AIDS Daily Summary April 18, 1994 The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse makes available the following information as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1994, Information, Inc., Bethesda, MD "AIDS Oversold as Threat to Mainstream, Many Say" Washington Times (04/18/94) P. A1; Haney, Daniel Q. Contrary to public health messages, the actual risk of contracting AIDS is being oversold to mainstream America, say some concerned critics. For the typical American--someone who is heterosexual and does not inject drugs or knowingly have sex with someone who does--most experts agree that the risk of AIDS is low to infinitesimal. This "democratization" is well-meant, but will backfire because people will eventually realize that not everyone carries the same risk, says Jeff Stryker, a researcher at the Centers for AIDS Prevention Studies at the University of California at San Francisco. Dr. Deborah Cotton of Massachusetts General Hospital points out the political implications of the problem. "We have to package this disease as a threat to the white middle class to get funding for it, to get attention, to get support," she says. Advocates of broad-based AIDS warnings argue that no one is 100 percent free of the risk of AIDS unless they abstain from sex, or have sex with one partner who they know is not infected. Telling people that their risk is low will cause many to abandon caution, they fear. "I personally think it's remiss to try to quantify to the public at large that they are at low risk, because it depends on the specific behaviors that people engage in," says Dr. Patricia Fleming of the Centers for Disease Control and Prevention. "Scarcely a Dent in the AIDS Menace" Washington Post (04/18/94) P. A1; Sanchez, Rene After two years of experimentation with a needle-exchange program designed to curb the spread of AIDS among drug users in the nation's capital, the effort has been called ineffective. Mayor Sharon Pratt Kelly backed the program following reports that AIDS was spreading more rapidly in the District of Columbia than anywhere else in the country, but the D.C. Council approved only a limited approach that critics say is too passive. Since the program began, only 58 addicts have received new needles, and about half only participated once. Health officials and AIDS activists say the city's needle-exchange is hampered by several factors--including the fact that it is operated out of a single base, while other cities distribute needles in neighborhoods that need them most, or have roving vans. In addition, addicts cannot obtain clean needles unless they submit to a physical, provide their names, and answer dozens of survey questions about sexual and drug history--requirements that activists say scare addicts away. "Ours is just about the most restrictive needle exchange in the country," admits Maude R. Holt, director of the District's alcohol and drug treatment office. "We haven't been able to do much." Other cities, however, have had more success. A study of nearly 40 exchange programs in other cities found that many were reducing the spread of AIDS because addicts were returning used needles. Armed with the study results, Baltimore successfully won approval to implement its own program after two years of opposition from legislators. "We have definitely learned from what the District has done," says Peter Beilenson, Baltimore's health commissioner. "The model for our needle-exchange program isn't anything like that one." "Denmark Weighs AIDS-Assault Law" Boston Globe (04/16/94) P. 6 Health and justice ministers in Denmark said that the government is considering making it a crime for HIV-infected people to have sex without the protection of condoms. The announcement followed a Supreme Court ruling last Thursday that overturned the reckless endangerment conviction of an HIV-positive, Haitian-born street musician who received an 18-month prison sentence after having unsafe sex with 23 women. The eight-month sentence for having sex with two 18-year-old girls was upheld. "AIDS Panel to Zero in on New Research Areas" Reuters (04/15/94); Trautman, Robert A presidential task force, noting that few new AIDS drugs appear to be in the research pipeline, ordered a new study to find likely new treatments. "A critical problem appears to be the lack of good candidate drugs in the development process ... those products that are in the development process do not appear to be moving as quickly as they should," the task force said. The group, which was created to accelerate the development of new AIDS drugs, set a deadline of mid-July to identify the most encouraging areas for new research. Daniel Hoth, chairman of the AIDS task force, said he wanted research recommendations by July, when the Department of Health and Human Services makes its 1995 request for research funding. The task force said it would compile a list of all AIDS drugs that currently are in development by pharmaceutical firms. The panel consists of government officials, academic and drug company officials, and AIDS activists. "French AIDS Cult Hero in Posthumous Controversy" Reuters (04/15/94); Taylor, Paul French actor-director Cyril Collard, who became a youth cult figure after dying from AIDS, became the subject of intense posthumous controversy last week. The controversy was sparked when writer and former minister Francoise Giroud said in radio and television interviews that Collard had infected the granddaughter of a noted French writer with AIDS and should not be idolized. An attorney for the Collard family threatened legal action to uphold his name, saying that Cyril Collard did not learn of his condition until 1987, more than two years after his relationship with the granddaughter of writer Suzanne Prou. There was no evidence that it was Collard who infected the young woman, who died of AIDS at age 25, said the lawyer, Jean-Pierre Mignard. Giroud said in the interviews that Collard was no role model for French youth, pointing to his autobiographical film "Les Nuites Fauves," (Savage Nights) which romanticized the bisexual life of an HIV-positive protagonist who continues to have unprotected sex with his girlfriend without disclosing his infection. "I think this romantic halo that has been built around Cyril Collard is dreadful--the angel of death sowing disaster in his path of love," said Giroud. Philosopher Andrew Glucksmann, author of a recently released book on AIDS, also entered the controversy, saying that Collard's depiction of unsafe sex was dangerous and irresponsible. "Ruling on Control of Blood Supplies Sought" Toronto Globe and Mail (04/15/94) P. A8 The Canadian Hemophilia Society has requested that Prime Minister Jean Chretien ask a court to rule on whether the federal Health Department has regulatory authority over blood collected before 1989. The issue surfaced when testimony last month at a federal inquiry into the country's contaminated-blood tragedy revealed that the Canadian Red Cross has at least 100,000 samples from donations made in 1984 and 1985--just before HIV screening methods were introduced. The hemophilia society wants the samples traced to determine which may be infected with HIV and which patients may have received tainted blood. The Health Department has argued that, because blood collected before 1989 was not covered by the Food and Drug Act, it cannot force the Red Cross to initiate such action. "AIDS Awareness Training Required for Everyone" Federal Times (04/11/94) Vol. 30, No. 9, P. 3; Walker, Meg In accordance with an executive order issued last year by President Clinton, all employees, managers, and supervisors must receive, or be scheduled to receive, AIDS awareness training by year end. Agencies were never previously required to have such a comprehensive AIDS education program, and some are likely to be unprepared to meet the December deadline. A team of employees has been selected to help develop guidelines and training documents to help managers and employees to cope with AIDS in the workplace. A key factor of the course for supervisors addresses how to react when an employee discloses that he or she in HIV-positive. "It's important for them not to react but plan," says Donald Donaldson, who worked on special programs at the Energy Department. "There have been some terrible reactions. The supervisor can create an environment where the employment feels so bad it causes them stress and internal anguish, and makes the disease worse." While supervisors need to be aware that an HIV-positive employee may not be infected, Donaldson says they should also be prepared to work with the employee early to plan ways to accommodate illness. "Changes in Survival Time in Two San Francisco Cohorts of Homosexual Men, 1983 to 1993" Journal of the American Medical Association (04/13/94) Vol. 271, No. 14, P. 1083; Osmond, Dennis; Charlebois, Edwin; Lang, William et al. In the first decade since the onslaught of the AIDS epidemic, a variety of new treatments have been introduced, and the frequency of clinical manifestations has been affected. The impact of these changes on AIDS survival, however, has not been well-documented. To study the outcomes of HIV infection, a total of 761 HIV-positive gay and bisexual men living in San Francisco, Calif., were recruited for two prospective studies in 1983 and 1984, and then followed up for more than nine years. The researchers' primary measurement was survival time from a CD4 count of 200, and from clinical AIDS diagnosis to death. Median survival time from a CD4 count of 200 rose from 28.4 months in the Oct.-Nov. 1986 period to 40.1 months in the Nov. 1986-1988 period, and is estimated at 38.1 months in the November 1988 to February 1993 period. Patients with pneumocystis carinii pneumonia largely accounted for this increase. Analysis indicated that the rate of CD4 cell loss and receipt of both PCP prophylaxis and antiretroviral therapy were significantly linked to prolonged survival time, although antiretroviral therapy alone was not. The researchers conclude that survival time from a CD4 count of 200 has improved by about one year, but survival time using the 1987 AIDS case definition has registered little improvement. The largest increase in survival time occurred in patients diagnosed with PCP, implying that PCP prophylaxis and treatment were more important factors in longer survival time than was antiretroviral therapy. "Bends and Loops" Science (04/01/94) Vol. 264, No. 5155, P. 9 The V3 loop of HIV-1, located at the site recognized by most antibodies that activate the virus, is crucial for HIV infectivity. Ghiara et al. determined the crystal structure of a 24-amino acid peptide from the V3 loop in a complex with a fragment from a neutralizing antibody. The tip of the V3 loop includes a type III-I double bend which was not previously anticipated by computer simulations. Knowledge of V3 loop conformation may be useful in designing vaccines and drugs to inhibit HIV infection. "AIDS Plagued by Journalists" Nature (03/31/94) Vol. 368, No. 6470, P. 387; Hodgkinson, Neville Contrary to some reports, London's Sunday Times has never passed judgment on whether HIV causes AIDS, says Neville Hodgkinson, science correspondent to the paper. The Times does believe, Hodkinson corrects, that there is sufficient scientific evidence to suggest that HIV does not, in fact, cause AIDS. The issue is important enough to warrant wide discussion and examination, yet in the past year--during which many of these developments occurred--the Times was almost alone among the media in challenging the orthodox acceptance that HIV causes AIDS. Because no one else did, Hodgkinson concedes that it would seem that the Times was running a campaign on the issue. In reality, he says, the paper was running articles of genuine news interest, and it will continue to report views and findings relative to this debate.