&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& J O H N J A M E S writes on A I D S &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Copyright 1992 by John S. James; permission granted for non-commercial use. AIDS TREATMENT NEWS Issue #162, Nov 6, 1992 phone 800/TREAT-1-2, or 415/255-0588 CONTENTS: [items are separated by "*****" for this display] Kaposi's Sarcoma Trial Recruiting: TNP-470 (AGM-1470), New Kind of Treatment WF-10: Big Claims, Little Information Anger at Women's History Study Delay After the Election: Are We Ready? Effective Transition: Interview with Tom Sheridan National Commission on AIDS Preparing Presidential Recommendations AIDS Treatment Information Sources: Other Newsletters ***** Kaposi's Sarcoma Trial Recruiting: TNP-470 (AGM-1470), New Kind of Treatment A new kind of treatment for Kaposi's sarcoma (KS) has now begun human testing at the U. S. National Cancer Institute. The treatment, TNP-470 (formerly called AGM-1470) prevents the growth of new blood vessels; KS is associated with excessive growth of blood vessels. The current trial is only for persons with KS; however, animal studies have suggested that this class of compounds, called angioinhibins, could also be important for treating many kinds of solid-tumor cancers. [For background on TNP-470, see "Angiogenesis Inhibitors -- New Approach to Cancer, KS Treatments," AIDS TREATMENT NEWS #135, September 20, 1991.] Volunteers must: * be HIV positive; * have KS but no evidence of pulmonary or gastrointestinal KS; * be ambulatory and at least well enough to care for themselves; and * be on a stable dose of antiretroviral therapy for at least a month. Also, because the drug has caused small hemorrhages in animals at very high doses, this trial has strict exclusion criteria for hematological abnormalities, including hemoglobin less than 9, ANC less than 1,000, platelets less than 100,000, or APTT or PT greater than 120 percent of normal, or known bleeding disorders. Persons are also excluded if they have pulmonary KS, actively bleeding or critically located KS, or life-threatening KS which is responsive to other treatments. Other exclusions are grade 2 or greater peripheral neuropathy from any cause, seizures in the last 10 years, any cancer except completely removed basal cell carcinoma of the skin, active severe or life-threatening infection, or KS treatment in the last three weeks with chemotherapy, interferon, radiation, steroids, or any local KS treatment such as intralesional injections. There are other entry criteria, but the ones listed above are most likely to exclude potential volunteers. Because this is the first human trial of the drug, the entry criteria are strict both to reduce the danger to the volunteers and to allow the most scientific knowledge to be obtained; future trials will probably have less severe restrictions. As this article goes to press, two volunteers are enrolled; as many as 48 will be recruited. The drug is given intravenously, during one hour, every other day. Eight dosage levels will be tested (from 4.6 to 76.3 mg per meter squared every other day), with three to six patients at each level, unless toxicity prevents the higher doses from being tried. The reason for the schedule with the two-week break is that new drugs are not usually tested in humans for longer than the animal toxicity trials have run, in this case four weeks; the FDA allowed a six-week test after the break, since there was no evidence of any cumulative toxicity in the animals. Arrangements Volunteers will probably need to stay near Washington, D. C. for most of the 12 weeks of the trial. (The 12 weeks includes a two-week rest period, after the first four weeks, during which volunteers from outside the Washington area can go home.) For the first two weeks of receiving the drug, each volunteer will be an inpatient at the Clinical Center of the National Institute of Health, in order to allow careful medical monitoring. For the rest of the time, living expenses can be partially covered for those from outside the Washington area. Persons must pay their own expenses for traveling to NIH for the first time to be evaluated for this trial; after they are accepted as NIH patients, NIH will pay transportation to and from home, in addition to the living expenses. For information about volunteering for this trial, call Sergio Bauza, R. N., or Kathleen Wyvill, R. N., at the National Cancer Institute, 301/496-8959, or James Pluda, M. D., 301/496- 8398. ***** WF 10: Big Claims, Little Information by John S. James In late October the Associated Press reported on the testing of an AIDS drug, called 'WF 10', in Thailand. The story generated much interest after it was reported on television and radio as "a breakthrough in AIDS therapy" that "completely abolishes the ability of free virus particles to infect cells." The AP story for newspapers reported that the drug was made in Switzerland and had been tested in 70 people with AIDS at Bamrasnaradura Hospital near Bangkok, by a German researcher, Dr. Friedrich-Wilhelm Kuehne, described as recognized in wound healing. It said that the drug had been administered since 1991, and quoted Dr. Kuehne saying that the drug had been given to 500 patients without serious side effects. Neither of the stories we have seen has included any information about what the drug is, how it is supposed to work, or how it is used. An AIDS TREATMENT NEWS computer search of AIDSLINE, a database produced by the U. S. National Library of Medicine which includes citations to AIDS-related articles published in over 3,000 different journals, found no reference to WF 10 or to Dr. Kuehne. A search of the last 25 years of MEDLINE, which contains citations and often abstracts for millions of journal articles in all fields of medicine, was similarly fruitless. (AIDSLINE contains the AIDS-related entries of MEDLINE, plus additional entries for AIDS conference presentations which do not appear in MEDLINE itself.) We also searched the last 17 years of EMBASE, a European database comparable to Medline. EMBASE is often better than MEDLINE for researching the newest and most experimental drug trials, because it indexes hundreds of European and other journals which are not covered by Medline and seldom seen by U. S. scientists and physicians. EMBASE had two references to articles co-authored by FW Kuehne, published in 1977 and 1978; both concerned wound healing. This is all we know so far. If anyone has more information about WF 10, we would appreciate hearing from them. Comment The new-drug stories which flash onto the media and then disappear create unwanted stresses for patients subjected to repeated cycles of excitement and disappointment. This is why researchers are expected to present their results first to a professional forum where their work can be evaluated. There may still be newspaper publicity, but then other professionals can at least respond intelligently, helping to balance the story. But we cannot be too quick to condemn, because it is also true that physicians or other researchers without connections seldom have any viable opportunity to obtain a fair evaluation of a treatment they believe in. AIDS TREATMENT NEWS gets requests from persons, especially in developing countries, wondering where they can go next with what they think might be a useful AIDS treatment. We have not yet found advice to give them that we can be happy with. Even in the U. S., dozens if not hundreds of promising leads generated by recognized scientists in major research centers get published in journals and then sit unused, because there is no mechanism to research them further; university scientists can seldom afford to move a drug into clinical development, and usually no company chooses to do so. What is needed is an unbiased professional team which can quickly scan all these leads and make sure that the most promising ones get further attention. We believe that major AIDS treatment improvements are still as likely to come from unexpected discoveries as from rational drug development. Unless the system is open to chance discoveries and unanticipated observations -- and it is seldom open today -- the best opportunities may be lost. This is why we avoid dismissing new-drug stories too quickly, even when the early information is less than convincing. ***** Anger at Women's History Study Delay by Nancy Solomon Doctors, researchers and activists say a two-year delay of a study that could help understand the progression of HIV disease in women is hampering efforts to prolong the lives of women with AIDS. A natural history study of women with HIV was promised by the National Institutes of Health during the December 1990 Women and HIV Conference in Washington D. C. But the Request for Applications (RFA), the governmental process that allows researchers to apply for funding and participation in the study, has not yet been released. "We could have good answers by now," said Dr. Judith Cohen, an epidemiologist who studies HIV in women at the University of California, San Francisco. "While we waited the last year, 10,000 more women were diagnosed." A similar study of men, the Multicenter AIDS Cohort Study (MACS), has been following the progress of more than 5,000 gay and bisexual men since 1984, and has spent $100.3 million. The National Institute of Allergies and Infectious Disease (NIAID) is coordinating the women's study, called the Women's Interagency HIV Study, and has allocated $5 million for 1993. A nurse in the epidemiology branch said that the RFA was just approved by the head office at the NIH and that it should be published by mid-November at the earliest. "It just takes a long time for RFA to go through the approval process," said Miriam Galbraith, a nurse consultant for NIAID who is the deputy project officer for the study. "The idea has to be approved before writing the RFA itself." In San Francisco, Dr. Cohen is waiting for the RFA so that she can apply for funds for the study. She is working with Bay Area Research Consortium on Women and AIDS (BARCWA), which is ready with 450 HIV-positive women to begin the natural history study. Once approved, the study would continue to enroll women as soon as they know they are HIV-positive and monitor their health for four years. "We just don't have much research on women," Dr. Cohen said. "It is particularly important (to look at) women (because) we have a whole set of indirect evidence that something else is going on ...women have body parts that men do not." The current standard of care for women with HIV does not include information about gynecological problems, Dr. Cohen said. The Centers for Disease Control announced on October 27 that it would expand the definition of AIDS illnesses to include invasive cervical cancer, pulmonary tuberculosis and recurrent pneumonia, after a two year battle by women activists. This decision, while it does not go far enough, is expected to improve the standard of care for women, activists said. Earlier this year, the CDC announced plans to expand the AIDS definition to include people whose T-cell count is below 200, but criticism that the change still did not address women's needs stalled implementation. Women continue to have shorter survival rates than men, although the gap has narrowed. Dr. Cohen published research in the July 1992 Journal of Infectious Diseases that showed that men in San Francisco survive four to five months longer than women in San Francisco. The study examined men and women with comparable opportunistic infections. ***** After the Election: Are We Ready? by John S. James Note: Due to travel schedules, this issue had to go to press one day before the election. This article and the one below report on the rethinking of the relationship between AIDS and government which has been stimulated by the chance of a Clinton victory. This issue is important no matter what happens in the election. If Clinton wins, the AIDS community must immediately attend to the transition. But even if Bush wins, the issues below are still critical; the momentum of the rethinking must be continued, so that the AIDS community can do better in detailing what needs to be done and advocating for it. For several weeks the prospect of a Clinton presidency has stimulated new thinking among those concerned with AIDS policy. The possibility of a government open to rational and compassionate health policies is widely seen as the opportunity of a lifetime to improve AIDS research and development of treatments and vaccines, to develop effective prevention programs, and to reform healthcare delivery for the benefit of all. But the AIDS community must move rapidly to take full advantage of these opportunities; some critical times have already passed, others are between now and January, and during the first 100 days of the new administration. Are we ready? Over 25 interviews with policy experts have given mixed answers. On a number of clear and easy recommendations, problems Clinton could fix almost with the stroke of a pen, there is very good consensus within and among the AIDS community, the medical community, and, we believe, Clinton's team. Here, actions likely to be taken quickly will build momentum and good will. But on the most difficult questions, such as detailed recommendations on how to coordinate AIDS research policy and management among the many government agencies involved, discussion and consensus building have only begun. And few are yet willing to address the issue of which people to recommend for particular positions. Yet these decisions will have to be made in the next few weeks or months; to the extent that the AIDS community is not ready to participate, they will be made without its input. (The good news, on the other hand, is that thinking is fluid and open, without hardened positions or division into camps. People in the AIDS community basically agree on what is needed, and agree with what Clinton has said; where we lack formal consensus it is because people have not had time to think through and discuss the issues, not because of incompatible visions or goals.) The article below is an interview with AIDS organizer and professional lobbyist Tom Sheridan, who worked on the transition four years ago when Bush was first elected, but has not been involved this time. We asked Mr. Sheridan to outline what an effective transition might look like, what went wrong in the Bush administration, and what the AIDS community should do now. We asked for an ideal picture in order to help guide the real-world efforts. We hope to publish a separate article looking in depth at the transition proposals and preparations under way, and at some of the substantive ideas being discussed. ***** Effective Transition: Interview with Tom Sheridan by John S. James Tom Sheridan is the founder of The Sheridan Group, a government and public relations organization in Washington. Previously he was director of public policy at the AIDS Action Council. ATN: What would a good presentation to a presidential transition team look like? TS: From a substantive standpoint, you need a fully expert and politically savvy document, one that all of the major leaders of the AIDS community have participated in; you need a consensus document from the community. The recommendations must be so well done and thoroughly researched that they are unassailable. If you ever give people information they can't trust, you're in big trouble; at this level of politics, you must give extremely accurate and useful information. The document must be very specific. If you think that NIH should change how it does business, for example, you would want to tell how the changes should be set up, who would be in charge, what the components of the research objectives should be, what the budget would look like, etc. If it required a legislative component, you would spell that out as well (which Congressional committees the legislation would go through, etc.) I would also recommend having a dossier on potential personnel, and the jobs that would be ideal for them. ATN: Most of those I have interviewed don't want to discuss people yet. TS: That is unfortunate. For one thing, there is going to be an AIDS policy coordinator ("AIDS czar"). ATN: There is talk about this being two persons, one in the White House and one in HHS (Dept. of Health and Human Services). TS: What is most important to understand is what Bill Clinton thinks of this issue. Clinton wants somebody in the White House. I imagine this person will be in charge on these issues, and not share responsibility with someone at HHS, but oversee responsibility for all AIDS issues. This is not just an HHS role; the AIDS czar at the White House is also going to be looking into issues like mandatory testing of Job Corps applicants, and the defense department. For example, the recent controversy over the $20 million dollars appropriated specifically to study the gp 160 vaccine raises huge issues over how well we're coordinating the research on a Federal level. $20 million to one drug because of a lobbyist. [Note: Sheridan had represented Genentech in opposing the earmarking of that money for studying a particular kind of vaccine. Many others have agreed with this position; for background, see "Lobbying for an AIDS Trial," Science, October 23, 1992, pages 536-539.] Clinton wants somebody in the White House to be in charge. The politics is, what does Bill Clinton intend? Do we agree with his commitment to this? I think we do. Then the issue is what can we do to use this position and this commitment to the best possible advantage for people with HIV. The first level of a good (transition) document and presentation is to understand what the politics is giving you, and then take advantage of those things. In social work, there's an old saying that says start where the client is. In this case the client is Bill Clinton, and we need to know where he is. I think we do know, that he's with us by and large. He knows what he's doing, and is willing to do what we think is good to do, but we need to be coordinated in our approach. We should not have multiple and conflicting recommendations going into the transition team. If the National Commission wants to coordinate this, that's not a bad idea. But these decisions need to be made now. Also, we should be coordinated with, but not necessarily the same as, what the gay and lesbian community is doing in getting gay and lesbian people appointed to positions in the new administration. ATN: This kind of thinking has been lacking. In the last few months, when a Clinton victory became possible, many people started saying, "Oh -- we better start working out what we want." TS: The onus of responsibility here, in taking advantage of any change of political leadership, is on the shoulders of those in the AIDS community who claim leadership. Our inability to coordinate our efforts, to better present substantive information, and to have consensus on recommendations, will hurt us. We have to agree with each other before we can expect the President of the United States and the whole administration to agree with us. But on the big picture, we have had difficulty allowing people to lead. ATN: I'm hearing wide agreement on the need for consensus if we are going to have influence in the transition. But to get that, people are staying with generalities. TS: That reflects our politics, our inability to have tough conversations with each other, to sit and work out consensus. That's not simple. But if we can't do it, we have lost the opportunity. If we don't know what we want, how are we expecting to tell the United States government? If you put out platitudes, if you don't take the opportunity to talk about people who would be good, if you can't put away personal ego, vendetta, jealousy, then we're in the wrong epidemic. ATN: It might help to outline what you did in the transition in 1988. TS: In 1988 we got the national leadership of NORA (National Organizations Responding to AIDS) together, and we asked for substantial input from experts in the research community on the NIH part of it. We identified all key staff members and worked with them closely. In November 1988 we scheduled a meeting with the director of the transition team for Bush, we met with all the people who had any influence in the transition on health and social services issues of AIDS. Bush himself happened to come in on this conversation, and sat for a few minutes and discussed what our recommendations were. We were the first ones there, we had our document ready. We knew there would be a new president, and whoever it was, we were going to say the same things to them. ATN: What went wrong in the Bush administration? Why wasn't that early momentum sustained, at least as far as us being able to express what we wanted? TS: We were good at expressing it. The Bush administration had the largest distance I had ever seen between policy and politics. George Bush will do anything politically; he will talk to anyone, say anything, he is incredibly "out there" in conversations with people. He would come into the room with AIDS activists and talk about the issues, and his hopes for doing better, being compassionate. But after that was over, there was never any serious presidential leadership. That's what it takes. It will take a president to say to the heads of the agencies, to the AIDS czar, "This is what I want done." That's what George Bush personally was never capable of doing. He was not capable of saying out loud that this was an issue of importance to him. And that message got across to everyone loud and clear. If we still have Bush after the election, then there's a lot that needs to be done in terms of pressure points, and serious work with the Congress and the president. But if Bush wins this election, I think it's clear that he'll perceive his win to be that right-wing coalition; what he will be forced to do is to set things up for Dan Quayle in 1996, and that doesn't bode well for us at all. I think we will have a worse, more entrenched, more resistant presidency. With no threat to re-election, I think George Bush, having sold his soul already, will simply pay the rest of the tab. The possibility for changes with the re- election of a president is very limited -- only a shuffling of people within the agencies and the cabinet. ATN: If Clinton wins, one issue is whether the AIDS czar will have to be an M. D. TS: I don't believe the AIDS czar needs to be an M. D. He or she will probably need a scientific advisor, probably an M. D. The central criterion for the AIDS czar job is a personal relationship and respect with the president of the United States. That is what will get the job done. If people are not working together, that AIDS czar has to be able to go to the president directly and get results. Otherwise what we will have is NAPO (National AIDS Program Office) transferred to the White House. We don't need that. What we don't need is another level of bureaucracy. We do need political and policy sophistication to get some very important work done. The AIDS community has the opportunity now to lay out the blueprint for that substantive work in the transition process. But doing so requires substantive and political work internally. ATN: One concern is that we clearly need more coordination, including across institute boundaries at the NIH. But NIH has a strong tradition of independence of the institutes. And the scientists like the investigator-initiated free-form grants, as undirective an approach as possible. The scientific community is in a position to drag its feet and hurt things no matter what the push is from the top. How do we avoid that? TS: We need to recognize that the U. S. Public Health Service, and therefore the National Institutes of Health, is a government agency. They are responsible to serve people, taxpayers in the U. S. What they do scientifically is not appropriate for political manipulation. But what they do with the money they spend is something they should be held accountable for. We cross those two lines all the time. Accountability is different than manipulation. Politics is about accountability. NIH gets its money through Congress; that's politics. They're accountable to Congress for what they spend and do. But when Congress says spend $20 million for gp 160 (a particular kind of vaccine), that's wrong, that's manipulation of science using a political process. These are two different things. But it is naive of scientists to say they don't want politics interfering with their work. They should work for a private research entity and not the U. S. government if this is their major concern. ATN: That can be a hard distinction to make. TS: It shouldn't be. Government agencies are paid for by the taxpayers. We have the right in a democracy to expect them to do things on our behalf. Reasonable expectations and accountability should be clearly understood by government scientists. ATN: But if it boils down to who's in charge, then how do you leave the gp 160 to scientific judgment, and still have political accountability, that the public wants improved treatments? TS: The public wants improved treatments, and there are 11 vaccines that have been produced by private-sector initiative, and here's $20 million to figure out what works. But to say here's $20 million for one drug because the company has a lobbyist, that's manipulation. There's a certain level at which politics can and should ask for accountability; but there is a fine line between legitimate accountability and micro management, political interference and manipulation. The NIH wouldn't exist without politics; but we have to be very careful about how far anyone goes politically to manipulate what it does. There is clearly a distinction (between accountability and manipulation). Clinton has already set a tone, that we can do better, and our institutions can be more accountable for their work, and should be more responsive to the needs of people. That's a tone that gets set only at the presidential level. Another lesson of the gp 160 incident is that we will need a much more vigilant advocacy effort, to find out about such problems earlier. To be good politically, you have to be able to get things done affirmatively; but you also need to know what's going on so that you can protect defensively when necessary. ATN: How would you summarize what we must do for the transition? TS: You need good substance, very specific, very well researched. You need good people to recommend for key jobs. And you need to do good politics to get that presentation seen, talked about, and acted on. ATN: One 64-dollar question. Who in the AIDS community would you see as taking the lead in this? The National Commission just had layoffs. TS: The National Commission may be appropriate. They just got an appropriation of over a million dollars; they have the money to do it. I can't think of anything more important for them to do. You don't need legions of people here; you need a community that wants to work together, and you need leaders that can build consensus, and somebody that understands politics. It's not that big a deal. Maybe a foundation could hire someone, a neutral party to come in and broker these matters. It could be a firm, or a single person with respect and credibility. But the time to do it has on some level already passed. This is an immediate priority, and if it's not done well, it could put us five steps behind where we could be. If we get Bill Clinton and yet lose the ability to take dramatic steps because we didn't do our homework well, then somebody is indictable to people with HIV. This opportunity is gold, we've never had it before in this epidemic. George Bush was Ronald Reagan in another body; we didn't have the mindset, leadership, public statements. Now we have these wonderful tools to use -- but for little gain if we let them lie around and we don't build. ***** National Commission on AIDS Preparing Presidential Recommendations The National Commission on AIDS is developing recommendations for the first 100 days of the administration of whatever president wins the November 3 election, as well as the new Congress. A one-day hearing is planned in Washington for November 17. Also, written statements will be received through November 23, 1992. According to the Federal Register notice of October 23 (page 48402), "Submissions (2 copies) may be of any length (and include supporting documents) but must include a two-page summary listing specific recommendations directed to Executive and Legislative branches." All material sent to the Commission is public and available for review. ***** AIDS Treatment Information Sources: Other Newsletters by Tadd Tobias When AIDS TREATMENT NEWS began publishing in 1986 there were few options for obtaining treatment information. Today there exist well over a hundred different AIDS-related publications offering diverse coverage and views. We have selected the following newsletters that may help our readers meet their needs for treatment information. There is some overlap but each publication offers a unique perspective and material not found elsewhere. * Treatment Issues. Published 10 times yearly by the Gay Men's Health Crisis, Medical Information, 129 West 20th St., New York, NY 10011. Suggested donation for individual subscription is $30, or $50 for physicians and institutions. Newsletter covers experimental treatment research for HIV disease and related opportunistic infections, including advances in prophylaxis and prevention strategies. A recent issue focusing solely on the various aspects of HIV disease and women is available, though most editions do not have an overall theme but cover a variety of subjects. * PI Perspective. Published twice yearly by Project Inform, 1965 Market St., Suite 220, San Francisco, CA 94103; 415/558-9051 from San Francisco and from outside the U. S., 800/334-7422 from elsewhere in California, 800/822-7422 from U. S. locations outside California. Newsletter covers allopathic treatment information including pharmaceutical drug development and clinical trials, vaccine development, and AIDS research policy. It addresses broad-based community needs like standard of care, early intervention strategies, and prophylaxis for opportunistic infections. * Bulletin of Experimental Treatments for AIDS (BETA). Published four times yearly by the San Francisco AIDS Foundation, BETA Subscription Department, P. O. Box 426182, San Francisco, CA 94142, 800/327-9893. Subscriptions are free for residents of San Francisco, $45 for nonresidents, $90 for organizations. Interested individuals should inquire about low cost subscriptions. BETA mainly covers current AIDS research and developments in mainstream medicine. The newsletter devotes whole issues to specific topics such as HIV and women, the skin, the eyes, etc. * Positively Aware. Published monthly by Test Positive Aware Network, Inc., 1340 W. Irving Park, Box 259, Chicago, IL 60613. Funded in part by Burroughs-Wellcome for distribution to HIV- impacted communities, this community-based newsletter covers many aspects of the AIDS epidemic. It focuses on research, mainstream and alternative treatment information, funding alerts, public policy issues, social concerns and community events. Each edition also includes a Spanish language section. Because of it location, Positively Aware includes information about clinical trials in the Chicago area, as well as local support services. * Critical Paths AIDS Project. Published monthly by Kiyoshi Kuromiya, 2062 Lombard St., Philadelphia, PA 19146, 212/545- 2212. Subscriptions are free for people with AIDS or HIV, others are asked to contribute $50/yr. Publishes in-depth information about treatments, research, and related political issues. Also contains an extensive listing of community events and support services in the Philadelphia area. * STEP Perspective. Published three times yearly by the Seattle Treatment Education Project, 127 Broadway East, Suite 200, Seattle, WA 98102, 800/869-7837. Although subscriptions are free, donations are encouraged. Newsletter primarily covers treatment information including both mainstream and alternative approaches. Some articles address insurance and other practical concerns. A general information packet and a variety of fact sheets are available. Magazine style format allows topics to be examined thoroughly by an extensive scientific review committee. * TreatmentUpdate (TraitementSida, French language edition) published 10 times yearly by Community AIDS Treatment Information Exchange, Suite 324 -- 517 College Street, Toronto, Ontario, Canada M6G 4A2, 416/944-1916. Canadian subscriptions are free. Individuals in the U. S. are asked to pay $15/year. Sliding scale subscriptions are available. Funded to serve a Canadian audience, it also follows what is happening in the U. S. and Europe. Newsletter covers broad range of AIDS-related treatment issues originating from over 100 peer-review journals. Often dealing with experimental and alternative treatments not covered in U. S. publications, the articles include innovative approaches not in wide use, or not yet thoroughly researched. * PWA Newsline. Published monthly by Bree Scott-Hartland, Editor, Newsline Coalition, Inc., 31 West 26th St., New York, NY, 10010, 212/532-0290. Subscriptions are $35 a year, free to persons with AIDS who cannot afford the expense. This publication is committed to including diverse opinions of the many different people affected by the AIDS epidemic. Examining an extensive array of HIV-related community concerns, the editorial content consists of reader's submissions and regularly appearing departments such as News/Analysis, International Digest, Medical Matters, Prisoner Perspectives, and Bulletins (listings of New York area events and services). * Notes From the Underground. Published six times a year by the PWA Health Group (the New York City buyers' club), 150 W. 26th St., Suite 201, New York, NY 10001, 212/255-0520. Subscriptions are $35/individual rate, $75/institution and physician rate, and sliding scale for low income individuals. The newsletter reports on issues pertaining to AIDS treatments including background information about particular alternative therapies and their use. Also covered are experimental pharmaceutical treatments including those already approved but not indicated for HIV-associated diseases. * Treatment and Data Digest. Published twice monthly by ACT- UP/New York, 135 W. 29th St., New York, NY 10001, 212/564-AIDS. Subscriptions are $40. This newsletter is essentially the report of the treatment and data committee of ACT UP/New York. Very current information about public policy, clinical trials and research issues. Newsletter often covers first reports about issues not yet thoroughly known by the larger AIDS community, which usually leads to further investigations by others. Good publication for the latest treatment activism news. * I Heard It Through the Grapevine. Published sporadically by Stephen Korsia, experimental treatment specialist, AIDS Project Los Angeles, 6721 Romaine St., Los Angeles, CA 90038. Request free subscriptions by mail. Newsletter gives a strictly subjective yet insightful perspective on alternative treatments, and is adept at finding research about little known or studied treatments. Recent topics have included garlic, bitter melon, shark cartilage, PCM-4, and others. * WORLD. Published monthly by Rebecca Denison. P. O. Box 11535, Oakland, CA 94611, 510/658-6930. Rates are sliding scale $5 to $100 No one denied subscription because of inability to pay. Written by and for HIV-positive women to address concerns specific to HIV disease and women including treatment information and psychosocial issues. Newsletters also include forums for personal testimonies, activist alerts, and events calendar. * The Positive Woman. P. O. Box 34372, Washington, DC 20043, 202/898-0372. Sliding scale subscriptions from $12 to $75. Published bimonthly by and for HIV-positive women. As stated in the newsletter, its purpose is to provide mainstream and alternative treatment information, and to provide "a forum for affected people to express their opinions and to evaluate current services, legislation and the social impact of HIV/AIDS." * Body Positive. Published monthly by Body Positive Group, 51B Philbeach Gardens, London, SW5 9EB, Great Britain. Subscription fees vary. Information can be requested by mail or by fax at 011-71-373-5237. This newsletter provides a European perspective of treatment information not seen in similar U. S. publications. Recent editorial content has included overviews of opportunistic infections, international conference coverage, pregnancy and women with HIV, and social issues affecting people living with HIV. * SIDAhora. Published quarterly by Moises Agosto, Editor, PWA Coalition, 31 W. 26th St., New York, NY 10010, 212/532-0290. Suggested donation of $20 (plus additional charge for international delivery). Original material published in Spanish. Each edition focuses on specific aspects of the AIDS epidemic and its effect within the Latino/Latina community. Comprehensive coverage includes treatment information, women's issues, pediatric concerns, public policy, art, and literature. ***** California Residents: No Sales Tax on Newsletters After November 1 Starting November 1, California will no longer collect sales tax on newsletter subscriptions. However, sales tax will still be collected on books of back issues and all other items we sell. All our forms are being revised to reflect this change. Sorry, we cannot prorate the tax over the period of the subscription. If the order or renewal was placed before November 1 (even if received by us after that date), then the full tax is due, even if most of the newsletter issues are received after the tax is no longer in effect. For new subscriptions or renewals ordered on or after November 1 which include the tax by mistake, we will prorate the paid amount to extend the subscription, in order to avoid the expense and trouble of refunding many small checks. If anyone who pays California tax by mistake (after November 1, and on the newsletter subscription only) wants the refund instead, we will send it. ***** 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: Jason Heyman John S. James Nancy Solomon Reader Services and Business: David Keith Thom Fontaine 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. If you cannot afford a subscription, please write or call. Outside North, Central, or South America, add air mail postage: $20/year, $10 for six months. Back issues available. Fax subscriptions, bulk rates, and multiple subscriptions are available; contact our office for details. Please send U. S. funds: personal check or bank draft, international postal money order, or travelers checks. VISA, Mastercard, and purchase orders also accepted. ISSN # 1052-4207 Copyright 1992 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&