+---------------------------------------------------------------+ | AIDS TREATMENT NEWS NO. 147, March 20, 1992 | +---------------------------------------------------------------+ Copyright 1992 by John S. James; permission granted for non-commercial use. phone 800/TREAT-1-2, or 415/255-0588 CONTENTS: [items are separated by "*****" for this display] Treatment Activism Today AIDS Pathogenesis: Introductory, Background Articles Published AIDS Origin Theory: Polio Vaccine? San Francisco: Study of Septra (Bactrim) Desensitization ***** Treatment Activism Today by John S. James One view of AIDS activism at present sees mostly burnout and infighting. But this appearance hides a different reality, for the current time is one of transition. Some activities that worked in the past have now accomplished their aims and therefore are less relevant. Meanwhile, new developments are creating both ominous threats and critical opportunities. We believe that this time of transition must also be used to address the greatest shortcoming of AIDS treatment activism in the past -- the failure to develop and articulate some of the most critical issues, and to communicate them to the AIDS community, the professional communities, and the public. AIDS Research: The Major Problem We believe that the major problem in AIDS treatment research and development today is the same as it has always been -- the squandering of opportunities to save lives, due to lack of coordination and management of the overall research effort. This failing, in turn, stems from defective national mobilization around the epidemic, which reflects ambivalent political will. Even treatment activists have often had only a hazy idea of how serious the problem is; and when we have understood what was happening, we have not known how to communicate it. Some examples: (1) In a recent memo, officials of one of the world's leading research universities forbade one of its leading scientists, who had developed a potential treatment, from providing a sample for testing to an outside organization which had requested it, or to any company. The reason was fear of trespassing on the proprietary rights of a pharmaceutical company which years ago had provided a reagent to the scientist, in return for rights to resulting products. That company's interests have apparently turned elsewhere, and the project is now on hold until the clock runs out on the rights. This writer has a copy of the memo, but has agreed not to reveal the parties involved. To do so could damage at least one AIDS research project, as well as our ability to obtain information in the future. This case illustrates a major but hidden problem: that it is often impossible to tell the public what is going on without doing more harm than good. Therefore the public debate, even in the AIDS community and even among physicians, scientists, and other specialists, often does not address the real facts and issues. If there were a serious national, institutional commitment to AIDS, an incident like the one described above would be unthinkable. In fact, it is routine business, not surprizing or unexpected. If there were national leadership on AIDS, the atmosphere which allows research to be routinely hampered in such ways would change. But the President will not provide such leadership, because to do so would anger those who would rather have fewer gays and members of other stigmatized groups. And most leaders throughout U. S. institutions either do not care about AIDS, or do not want to be seen to care. So the mismanagement of treatment research continues today, much as it has since the beginning of the epidemic. And the public discussion, in the media, in Washington, in professional conferences, and elsewhere, proceeds as if the problems which are in fact the most important causes of delay and lack of productivity of AIDS treatment research did not exist. (2) Treatment activists who get close to specific projects often need to carry messages back and forth between researchers who are unwilling to communicate directly with each other. In one typical case, researchers from different organizations were about to meet, and one of the participants asked an ACT UP member to write to remind another to bring toxicology data to the meeting; the activist did so. In another case, an activist was needed to carry messages between scientists in the same Federal agency. In still another, an activist became the only person anywhere to know that two groups of scientists within the same program were quietly planning nearly identical clinical trials; neither group knew what the other was doing. Treatment activists do not mind handling these jobs, since facilitating research is what they want to do. But they cannot be everywhere that researchers are failing to communicate with each other. And researchers themselves sometimes hold unrealistic hopes that the activists will be able to solve organizational problems which they themselves cannot. Meanwhile, all of this remains entirely invisible to the public, disconnected from public discourse and from most professional discourse as well. And when such problems do come to light, there is no place to take them to try to get them fixed. Making the whole AIDS research program work effectively is nobody's responsibility. (3) Almost every AIDS drug which has been or is now being developed (with the notable exception of AZT) has been delayed for years for non- medical, non-scientific reasons, such as commercial and bureaucratic obstacles. To explain the examples would require writing a book; some drugs, like peptide T, would require a book by themselves. But over the years we have observed a pattern in almost all of these delays. Ordinary, unremarkable obstacles arise, much as they would in any medical research or drug development; this is not the problem. The problem is that then there is no coherent push to overcome them. If the researchers on the scene do not personally have the authority, influence, or other resources needed to do so, there is no one they can ask for help. And they cannot make a public issue without risk of damage to necessary relationships; it is not worth taking that risk when there is no national consensus on AIDS, or spirit of cooperation, to which to appeal. As a result, major projects get suspended indefinitely for minor or even trivial reasons. Treatment activism has not succeeded in the very difficult task of developing issues like these so that they can be communicated to specialists and to the public. To do so will be its biggest challenge in the future. Problems in Activism 1. Burnout We have long believed that burnout is caused not by overwork, but by betrayal. Neither of these causes seems most important today -- but both can contribute. One way to help avoid burnout from overwork was suggested to us by Jay Lipner, who made some of the most important contributions ever to the AIDS community before he died last November. Jay remained active despite poor health; one of his personal rules when doing so was to avoid, when at all possible, any appointment or commitment which he could not get out of if necessary. That way he could remain active without sacrificing his health. Concerning burnout caused by betrayal, we are not referring to the betrayal of people with AIDS or HIV by government and other major institutions, since this has been all but constant during the entire epidemic; it is just part of the problem to be dealt with. The sense of betrayal which causes burnout is that which stems from one's own community -- for example, if one has made personal sacrifices to work for the good of the community but then is unjustifiably trashed by it. In AIDS there has been relatively little of this, because the problems we face are so severe that most of the community's energy has been focused directly on them, not on fighting each other. But infighting can lead to a sense of betrayal and futility, as activists who do good work see their efforts and energies wasted because of pointless attacks from other activists. Burnout can also be caused by depression -- due to lack of support, and the problems getting worse with no end in sight. But we suspect that the biggest cause of what appears to be burnout is not one of these, but rather the current time of transition in treatment activism. The activities which worked for people in the past do not work as well any more, and there is no clear direction to go in replacing them. It will take time for new kinds of activism to develop; we suggest some possibilities below. 2. Infighting and Elitism While infighting among AIDS activists is often seen as a problem today, there may in fact be less of it than meets the eye. In San Francisco there are ongoing quarrels, but most of what happens in the AIDS community has nothing to do with them. Perhaps the biggest problem is that mainstream press coverage of AIDS has been unduly influenced by factional fighting, since reporters, looking for dramatic stories, are frequently used by one faction as a weapon against another, often without knowing whether the battle is driven by public issues or by personal ones. A related and equally destructive problem is elitism. Many people feel excluded from treatment activism by cliquishness, competitiveness, and excessive control by small inside groups. Today in San Francisco, at least, this is less of a problem than some people believe. But when it does exist, it prevents treatment activism from attracting new people and building the power necessary to make the changes which could save lives. The basic force which fuels infighting and elitism is the continuing struggle for a place in society. One way to secure a place is through ego, pushing others aside to get one's message across; this is how people learn to be leaders in much of U. S. business and public life. Because AIDS is a life and death issue for people in all social positions (not only for the poor, as is the case with most issues), AIDS activism attracts some very competent (and sometimes very competitive) people. As a result, new people may feel that either they must be pushy too, or they have no place -- that they will not be listened to, so their work will go nowhere and therefore they might as well not get involved. One way around this dilemma is through realizing that an emergency as severe as AIDS, one so badly neglected and with so much needing to be done, also creates opportunities to have a place in society through service. It is not necessary to outshout others. The alternative is to find work which needs to be done -- work suited to one's strengths, talents, and opportunities. A key insight is that service is not only a way to help others, but also a way to have role for oneself, to circumvent the need to either become domineering or be forced out by those who are. Demonstrations ACT UP, which is really a group of many independent AIDS activist organizations, has typically focused primarily on street theater, and secondarily on other activities such as research, advocacy, and lobbying. We believe that the most important purposes of the demonstrations have been (1) to force public attention to central issues which otherwise would be ignored, and (2) to open doors so that activists can meet with government, corporate, and other officials and leaders so that our community's concerns can be heard. But past demonstrations have largely failed to (3) inform the public what the real issues are and build understanding of the AIDS community. The first purpose above remains necessary, and always will be, especially given the U. S. public's tendency to avoid dealing with serious but unpleasant issues. But the second purpose may have been been largely completed. For today, university research centers, pharmaceutical corporations, and other institutions -- even some of the most distant and elitist ones -- are rushing to develop community advisory boards or otherwise obtain patient or community input. And they are doing so for reasons very different from the fear of demonstrations if they refused to communicate, which was an important reason in earlier years. We believe that the third purpose of demonstrations, reaching the "hearts and minds" of the public, will be central in the future. But in the past, treatment activists have often failed to develop and express the issues properly. We ourselves have seldom understood in detail what is wrong in the research process and how to make it work better -- except in an emotional sense, and emotion alone is hard to communicate to people who are living in very different circumstances. The objective justice of our case, both in human terms and in terms of rational public policy, must always be clear. But often it has been murky. Demonstrations are often called almost instantly by group acclamation, just because something is wrong. There is little analysis of the issues, let alone any thought about how they should be communicated. New Activists: Opportunities for Entry? Perhaps the most serious problem (and most straightforward to fix) is the lack of organizational opportunities to become a treatment activist. People should not be expected to do all of it by themselves. One of the rewards of this work is being able to receive new treatment information as it comes through, and that requires a community. In San Francisco there are several major opportunities to enter this work -- for example, ACT UP/Golden Gate Treatment Issues Committee, ACT UP/San Francisco Treatment Issues Committee, and Project Inform. (AIDS TREATMENT NEWS originally chose not to seek volunteers, something we are reconsidering). But in most cities there are no opportunities at all, a situation which strangles the growth of treatment activism. The ACT UP/Golden Gate Treatment Issues Committee, with which this writer is most familiar, works very well with a format which might be useful for other treatment organizations. It has many separate working groups organized primarily around different treatments; new groups ask to be recognized as there is interest. The committee itself meets every Thursday evening; anyone can put issues on the agenda for discussion and/or decision, and in this way the different groups share information, through announcements and discussion of what they are working on. They also seek group authorization when necessary -- to write a letter to a public or corporate official, for example, or to get Treatment Issues endorsement for a demonstration, which then goes with this endorsement to the ACT UP general body. New working groups can be recognized at any time, and anyone willing to work can join. These groups, and also any individual, also bring copies of written information to give out at meetings. [Note: for more information about the ACT UP/Golden Gate Treatment Issues Committee, or how you can become involved, call G'Dali Braverman at 415/252-5689.] There are ACT UP treatment groups in several major cities. Some buyers' clubs also have volunteer programs. PWA and HIV- positive groups may also provide structures for doing treatment work. (For a recent U. S. list of ACT UP affiliates, buyers' clubs, and PWA coalitions, see AIDS TREATMENT NEWS #143, January 17, 1992.) Other opportunities to become involved in treatment work are provided by the new Community Advisory Boards, which are being set up by all ACTG sites (AIDS Clinical Trials Groups, of the U. S. National Institute of Allergy and Infectious Diseases) and by some other research organizations. Treatment committees can be intimidating to new people, who find it hard to follow what is going on during their first meetings. What is needed is an orientation program, with someone in charge of preparing an information packet for newcomers, and being available to answer their questions and help them connect with what they want to do in the group. Until such a program is available, newcomers should realize that the key is finding one or two areas that they want to work on; it will not be hard to learn these. Most members of these treatment committees do not have a technical background, so none is required. But sometimes so much is happening that the overall impression can be overwhelming. One of the greatest needs in activism is to develop programs to facilitate the entry and development of new activists. One part of this will be to create opportunities for persons who are geographically remote, perhaps communicating by computer, conference calls, and fax (or, when cost is an issue, having the organizational support to allow productive entry to the same discussions by phone or mail). In any case the goal is to develop true collaborative relationships, to allow meaningful participation in real, ongoing issues, so that no matter where people are located they can explore and find out what they want to do and what they can do best. Some computer bulletin-board systems would be well suited for building such relationships. So far, however, AIDS uses of these systems have largely been limited to information dissemination -- publishing information by computer, and receiving it that way, but usually with little or no further relationship between the parties. Note: AIDS TREATMENT NEWS may publish a list of organizations and other opportunities through which people can get involved in treatment activism. If you know of anything we should list, you can write to: attn: Treatment, AIDS TREATMENT NEWS, P. O. Box 411256, San Francisco, CA 94141, or call us at 415/255-0588. Political Funerals Discussion of political funerals in response to AIDS and its mismanagement by government and other institutions has occurred over the years, usually in conversations that follow a memorial service for an activist. Someone will note that the person had mentioned having his ashes scattered on the White House lawn -- or his coffin carried to a Federal office and chained to the door. But no definite arrangements had been made, so usually only the conversation has taken place. It is quite clear why political funerals have not happened in the past -- and what needs to be done for them to happen now. Political funerals are common in some parts of the world, such as South Africa, or Ireland, or the Middle East, but they are not part of the traditional culture in the United States. A person who is seriously ill and expecting to die is not in a good position to take on the extensive arrangements, the groundwork required to introduce something like this for the first time, where there is little institutional support for it. And while their friends might be able to take the initiative to do so, who wants to ask a friend (or anyone else) to provide the body for this purpose? Also, most individuals and their friends will not have all the resources needed -- the time, energy, money, and specialized expertise -- to make the funeral work as well as it should for communicating with the national public. What is needed is for a third party, a credible activist organization, to take on the project of developing the capability of organizing political funerals, including fundraising and professional legal and media preparations, probably before they had any particular person is in mind. This organization would then, as a service, offer assistance to persons who wanted their memorial event to take such a form. If no one asked for that help, or if no workable arrangements could be agreed to, then the funeral would not take place. AIDS-related political funerals (unlike most others, which happen when someone has been assassinated or otherwise killed unexpectedly) can be planned in advance to get their message across as effectively as possible. For example, the person and their friends could speak on broadcast-quality videotape. After the death a video press release would be sent to news outlets -- tape ready for use on the air, important in these days when shrinking news budgets can determine what news gets covered. Then the body might be carried in an open casket to where the President was speaking -- or to some other relevant, newsworthy event, in the current Presidential campaign, for example, where camera crews would already be present. There are many different rainbows of people -- different racial and ethnic groups, social classes and occupational groups, personality types, interests, achievements, etc. Therefore these funerals would speak to many different publics, and have endlessly varying human- interest newsworthiness. And the events themselves could always be new and creative, and therefore even more likely to be listened to. The cumulative impact will make it difficult for AIDS to be ignored, by national officials, political candidates, corporate, foundation, or cultural leaders, or anyone else in a position of responsibility. Political funerals might first focus on non-treatment issues, because they are most immediate -- the lack of proper medical care, for example, or the very ominous neglect of heterosexual transmission of HIV among teenagers. Any FDA or other government crackdown that seriously impedes access to rational treatment options would be another obvious target. The hardest part of developing political funerals as a new American institution is the part we most need to be working on anyway -- formulating the issues well, and learning better how to communicate them. One advantage of funerals as communication is that nothing will happen at all unless there is a compelling issue. With AIDS there are many compelling issues -- but often no one knows how to express them, and then the community's statement is easily derailed with superficial, stock arguments such as that the government is already spending money on AIDS, or that good science takes time. Learning how to tell the public what is really happening, and what the real issues are, will benefit the AIDS community whether or not political funerals actually take place. ***** AIDS Pathogenesis: Introductory, Background Articles Published by John S. James The pathogenesis of AIDS, or how the disease actually develops, was widely neglected during most of the epidemic, but has recently become a major focus of research. The early "conventional wisdom," that HIV infects T-helper cells and kills them, resulting in immune deficiency because of the loss of these cells, was generally accepted without much thought, and is still the basis of AIDS-education material for the public. This theory has a number of problems, however, especially: (1) Only a small fraction of T-helper cells are infected at any one time in persons with latent HIV infection or with AIDS, and the body could easily replace these cells; and (2) the theory does not explain the long delay in the development of disease, with an average of about ten years between infection and AIDS. Over the last few years it has become clear to researchers that much was unknown about how the virus actually causes disease in the body. The issue is important because the old theory only suggested one basic approach to fighting AIDS -- stopping the virus. There were also thoughts about "boosting" the immune system, but without an understanding of how this system had been damaged, it was difficult to design rational therapies. Even the development of antivirals was hindered because it was not known which cells were most important in the infection. Today there are a number of newer theories of pathogenesis. Most of them focus on how HIV could kill T-helper cells indirectly, other than by infecting them. These new theories are not mutually exclusive; it is likely that several of them may be true. To the extent that they are supported by new findings as more research is done, they may help guide efforts to develop treatments to greatly reduce the damage caused by HIV, as well as to design better antiviral drugs. A recent article in THE NEW YORK TIMES ("How AIDS Smolders: Immune System Studies Follow the Tracks of HIV," by Gina Kolata, March 17, 1992) provides an accessible introduction to several of the newer theories of pathogenesis, including: * Infection of lymph nodes. This theory suggests that HIV primarily infects T-helper cells which are in lymph nodes, not circulating in the blood. This infection has tended to be overlooked, because it is harder to measure in clinical trials, since lymph-node biopsies would be required. * Dendritic cells. These immune-system cells, in the skin and mucous membranes, are more easily infected by HIV than T- helper cells. They may be a major reservoir of infection, and pass it on to the T- helper cells. * Superantigens. Antigens are substances, often produced by bacteria or viruses, which are capable of stimulating an immune response. Ordinary antigens will not do so unless they match two different parts of the T-cell receptor (a molecule on T-helper or T- killer cells) called the alpha and beta chains. In any one individual there are many different kinds of alpha and beta chains, and they are combined at random in different T-cells, giving many millions of different combinations. Most antigens, therefore, are selectively recognized by only a few of the of the many T-cells in the body. Superantigens, produced by some bacteria and some viruses, attach to the beta chain only; this process commonly kills the cell, by unknown mechanisms which may involve overstimulation. A single superantigen can therefore kill the whole class of cells with a given beta chain, since it does not matter what the alpha chain is. It is suspected that HIV can produce a superantigen, although this is not known for sure. Mutations of the virus could cause changes in the superantigen, destroying cells with one kind of beta chain after another. Recently a research group at the University of Brescia in Italy found that certain beta chains were missing in the T-helper cells of persons with HIV, although the alpha chains were normal, strongly suggesting that a superantigen was killing the cells. ("Selective Depletion in HIV Infection of T Cells that Bear Specific T Cell Receptor V Beta Sequences," by L. Imberti and others, Science, November 8, 1991, pages 860-862.) * Programmed cell death (also called apoptosis). It is believed that when T-cells develop, they have a "suicide program" built in, as part of the body's means of allowing the immune system to distinguish "self" (its own proteins and other potential antigens) from "non-self" (foreign substances, usually from bacteria or viruses). According to a theory called clonal deletion, which is becoming widely accepted, random variations in inherited genes cause the development of many millions of different T-cell receptors in any one individual; this group of many different kinds of cells would cause an immune response against the body's own cells as well as against an invader. But at a certain stage of development, immature T-cells are killed in the thymus if they are activated by any antigen. Since only the body's own antigens are present then, any cells which are activated at that stage are killed (by their own suicide program), leaving only cells which will not attack the body. It is possible that HIV causes abnormal recurrence of this suicide program later, in mature cells. There are several other theories of AIDS pathogenesis. One important possibility is that HIV causes autoimmunity, an abnormal immune response against other cells in the body -- perhaps against immune-system cells. [Note: for background on the clonal deletion theory, see "How the Immune System Learns About Self," SCIENTIFIC AMERICAN, October 1991, pages 74-81.] ***** AIDS Origin Theory: Polio Vaccine? by John S. James In March 1992 two separate theories have been published suggesting that AIDS may have been accidentally introduced into humans by live- virus polio vaccines which may have been contaminated with unknown monkey viruses. These theories are more plausible than most of the AIDS-origin ideas which have come along. But they are still speculative; the evidence only suggests that it is possible that AIDS started this way, not that it actually did. Important articles about the polio-vaccine theory have appeared recently in ROLLING STONE, THE LANCET, and THE HOUSTON POST. Instead of restating the points they made, this article will provide annotated references, so that readers who are interested can go to the original sources. "The Origin of AIDS," by Tom Curtis, an 8,000-word article in the March 19, 1992 ROLLING STONE, suggests that an oral polio vaccine used in over 300,000 people in the Belgian Congo (now Zaire) in the late 1950s may have transmitted an unknown virus which may have been present in monkey kidney cells in which the polio virus was grown during the making of the vaccine. Use of this vaccine was apparently discontinued in 1959, after Albert Sabin, M. D., developer of the polio vaccine in most widespread use today, reported that an unidentified virus had been found in it. No known monkey virus resembles HIV-1, but there are believed to be many unknown monkey viruses; it is possible that a virus close to HIV-1 exists but has not been discovered. "Simian Retroviruses, Poliovaccine, and Origin of AIDS," by Walter S. Kyle, published in THE LANCET, March 7, 1992, suggested that AIDS might have been transmitted to the gay community in the United States by use of the Sabin live-virus oral polio vaccine as a treatment for herpes, before the development of acyclovir. This use was suggested by A. Trager, in at least two articles published in 1974. The vaccine was given orally (the same way as when used for prevention of polio, but apparently in larger doses), once a month for three months only. Several published letters, in English, German, French, and Hebrew, discussed this use of the Sabin vaccine. Kyle, a lawyer who researched vaccine safety for a legal case concerning paralysis after contact with a vaccine, said that a particular lot of polio vaccine was released by U. S. regulators, despite tests in 1976 and 1977 which suggested that it may have contained an unknown virus, probably a retrovirus. A weakness of the theory that AIDS was spread this way is that it does not explain why AIDS would have occurred in gay men, but not to any of the millions of children who also took the Sabin vaccine by mouth. Kyle had to speculate "that this virus either survived passage through the gastrointestinal system because of the rate of exposure [referring to the fact that the dose used was larger than those for polio vaccination] and/or bypassed it because of the nature of the sexual activity." Ongoing coverage of these theories and the controversy around them has appeared in THE HOUSTON POST, in a series of articles by Tom Curtis (who also wrote the story in Rolling Stone). Articles have appeared on March 15, 16, 17, and 18 (the day this issue of AIDS TREATMENT NEWS goes to press); we expect there will be more in the future. Perspective We suggest that several points be kept in mind so that this unproven but potentially important story does not do more harm than good: * None of the evidence presented suggests that there is any danger of AIDS from polio vaccination today. Even if all the theories which have been suggested are true, the only AIDS transmission from vaccination against polio would have occurred in Africa in the 1950s, from a vaccine which has not been used anywhere in the last three decades. The worst thing that could happen from this story would be for unthinking panic to interfere with important vaccination programs. According to an expert quoted March 18 in The Houston Post, polio vaccination is saving at least 450,000 children each year from paralytic polio worldwide, and preventing 40,000 deaths. * There is also no grounds for scandal, even if the theory is true. There is always a risk of unknown danger in any new medicine, no matter how much care is taken. Who would have wanted to not vaccinate against polio because of the remote possibility that something unforeseen would go wrong later? * It is important that further tests be done, especially to analyze "seed stocks" of early polio vaccines, which are normally preserved in freezers in case any questions arise later. These stocks could easily be tested for HIV. If AIDS did originate from monkey viruses inadvertently transmitted in vaccination programs, that would be important to know, both for preventing any such occurrence in the future, and also for insights which might be provided for treatment development. If the vaccine seed stocks are free of HIV, suggesting that such transmission was unlikely, then this is also important to know, to set peoples' minds at ease. ***** San Francisco: Study of Septra (Bactrim) Desensitization Marcus Conant, M. D., will soon begin a study of ways to reduce the incidence of drug reaction to co-trimoxazole (also called Septra, or Bactrim; it also has other brand names) in HIV-positive persons. He is seeking two groups of volunteers: * Those with T-helper counts less than 250 who have had a reaction to the drug; and * Those with T-helper counts more than 400 who have never had a reaction to co-trimoxazole (whether or not they have ever used the drug). For more information about this study, call Mark Dybul, M. D., at 415/923-1333. Background Co-trimoxazole is widely believed to be better than aerosol pentamidine for pneumocystis prophylaxis (prevention); it may also help to prevent toxoplasmosis. Co-trimoxazole is also much less expensive than aerosol pentamidine. But many people who are HIV positive cannot use this drug because of allergic reactions. In the past, Dr. Conant has had some success with a special protocol for desensitizing patients who had already developed sensitivity to co-trimoxazole; some of them have been able to resume its use. The new study attempts to build on this experience to see if it is possible to prevent the reaction in the first place; it is seeking quantitative data which can be used widely to improve the general standard of care. ***** AIDS TREATMENT NEWS Published twice monthly Subscription and Editorial Office: P. O. Box 411256 San Francisco, CA 94141 800/TREAT-1-2 toll-free U. S. and Canada 415/255-0588 regular office number 415/255-4659 fax Editor and Publisher: John S. James Medical Reporters: John S. James Michelle Roland Denny Smith Reader Services, Business, and Marketing: Thom Fontaine Jason Heyman Laura Thomas Tadd Tobias Rae Trewartha Statement of Purpose: AIDS TREATMENT NEWS reports on experimental and standard treatments, especially those available now. We interview physicians, scientists, other health professionals, and persons with AIDS or HIV; we also collect information from meetings and conferences, medical journals, and computer databases. Long-term survivors have usually tried many different treatments, and found combinations which work for them. AIDS Treatment News does not recommend particular therapies, but seeks to increase the options available. Subscription Information: Call 800/TREAT-1-2 Businesses, Institutions, Professionals: $230/year. Nonprofit organizations: $115/year. Individuals: $100/year, or $60 for six months. Special discount for persons with financial difficulties: $45/year, or $24 for six months. 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