From: drfair@CritPath.Org
Date: Wed, 19 Mar 1997 22:24:40 -0500 (EST)

FASTFAX #117 March 23, 1997
published by We The People Living with AIDS/HIV of the Delaware Valley, Inc.
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News That Matters to People Living with HIV/AIDS
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In this issue:

Commission votes down spending new funds for minority groups by 10-9 vote
Survey says 41% of PWAs can't afford housing
Ritonavir approved for kids with HIV
HIV "Prevention" Act is back
We The People on the radio
CCASS seeks new director
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section.  Sources for some information in this issue include Reuters.
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10-9 vote on racial lines
Commissions votes down spending new funds for minority groups

	By a 10 to 9 vote, the Philadelphia HIV Commission Wednesday voted down a
motion from its African American Caucus to concentrate over $2 million in
new federal funding to expand capacity of minority AIDS organizations to
provide AIDS services.
	With less than half of the Commission members present, ten white members
voted against the resolution, with eight black members voting for it.  One
white member also voted for the caucus motion.  Most of the African
Americans voting for the motion were people living with HIV/AIDS.  The vote
reinforced the racial division of the Commission membership, which in
January defeated by one vote the election of an African American as its
co-chair.  The vote left no people of color in leadership positions at the
Commission, although one of its committees later elected a black co-chair
after one of the white co-chairs resigned in protest.
	The majority of the Commission members are white, even though federal law
requires that its composition be based on the demographics of the local
epidemic.  Over 71% of people living with HIV/AIDS in the region are people
of color, according to the federal Health Resources and Services
Administration (HRSA).
	The caucus motion called for the Commission to suspend a proposal from the
city's AIDS Activities Coordinating Office (AACO) to allocate most of the
new funding -- amounting to slightly over $3 million in two Ryan White CARE
Act Title I awards -- to existing AIDS service organizations, and set aside
over $1 million for "one-time" expenditures on activities which would not be
carried forward past next March.
	Noting that the Commission had previously passed a comprehensive AIDS plan
which called for "ensur[ing] that the resources that come into this region
follow the path of the virus as it changes and develops, and mov[ing]
resources into minority communities that are hardest hit by the epidemic,"
the caucus members charged that the AACO plan would shore up services that
they claim do not adequately serve African Americans and prevent serious
efforts to enhance the capacity of minority organizations to provide services.
	The defeated resolution called for a delay in developing an allocations
process until a "rational discussion" of how to use the new funds to
building minority community capacity could be held.
	The Commission also ruled out of order a motion to develop a competitive
bidding process for the entire $14 million pool of CARE Act funding
available to the region.  Many advocates have complained that in each of the
seven years the CARE Act has been providing money to the region for AIDS
services, no attempt has been made to evaluate the quality of the services
or to ask existing groups to compete with new initiatives for the money.
This "hold harmless" policy has been targeted by minority AIDS groups as the
primary mechanism by which the city guarantees that minority AIDS services
cannot be expanded, since a larger portion of available dollars is set aside
each year for existing groups.
	James McCann, the HRSA official responsible for monitoring the city's
expenditures of Ryan White money, told the African American Caucus on
Tuesday that his agency encouraged cities to hold competitions for CARE Act
funds periodically.  "This is not an entitlement program," McCann said.
"The only way to make sure you're doing things right is to be able to change
things when you need to."
	According to a recent report released by the Minority AIDS Project of
Philadelphia, over 70% of federal AIDS funds are allocated to groups which
are not based in minority communities.  
	In a highly contentious meeting reminiscent of the most dysfunctional days
of the now-defunct Title I planning council operated by The Philadelphia
AIDS Consortium, most of the Commission's African American members walked
out of the meeting after their defeat.
	The remaining members of the Commission eventually passed a motion giving
the city two weeks to revisit its proposal and develop a strategy for using
that funds that honors its "general instructions" on priorities for CARE Act
funding.  These instructions include a recommendation that the city
"contract services that are targeted to populations heavily impacted by" the
epidemic. The instructions also require that "services to women, infants and
children" are supported by a percentage of the funding at least equal to the
percentage of total AIDS cases reported in those populations.  About 16% of
AIDS cases in the city are women, and almost 73% of the women with AIDS are
black or Latino.  Almost 80% of children with AIDS are children of color.
They also require that the city assure that federal AIDS funds are allocated
fairly throughout the nine-county Philadelphia region, which includes the
five southeastern Pennsylvania counties and four counties in southern New
Jersey.
	Prior to the Commission debate, an ad hoc coalition of African American
people living with HIV/AIDS and five black AIDS service organizations also
called on city health commissioner Estelle Richman to prevent AACO from
implementing its plan.  The organizations involved included BEBASHI,
Colours, Ecumenical Information AIDS Resource Center, We The People and the
Craig Foundation.
	"The plan developed by AACO...will make it almost impossible for meaningful
efforts to be made this year in enhancing the capacity of minority AIDS
service organizations to meet the desperate needs of our community," the
group said.  "In effect, following this allocations plan -- given the
likelihood that new funding in the amounts available this year are greater
than they will be in future years -- actually guarantees that the existing
framework of services and agencies will continue unchanged for the
foreseeable future, and will make it even more difficult, if not impossible,
to ever be able to expand capacity in minority organizations to serve
minority people with HIV/AIDS, without significantly reducing funding for
existing groups."
	It called on Richman to "suspend [AACO's] actions until a reasonable
discussion can take place about ways in which this funding can be allocated
with the priority of enhancing minority community capacity as a fundamental
principle."
	The group also submitted to Richman an early draft of a proposal, being
developed under the leadership of members of We The People, to recommend
priorities for capacity building in the African American community.  It
noted that its draft plan was unfinished and had not yet been able to
receive the input of many other African American service providers or
consumers, but that "We share it with you now in its unfinished state in the
hope you will understand that we are making a legitimate effort to define
the need for new capacity in the African American community and that we have
concrete strategies for building that capacity.  But our efforts will be for
naught if the funding is allocated according to inappropriate standards in
the meantime."

Survey says 41% of PWAs can't afford housing

	A survey of 765 people living with HIV/AIDS in the Philadelphia region
found that 41% of the respondents spend more than half of their monthly
income on rent -- and 13% were spending over 70% of their income on rent.
The report also found that 44% of PWAs had been homeless at some point over
the past year, and that over half (52%) of the PWAs participating in the
survey had incomes of less than $6,000 per year, mostly drawn from welfare
and SSI benefits.
	Federal guidelines say that individuals and families should be classified
as "housing needy" if they spend more than a third of their monthly income
on housing costs.
	The study, conducted as part of a local AIDS housing needs assessment
conducted under contract to the Philadelphia Office of Housing and Community
Development, highlighted increased levels of poverty and homelessness as the
epidemic expands rapidly in communities of color in Philadelphia.
	Among African Americans, according to the survey, 63% reported incomes of
$6,000 or less, while 27% of whites earned at that level.  Among Latinos,
50% earned less than $6,000 per year.
	The report also found that 44% of PWAs responding to the survey had either
lived in a homeless shelter over the prior year, or had lived
"night-to-night" with friends or family.  Both categories are considered
"homeless" under federal and local definitions.  Respondents to the survey
were "17 times more likely than individuals in the general population to be
currently homeless," the report said.  A second study, which compared city
shelter admissions with the AIDS registry kept by the Philadelphia Health
Department, said that on average, people with AIDS were ten times more
likely to be homeless than the general population, and homeless people were
three times more likely to have AIDS than the general population.
	Race also plays a role in homelessness among PWAs, according to the report,
especially among those who are very ill.  "Among severely symptomatic
respondents, African Americans are seven times more likely to be homeless
than Caucasians," the analysis reported.
	The analysis of the survey was conducted by Kimberly Acquaviva and Dennis
Culhane of the University of Pennsylvania.  The OHCD housing needs
assessment is expected to be formally released this spring.

Ritonavir approved for kids with HIV

	Abbott Laboratories has received clearance from the U.S. Food and Drug
Administration (FDA) for the use of Norvir, a protease inhibitor, in
children with HIV and AIDS.  	Norvir is one of the first of currently
marketed protease inhibitors to receive FDA clearance for use in children
with HIV and AIDS.  The drug is one of the first-generation protease
inhibitors that has been shown to have a positive impact in the lives of
AIDS patients. Norvir was cleared for marketing for adult use on March 1, 1996.
	The dosing recommendation for Norvir in children (age 2-16) is based
primarily on pharmacokinetic and safety data from an ongoing Phase I/II
study being conducted by a team of scientists at the HIV and AIDS Malignancy
Branch of the National Cancer Institute, in collaboration with Abbott
Laboratories.
	Currently, researchers have enrolled 51 HIV-infected children with either
no prior therapy, progressive disease, or toxicity to another antiretroviral
regimen.  The use of Norvir was evaluated in the 44 children who had
completed at least four weeks of treatment as of Sep. 30, 1996. Norvir was
given alone for the first 12 weeks, then in combination with zidovudine
and/or didanosine.
	The recommended dosage of Norvir in children, in combination with
nucleoside analogues, is 400 mg/m2, twice daily, and should not exceed 600
mg, twice daily. 
	The starting dose is 250 mg/m2, twice daily, which should be titrated to
400 mg/m2.  The evaluation of the antiviral effect of Norvir in children is
ongoing.
	In HIV-infected patients age 2-16 years, the adverse event profile was
similar to that seen during clinical trials and post-marketing experience in
adults. The most common adverse events in adults include nausea, diarrhea,
vomiting, asthenia and taste disturbance.  Safety of Norvir in children
below age 2 has not been established.  Norvir should not be used in
combination with highly metabolized medications known to cause "serious or
life-threatening adverse events," the company said.

HIV "Prevention" Act is back

	A controversial bill calling for a wide variety of what the AIDS Action
Council calls "coercive" actions against people with HIV/AIDS was
reintroduced in Congress on March 12th by  Rep. Tom Coburn (R-OK).
	The bill, called the HIV Prevention Act of 1997, has 72 co-sponsors, and
requires the federal government to keep a list of all people who test
positive for HIV, and requires states to change their laws to follow the
bills provisions or be cut out of the federal Medicaid program.
	Nationally, 53% of adults and 90% of children living with AIDS rely on
Medicaid to receive basic health care services. 
	The Coburn bill specifically provides that states can pass Coburn-required
laws or regulations that violate current requirements of the Ryan White CARE
Act and still get CARE Act funds. The Ryan White CARE Act requires states to
meet certain requirements in order to receive Ryan White dollars, such as
having laws protecting confidentiality. The Coburn bill would render these
and all other protections of the Ryan White CARE Act "meaningless,"
according to the Council.
	The Coburn bill includes provisions that allow medical professionals to
refuse treatment to any individual who has not been tested for HIV, instead
of encouraging medical professionals to talk to their patients about HIV,
counsel them about risk reduction, and encourage patients to be tested
voluntarily.  "It also places these professionals at greater risk by not
encouraging them to use universal precautions, the only practice that really
protects them from accidental exposure to HIV and other blood-borne
diseases," the Council said.
	The bill also mandates that all states report names of HIV-positive
individuals to the CDC to create a federal partner notification program,
despite the fact that all states already have partner notification programs.
States would be required to provide detailed "information" about everyone
who tests positive to the CDC to be "shared" between states to track
partners nationally. 
	It also requires states to implement new complicated and confusing
processes for HIV testing of accused sexual offenders, even though the Crime
Control Act of 1994 already provides for testing of sex offenders in federal
court and at least 44 states and D.C. have laws explicitly providing for HIV
tests in sexual offense cases.  The Coburn bill does not give victims
control over whether or not testing occurs nor does it require that the
victim be given counseling, testing or care.  It also compromises the
victim's confidentiality by requiring disclosure of the defendant's test
results to practically every attorney involved in the case, as well as the
public health department.  
	The Coburn bill includes several other "test and report" provisions dealing
with everything from funeral homes to adoption agencies, all of which are
state-law issues and none of which have previously been subject to federal
oversight.
	"Many of the policies advocated in the Coburn bill have explicitly been
rejected as ineffective and prohibitively expensive by medical, public
health and prevention experts nationwide," the Council said.  "Others are
unnecessary and confusing variations of current law.  And the Coburn bill as
a whole will just tie the hands of states and communities already
implementing real prevention programs and practices to stop the spread of
HIV locally.    
	AIDS Action Council lobbyists said that it is unclear how quickly this bill
will move in the House, but that its passage becomes more likely as
co-sponsors sign on.  Many right-wing religious and women's groups have made
passage of the bill one of their highest priorities for this Congress.  The
Council encourages the bill's opponents to be vocal to their local
representatives in Congress to counter the impact of the highly-organized
right-wing groups.
	For more information, call the AIDS Action Council at 202-986-1300.

We The People on the radio

	We The People, which currently publishes two newsletters and broadcasts a
weekly television program for people living with HIV/AIDS, moved into radio
this week with a new weekly program on WPEB-FM, located at 88.1 on the dial.
The neighborhood station reaches primarily residents of West and Southwest
Philadelphia.  Sr. Atikah Bey, the station's director, offered the free air
time to WTP earlier this year.
	The new program will be broadcast every Tuesday from 1-3 p.m., and is
hosted by WTP Life Center Coordinator Curtis Osborne and WTP Housing
Counselor Melody Walker.  For more information, call 215-545-6868.

CCASS seeks new director

	Chester County AIDS Support Services, the only AIDS-specific organization
in Chester County, has announced that it is looking for a new executive
director.
	Julie Hazzard, the group's first director, announced her resignation from
the post as of May 2nd at a CCASS board meeting this week.  Hazzard has
built the organization from an all-volunteer operation to one which now
employs four staff, who provide case management, AIDS education, children's
programs and food services.
	Dan Daniel, president of the CCASS board of directors, said that the
organization is accepting applications for a new executive director through
March 31st.  The current salary for the position is $25,000 plus benefits.
Interested persons should send their resumes to the Search Committee, CCASS,
1822 Strasburg Road, Glenview Building, Coatesville, PA 19380.
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David R. Fair, 1008 S. 45th St., Phila., PA 19104-4409
Voice: 215-387-4409
Fax: 215-387-4069
Pager: 1-215-741-2818
Email: drfair@critpath.org