugs, promiscuous male homosexual activity associated with drugs, acute parasitic infections, and malnutrition. Drugs such as AZT promote AIDS, rather than fight it. His theory is explained in detail in "Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome: Correlation but not Causation", Proc. Natl. Acad. Sci. USA V86 pp.755-764, (Feb. 1989). He claims as evidence for his theory: * HIV does not meet Koch's postulates for the causative agent of an infectious disease. * The conversion rate from HIV infection to AIDS depends greatly on the country and risk group membership, so HIV isn't sufficient to cause AIDS. * The HIV virus is minimally active, does not seem to infect many cells, and is suppressed by the immune system, so how could it cause problems? * It takes between 2 and 15 years from HIV infection for AIDS to occur. HIV should cause illness right away or never. * HIV is similar to other retroviruses that don't cause AIDS. There seems to be nothing special about HIV that would cause AIDS. * AIDS patients suffer very different diseases in the US and Africa, which suggests that the cofactors are responsible, not AIDS. * How could two viruses, HIV-1 and HIV-2, evolve at the same time? It doesn't seem likely that two deadly viruses would show up together. Virtually the entire scientific community considers Duesberg's theory unsupportable, although he was a respected researcher before he came out with his theory about AIDS. There is no suggestion that his theories are the result of a political agenda or homophobia. Some of the arguments against him are: * People who receive HIV tainted blood become HIV+ and come down with AIDS. People who receive HIV-free blood don't get AIDS (unless they get HIV somewhere else). Thus, it is the HIV, not the transfusion, that causes AIDS. See also Q2.4 `How risky is a blood transfusion?' for details on how blood transfusions have become less dangerous since HIV antibody testing began. * The risk factors (homosexuality, drug use, transfusions, etc.) have been around for a very long time, but AIDS doesn't show up until HIV shows up. People who engage in homosexuality, drug use, etc. but aren't exposed to HIV don't get AIDS. On the other hand, people who aren't members of "risk groups" but are exposed to HIV get AIDS. Thus, it is the HIV, not the risk factors, that causes AIDS. * With a few recent exceptions, everyone with an AIDS-like immune deficiency tests positive for HIV. Everyone with HIV apparently gets AIDS eventually, after an average of 8 years. * Koch's postulates are more of historical interest than practical use. There are many diseases that don't satisfy the postulates. * It is not understood exactly how HIV causes AIDS, but a lack of understanding of the details isn't a reason to reject HIV. * A recent study by Ascher (see abstract below) matched up people in the same risk groups and found those with HIV got AIDS but those without HIV didn't. More information can be found in published rebuttals to Duesberg, such as in Nature V345 pp.659-660 (June 21, 1990), and in Duesberg's debate with Blattner, Gallo, Temin, Science V241 pp.514-517 (1988). Here are some recent references to Duesberg's theory: Kolata, Gina, Debunking Doubts That H.I.V. Causes AIDS, New York Times (03/11/93), P. B13. A team of California researchers has disproved a theory claiming that recreational drug use, and not HIV, is the cause of AIDS. The scientists reported in a commentary published today in Nature that their research shows no relationship between recreational drug use, excluding IV-drugs, and the development of AIDS. The research team was led by Dr. Michael S. Ascher, an immunologist at the California Department of Health Services, and Dr. Warren Winklestein Jr., an epidemiologist at the University of California--Berkeley. Dr. Ascher and colleagues wrote their paper in response to a challenge by Tom Bethell, a media fellow at the Hoover Institution at Stanford University, to compare people who used drugs with those who didn't and to determine whether those who took drugs had a higher incidence of AIDS. Bethell wrote in an article in the San Francisco Chronicle of the theory proposed six years ago by Dr. Peter H. Duesberg, a molecular biologist at the University of California--Berkeley. Duesberg argues that HIV is not the cause of AIDS and that the drug AZT speeds, rather than slows, the depletion of the immune system. Bethell asked why no research had been done on this hypothesis. Therefore, Dr. Ascher et al. retested their hypothesis of the analysis of the San Francisco Men's Study, a group of 1,034 randomly selected single men who lived in San Francisco and were 25-54 years old in 1984, when the study began. The researchers found that homosexuals and heterosexuals in the study were equally likely to use drugs. However, 26 percent of homosexuals developed AIDS, whereas none of the heterosexuals did. All of the men were infected with HIV, but there was no link between drug use and AIDS. Related Story: Wall Street Journal (03/11) P. B5 Ascher, M.S. et al., Does Drug Use Cause AIDS?, Nature (03/11/93) Vol. 362, No. 6416, P. 103. Although Peter Duesberg, a professor of molecular biology at the University of California--Berkeley, believes that AIDS and drug use are related, they are not, writes M.S. Ascher et al. of the California Department of Health Services in Berkeley, Calif. Duesberg has maintained since 1987 that HIV is not the infectious aetiological agent for AIDS and has recently stated that either drug consumption or conventional clinical deficiencies and their treatments cause AIDS-related illnesses. However, the researchers found this untrue. They analyzed data from a unique population-based cohort study, the San Francisco Men's Health Study (SFMHS). It is based on a randomly selected cohort of 1,027 single men 25-54 years old. The researchers examined the cohort at 6-month intervals for 96 months, and obtained drug-use data and determined HIV serostatus at each examination. The researchers compared heavy drug use for the 25-months period before entry into the study among 215 heterosexual and 812 homosexual/bisexual cohort members. Except for amyl nitrate, with 18 percent heavy use in homosexuals versus no heavy use among heterosexuals, the percentage of subjects reporting heavy use of each drug was similar in both sexual preference groups: 36 versus 39 percent for marijuana; 7 versus 4 percent for cocaine; and 1 versus 5 percent for amphetamines, respectively. During the 96 months of follow-up, 215 cases of AIDS occurred among the homosexual/bisexual men compared with none among the heterosexuals. It was found that if heavy use of marijuana, cocaine or amphetamines is casually linked to AIDS, a cumulative incidence of 56 cases among the heterosexual subjects would be expected. Duesberg, Peter, HIV and the Aetiology of AIDS, Lancet (04/10/93) Vol. 341, No. 8850, P. 957. Because there is no proof that HIV is the cause of AIDS, the hypothesis that drug use leads to AIDS will hopefully become a hindrance to the physiologically (AZT) and psychologically (positive AIDS test) toxic public health initiatives, writes Peter Duesberg of the University of California--Berkeley. In the Lancet's March 13 issue, Schechter et al. call Duesberg's hypothesis that injected and orally used recreational drugs and AZT lead to AIDS, "a hindrance to public health initiatives." However, their hypothesis that HIV is the cause of AIDS has not attained any public health benefits. The U.S. government spends $4 billion annually, but no vaccine, no therapy, no prevention, and no AIDS control have resulted from work on this hypothesis. Schechter et al. conclude that HIV has a key role in CD4 depletion and AIDS based on epidemiological correlations with antibodies against HIV and with self reported recreational drug use among homosexuals from Vancouver. However, their survey neglects to disprove Duesberg's drug-AIDS hypothesis, because it does not provide controls--i.e., confirmed drug-free AIDS cases--and because it does not quantify drug use and ignores AZT use altogether. To refute Duesberg's hypothesis Schechter would have to produce a controlled study demonstrating that over a period of up to 10 years HIV-positive patients who use recreational drugs or AZT or both have the same AIDS risks as positives who do not do so. The 10 year period is claimed by proponents of the HIV hypothesis to be the time needed for HIV to cause AIDS. Alternatively, they could show that HIV-free individuals who have used drugs for 10 years never get AIDS-defining illnesses, concludes Duesberg. Clayton, Julie, Duesberg's Anti-AZT Campaign Continues, Nature (06/24/93) Vol. 363, No. 6431, P. 660. The controversial American molecular biologist who claims that recreational drug use rather than HIV is the cause of AIDS has rejected as a "fabrication" the findings of a recent study designed to disprove his hypothesis. Michael Ascher and colleagues of the California Department of Health Services used data from the San Francisco Men's Health Study to demonstrate that men who were heavy drug users but showed no evidence of HIV infection did not contract the virus, whereas those in the study who were either light drug users, or did not use drugs at all, were shown to be infected with HIV. The study contradicts Peter Duesberg's idea that AIDS is a clinical development of long-term consumption of recreational drugs and of treatment with AZT. But Duesberg said at a recent meeting in London organized by a group known as the Steering Committee Against AZT Malpractice (SCAM), that he refused to accept the group's conclusion, and continued to insist that his own interpretations are sound. He continued to criticize the labeling of one table in the publication of the California study for not indicating the category of "no drug use," and that the paper was therefore invalid. He apparently ignored an explanation in the text that these subjects were represented in the table's category of "light" drug users. In addition, he said that he refused to accept the way that the results of the study were presented in a graph, claiming that "the curve is a fabrication and the conclusions are flawed." Moreover, Duesberg said that the research group's findings could be interpreted to support the opposite conclusion and suggested that there was a 100 percent correlation between AIDS and drug use. Maddox, John, Where the AIDS Virus Hides Away, Nature (03/25/93) Vol. 362, No. 6418, P. 287. Because of the new findings that HIV replicates in the lymph nodes while in the so-called latent period, Professor Peter Duesberg of the University of California--Berkeley may want to change his position, writes John Maddox of Nature. Duesberg has held that drug taking is responsible for AIDS, and not HIV. Most viruses are DNA viruses, which ordinarily replicate within cells by hijacking the preexisting machinery of DNA transcription and translation. But the genomes of retroviruses, like HIV, by contrast, consist of RNA. Those of the lentiviruses, of which HIV is one, come equipped with a gene specifying a reverse transcriptase (for converting RNA into the complementary DNA). While the RNA genome may be used, as if it were one of the infected cell's own messenger molecules, to generate the proteins that would allow an intact virus particle to be regenerated, by far the more efficient means of replication is that DNA complementary to the viral RNA should be incorporated in the genome of the cell, where it will serve as a template for the production of its own genomic RNA and thus for intact viral particles. Duesberg claims that it is difficult to recover from helper T lymphocytes, whose attrition for many patients indicates the onset of overt AIDS, virus particles that might plausibly infect others. The new findings show that the virus is alive and well in the lymph nodes, among other locations, of those infected with HIV. The recent revelations suggest that, nevertheless, the alternatives for AIDS patients are even less justifiable than seemed likely a few years ago. Duesberg should now admit the possibility that he has been mistaken, concludes Maddox. ------------------------------------------------------------------------------- Question 5.4. Contaminated polio vaccine? (please contribute) (please contribute to this FAQ) ------------------------------------------------------------------------------- Question 5.5. Who is Lorraine Day? (please contribute) (please contribute to this FAQ) Archive-Name: aids-faq4 Last-Modified: 10 Nov 1993 =============================================================================== Section 6. Internet resources. Q6.1 Ben Gardiner's Gopher AIDS Database Q6.2 CDC AIDS Public Information Dataset. Q6.3 HIVNET/AEGIS Gateway (BETA VERSION) Q6.4 Other USENET newsgroups. ------------------------------------------------------------------------------- Question 6.1. Ben Gardiner's Gopher AIDS Database The 'gopher' system provides convenient menu-driven access to a wealth of arcana--and valuable information--on the Internet. Daily, more and more resources are made available in gopherspace. Generally, your local gopher client (if one is installed) will be available by typing 'gopher' at your system prompt; your local system administrator should be able to provide further details. Local gopher clients in turn allow convenient access to other remote gopher clients throughout the Internet. One of the most valuable gopher resources for AIDS-related information is the mirror of Ben Gardiner's AIDS-Info BBS database (also available by direct modem dialup -- see below section). This database exists on the University of California at San Francisco Experimental Gopher. It may be reached either, (1) through the menu system of your local gopher: --> More Gophers and Other Internet Services/ --> All Registered Gophers/ --> North America/ --> USA/ --> california/ --> University of California - San Francisco, UCSFYI/ --> Computers and Networking Guide to Services at UCSF/ --> Questions, Answers and Information about Everything/ --> Databases (including Ben Gardiner's AIDS BBS database)/ or, (2) by typing 'gopher itsa.ucsf.edu', and going through the final three menus. However, these particular menus are subject to change. The most convenient means of reaching the database is by adding the below information to your '.gopherrc' file. This will set a bookmark in your personal gopher for the AIDS-Info BBS, which may be reached by typing 'v' from anywhere within the gopher system. The information to add, using your favorite system editor, is: Type=1 Name=Databases (including Ben Gardiner's AIDS BBS database) Path=1/.i/.q/.d Host=itsa.ucsf.edu Port=70 The University of California at San Francisco Experimental Gopher also provides gopher gateways to a wide variety of Biology and Medical resource gophers. The UCSF gopher may be reached as described above ('gopher itsa.ucsf.edu'), or most simply by adding the following to your '.gopherrc' file: Type=1 Name=Bio and Medical Gophers and Info. Sites Path=1/Bio and Medical Gophers and Info. Sites Host=itsa.ucsf.edu Port=70 ------------------------------------------------------------------------------- Question 6.2. CDC AIDS Public Information Dataset. You can get the CDC AIDS public information Dataset via anonymous ftp. Michelle Murrain has set up a small AIDS ftp site, which has the most recent dataset (data through 1992). She gets each year's version (usually in June-July) and puts it there. It contains a line of data on each individual, including transmission category, OIs diagnosed, date of diagnosis, etc. If you send her your snail mail address she'll send you a copy of the guide to the dataset. Michelle has used the dataset to analyze differences in OI prevalence in women and men (J Women's Health - out soon) and is now in the process of looking at ethnic and gender differences in survival, especially at whether everybody has benefited from recent improvements in survival with AIDS. The ftp site is: dawn.hampshire.edu:AIDS The name of the file is PIDS92Q4.DAT (BEWARE the file is 16 MB!!) There is also a Women and AIDS bibliography there. If anyone has resources they would like to share with folks via FTP let her know and she'll be glad to add them. Contact Michelle Murrain via mmurrain@HAMP.HAMPSHIRE.EDU ------------------------------------------------------------------------------- Question 6.3. HIVNET/AEGIS Gateway (BETA VERSION) After a lot of to-ing and fro-ing, the gateway for the HIVNET/AEGIS message areas is about to go into testing. If you are interested, I would like to invite you to be part of our test group. Thank you for your interest in the HIVNET/AEGIS mailing lists. HIVNET is, as you probably know, a network for HIV and AIDS information and discussion. HIVNET is primarily based in Europe and, together with our sister organization, AEGIS, based in the US and reaching to other continents as well, try to make as much free information available as possible. We distribute both message areas (analogous to Usenet newsgroups) and files, containing periodicals such as Aids Treatment News and the CDC Aids Daily Summary, as well as one-shot documents and reports. HIVNET and AEGIS have been based on Fido protocols and technology, allowing low-cost entry into the net. The file distribution capabilities of Fidonet have been put to good use as well. For this test period, we are gatewaying the following areas to mailing lists, based at NLnet. NLnet, the commercial Internet provider in the Netherlands, has been kind enough to subsidize our connectivity. For the time being, we do NOT wish to distribute these areas as newsgroups, out of concern for the signal to noise ratio. Up until now, these groups have all been extremely high signal in comparison with areas such as sci.med.aids. In the future, if the demand grows enough, we will look into distribution as a separate hierarchy. The configuration is still be tested, so please feel free to report any anomalies. The lists are all resident on inter.nl.net. The available lists are: Fido area List name Source Description --------- --------- ------ ----------- AIDS.DATA AEGIS Read-only - data postings AIDS.DIALOGUE hiv-aids-dialogue AEGIS Discussion area AIDS.DRUGS AEGIS Read-only - NLM Drug desc. AIDS.SPIRITUAL hiv-aids-spiritual AEGIS Spiritual discussion AIDS.TRIALS AEGIS Read-only - NLM Drug trials AIDS.WOMEN hiv-aids-women AEGIS Discussion of women's issues AIDS.NL hiv-aids-nl HIVNET Dutch language discussion and data AIDS.FR hiv-aids-fr HIVNET French language discussion and data HIVNET.GER hiv-hivnet-ger HIVNET German language discussion and data AIDS/ARC hiv-aids-arc FIDONET Discussion - from Fidonet backbone INTERNET hiv-internet HIVNET Discussion and announcements about the lists and gateway If anyone should have an article for submission to AIDS.DATA, it should be sent to hiv-aids-data, which will forward it on to the moderator. Please send me a list of which lists you want to join. After the setup, to join a list or unsubscribe, send a message to the -request address, such as hiv-aids-dialogue-request@inter.nl.net. Submissions go to the list name at inter.nl.net, i.e., hiv-aids-dialogue@inter.nl.net. The file base should be available within the month via anonymous FTP and gopher. There will be a facility to receive announcements of new files. If you wish to join this list as well, let me know. A few notes about the lists and gateway: * E-mail replies to individuals are not really possible at this time, due to limitations in the gatewaying software. At the bottom of this document is a list of working addresses. * The volume on some groups can be pretty high, such as hiv-aids-data. Be warned! it is, however, a very useful source of information. * The gateway itself, at least for the time being, is a ramshackle, Rube-Goldbergesque collection of PD software (FredGate, Waffle), Fido software (Gecho, FrontDoor) and Perl scripts, all running on a poor 386SX in my work room. Later I hope to move the whole thing to a FreeBSD Unix box. First I have to find a machine to develop it on! Any questions can be addressed to either the hiv-internet list (by preference), or to me personally at matthew@ic.uva.nl. I am automatically connecting everybody to the hiv-internet list, at least during the test phase. Thank you for your interest! Best regards, Matthew Working e-mail addresses: Matthew Lewis matthew@hivnet.org Tjerk Zweers Tjerk.Zweers@amsterdam.hivnet.org (aids.data moderator) Sister Mary Elizabeth Mary.Elizabeth@aegis.hivnet.org (aids.data moderator) Jan Langenberg Jan.Langenberg@amsterdam.hivnet.org (aids.nl overseer) Lucas Vermaat Lucas.Vermaat@limburg.hivnet.org (sysop, HIVNET board) Ron Dixon Ron.Dixon@london.hivnet.org (sysop) Any of the users at the following BBS systems in HIVNET are reachable at the address of the system, with the FULL NAME as user name, with '.' instead of spaces: Fido Internet ---- -------- 1:103/927 aegis.hivnet.org 2:25/555 london.hivnet.org 2:280/413 amsterdam.hivnet.org 2:280/419 hivnet.org 2:284/306 limburg.hivnet.org Other systems may follow, as the gateway is expanded. ------------------------------------------------------------------------------- Question 6.4. Other USENET newsgroups. Questions about AIDS come up occasionally in sci.med and soc.motss. The newsgroup bionet.molbio.hiv may or may not be available at your site--it discusses technical issues related to the molecular biology of HIV. As with any newsgroup, including sci.med.aids, you should read these for a few days before posting, to see if your question has been answered already, and to get a feel for the tone of the group. =============================================================================== Section 7. Other Electronic Information Sources. Q7.1 Ben Gardiner's list of AIDS BBSes. Q7.2 National AIDS Clearinghouse Guide to AIDS BBSes. Q7.3 National Library of Medicine AIDSLINE (please contribute) Q7.4 Commercial Bulletin Boards Q7.5 Reappraisal of the HIV-AIDS Hypothesis. Q7.6 Lesbian/Gay Scholars Directory. ------------------------------------------------------------------------------- Question 7.1. Ben Gardiner's list of AIDS BBSes. The below list of Bulletin Board Systems is taken from Ben Gardiner's AIDS-Info BBS. First is a summary of telephone numbers, followed by writeups on some of the specific services. Subject: New Black Bag BBS List Date: Dec 7 1991 (760 lines) AIDSBBS.LST AIDS Bulletin Boards Systems (BBS) 7-4-91 Phone Number | Name of Service - | Baud |Rates or Other Information --------------------------------------------------------------------------- (415) 626-1246 |AIDS Info BBS SFO|300/2400|Free, can be an alias (512) 444-9908 |HEALTH-LINK AUS|300/2400|Free, can be an alias (302) 731-1998 |Black Bag BBS DE|300/1200|List of Medical BBSs &... (215) 755-1917 |ECB Systems |300/2400|Free, can be an alias (602) 235-9653 |St. Joseph's Hosp. PHX|300/1200|Free, Medical BBS (703) 578-4542 |GLIB VA|300/2400|Free, Donations/Over 18 (718) 849-1614 |BACKROOM NYC|300/2400|Charge, Gay BBS/ Gaycomm (800) 926-2792 |NAPWA-Link DCA|300/2400|Charge, 8 Toll Free Lines (206) 323-4420 |Seattle AIDS Info SEA|300/1200|Free, can be an alias (213) 825-3736 |UCLA-DAIMP (AIDS) LAX|300/2400|Free, can be an alias (800) 825-3736 |UCLA-DAIMP (AIDS) LAX|300/2400|Free, Toll Free-CA only (504) 584-1654 |Tulane Med. Ctr. BTR|300/9600|Free (516) 842-7518 |Utopian Quest NY|300/1200|Free, $$ or Services (212) 686-5248 |Utopian Quest NYC|300/1200|Free, $$ or Services (214) 247-5609 |AIDS Info. Exch. HOU|300/1200|Free, Login: Type AIDS (214) 247-2367 | " " " " |300/2400| " " " " (214) 247-8432 | " " " " |300/2400| " " " " (214) 247-8437 | " " " " |300/2400| " " " " (202) 639-8735 |HRCF NET DCA|300/2400|Free, can be alias (206) 543-3719 |U. of Wash. HHS SEA|300/9600|Free, can be alias (415) 863-9697 |FOG CITY SFO|300/2400|Free, Use Name: AIDS INFO (404) 351-9757 |Medical Forum ATL|300/2400|Free (518) 783-7251 |CCMC-AIDS |300/2400|Free (415) 863-9718 |AIDS Action BBS SFO|300/2400|Free (519) 822-0896 |AIDS Info - Canada |300/2400|Free (604) 681-0670 |Questor Project-Canada|300/2400|Free (800) 245-2601 |HOTFLASH STL|300/2400|Charge/GayCom (803) 252-6103 |Paragon SC|300/2400|Charge/Gaycom (713) 521-2191 |Exchange BBS HOU|300/2400|Charge/Gaycom (316) 269-4208 |Land of Awes KS|300/2400|Charge/Gaycom (800) 522-6388 |CDC AIDS Lab Info ATL|300/2400|Registration for labs (617) 245-9464 |Doug's Den BOU|300/2400|Charge/GayCom (301) 235-4651 |Harbor Bytes BLT|300/2400|Charge/GayCom (514) 597-2409 |S-TEK Montreal|300/2400|Charge/GayCom (201) 968-7883 |The Super Stud NJ|300/2400|Charge/GayCom (708) 694-4298 |The Lambda Zone CHI|300/2400|Charge/GayCom [Copyright Ben Gardiner, 1993, for AIDS Info BBS, San Francisco, California, U.S.A., 1-415-626-1246, source of this file. Only non-commercial reproduction is permitted.] ------------------------------------------------------------------------------- Question 7.2. National AIDS Clearinghouse Guide to AIDS BBSes. Subject: Guide to AIDS BBSes Date: Apr 2 1993 (396 lines) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention CDC National AIDS Clearinghouse A SELECTED GUIDE TO AIDS-RELATED ELECTRONIC BULLETIN BOARDS INTRODUCTION This is a guide to representative electronic bulletin boards containing information about HIV infection and AIDS. This guide is not a complete listing of all AIDS-related electronic bulletin boards, but has been prepared as an introduction to the subject and can be used as a starting point to locate information. This document was prepared by the CDC National AIDS Clearinghouse; please notify the CDC Clearinghouse with any updates or additions. Inclusion of a service does not imply endorsement by the Centers for Disease Control and Prevention, the CDC Clearinghouse, or any other organization. Electronic bulletin board systems, often called BBS's or bulletin boards, are computerized information services that are accessed by using a computer, modem, and telephone line. BBS's meet today's demands for current news on HIV infection and AIDS and provide a convenient means for information exchange among professionals, volunteers, and individuals involved in the fight against AIDS. BBS's can consist of any of the following features: electronic mail, bulletin board forums, searchable databases, and transferrable information files. Electronic mail is a convenient way of sending private messages to others using the same system. Bulletin board forums, sometimes called conferences, are interactive systems for posting public messages to groups of users connected to the same system. Searchable databases can sometimes be accessed through BBSs, providing a quick means of obtaining specific information such as bibliographic references, full-text articles, and information about organizations. Text files of information can be downloaded from most BBS's, then later edited and/or printed at the user's computer. Many BBS's provide gateways to national forums. Messages posted on these forums are "echoed" on networks linking BBS's throughout the country. Some examples of these forums include the FidoNet AIDS/ARC forum, the UseNet SCI.MED.AIDS newsgroup (available on all Internet nodes as the AIDS listserv), the GayComm Talk About AIDS forum, and the AIDS Education and General Information Service (AEGIS) network's AIDS.DATA and AIDS.DIALOG. To access a BBS, your computer (IBM-compatible or Macintosh) must be equipped with a modem (external or internal; 2400+ baud recommended) and communications software (such as ProComm, CrossTalk, or Red Ryder). The modem must be connected to the computer and to a phone line. It is preferable, but not necessary, to use a phone jack separate from any telephones; the phone and the modem can use the same phone line, but not simultaneously. CDC NAC ONLINE CDC NAC ONLINE is the computerized information network of the CDC National AIDS Clearinghouse and gives AIDS-related organizations direct computerized access to the CDC Clearinghouse and its information and bulletin board services. It contains the latest news and announcements about many critical AIDS- and HIV-related issues, including prevention and education campaigns, treatment and clinical trials, legislation and regulation, and upcoming events. CDC NAC ONLINE provides direct access to CDC Clearinghouse databases such as the Resources and Services Database of organizations providing AIDS-related services. The system also features electronic mail, interactive bulletin board forums, and is the original source of the AIDS Daily Summary newsclipping service. CDC NAC ONLINE users include U.S. Public Health Service agencies, universities, health administrators, community-based organizations, and other professionals working in the fight against AIDS. CDC NAC ONLINE is a free service for qualified non-profit organizations and can be accessed by dialing a toll-free number. For a registration form or more information, call the CDC Clearinghouse at (800) 458-5231. OTHER SERVICES Unless otherwise stated, services are free. The phone number listed at the top right of each record is the data-line that can be dialed with a modem. AIDS Info BBS. . . . . . . . . . . . .San Francisco, CA; (415) 626-1246 AIDS Info BBS is a long-established comprehensive electronic bulletin board targeted primarily to HIV-positive individuals, persons with AIDS, and others concerned about HIV infection. It contains hundreds of articles including AIDS Treatment News, electronic mail, and an open forum. Anyone can access AIDS Info BBS free. For more information, contact Ben Gardiner, AIDS Info BBS, P.O. Box 1528, San Francisco, CA 94101. AIDSQUEST. . . . . . . . . . . . . . . . . .Atlanta, GA; (404) 377-9563 AIDSQUEST is an electronic bulletin board provided by AIDS Weekly publishers for AIDS Weekly newsletter subscribers. AIDSQUEST replaces AIDS Weekly Infoline, an electronic bulletin board that was previously available to any caller. AIDSQUEST includes DAITA, the Database of Antiviral and Immunomodulatory Therapies for AIDS, articles from AIDS Weekly, statistics from CDC, an interactive forum, and the UseNet echo of SCI.MED.AIDS. Anyone can obtain information about AIDSQUEST by connecting online to the above number. For more information, contact AIDS Weekly, P.O. Box 5528, Atlanta, GA 30307-0528, (404) 377-8895. Black Bag BBS. . . . . . . . . . . . . . Wilmington, DE; (302) 994-3772 Black Bag BBS, a member of the AEGIS network, is an electronic bulletin board containing information about many medical topics including HIV/AIDS. The Black Bag Medical BBS List is a comprehensive list of medical-related electronic bulletin boards in the United States and abroad. Black Bag BBS also includes AIDS Treatment News, AIDS statistics and the FidoNet echo of the AIDS National Discussion. Donations are encouraged, but anyone can access Black Bag BBS free. For more information, contact Edward Del Grosso, MD, 1 Ball Farm Way, Wilmington, DE 19808. Boston AIDS Consortium SPIN. . . . . . . . . Boston, MA; (617) 432-2511 SPIN, or Service Provider Information Network, is maintained by the Boston AIDS Consortium. It includes AIDS Treatment News, statistics from CDC, and other AIDS-related information. Anyone can access SPIN by connecting online to and typing the username "spin." For more information, contact Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02112, (617) 432-0885. Breaking Walls; Building Bridges . . . . . . Concord, CA; (510) 827-0804 Breaking Walls; Building Bridges is sponsored by the Diablo Valley Metropolitan Community Church and includes general MCC information as well as AIDS dialog and files, including the AIDS Daily Summary. It serves the Oakland/East San Francisco Bay area and is a member of the AEGIS network. For more information, contact Breaking Walls; Building Bridges, Diablo Balley Metropolitan Community Church, P.O. Box 139, Concord, CA 94522- 0139. CAIN . . . . . . . . . . . . . . . . . . . . . . . .By Subscription Only CAIN is the Computerized AIDS Information Network sponsored by the state of California. CAIN contains electronic mail, an interactive bulletin board forum, and databases of upcoming events, educational materials, organizations, and articles. It resides on the Delphi network; charges for connect time are billed by Delphi. For more information, contact CAIN, 1625 N. Hudson Ave., Los Angeles, CA 90028-9998, (213) 993-7416. Can We Talk - Chicago. . . . . . . . . . . .Chicago, IL; (312) 588-0587 Can We Talk - Chicago (CWT) is a publicly accessible, privately operated system. It contains many newsletters, government information, and articles. It offers connections up to 9600 baud. For more information, contact Eddie V, Sysop, Can We Talk - Chicago, 3943 N. Whipple St., Chicago, IL 60618-3519. CESAR Board. . . . . . . . . . . . . . . Washington, DC; (301) 403-8343 Administered by the Center for Substance Abuse Research, University of Maryland, College Park and supported by Governor Schaefer's Drug and Alcohol Abuse Commission. Includes Maryland AIDS statistics. Within Maryland, call (800) 84-CESAR. For more information, contact Center for Substance Abuse Research, 4321 Hartwick Road, Suite 501, College Park, MD 20740, (301) 403-8329. CHEN . . . . . . . . . . . . . . . . . . . . . . . By Subscription Only CHEN is the Comprehensive Health Education Network sponsored by the Council of Chief State School Officers. It contains general information about HIV issues related to schools. It includes the biweekly HIV/AIDS Education Bulletin Board newsletter. Use of CHEN is free to qualified organizations; however, the purchase of IBM PSINet software is necessary. For more information, contact Council of Chief State School Officers, One Massachusetts Avenue, NW, Suite 700, Washington, DC 20001-1431, (202) 408-5505. Critical Path AIDS Project BBS . . . . Philadelphia, PA; (215) 563-7160 The Critical Path AIDS Project has developed an electronic bulletin board for persons with AIDS, researchers, health-care providers, and others. It includes an extensive series of forums, downloadable files including primarily resource and treatment information. Anyone can access the system free by typing "BBS" when first connecting to the system. A 9600-baud connection can be made by dialing (215) 463-7162. A user's manual is available. For more information, contact Critical Path AIDS Project, 2062 Lombard St., Philadelphia, PA 19146, (215) 545-2212. FDA Electronic Bulletin Board . . . . . . . .Toll-free; (800) 222-0185 The Food and Drug Administration operates a publicly accessible electronic bulletin board. Included are press releases related to AIDS, such as those announcing new drug approvals. To access, dial the above modem and enter "BBS" at the "Login" prompt. Local users in the Washington DC metro area should call (301) 227-6849. Those on an FTS2000 line should dial FTS-394-6849 or 394-5657. There is no charge and users can connect at up to 9600 baud. A users manual and technical support are also available. For more information contact the FDA Press Office, Parklawn Building, 5600 Fishers Lane, Rockville, MD, 20857. Fog City BBS . . . . . . . . . . . . San Francisco, CA; (415) 863-9697 Fog City BBS, a member of the AEGIS network, includes many articles, general information, and the GayComm Talk About AIDS forum. Although a subscription fee is charged for full membership, anyone can call Fog City BBS for free AIDS information by connecting online to and logging on as "AIDS INFO" when prompted for first and last name. For more information, contact Fog City BBS, 584 Castro Street #184, San Francisco, CA 94114-2588, Fax: (415) 863-9718. GLIB . . . . . . . . . . . . . . . . . . Washington, DC; (703) 578-GLIB GLIB, the Gay & Lesbian Information Bureau, is maintained by the Community Educational Services Foundation. It includes treatment information and the GayComm Talk About AIDS echo. Subscription fees vary and may not be required in some cases. GLIB is also available through Bell Atlantic's IntelliGate Service. Anyone can obtain information about GLIB by connecting online as a visitor. For more information, contact Community Educational Services Foundation, P.O. Box 636, Arlington, VA 22216, (703) 379-4568. HEEF . . . . . . . . . . . . . . . . . . . .Kenney, LA; (504) 443-5546 HEEF is the Health Education Electronic Forum, which replaces the Tulane Medical Center's BBS. A $2.00 subscription fee is requested. Anyone can register on HEEF by connecting and logging on as a visitor. For more information, contact Lifestyle and Health Promotion, 59 Monterey Dr., Kenner, LA 70065-3142. HIV/AIDS Information BBS . . . .San Juan Capistrano, CA; (714) 248-2836 HIV/AIDS Information BBS is the hub of the AIDS Education and General Information System (AEGIS), a growing network of HIV-related electronic bulletin boards (see last page). It includes many newsletters and hundreds of files that can be downloaded. It also echoes FidoNet and other networks, and is available via PC Pursuit. Anyone can access HIV/AIDS Information BBS free at connections up to 9600 baud. For more information, contact Sister Mary Elizabeth, Sisters of St. Elizabeth of Hungary, P.O. Box 184, San Juan Capistrano, CA 92693-0184. HNS HIV-NET. . . . . . . . . . . . . . . . . . Tollfree; (800) 788-4118 HNS HIV-NET, sponsored by Home Nutrition Services, is an electronic bulletin board for physicians and other health-care professionals treating HIV-positive patients and those with AIDS. It contains hundreds of files of newsletter articles, bibliographies, and graphics files of pictures of opportunistic infections. There are also a number of different forums, corresponding to different health-care professions. Interested users should dial the data line to register. After being validated or registered by the sysop, they can call back. For more information, contact John Owens, MD, HNS HIV-NET BBS, 9037 Kirby Drive, Houston, TX 77054. The Houston Exchange . . . . . . . . . . . .Houston, TX; (713) 521-2191 The Houston Exchange, a member of the AEGIS network, contains information from the Houston Clinical Research Network, an affiliate of the Montrose Clinic. Anyone can access the Houston Exchange free. For more information, contact Houston Clinical Research Network, 4211 Graustark, Houston, TX 77006, (713) 528-5554. LEGALNET . . . . . . . . . . . . . . . . Petersburg, FL; (813) 343-0797 The Stetson University College of Law's Legal Information Network sponsors an online discussion area and a selection of files relating to legal HIV issues. Anyone can access LEGALNET free with connections up to 9600 baud. For more information, contact Stetson University College of Law, 1401 61st Street South, St. Petersburg, FL, (813) 343-0797. LPIES . . . . . . . . . . . . . . . . . . . . . . By Subscription Only LPIES is the Laboratory Performance Information Exchange System sponsored by CDC's Public Health Program Practice Office and is available free to HIV testing laboratories and related organizations. Qualified users can register by connecting online to (800) 522-6388. For more information, contact Program Resources, Inc., P.O. Box 12794, Research Triangle Park, NC 27709, (800) 322-4383. NAPWA-Link . . . . . . . . . . . . . . . Washington, DC; (703) 998-3144 NAPWA-Link is the electronic bulletin board of the National Association of People With AIDS and is part of the network maintained by the Community Educational Services Foundation (see GLIB). NAPWA-Link contains electronic mail, announcements, and databases of news articles, drug interactions, and organizations. Users must pay a fee; several membership plans are available. Anyone can connect for online information about NAPWA and NAPWA-Link by logging on as a visitor. For more information, contact the National Association of People with AIDS, P.O. Box 34056, Washington, DC 20043, (202) 898-0414. NCJRS BBS . . . . . . . . . . . . . . . Washington, DC; (301) 738-8895 The NCJRS BBS is the electronic bulletin board of the National Criminal Justice Reference Service. It includes information about publications and services available from the National Institute of Justice AIDS Clearinghouse, such as information about HIV and incarceration. Anyone can access NCJRS BBS free. For more information, contact National Criminal Justice Reference Service, P.O. Box 6000, Rockville, MD 20849- 6000, (800) 851-3420. OASH BBS . . . . . . . . . . . . . . . . Washington, DC; (202) 690-5423 OASH BBS is the free and publicly accessible electronic bulletin board of the U.S. Public Health Service, Office of the Assistant Secretary for Health, National AIDS Program Office. It distributes many files of AIDS- related information from the federal government, including the AIDS Daily Summary, Federal Register announcements for funding, and the National Library of Medicine's AIDS Bibliography. OASH BBS has electronic mail, public forums, and file transfer. Anyone can access OASH BBS free; connections up to 9600 baud are available. For more information, contact National AIDS Program Office, Hubert Humphrey Bldg. Room 729-H, 200 Independence Ave., SW, Washington, DC 20201, (202) 690-6248. Ohio AIDS/HIV BBS. . . . . . . . . . . . . Columbus, OH; (614) 279-7709 Ohio AIDS/HIV BBS is a relatively new system that branched off from the Mystic Christian & Recovery BBS. It is a member of the AEGIS network. Connections up to 9600 baud are available. For more information, contact Michael Kelly, Sysop, Ohio AIDS/HIV Info BBS, P.O. Box 2970, Columbus, OH 43216. Public Health Network . . . . . . . . . . . . . . .By Subscription Only The Public Health Network is produced for public health administrators by the Public Health Foundation and contains information posted by a number of U.S. Public Health Service agencies including CDC, the National Institute for Drug Abuse, and the Health Resources and Services Administration. A subscription is required and connect fees are charged. For more information, contact Chris Frank, Public Health Foundation, 1220 L St., NW, Suite 350, Washington, DC 20005, (202) 898-5600. Questor . . . . . . . . . . . British Columbia, Canada; (604) 681-0670 Questor is UseNet system (for Unix users) that echoes the UseNet SCI.MED.AIDS discussion. Anyone can access Questor free by connecting online to the above number. Seattle AIDS Information BBS . . . . . . . .Seattle, WA; (206) 323-4420 Seattle AIDS Information BBS, a member of the AEGIS network, is targeted to persons with AIDS and HIV infection. It contains electronic mail, bulletin board forums, and hundreds of articles available for viewing and file transfer. Donations are encouraged, but anyone can access Seattle AIDS Information BBS free. For more information, contact Seattle AIDS Information BBS, 1202 E. Pike, Suite 658, Seattle, WA 98122-3918. 888 Online . . . . . . . . . . . . . . . . Richmond, VA; (804) 266-0212 888 Online is a member of the AEGIS network and includes all AEGIS files as well as interactive forums. Files can be searched by words in their text. 888 Online also includes information related to alternative lifestyles and recovery. For more information, contact Bill Smith, 888 Online BBS, P.O. Box 15885, Richmond, VA 23227-5885. AEGIS Listed below are the network affiliates of the AIDS Education and General Information System (AEGIS). These BBSs echo messages and exchange files of HIV/AIDS information, including the AIDS Daily Summary. The AEGIS network is also linked to a similar network in Europe called HIVNET. Anyone can log on anonymously to an AEGIS BBS for free. Other BBS services interested in joining AEGIS should contact Sister Mary Elizabeth of the HIV/AIDS Information BBS (which see). AEGIS NETWORK AFFILIATES State BBS Name Fidonet Node Phone Number Arizona The Meat Rack BBS 1:114/188 602.273.6956 California Breaking Walls; Building Bridges 1:161/203 510.827.0804 California The Task Force 1:161/513 707.746.6091 California Fog City BBS 1:125/100 415.863.9697 California The Clovis Co of Fresno 1:205/48 209.323.7583 California HIV/AIDS Info BBS 1:103/927 714.248.2836 Colorado Telepeople 1:104/69 303.426.1866 Colorado The Denver Exchange 1:104/909 303.623.4965 Delaware Black Bag Medical BBS 1:150/140 302.994.3772 Florida MOTSS BBS of Satellite Beach 1:374/41 407.779.0058 Florida Aftermidnite BBS / Tampa 1:377/43 813.831.7587 Massachusetts The Den 1:101/225 617.662.6969 Minnesota Drag-Net / Andover 1:282/1007 612.753.1943 Missouri Doc in the Box 1:289/8 314.893.6099 Missouri KC AIDS InfoLink 1:280/14 816.561.1187 Nevada Las Vegas AIDS Info BBS 1:209/238 702.658.3591 New York Brooklyn College ONLINE! 1:278/0 718.951.4631 New York The Erie Canal BBS 1:2608/31 315.445.4710 North Carolina The Isolated Pawn / Durham 1:3641/281 919.471.1440 Ohio The Mystic Christian 1:226/520 614.279.7709 Oklahoma The Looking Glass BBS / Tulsa 1:170/706 918.743.1268 Tennessee Riverside BBS 1:123/424 901.452.6832 Texas The Houston Exchange 1:106/20 713.521.2191 Texas Puss-N-Boots / Grand Prairie 1:124/3103 214.641.1822 Texas AIDS Chat Line / Grand Prairie 1:130/55 214.256.5586 Texas Loaves & Fishes BBS 8:3000/7 512.444.8790 Virginia 888 Online 1:264/190 804.266.0212 Washington Seattle AIDS Info BBS 206.323.4420 Ontario Mother's Board / Ottawa 1:243/38 613.728.4122 Quebec EC / Bellefeuille, Pq 1:242/90 514.433.1105 Australia SouthMed of Sydney Net 3:712/700 61.2.583.1027 NOTES Several publicly accessible commercial networks have AIDS-related forums, such as The Well [Whole Earth 'Lectronic Network, online registration: (415) 322-7398]; GEnie [the General Electric Network for Information Exchange, voice phone: (800) 638-9636]; and CompuServe [voice phone: (800) 848-8990]. There are also several database vendors that provide gateway access to AIDS-related databases, including the National Library of Medicine [voice phone: (800) 638-8480]; BRS Search Services [(a division of Maxwell Online; voice phone: (800) 456-7248]; and DIALOG [voice phone: (800) 334-2564]. More information about AIDS-related databases can be obtained by calling a Reference Specialist at the CDC Clearinghouse, (800) 458-5231. ------------------------------------------------------------------------------- Question 7.3. National Library of Medicine AIDSLINE (please contribute) If you know how to obtain access to this service, please contribute instructions to the FAQ (e-mail to aids-request@cs.ucla.edu). ------------------------------------------------------------------------------- Question 7.4. Commercial Bulletin Boards There are AIDS-related areas on Compuserve and America Online. (we need details: how to contact Compuserve and America Online, what the newsgroups are called, etc.) ------------------------------------------------------------------------------- Question 7.5. Reappraisal of the HIV-AIDS Hypothesis. Please see Q5.3 `Duesberg's Risk-Group Theory' for introductory information on this question. The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis (hereafter just 'Group' for short) is an organization of scientists, AIDS-activists and educators, and other concerned persons, currently numbering around four hundred. As their name indicates, the Group wishes for the scientific community to reexamine an hypothesis which they believe to have been prematurely, dogmatically, and even dangerously, accepted. Many or most of the best known AIDS-skeptics are members of the Group, including Peter Duesberg, Robert Root-Bernstein, John Lauritsen, Eleni Eleopoulos, Michael Callen, Jad Adams and Kary Mullis. The Group may be contacted at 2040 Polk St. Suite 321, San Francisco, CA 94109 USA; Fax: 415-775-1379. The Group publishes a newsletter entitled Rethinking AIDS, for which a $25/year donation is requested. The Group came into existence as a result of efforts to get the following four sentence letter published in a number of prominent scientific journals, including Nature, Science, JAMA, The New England Journal of Medicine, and Lancet. As of October 1993, all have refused to do so. "It is widely believed by the general public that a retrovirus called HIV causes the group of diseases called AIDS. Many biomedical scientists now question this hypothesis. We propose that a thorough reappraisal of the existing evidence for and against this hypothesis be conducted by a suitable independent group. We further propose that critical epidemiological studies be devised and undertaken." The members of the Group do not necessarily agree with each other on the precise nature and causes of "AIDS;" all they automatically have in common is disbelief that HIV (sole) causation of AIDS has been scientifically established. ------------------------------------------------------------------------------- Question 7.6. Lesbian/Gay Scholars Directory. From: "Louie Crew" Date: Tue, 2 Nov 93 11:06:05 EST I have compiled an E-Mail Directory of Lesbigay Scholars, with now more than 195 persons listed. To be included, fill out the form below and return it to me: lcrew@andromeda.rutgers.edu Do NOT send by snail mail. The E-Directory helps lesbigay scholars connect regarding on-going manuscripts, conferences, and other scholarly projects. I send the Directory to all who agree to be listed, with updates individual by individual. I also make available to one e-mail address by which those listed can post announcements of interest to the entire group. But this is not a discussion list per se--rather, a resource list. Please share this announcement with any friends who might be interested and with any other e-networks where forthright lesbigay scholars might assemble qua scholars. Thank you. Louie Crew Author/editor of _The Gay Academic_ and 950+ others Co-founder of the Lesgay Caucus of the National Council of Teachers of English Founder of Integrity, the lesgay justice ministry of the Episcopal Church Academic Foundations Department, Rutgers University/Newark (Snail mail: P. O. Box 30, Newark, NJ 07101) ============================================================================ Entry Form for E-Directory of Lesbigay Scholars Name: Institutional affiliation: Department: Position: E-mail address(es): Snail mail: Phone(s) FAX: Citations of a sample of yr. previous lesbigay scholarly projects: List/description of yr. on-going lesbigay scholarly projects: =============================================================================== Section 8. Non-Electronic Information Sources. Q8.1 Phone Information about AIDS. Q8.2 Phone Information about AIDS drug trials. Q8.3 US Social Security: Information for Organizations ------------------------------------------------------------------------------- Question 8.1. Phone Information about AIDS. For general information about AIDS and referrals to other AIDS information sources, call CDC National AIDS Hotline: 1-800-342-AIDS Spanish: 1-800-344-7432 Deaf: 1-800-243-7889 ------------------------------------------------------------------------------- Question 8.2. Phone Information about AIDS drug trials. You can obtain information about ongoing AIDS drug trials in the United States by calling the AIDS Trials hotline at 1-800-TRIALSA ------------------------------------------------------------------------------- Question 8.3. US Social Security: Information for Organizations SSA is committed to disseminating information about its benefit programs to as wide an audience as possible. If your organization has a newsletter, electronic bulletin board, informational database, or other system for housing and disseminating information to people living with AIDS and their caregivers, SSA would like to know about it. SSA wants to work with you to share information about Social Security benefit programs and eligibility criteria. SSA will share or exhibit public information materials if you will inform them of any meetings/conferences. Also, if you believe your staff could benefit from an in-service training program covering SSDI/SSI, Medicare, Medicaid, and other topics, please inform SSA. SSA looks forward to a continuing partnership with your organization to inform the thousands of men, women and children living with HIV/AIDS about the benefits available through Social Security. If you have any questions, or have any additional public information needs, contact Robert G. Goldstraw, Social Insurance Affairs Specialist (AIDS Outreach), Social Security Administration, Baltimore MD 21235. Telephone: (410) 965-4064. =============================================================================== Section 9. Administrative information and acknowledgements Q9.1 Feedback is invited Q9.2 Formats in which this FAQ is available Q9.3 Authorship and acknowledgements ------------------------------------------------------------------------------- Question 9.1. Feedback is invited Please send me your comments on this FAQ. We accept submissions for the FAQ in any format; All contributions comments and corrections are gratefully received. Please send them to aids-request@cs.ucla.edu. ------------------------------------------------------------------------------- Question 9.2. Formats in which this FAQ is available This document is available as ASCII text, an Emacs Info document and PostScript. We currently make only the ASCII text available as a posting. We are working on establishing a sci.med.aids archive where the other formats will be stored. ------------------------------------------------------------------------------- Question 9.3. Authorship and acknowledgements The following people contributed to this FAQ: Dan Greening assembled and edited this document. Jack Hamilton wrote the introduction and first section. Phil Miller offered periodic edits. Anne Wilson forwarded many valuable articles from the CDC National AIDS Clearinghouse. Robert Walker wrote the section on minimizing the risk of HIV infection. Michael Howe's sci.med.aids response regarding blood banks is reproduced here. Paul M. Karagianis contributed archives answering question about mosquito transmission. Iain Nicholson, who works on Plasmodium falciparum, wrote the section on malaria. Vince Hammer wrote the review of ``Do Insects Transmit AIDS?'' Michael Howe provided references for the question "Does HIV cause AIDS?", and has scanned several documents for this FAQ. Ken Shirriff wrote about the USSR disinformation campaign. Rob James wrote a description of the US blood testing process. David Wright wrote the reasons why we should not donate blood to get a free HIV test. David Mertz wrote the section on internet access to the gopher database. Michelle Murrain wrote the section on the CDC patient data FTP site.